Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
Catholic Healthcare West
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
185 Berry Street
 
Room/suite
City or town, state or country, and ZIP + 4
San Francisco, CA94107
D Employer identification number

94-1196203
E Telephone number

G Gross receipts $ 13,266,734,465
F Name and address of principal officer:
Michael Blaszyk
185 BERRY STREET
SAN FRANCISCO,CA94580
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.chwhealth.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1954
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Catholic Healthcare West and our Sponsoring Congregations are committed to furthering the healing ministry of Jesus.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 13
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 52,481
6 Total number of volunteers (estimate if necessary) .... 6 7,328
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 25,195,373
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -1,439,087
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 97,575,926 97,147,541
9 Program service revenue (Part VIII, line 2g) ......... 7,833,539,936 8,779,351,242
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 113,216,061 285,531,034
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 112,917,285 49,678,394
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 8,157,249,208 9,211,708,211
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 68,346,972 104,771,301
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 4,187,378,160 4,423,096,831
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet222,427    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 3,719,617,259 4,173,204,334
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 7,975,342,391 8,701,072,466
19 Revenue less expenses. Subtract line 18 from line 12...... 181,906,817 510,635,745
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 10,197,049,833 11,364,399,198
21 Total liabilities (Part X, line 26)............ 7,422,975,561 7,233,832,220
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 2,774,074,272 4,130,566,978
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: OUR MISSION: CATHOLIC HEALTHCARE WEST AND OUR SPONSORING CONGREGATIONS ARE COMMITTED TO FURTHERING THE HEALING MINISTRY OF JESUS. WE DEDICATE OUR RESOURCES TO DELIVERING COMPASSIONATE, HIGH-QUALITY, AFFORDABLE HEALTH SERVICES; SERVING AND ADVOCATING FOR OUR SISTERS AND BROTHERS WHO ARE POOR AND DISENFRANCHISED; AND PARTNERING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE. OUR VISION: A GROWING AND DIVERSIFIED HEALTH CARE MINISTRY DISTINGUISHED BY EXCELLENT QUALITY AND COMMITTED TO EXPANDING ACCESS TO THOSE IN NEED. OUR VALUES: CATHOLIC HEALTHCARE WEST IS COMMITTED TO PROVIDING HIGH-QUALITY, AFFORDABLE HEALTH CARE TO THE COMMUNITIES WE SERVE. ABOVE ALL ELSE WE VALUE: DIGNITY - RESPECTING THE INHERENT VALUE AND WORTH OF EACH PERSON. COLLABORATION - WORKING TOGETHER WITH PEOPLE WHO SUPPORT COMMON VALUES AND VISION TO ACHIEVE SHARED GOALS. JUSTICE - ADVOCATING FOR SOCIAL CHANGE AND ACTING IN WAYS THAT PROMOTE RESPECT FOR ALL PERSONS AND DEMONSTRATE COMPASSION FOR OUR SISTERS
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 7,624,879,738 including grants of $ 104,538,568 ) (Revenue $ 8,756,742,816 )
Catholic Healthcare West is a California nonprofit public benefit corporation headquartered in San Francisco, California. Catholic Healthcare West, together with its subsidiary corporations (CHW), is one of the largest not-for-profit acute healthcare delivery systems in the United States as measured by annual revenue. CHW operates 40 hospitals throughout major California markets and in the Phoenix, Arizona and Las Vegas and Reno, Nevada metropolitan markets. CHW's facilities include approximately 7,735 licensed acute care beds and approximately 619 licensed skilled nursing beds. CHW maintains prominent market shares in many of its service areas, and many of its hospitals rank among the finest in the nation. With a significant presence in Sacramento, San Francisco, Southern California, San Joaquin Valley, Central Coast, Central California, Northern California and Santa Cruz, CHW's California operations are well dispersed throughout the state. The hospital activities of the sponsors of CHW date back to 1856. CHW was founded in 1986 when two religious congregations brought together the 10 facilities they sponsored at the time. Since then, CHW has grown significantly in size through mergers, affiliations and development of expanded markets. Today, CHW includes many facilities that are non-Catholic community sponsored facilities, as well as those that are Catholic religiously sponsored facilities. CHW's hospitals operate emergency rooms that are open to all persons regardless of ability to pay; have open medical staffs with privileges available to all qualified physicians in the area; have governing bodies in which primarily independent persons representative of the community comprise a majority; engage in the training and education of healthcare professionals; and participate in Medicaid, Medicare, CHAMPUS, Tricare and/or other government-sponsored healthcare programs. This organization is a public benefit corporation exempt from taxation under section 501(c)(3) of the internal revenue code. CHW is listed in the Official Catholic Directory (OCD). Qualified Catholic Organizations which are listed in the OCD qualify for automatic exemption under 501(c)(3) via a group ruling. The annual ruling dated July 12, 2010 reaffirmed the original ruling dated March 25, 1946.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 7,624,879,738
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
Yes
 
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see list of attachments
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
Yes
 
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
5,761
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
52,481
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ , GR , KS , MY , PL
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
Yes
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
18
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
13
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
Yes
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
AZ , CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MARY CONNICK - FINANCE DEPT
185 BERRY STREET
SAN FRANCISCO,CA94107
(415) 438-5500
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Andrew C Agwunobi MD
Board Member
 2.0 X           0 0 0
(2) Sheila Browne RSM
Board Member
 2.0 X           0 0 0
(3) Judy Carle RSM
Board Member
 2.0 X           0 0 0
(4) Morgan Clayton
Board Member
 2.0 X           0 0 0
(5) Mark DeMichele
Board Member
 2.0 X           0 0 0
(6) James M Givens CFA
Board Member
 2.0 X           0 0 0
(7) Peter G Hanelt CPA
Board Member
 2.0 X           0 0 0
(8) Lillian Anne Healy CCVI
Board Member
 2.0 X           0 0 0
(9) Rodney F Hochman MD
Board Member
 2.0 X           0 0 0
(10) Julie Hyer OP
Board Member
 2.0 X           0 0 0
(11) Maureen McInerney OP
Board Member
 2.0 X           0 0 0
(12) Kenneth Mills MD
Board Member/Medical Director
 8.0 X           36,658 0 0
(13) Patricia Rayburn OSF
Board Member
 2.0 X           0 0 0
(14) Susan Snyder OP
Board Member
 2.0 X           0 0 0
(15) Jarrett Anderson Esq
Board Chair
 10.0 X   X       0 0 0
(16) Caretha Coleman
Board Member/Secretary
 2.0 X   X       0 0 0
(17) Tessie Guillermo
Board Vice Chair
 2.0 X   X       0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Lloyd H Dean
Board Member, President/ CEO
 40.0 X   X       3,907,346 0 1,229,537
(19) Michael D Blaszyk
EVP, Chief Financial Officer
 40.0     X       2,419,590 0 525,537
(20) Derek F Covert
SVP, Legal Svcs/Gen Counsel
 40.0     X       1,093,842 0 106,794
(21) William J Hunt
EVP, Chief Operating Officer
 40.0     X       1,956,692 0 158,629
(22) Diane Lee
VP & Assoc Gen Cnsl, Asst Sec
 40.0     X       336,363 0 49,505
(23) Marvin O'Quinn
EVP, Chief Operating Officer
 40.0     X       2,055,467 0 331,617
(24) Elizabeth Shih
SVP, Chief Admin Officer/Asst
 40.0     X       1,384,420 0 373,117
(25) Keith Callahan
VP, Supply Chain Mgmt & E.comm
 40.0       X     544,711 0 66,048
(26) Gary F Conner
VP, Financial Operations
 40.0       X     868,562 0 80,562
(27) Mary Connick
VP Finance, Corp Controller
 40.0       X     566,987 0 64,289
(28) Charles P Francis
SVP, Chief Strategy Officer
 40.0       X     1,310,501 0 257,317
(29) Linda Hunt
President & CEO of SJHMC
 40.0       X     843,511 0 89,269
(30) Jeffrey W Land
VP, Corporate Real Estate
 40.0       X     491,401 0 70,583
(31) Bernita McTernan
SVP, Sponsorship, Mission Inte
 40.0       X     1,045,850 0 110,528
(32) Timothy Moran
President & CEO of Methodist
 40.0       X     608,828 0 79,837
(33) Karl Silberstein
VP, Financial Operations
 40.0       X     668,603 0 80,378
(34) LeAnne Trachok
VP, Revenue Services
 40.0       X     504,659 0 54,704
(35) Ernest H Urquhart
SVP, Chief HR Officer
 40.0       X     1,762,301 0 96,194
(36) Herbert Vallier
EVP/Chief HR Officer
 40.0       X     507,759 0 73,933
(37) Robert Wiebe MD
SVP, CMO
 40.0       X     1,187,920 0 219,942
(38) Benjamin R Williams
SVP, Chief Information Officer
 40.0       X     965,573 0 95,738
(39) John M Wray
SVP, Managed Care
 40.0       X     921,962 0 97,219
(40) Lisa Zuckerman
VP, Treasury Services
 40.0       X     502,671 0 69,064
(41) Lishan Aklog MD
Div Chief Adult Cardio-Vascula
 40.0         X   866,669 0 77,247
(42) David Cleveland MD
Exec Dir Heart & Lung Inst
 40.0         X   807,949 0 61,481
(43) Thomas Hennessy
President and CEO SFMH
 40.0         X   789,687 0 74,790
(44) Scott R Petersen MD
Faculty Physician
 40.0         X   791,505 0 74,426
(45) Dana G Seltzer MD
Chairman - Orthopedics
 40.0         X   836,165 0 73,033
(46) Saliba Salo
VP, COO Northridge Hospital
 40.0           X 397,115 0 42,449
(47) Mike Uboldi
President and CEO SMRMC
 40.0           X 603,243 0 71,386
(48) William Fuchs
President Group Operations
             X 569,524 0 0
(49) Jeff Winter
President Group Operations
             X 673,378 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 32,827,412 0 4,855,153
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet8,227
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
KITCHELL CONTRACTORS INC
1707 E HIGHLAND AVE SUITE 200
PHOENIX,AZ85016 		Contractor 46,054,944
ANGELICA TEXTILE SERVICES
925 S 8TH ST
COLTON,CA92324 		Laundry Services 23,683,358
DPR CONSTRUCTION INC
2480 NATOMAS PARK DR STE 100
SACRAMENTO,CA95833 		Contractor 23,303,784
MCCARTHY BUILDING COMPANIES
1341 NORTH ROCK HILL RD
ST LOUIS,MO63124 		Contractor 19,808,862
TURNER CONSTRUCTION CO
1211 H ST
SACRAMENTO,CA95814 		Contractor 17,753,581
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet976
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 57,872,411
e Government grants (contributions)1e 27,945,774
f All other contributions, gifts, grants, and
similar amounts not included above1f 		11,329,356
g Noncash contributions included in lines 1a-1f:$ 1,963,805
h Total. Add lines 1a-1f.......MediumBullet 97,147,541
Program Service Revenue Business Code
2a PATIENT/CHARITY 900,099 5,127,521,138 5,127,521,138    
b MEDICARE/MEDICAID PAYMENTS 900,099 3,480,502,329 3,480,502,329    
c MED OFFICE BLDG 621,300 14,161,162 14,161,162    
d LABORATORY 541,380 12,777,616   12,777,616  
e MANAGEMENT SERVICES 541,610 73,127,005 72,649,847 477,158  
f All other program service revenue . 71,261,992 61,908,340 9,353,652  
g Total. Add lines 2a–2f........MediumBullet 8,779,351,242
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 89,496,391   373,908 89,122,483
4 Income from investment of tax-exempt bond proceeds..MediumBullet 339,557     339,557
5 Royalties............MediumBullet 339,726     339,726
(i) Real (ii) Personal
6a Gross Rents 2,493,109  
b Less: rental expenses 113,739  
c Rental income or (loss) 2,379,370  
d Net rental income or (loss).......MediumBullet 2,379,370     2,379,370
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 4,200,646,014 49,961,587
b Less: cost or other basis and sales expenses 4,053,676,227 1,236,288
c Gain or (loss) 146,969,787 48,725,299
d Net gain or (loss)..........MediumBullet 195,695,086     195,695,086
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA 900,099 22,437,513     22,437,513
b PARKING LOT 812,930 2,756,610   173,289 2,583,321
c CHILD CARE 624,410 2,128,910   885,741 1,243,169
d All other revenue .... 19,636,265   1,154,009 18,482,256
e Total. Add lines 11a–11d ......MediumBullet 46,959,298
12 Total revenue. See Instructions....MediumBullet 9,211,708,211 8,756,742,816 25,195,373 332,622,481
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 104,223,834 104,223,834
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 547,248 547,248
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 219 219
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 30,564,189 26,599,784 3,964,405  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 245,258 97,067 148,191  
7 Other salaries and wages 3,364,818,632 2,961,218,474 403,402,923 197,235
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 308,309,145 275,139,567 33,169,578  
9 Other employee benefits ....... 481,870,555 443,920,438 37,949,897 220
10 Payroll taxes ........... 237,289,052 219,187,312 18,101,740  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 12,788,169 22,283 12,765,886  
c Accounting ........... 8,390,927   8,390,927  
d Lobbying ........... 1,387,910 182,876 1,205,034  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 13,903,761   13,903,761  
g Other .......... 711,110,931 505,667,302 205,443,629  
12 Advertising and promotion .... 21,642,673 1,249,695 20,392,978  
13 Office expenses ....... 202,397,520 168,252,766 34,137,438 7,316
14 Information technology ...... 129,207,058 34,593,648 94,613,410  
15 Royalties .. 0      
16 Occupancy ........... 109,358,572 91,246,268 18,112,304  
17 Travel ............ 13,789,718 5,664,712 8,110,693 14,313
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 6,510,622 2,624,251 3,883,921 2,450
20 Interest ........... 149,638,975 149,638,975    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 385,291,615 278,447,913 106,843,702  
23 Insurance .............. 60,397,231 44,349,010 16,048,221  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEDICAL SUPPLIES 1,091,501,384 1,091,501,384    
b BAD DEBT 777,008,692 777,008,692    
c MEDICAL PRVDR/OUT-OF NTWRK CST 64,644,768 64,644,768    
d MEDI-CAL PROVIDER FEE 317,453,045 317,453,045    
e UNRELATED BUSINESS INC TAXES 23,883 23,883    
f All other expenses 96,756,880 61,374,324 35,381,663 893
25 Total functional expenses. Add lines 1 through 24f 8,701,072,466 7,624,879,738 1,075,970,301 222,427
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 21,838 1 209,628
2 Savings and temporary cash investments ....... 1,258,073,060 2 1,366,641,634
3 Pledges and grants receivable, net ......... 9,029,148 3 15,845,346
4 Accounts receivable, net ......... 1,055,515,244 4 1,103,971,165
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 533,333 5 866,667
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 86,439,693 7 81,007,175
8 Inventories for sale or use .............. 137,666,675 8 143,678,916
9 Prepaid expenses and deferred charges ............ 243,180,236 9 447,266,947
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 7,473,130,125
b Less: accumulated depreciation. ..... 10b 3,862,453,149 3,435,314,323 10c 3,610,676,976
11 Investments—publicly traded securities .......... 2,739,423,276 11 3,169,224,216
12 Investments—other securities. See Part IV, line 11 ...... 588,527,356 12 605,767,197
13 Investments—program-related. See Part IV, line 11 .. 571,750,574 13 752,252,844
14 Intangible assets ......... 6,212,886 14 6,197,886
15 Other assets. See Part IV, line 11 ........... 65,362,191 15 60,792,601
16 Total assets. Add lines 1 through 15 (must equal line 34)... 10,197,049,833 16 11,364,399,198
Liabilities 17 Accounts payable and accrued expenses . 1,753,060,141 17 1,686,427,192
18 Grants payable .......... 6,022,731 18 2,848,549
19 Deferred revenue .......... 32,833,601 19 193,634,991
20 Tax-exempt bond liabilities .......... 3,584,111,299 20 3,542,101,637
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 553,930,080 23 574,590,964
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 1,493,017,709 25 1,234,228,887
26 Total liabilities. Add lines 17 through 25..... 7,422,975,561 26 7,233,832,220
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 2,646,990,892 27 3,975,743,442
28 Temporarily restricted net assets ..... 100,281,591 28 122,431,687
29 Permanently restricted net assets ..... 26,801,789 29 32,391,849
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 2,774,074,272 33 4,130,566,978
34 Total liabilities and net assets/fund balances ..... 10,197,049,833 34 11,364,399,198
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
9,211,708,211
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
8,701,072,466
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
510,635,745
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
2,774,074,272
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
845,856,961
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
4,130,566,978
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Catholic Healthcare West
  		Employer identification number

94-1196203
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Catholic Healthcare West
  		Employer identification number

94-1196203
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Catholic Healthcare West
  		Employer identification number

94-1196203
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$ 930
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$ 94
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
54,280
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
468,204
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
227,275
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
638,151
j
Total. lines 1c through 1i ...................................
1,387,910
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
PART I-B, LINE 4B   During the year, Catholic Healthcare West paid membership dues to The Chamber, Cal Chamber and Folsom Chamber of Commerce (Chambers). The invoices provided for voluntary contributions to the Chambers' Political Action Committee (PACs). The check requests for the annual dues inadvertently included an amount for the voluntary contributions to the PACs. Catholic Healthcare West has policies and procedures in place to avoid such transactions, and once the organization became aware of this situation, immediate action was taken to obtain a refund from the Chambers for the amounts designated for the PAC. Attached are copies of the refund checks, dated 3/26/2012, 3/20/2012 and 4/19/2011, evidencing that $930.00 has been recovered. This represents the full amount of inadvertent payments made related to voluntary contributions to The Chambers' PACs.
PART II-B   THE ORGANIZATION PAID FEES TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES, PAID AS COMPENSATION TO STAFF AND MANAGEMENT IN THE PERFORMANCE OF THEIR DUTIES IN ATTEMPTING TO INFLUENCE LEGISLATION, WHICH INCLUDED MEETING WITH AND CALLING GOVERNMENT OFFICIALS, AND DEVELOPED AND SENT LETTERS AND PUBLICATIONS. IN ADDITION, THIS ORGANIZATION IS A MEMBER OF HEALTHCARE ASSOCIATIONS WHOSE PURPOSEs include DIRECTing, DEVELOPing, AND AFFECTing PUBLIC POLICY AND LEGISLATION WITH REGARD TO ISSUES AFFECTING HEALTHCARE. THE ORGANIZATION PAID ANNUAL DUES TO THESE ASSOCIATIONS, which may be used FOR LOBBYING PURPOSES AS REFLECTED ON PART II-B, LINE 1i, OTHER ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 92,617,477 78,739,233 89,391,160
b Contributions ........ 9,388,271 12,468,055 1,411,823
c Investment earnings or losses ... 14,666,246 7,851,317 -10,569,881
d Grants or scholarships ..... 304,610 87,952 0
e Other expenditures for facilities
and programs ........ 		1,542,648 6,353,176 1,493,869
f Administrative expenses .... 0 0 0
g End of year balance ...... 114,824,736 92,617,477 78,739,233
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet13.000 %
b
Permanent endowment: SchDMd Bullet87.000 %
c
Term endowment: SchDMd Bullet0 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 0 199,330,214 199,330,214
b Buildings ................ 0 3,519,136,546 1,705,540,868 1,813,595,678
c Leasehold improvements ............ 0 53,853,520 30,165,830 23,687,690
d Equipment ................ 0 3,031,240,357 2,053,148,465 978,091,892
e Other ................. 0 669,569,487 73,597,986 595,971,501
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 3,610,676,975
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) POOLED INVESTMENTS 		605,767,197 F








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet 605,767,197
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) INTEREST IN NET ASSETS OF 138,609,129 F
(2) INVESTMENTS IN HEALTH RELATED 613,643,715 F







Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet 752,252,844
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 59,883
DEFERRED COMPENSATION 12,066,075
OTHER NON-CURRENT LIABILITIES 9,683,871
ASSET RETIREMENT OBLIGATIONS 28,698,852
OTHER LIABILITY FEMA 17,726,610
PHYSICIAN GUARANTEES 6,629,319
ANNUITIES PAYABLE 21,649
DUE TO RELATED PARTIES 281,956,801
PENSION & OTHER RETIREMENT OBLIGATION 877,385,827

Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,234,228,887
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
SCH D, Part V, Line 4   CHW has various supporting 501(C)(3)fundraising foundations. AS sUPPORTING ORGANIZATIONs, THEy OPERATE TO RAISE FUNDS FOR THE BENEFIT OF, AND TO CARRY OUT THE PURPOSES OF, CHW's HOSPITALs. CHW'S INTENDED USE FOR THE FUNDS IS TO INVEST IN EXPANDING ACCESS TO CARE, PURCHASE or construct STATE-OF-THE-ART EQUIPMENT and buildings, AND PROVIDE ADVANCED TRAINING AND EDUCATION TO CAREGIVERS AND PATIENTS.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Program Services see Sch F, Part IV 100,462
Central America and the Caribbean 0 0 Investments N/A 250,104
Central America and the Caribbean 0 0 Investments N/A 183,771
East Asia and the Pacific 0 0 Investments N/A 39,185,038
Europe (Including Iceland and Greenland) 0 0 Investments N/A 419,804,513
North America 0 0 Investments N/A 21,118,227
Sub-Saharan Africa 0 0 Investments N/A 404,258
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 481,046,373
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 481,046,373
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
Part I, Line 3 (1)   CHW SENDS MEDICAL MISSION TEAMS ANNUALLY TO ESQUIPULAS, GUATEMALA, A REMOTE AREA SOUTHEAST OF GUATEMALA CITY, IN SUPPORT OF THE SISTERS OF CHARITY OF THE INCARNATE WORD AND THE SISTERS OF MERCY OF THE AMERICAS. WITH A TOTAL POPULATION OF NEARLY 13 MILLION PEOPLE, APPROXIMATELY 10 MILLION GUATEMALANS LIVE IN POVERTY AND TWO-THIRDS OF THAT NUMBER LIVE IN EXTREME POVERTY. CHW'S VOLUNTEER DOCTORS, NURSES, AND SPECIALISTS PROVIDE PRIMARY CARE TREATMENT TO ABOUT 200 PEOPLE PER CLINIC. NURSE EDUCATORS ARE ALSO PRESENT TO OFFER HEALTH AND WELLNESS EDUCATION TO COMMUNITY LEADERS AND FAMILIES. EXPENDITURES REPORTED ARE FOR MEDICAL SUPPLIES AND EQUIPMENT, SALARIES, WAGES, AND OTHER EMPLOYMENT-RELATED COSTS, AND TRAVEL COSTS. THESE EXPENDITURES WERE BASED ON THE ACCRUAL METHOD OF ACCOUNTING AS REPORTED ON THE ORGANIZATION'S FINANCIAL STATEMENTS. AFTER FULFILING THE PROGRAM'S INITIAL FIVE-YEAR COMMITMENT, AND KNOWING THAT THE WORK IN ESQUIPULAS WAS FAR FROM COMPLETE, CHW HAS SHIFTED FROM THE PRIMARY CARE CLINIC MODEL TO FOCUS ON CLINICAL EDUCATION AND TRAINING. THIS SHIFT IS IN DIRECT RESPONSE TO THE FEEDBACK FROM BOTH THOSE IN GUATEMALA AND THE CHW TEAM MEMBERS.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		  82,535 145,932,408 6,223,691 139,708,717 1.760 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		  897,589 1,939,779,862 1,515,918,078 423,861,784 5.350 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....   241,708 96,349,597 41,450,322 54,899,275 0.690 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		  1,221,832 2,182,061,867 1,563,592,091 618,469,776 7.800 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		824 2,494,037 86,108,481 9,116,043 76,992,438 0.970 %
f Health professions education
(from Worksheet 5) .. 		146 72,995 84,607,154 9,044,344 75,562,810 0.950 %
g Subsidized health services
(from Worksheet 6) .. 		74 270,186 54,102,895 8,012,238 46,090,657 0.580 %
h Research (from Worksheet 7) 24 5,057 24,498,789 340,758 24,158,031 0.300 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		265 376,039 38,856,951 196,331 38,660,620 0.490 %
jTotal Other Benefits ... 1,333 3,218,314 288,174,270 26,709,714 261,464,556 3.290 %
kTotal. Add lines 7d and 7j. .. 1,333 4,440,146 2,470,236,137 1,590,301,805 879,934,332 11.090 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing 6 55 2,196,279 1,575,442 620,837 0.010 %
2 Economic development 5 3,720 166,475 0 166,475  
3 Community support 41 11,678 1,434,142 3,539 1,430,603 0.020 %
4 Environmental improvements 5 1,458 17,111 0 17,111  
5 Leadership development and training for community members 28 7,437 3,738,356 1,960 3,736,396 0.050 %
6 Coalition building 60 52,498 1,442,335 0 1,442,335 0.020 %
7 Community health improvement advocacy 39 1,548 452,618 0 452,618 0.010 %
8 Workforce development 9 242 1,924,154 0 1,924,154 0.020 %
9 Other            
10 Total 193 78,636 11,371,470 1,580,941 9,790,529 0.130 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
165,838,628
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
1,707,708,631
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
2,005,696,342
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-297,987,711
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1See Prt VIEntity 1
  		Surgery 56.900 % 0 % 36.000 %
2See Prt VIEntity 2
  		Real Estate 11.630 % 0 % 88.370 %
3See Prt VIEntity 3
  		Surgery 50.100 % 0 % 13.000 %
4See Prt VIEntity 4
  		Litho/Kidney 9.000 % 0 % 79.000 %
5See Prt VIEntity 5
  		Surgery 14.240 % 0 % 70.810 %
6See Prt VIEntity 6
  		Surgery 20.000 % 0 % 33.330 %
7See Prt VIEntity 7
  		Surgery 51.790 % 0 % 24.240 %
8See Prt VIEntity 8
  		Imaging 51.000 % 0 % 49.000 %
9See Prt VIEntity 9
  		Surgery 57.260 % 0 % 45.000 %
10See Prt VIEntity 10
  		Surgery 55.000 % 0 % 37.330 %
11See Prt VIEntity 11
  		Real Estate (Rent/Lease) 4.700 % 0 % 33.500 %
12See Prt VIEntity 12
  		Ambulance 50.100 % 0 % 16.600 %
13See Prt VIEntity 13
  		Surgery 20.000 % 0 % 80.000 %
14See Prt VIEntity 14
  		Surgery 51.000 % 0 % 49.000 %
15See Prt VIEntity 15
  		Surgery 61.030 % 0 % 38.970 %
16See Prt VIEntity 16
  		Surgery 57.530 % 0 % 18.310 %
17See Prt VIEntity 17
  		Surgery 45.610 % 0 % 31.590 %
18See Prt VIEntity 18
  		Surgery 62.340 % 0 % 36.470 %
19See Prt VIEntity 19
  		Surgery 80.000 % 0 % 13.300 %
20See Prt VIEntity 20
  		Surgery 60.000 % 0 % 40.000 %
21See Prt VIEntity 21
  		Surgery 50.000 % 0 % 50.000 %
22See Prt VIEntity 22
  		Imaging 50.000 % 0 % 50.000 %
23See Prt VIEntity 23
  		Imaging 50.000 % 0 % 50.000 %
24See Prt VIEntity 24
  		Imaging 80.000 % 0 % 20.000 %
25See Prt VIEntity 25
  		Surgery 51.000 % 0 % 49.000 %
26See Prt VIEntity 26
  		Surgery 65.260 % 0 % 34.740 %
27See Prt VIEntity 27
  		Surgery 51.000 % 0 % 49.000 %
28See Prt VIEntity 28
  		Surgery 25.000 % 0 % 75.000 %
29See Prt VIEntity 29
  		Real Estate (Rent/Lease) 25.000 % 0 % 64.680 %
30See Prt VIEntity 30
  		Imaging 50.000 % 0 % 50.000 %
31See Prt VIEntity 31
  		Surgery 68.500 % 0 % 29.500 %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?34
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 St Joseph's Hospital and Medical Center
350 W Thomas Rd
Phoenix,AZ85013 		X X   X   X X    
2 Mercy San Juan Medical Center
6501 Coyle Ave
Carmichael,CA95608 		X X         X    
3 Mercy General Hospital
4001 J st
Sacramento,CA95819 		X X   X     X    
4 St Josephs Medical Center of Stockton
1800 N California St
Stockton,CA95204 		X X   X     X    
5 Northridge Hospital Medical Center
1830 Roscoe Blvd
Northridge,CA91328 		X X   X     X    
6 Mercy Medical Center Redding
2175 Rosaline Ave
Redding,CA96001 		X X   X     X    
7 Mercy Southwest Hospital
400 Old River Rd
Bakersfield,CA93311 		X X         X    
8 Chandler Regional Hospital
475 South Dobson rd
Chandler,AZ85224 		X X         X    
9 St Rose Dominican Hospital - Siena
3001 St Rose Parkway
Henderson,NV89052 		X X         X    
10 Dominican Hospital
1555 Soquel dr
Santa Cruz,CA95065 		X X         X    
11 St Bernardine Medical Center
2101 N Waterman Ave
San Bernardino,CA92404 		X X         X    
12 California Hospital Medical Center
1401 South Grand Ave
Los Angeles,CA90015 		X X   X     X    
13 Saint Mary's Regional Medical Center
235 West Sixth St
Reno,NV89503 		X X         X    
14 Mercy Gilbert Medical Center
3555 S Val Vista Dr
Gilbert,AZ85297 		X X         X    
15 St Mary Medical Center
1050 Linden Ave
Long Beach,CA90813 		X X   X     X    
16 St John's Regional Medical Center
1600 North Rose Ave
Oxnard,CA93030 		X X         X    
17 Mercy Medical Center Merced
333 Mercy Avenue
Merced,CA95340 		X X   X     X    
18 Sequoia Hospital
170 Alameda de las Pulgas
Redwood City,CA94062 		X X         X    
19 Methodist Hospital of Sacramento
7500 Hospital Dr
Sacramento,CA95823 		X X   X     X    
20 Glendale Memorial Hospital & Health Ctr
1420 South Central Ave
Glendale,CA91204 		X X         X    
21 Marian Regional Medical Center
1400 E Church st
Santa Maria,CA93454 		X X         X    
22 St Mary's Medical Center
450 Stanyan St
San Francisco,CA94117 		X X   X     X    
23 St Rose Dominican Hospital - San Martin
8280 West Warm Springs Rd
Las Vegas,NV89113 		X X         X    
24 Mercy Hospital of Folsom
1650 Creekside Dr
Folsom,CA95630 		X X         X    
25 St Rose Dominican Hospital-Rose de Lima
102 E Lake Mead Dr
Henderson,NV89015 		X X         X    
26 Woodland Memorial Hospital
1325 Cottonwood St
Woodland,CA95695 		X X         X    
27 French Hospital Medical Center
1911 Johnson Ave
San Luis Obispo,CA93401 		X X         X    
28 St Elizabeth Community Hospital
2550 Sister Mary Columba Dr
Red Bluff,CA96080 		X X         X    
29 St John's Pleasant Valley Hospital
2309 Antonio Ave
Camarillo,CA93010 		X X         X    
30 Arroyo Grande Community Hospital
345 S Halcyon rd
Arroyo Grande,CA93420 		X X         X    
31 Mercy Medical Center Mt Shasta
914 Pine St
Mt Shasta,CA96067 		X X     X   X    
32 St Joseph's Behavioral Health Center
2510 N California St
Stockton,CA95204 		X                
33 Marian Medical Center West
505 East Plaza Drive
Santa Maria,CA93454 		X                
34 Mercy Hospital
2215 Truxtun Ave
Bakersfield,CA93301 		X X         X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Joseph's Hospital and Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy San Juan Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy General Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Josephs Medical Center of Stockton
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Northridge Hospital Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Medical Center Redding
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Southwest Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Chandler Regional Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Rose Dominican Hospital - Siena
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Dominican Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Bernardine Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:California Hospital Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):12

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Saint Mary's Regional Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):13

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Gilbert Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):14

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Mary Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):15

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St John's Regional Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):16

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Medical Center Merced
Line Number of Hospital Facility (from Schedule H, Part V, Section A):17

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Sequoia Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):18

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Methodist Hospital of Sacramento
Line Number of Hospital Facility (from Schedule H, Part V, Section A):19

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Glendale Memorial Hospital & Health Ctr
Line Number of Hospital Facility (from Schedule H, Part V, Section A):20

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Marian Regional Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):21

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Mary's Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):22

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Rose Dominican Hospital - San Martin
Line Number of Hospital Facility (from Schedule H, Part V, Section A):23

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Hospital of Folsom
Line Number of Hospital Facility (from Schedule H, Part V, Section A):24

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Rose Dominican Hospital-Rose de Lima
Line Number of Hospital Facility (from Schedule H, Part V, Section A):25

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Woodland Memorial Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):26

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:French Hospital Medical Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):27

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Elizabeth Community Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):28

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St John's Pleasant Valley Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):29

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Arroyo Grande Community Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):30

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Medical Center Mt Shasta
Line Number of Hospital Facility (from Schedule H, Part V, Section A):31

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Joseph's Behavioral Health Center
Line Number of Hospital Facility (from Schedule H, Part V, Section A):32

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Marian Medical Center West
Line Number of Hospital Facility (from Schedule H, Part V, Section A):33

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Mercy Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):34

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?44
Name and address Type of Facility (Describe)
1 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
2 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
3 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
4 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
5 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
6 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
7 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
8 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
9 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
10 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
11 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
12 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
13 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
14 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
15 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
16 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
17 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
18 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
19 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
20 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
21 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
22 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
23 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
24 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
25 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
26 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
27 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
28 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
29 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
30 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
31 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
32 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
33 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
34 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
35 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
36 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
37 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
38 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
39 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
40 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
41 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
42 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
43 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
44 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
Part I, Line 6a and 6b   EACH HOSPITAL FACILITY LISTED IN SCHEDULE H, PART V, PREPARES A SEPARATE COMMUNITY BENEFIT REPORT. CALIFORNIA HOSPITALS SUBMIT THEIR REPORTS TO THE OFFICE OF STATEWIDE HEALTH PLANNING DEPARTMENT AND NEVADA HOSPITALS SUBMIT THEIR REPORTS TO THE NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES. CHW INCLUDES A CONSOLIDATED COMMUNITY BENEFIT REPORT IN ITS ANNUAL AUDITED FINANCIAL STATEMENTS FOR ITS HOSPITALS AND THE HOSPITALS OF RELATED ORGANIZATIONS THAT ARE CONSOLIDATED FOR FINANCIAL REPORTING PURPOSES (SEE PART VI, LINE 7). CHW'S FINANCIAL STATEMENTS ARE POSTED ON CHW'S EXTERNAL WEB SITE. SUMMARIES OF THE INDIVIDUAL HOSPITALS' REPORTS ARE POSTED ONLINE AND FULL REPORTS ARE AVAILABLE BY REQUEST.
Part I, Line 7g   CHW REPORTED $7,591,496 OF SUBSIDIZED HEALTH SERVICES ASSOCIATED WITH PHYSICIAN CLINICS AS THESE SERVICES ARE PROVIDED TO THE COMMUNITIES AT A FINANCIAL LOSS. IF CHW DID NOT PROVIDE THESE SERVICES, THEY WOULD BE UNAVAILABLE IN THE COMMUNITY, THERE WOULD BE INSUFFICIENT AVAILABILITY IN THE COMMUNITY, OR THE SERVICE WOULD BECOME THE RESPONSIBILITY OF THE GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION.
Part I, Line 7, column (f)   THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) IS $777,008,692 AND HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN COLUMN (F).
Part I, Line 7   FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, CHW USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT EACH INDIVIDUAL HOSPITAL WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE CALCULATION ON WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF FINANCIAL ASSISTANCE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS.
Part I, line 7b, column (f)   IN JANUARY 2010, THE STATE OF CALIFORNIA ENACTED LEGISLATION THAT PROVIDED FOR SUPPLEMENTAL MEDI-CAL PAYMENTS TO CERTAIN HOSPITALS FUNDED BY A QUALITY ASSURANCE FEE PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS ("THE 2010 HOSPITAL FEE PROGRAM"). THE LEGISLATION COVERED THE PERIOD OF APRIL 1, 2009 THROUGH DECEMBER 31, 2010. THE CENTERS FOR MEDICARE & MEDICAID SERVICES APPROVED THE 2010 HOSPITAL FEE PROGRAM IN ITS ENTIRETY IN DECEMBER 2010, AND THEREFORE ALL ACTIVITY OF THE PROGRAM WAS RECOGNIZED DURING THE YEAR ENDED JUNE 30, 2011. QUALITY ASSURANCE FEES RECOGNIZED DURING THE YEAR OF $317.6 MILLION ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $500.6 MILLION RECOGNIZED DURING THE YEAR ARE REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET REDUCTION IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE DECREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. THE CALIFORNIA HOSPITAL ASSOCIATION CREATED A PRIVATE PROGRAM, THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT"), ESTABLISHED FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA. UPON APPROVAL OF THE LEGISLATION NOTED ABOVE IN DECEMBER 2010, CHW RECORDED A PLEDGE TO A GRANT FUND ESTABLISHED BY CHFT IN THE AMOUNT $21.6 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS.
Part II - Community Building Activities   AT CHW, EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE GO BEYOND PROVIDING HEALTH SERVICES. CHW'S ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND SERVICES OF THE ORGANIZATION. CHW TAKES A PROACTIVE APPROACH TO ADDRESSING THE SOCIAL AND ECONOMIC BARRIERS TO GOOD HEALTH AND SUPPORTS THE WORLD HEALTH ORGANIZATION DEFINITION OF HEALTH AS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. THROUGH THE CHW COMMUNITY INVESTMENT PROGRAM LOW INTEREST LOANS AND LINES OF CREDIT ARE PROVIDED TO NON-PROFITS WHO ARE ADDRESSING SOME OF THE SOCIAL DETERMINANTS, INCLUDING AFFORDABLE HOUSING AND SERVICES, VITAL TO A COMMUNITY'S HEALTH. OFTEN THE LARGEST EMPLOYER IN THE COMMUNITY, CHW HOSPITALS PARTICIPATE IN ECONOMIC DEVELOPMENT COUNCILS AND LOCAL CHAMBERS OF COMMERCE. GRANTS ARE OFFERED TO COMMUNITY ORGANIZATIONS FOR THE PURPOSE OF ECONOMIC DEVELOPMENT OR TO HELP ENSURE A CONTINUUM OF CARE FOR THE COMMUNITY. YOUTH PROGRAMS FOCUS ON ACTIVITIES TO DETER DELINQUENCY, DEVELOP LEADERSHIP SKILLS, ENHANCE LITERACY AND ACADEMIC SUCCESS, IMPROVE HEALTH, CULTIVATE COMMUNITY RESPONSIBILITY, PROVIDE EDUCATION WITH CULTURAL ENRICHMENT AND OFFER CAREER EXPLORATION OPPORTUNITIES. THERE ARE ONGOING EFFORTS TO REDUCE COMMUNITY ENVIRONMENTAL HAZARDS IN THE AIR, WATER AND GROUND, AS WELL AS THE SAFE REMOVAL OF OTHER TOXIC WASTE PRODUCTS. LIFE AND CIVIC SKILLS TRAINING PROGRAMS ARE OFFERED, INCLUDING CAREER DEVELOPMENT TO ENSURE GAINFUL EMPLOYMENT IN AN ERA OF UNPRECEDENTED UNEMPLOYMENT. CHW HOSPITALS OPEN THEIR DOORS TO COMMUNITY GROUPS AND ALSO REPRESENT THE HOSPITALS ON COMMUNITY COALITIONS THAT FOCUS ON THE WELL-BEING OF THEIR RESPECTIVE COMMUNITIES. CHW ADVOCACY REPRESENTATIVES ARE TIRELESS AS THEY STRIVE TO IMPROVE ACCESS TO HEALTHCARE, PROMOTE THE HEALTH OF THE PUBLIC, AND ADVOCATE FOR SOCIAL JUSTICE AND HUMAN RIGHTS. IN MEDICALLY UNDERSERVED AREAS, RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS ARE ONGOING, AS ARE THE PARTNERSHIPS WITH COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE. MANY CHW HOSPITALS OFFER HEALTH CAREER MENTORING PROJECTS AND PROVIDE SCHOOL-BASED AND COMMUNITY PROGRAMS THAT DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. COMMUNITY BUILDING - PHYSICAL IMPROVEMENTS / HOUSING o EMPLOYEES PARTNERED WITH REBUILDING TOGETHER TO MAKE CRITICAL REPAIRS TO THREE HOMES IN THE LAS VEGAS VALLEY FOR LOW-INCOME, DISABLED AND/OR AGING RESIDENTS. THIS PROJECT STRIVES TO PRESERVE AFFORDABLE HOME OWNERSHIP AND REVITALIZE COMMUNITIES. COMMUNITY BUILDING - ECONOMIC DEVELOPMENT o LEADERSHIP STAFF MEMBERS OF SEVERAL CHW FACILITIES ACTIVELY PARTICIPATE IN CHAMBERS OF COMMERCE, CIVIC ORGANIZATIONS AND COALITIONS AIMED AT ENSURING THE ECONOMIC DEVELOPMENT, GROWTH AND STABILITY OF THEIR LOCAL COMMUNITIES. COMMUNITY BUILDING - COMMUNITY SUPPORT o CHW FACILITIES LEAD OR COLLABORATE WITH OTHER COMMUNITY-BASED ORGANIZATIONS IN SUPPORT OF THE SUCCESS OF CHILDREN, YOUTH AND FAMILIES, WHICH ALSO ENGAGES AND STRENGTHENS THE SCHOOL COMMUNITY. COMMUNITY BUILDING - ENVIRONMENTAL IMPROVEMENTS o THE COMMITMENT OF CHW TO IMPROVE AND SUSTAIN OUR ENVIRONMENT IS CODIFIED BY POLICIES, INCLUDING A PURCHASING POLICY WHICH PURSUES MULTIPLE ENVIRONMENTAL GOALS. FIRST, WE SEEK TO REDUCE WASTE AT ITS SOURCE BY REDESIGNING PROCESSES AND PURCHASING PRACTICES TO REDUCE THE AMOUNT OF VIRGIN MATERIALS PURCHASED. SECOND, ONCE A PROCUREMENT NEED IS IDENTIFIED, WE TRY TO PURCHASE GOODS WITH RECYCLED CONTENT THAT CAN SPECIFICALLY BE RECYCLED, AND HAVE A LOW LIFE CYCLE IMPACT ON THE ENVIRONMENT. ONCE PURCHASES REACH THE END OF THEIR INITIAL USE, WE FOCUS ON REUSE WITHIN THE HOSPITAL, TRANSFER TO ANOTHER USER (SUCH AS COMMUNITY ORGANIZATIONS), RECYCLING, AND FINALLY TO PROPER WASTE DISPOSAL. o MARIAN MEDICAL CENTER IS ONE OF ONLY A FEW HOSPITALS IN THE NATION TO HAVE A COGENERATION PLANT THAT OPERATES ON METHANE GAS. THE 2000 SQUARE FOOT FACILITY USES WASTE METHANE GAS TO PRODUCE AS MUCH AS ONE MEGAWATT OF ELECTRICITY. THE COGENERATION PROCESS SIGNIFICANTLY REDUCES METHANE EMISSIONS IN THE ENVIRONMENT AND OFFSETS THE USE OF NON-RENEWABLE RESOURCES SUCH AS COAL, NATURAL GAS AND OIL. COMMUNITY BUILDING - LEADERSHIP DEVELOPMENT / TRAINING FOR COMMUNITY MEMBERS o CHW HOSPITALS ARE COMMITTED TO BUILDING HEALTHIER COMMUNITIES THROUGH LEADERSHIP DEVELOPMENT, PARTICULARLY OF ADOLESCENT, TEEN AND YOUNG ADULT LEADERSHIP, AND CAREER DEVELOPMENT. COMMUNITY BUILDING - COALITION BUILDING o THE CHW MISSION STATEMENT SPECIFICALLY CALLS UPON US "TO PARTNER WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE." CHW FACILITIES PROVIDE REPRESENTATION ON COMMUNITY COALITIONS AND COLLABORATIVE PARTNERSHIPS TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY, AND HOST AND/OR PARTICIPATE IN COMMUNITY COALITION MEETINGS AND SPECIFIC PROJECTS AND INITIATIVES. COMMUNITY BUILDING - ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT o STAFF AT CHW HOSPITALS THROUGHOUT THE SYSTEM ADVOCATE ON BEHALF OF THE POOR AND DISENFRANCHISED, PARTICULARLY FOR IMPROVED ACCESS TO HEALTH CARE SERVICES AS WELL AS FOR ENVIRONMENTAL IMPROVEMENTS. o CHW ALSO ADVOCATES FOR SOCIAL JUSTICE AND HUMAN RIGHTS, THROUGH DUES AND GIFTS TO ORGANIZATIONS THAT SUPPORT SOCIAL JUSTICE, AND BY ADVOCATING FOR SOCIAL JUSTICE, ENVIRONMENTAL RESPONSIBILITY AND HUMAN RIGHTS THROUGH INVESTMENTS AS SHAREHOLDERS. COMMUNITY BUILDING - WORKFORCE DEVELOPMENT o CHW AND ITS ASSOCIATED FACILITIES ARE COMMITTED TO THE DEVELOPMENT OF THE HEALTH CARE WORKFORCE AND ACTIVELY ENGAGE IN THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN MEDICALLY UNDERSERVED AREAS. CHW SUPPORTS THE TRAINING AND RECRUITMENT OF UNDERREPRESENTED MINORITIES AND PARTICIPATES IN COMMUNITY WORKFORCE BOARDS AND PARTNERSHIPS o SEVERAL CHW FACILITIES, AS WELL AS THE ORGANIZATION ITSELF, HAVE PARTNERED WITH LOCAL COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE AND ACTIVELY ENGAGE IN HEALTH CAREER MENTORING PROGRAMS.
Part III, Section A, Line 4   THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. CHW PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS AT OR BELOW 200% OR 500%, RESPECTIVELY, OF THE FEDERAL POVERTY LEVEL. CHW ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, DISCOUNTS FOR THE MEDICALLY INDIGENT, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 25% FOR PATIENTS SEEN AT CALIFORNIA AND ARIZONA FACILITIES, AND 30% FOR PATIENTS SEEN AT NEVADA FACILITIES. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. CHW MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. CHW'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. CHW ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE FINANCIAL ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIO-ECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT NO SERVICES THAT HAVE QUALIFIED AS CHARITY ARE REPORTED AS BAD DEBT. AS SUCH, CHW DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE FOLLOWING IS AN EXCERPT FROM CHW AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2011, RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCES FOR CHARITY AND DOUBTFUL ACCOUNTS: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. MANAGEMENT PERIODICALLY REVIEWS THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORICAL EXPERIENCE, TRENDS IN HEALTH CARE COVERGE, AND OTHER COLLECTION INDICATORS. RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS HAVE BEEN ESTABLISHED AND ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE AUDITED FINANCIAL STATEMENTS.
Part III, Section B, Line 8   CHW HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. IN HOSPITALS, ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. CHW BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $429.3 MILLION, AS REPORTED BELOW IN PART VI, LINE 6, WHICH IS NET OF PRIOR YEAR COST REPORT SETTLEMENTS OF $33.9 MILLION, CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY CHW HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. THIS SHORTFALL INCLUDES $298.0 MILLION REPORTED ON PART III, SECTION B, LINE 7, FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS ADDITIONAL AMOUNTS RELATED TO THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS FOR CHW'S HOSPITALS AND THE HOSPITALS OF ITS SUBORDINATE ORGANIZATIONS.
Part III, Section C, Line 9b   CHW ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHW'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE CHW FACILITY OR BILLING COMPANY RETAINED BY CHW IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER CHW'S PATIENT PAYMENT ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, CHW WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT. CHW DOES NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF EACH HOSPITAL PATIENT FINANCIAL ASSISTANCE DEPARTMENT. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, CHW REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.
Part VI, Line 2 - Needs Assessment   IN ACCORDANCE WITH CHW POLICY AND CALIFORNIA STATE SENATE BILL 697, ALL CHW HOSPITALS ASSESS THE HEALTHCARE NEEDS OF THEIR RESPECTIVE COMMUNITIES ONCE EVERY THREE YEARS. THIS INFORMATION IS UTILIZED IN DEVELOPING A STRATEGY TO ADDRESS PRIORITIZED NEEDS AND IMPROVE THE HEALTH OF THE COMMUNITIES CHW SERVES. MANY CHW HOSPITALS CONDUCT ASSESSMENTS THROUGH THE AUSPICES OF MULTI-HOSPITAL CONSORTIA. OTHER CHW HOSPITALS HIRE OUTSIDE ORGANIZATIONS TO COMPILE DATA AND SOME UTILIZE EXISTING DATA COLLECTED AND MADE ACCESSIBLE BY OTHER ORGANIZATIONS, INCLUDING PUBLIC HEALTH DEPARTMENTS. QUANTITATIVE INDICATOR DATA ARE COLLECTED FROM SECONDARY DATA SOURCES, WHICH MAY INCLUDE CENSUS DATA, PUBLIC HEALTH ASSESSMENTS, THE LOCAL DEPARTMENT OF EDUCATION, AND LAW ENFORCEMENT RECORDS. PRIMARY DATA TO CAPTURE THE PERSPECTIVES OF THE COMMUNITIES' RESIDENTS MAY BE CONDUCTED THROUGH FOCUS GROUPS, IN-PERSON INTERVIEWS, COMMUNITY FORUMS, NEIGHBORHOOD SURVEYS OR THROUGH TELEPHONE INTERVIEWS. CHW ALSO USES UTILIZATION DATA TO ASSESS THE DEMAND FOR CARE FOR PERSONS PRESENTING WITH AMBULATORY CARE SENSITIVE CONDITIONS THAT EVIDENCE SUGGESTS COULD HAVE BEEN AVOIDED, AT LEAST IN PART, THROUGH MORE PROACTIVE OUTPATIENT CARE. HOSPITALS, COMMUNITY LEADERS, AND POLICY MAKERS USE SUCH DATA TO IDENTIFY COMMUNITY NEED LEVELS, TARGET RESOURCES, AND TRACK THE IMPACT OF PROGRAMMATIC AND POLICY INTERVENTIONS. IN ADDITION, CHW, IN PARTNERSHIP WITH THOMSON REUTERS (FORMERLY SOLUCIENT), DEVELOPED A COMMUNITY NEED INDEX (CNI), WHICH PROVIDES AN AGGREGATE SCORE OF THE SOCIO ECONOMIC BARRIERS THAT PUT RESIDENTS AT GREATER RISK OF NEEDING HEALTH SERVICES. THE CNI AGGREGATES FIVE SOCIOECONOMIC INDICATORS LONG KNOWN TO CONTRIBUTE TO HEALTH DISPARITY, WHICH ARE INCOME, CULTURE/ LANGUAGE, EDUCATION, HOUSING STATUS, AND INSURANCE COVERAGE, AND APPLIES THEM TO EVERY ZIP CODE IN THE UNITED STATES. EACH ZIP CODE IS THEN GIVEN A SCORE RANGING FROM 1.0 (LOW NEED) TO 5.0 (HIGH NEED). RESIDENTS OF COMMUNITIES WITH THE HIGHEST CNI SCORES WERE SHOWN TO BE TWICE AS LIKELY TO EXPERIENCE PREVENTABLE HOSPITALIZATION FOR MANAGEABLE CONDITIONS, SUCH AS EAR INFECTIONS, PNEUMONIA OR CONGESTIVE HEART FAILURE, AS COMMUNITIES WITH THE LOWEST CNI SCORES. THE CNI PROVIDES COMPELLING EVIDENCE FOR ADDRESSING SOCIOECONOMIC BARRIERS WHEN CONSIDERING HEALTH POLICY AND LOCAL HEALTH PLANNING. THE TOOL HIGHLIGHTS HEALTH CARE DISPARITIES BETWEEN GEOGRAPHIC REGIONS AND ILLUSTRATES THE ACUTE NEEDS OF SEVERAL NOTABLE GEOGRAPHIES, INCLUDING INNER CITY AND RURAL AREAS. FURTHER, IT SHOULD ENABLE HEALTH CARE PROVIDERS, POLICYMAKERS, AND OTHERS TO ALLOCATE RESOURCES WHERE THEY ARE MOST NEEDED, USING A STANDARDIZED, QUANTITATIVE TOOL. THE CNI PROVIDES CHW WITH AN IMPORTANT MEANS TO STRATEGICALLY ALLOCATE RESOURCES WHERE IT WILL BE MOST EFFECTIVE IN MAINTAINING A HEALTHY COMMUNITY. ADDITIONAL INFORMATION ABOUT THE CNI IS ACCESSIBLE ON CHW'S WEBSITE: HTTP://WWW.CHWHEALTH.ORG/WHO_WE_ARE/COMMUNITY_HEALTH/STGSS044508
Part VI, Line 3 - Patient Education on Eligibility for Assistance   COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT CHW'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE CHW FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES CHW'S FACILITIES SERVE. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS WITH ANNUAL INCOMES LESS THAN $250,000 RECEIVE AN UNINSURED DISCOUNT OF 25% FOR SERVICES PROVIDED IN A CALIFORNIA OR ARIZONA FACILITY, AND 30% FOR SERVICES PROVIDED IN A NEVADA FACILITY, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION. PAYMENT ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON CHW'S WEBSITE AT WWW.CHWHEALTH.ORG. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. UNINSURED PATIENTS RECEIVE COPIES OF THE FINANCIAL ASSISTANCE AND MEDICAID APPLICATIONS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. IT IS CHW'S POLICY THAT AT THE TIME OF PATIENT BILLING, CHW FACILITIES PROVIDE TO ALL UNINSURED PATIENTS THE SAME BILLING INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT CHW FACILITIES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF CHW REQUIRE ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE CHW FACILITY STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE.
Part VI, Line 4 - Community Information   CHW DELIVERS CARE TO DIVERSE COMMUNITIES ACROSS ARIZONA, CALIFORNIA AND NEVADA. FOLLOWING IS A SUMMARY OF THE COMMUNITIES SERVED BY CHW, INCLUDING THE DEMOGRAPHICS OF EACH COMMUNITY: ARROYO GRANDE COMMUNITY HOSPITAL (AGCH) - AGCH SERVES THE SOUTHERN PART OF SAN LUIS OBISPO COUNTY INCLUDING THE CITIES OF ARROYO GRANDE, GROVER BEACH, OCEANO, PISMO BEACH AND SHELL BEACH AND THE NORTHERN PART OF THE CITY OF NIPOMO. ARROYO GRANDE COMMUNITY HOSPITAL CONDUCTS ITS NEEDS AND ASSETS ASSESSMENT FOR 2011/2012 BY UTILIZING SECONDARY DATA FROM VARIOUS OTHER AGENCIES SUCH AS KIDSDATA.ORG; CHILDREN IN LUCIA MAR UNIFIED SCHOOL DISTRICT 2010, HUNGER IN AMERICA, HUNGER IN SAN LUIS OBISPO COUNTY, 2010; UNITED STATES CENSUS BUREAU 2009; CHILDREN NOW, CALIFORNIA REPORT CARD 2010; ACTION FOR HEALTHY COMMUNITIES COMPREHENSIVE REPORT 2010; AND CALIFORNIA CANCER FACTS & FIGURES 2010. OTHER SECONDARY DATA COMES FROM LOCAL COMMUNITY-BASED ORGANIZATIONS WHO WORK IN PARTNERSHIP WITH AGCH TO ASSESS THE COMMUNITY, PARTICIPATE IN HEALTHCARE PROGRAM DESIGN AND PARTNER TO RESEARCH FUNDING FOR PROGRAMS OFFERED FOCUSING ON THE DISPROPORTIONATE UNMET HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. COMMUNITY DEMOGRAPHICS (SAN LUIS OBISPO COUNTY) -POPULATION 265,577 -DIVERSITY 72.1% CAUCASIAN, 19.9% HISPANIC, 3.0% ASIAN, 2.0% AFRICAN AMERICAN, .6% AMERICAN INDIAN/ALASKA NATIVE, 2.4% OTHER -AVERAGE INCOME $57,365 -UNINSURED 22.7% -UNEMPLOYMENT 7.4% -NO HS DIPLOMA 7.3% -RENTERS 38.6% -CNI SCORE 3.33 -MEDICAID PATIENTS 11.1% -OTHER AREA HOSPITALS 3 CALIFORNIA HOSPITAL MEDICAL CENTER (CHMC) - THE COMMUNITY THAT CHMC SERVES IS DEFINED AS CHMC'S PRIMARY AND SECONDARY SERVICE AREA AND IS LOCATED IN CENTRAL/DOWNTOWN AND SOUTH CENTRAL LOS ANGELES. CHMC POOLED ITS RESOURCES WITH FIVE OTHER HOSPITALS AND ONE GROUP OF COMMUNITY CLINICS TO COLLECT INFORMATION ABOUT THE HEALTH AND WELL-BEING OF RESIDENTS IN THEIR SERVICE COMMUNITY. THE REPORT WAS DEVELOPED USING BOTH QUANTITATIVE AND QUALITATIVE DATA SOURCES. TO THE EXTENT NECESSARY, SECONDARY OR EXISTING DATASETS WERE ACCESSED TO UPDATE THE PREVIOUS NEEDS ASSESSMENT. DATA SOURCES FOR THIS PURPOSE INCLUDE REPORTS FROM THE LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES, INCLUDING THE LOS ANGELES HEALTH SURVEY, AND ADDITIONAL DATA ON LIVE BIRTHS AND DEATHS. THE PROJECT TEAM UTILIZED 2009 PROJECTION DATA. CALIFORNIA HOSPITAL MEDICAL CENTER IS LOCATED IN A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA AND SERVES A MEDICALLY UNDERSERVED POPULATION. COMMUNITY DEMOGRAPHICS (LOS ANGELES COUNTY) -POPULATION 9,758,256 -DIVERSITY 28.4% CAUCASIAN, 47.1% HISPANIC, 13.6% ASIAN, 8.5% AFRICAN AMERICAN, .2% AMERICAN INDIAN/ALASKA NATIVE, 2.2% OTHER -AVERAGE INCOME $55,476 -UNINSURED 28.9% -UNEMPLOYMENT 8.7% -NO HS DIPLOMA 10.2% -RENTERS 51.8% -CNI SCORE 4.4 -MEDICAID PATIENTS 65.2% -OTHER AREA HOSPITALS 19 CHANDLER REGIONAL HOSPITAL - THE DEFINED SERVICE AREA IS CONSIDERED TO BE ALL OF MARICOPA COUNTY. THE COMMUNITY NEEDS ASSESSMENT WAS COMPLETED THROUGH ARIZONA STATE UNIVERSITY'S HEALTH INFORMATION AND RESEARCH CENTER. MULTIPLE DATA SOURCES WERE INCLUDED IN THE ANALYSIS INCLUDING A COMBINATION OF QUALITATIVE INFORMATION (E.G. SURVEY RESULTS) AND QUANTITATIVE INFORMATION (E.G. ARIZONA HEALTHGRADES ADMINISTRATIVE HEALTH DATA). QUANTITATIVE INFORMATION WAS INCLUDED TO PROVIDE THE BEST PICTURE OF THE COMMUNITY'S HEALTH. SECONDARY DATA WAS OBTAINED FROM THE CHW CNI, THE U.S. CENSUS BUREAU, THE ARIZONA DISEASE CONTROL AND PREVENTIONS, AND THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. COMMUNITY DEMOGRAPHICS (MARICOPA COUNTY) -POPULATION 3,751,410 -DIVERSITY 59.7% CAUCASIAN, 29% HISPANIC, 3.3% ASIAN, 4.5% AFRICAN AMERICAN, 1.5% AMERICAN INDIAN/ALASKA NATIVE, 2.0% OTHER -AVERAGE INCOME $50,448 -UNINSURED 21% -UNEMPLOYMENT 7.7% -NO HS DIPLOMA 7.7% -RENTERS 33.7% -CNI SCORE 2.5 -MEDICAID PATIENTS 17.7 % -OTHER AREA HOSPITALS 7 DOMINICAN HOSPITAL - THE PRIMARY SERVICE AREA IS SANTA CRUZ COUNTY WHICH COVERS 441 SQUARE MILES, AND IS RELATIVELY A PHYSICALLY ISOLATED COMMUNITY. THE TWO MAJOR CITIES ARE SANTA CRUZ, LOCATED ON THE NORTHERN SIDE OF THE MONTEREY BAY, AND WATSONVILLE, SITUATED IN THE SOUTHERN PART OF THE COUNTY. OTHER INCORPORATED AREAS IN THE COUNTY INCLUDE THE CITIES OF SCOTTS VALLEY AND CAPITOLA. APPROXIMATELY 51% OF THE POPULATION LIVES IN THE UNINCORPORATED PARTS OF THE COUNTY, INCLUDING THE TOWNS OF APTOS, DAVENPORT, FREEDOM, SOQUEL, FELTON, BEN LOMOND AND BOULDER CREEK, AND DISTRICTS SUCH AS THE SAN LORENZO VALLEY, LIVE OAK AND PAJARO. DOMINICAN HOSPITAL PARTNERS WITH THE UNITED WAY OF SANTA CRUZ COUNTY IN CONVENING A CONSORTIUM OF PUBLIC AND PRIVATE HEALTH, EDUCATION, HUMAN SERVICE AND CIVIC ORGANIZATIONS IN THE SPONSORSHIP OF THE COMMUNITY ASSESSMENT PROJECT OF SANTA CRUZ COUNTY (CAP). UNDER THE GUIDANCE OF THE CAP STEERING COMMITTEE, APPLIED SURVEY RESEARCH, A NOT-FOR-PROFIT SOCIAL RESEARCH FIRM, MANAGES THE ASSESSMENT, COLLECTING SECONDARY (PRE-EXISTING) DATA AND CONDUCTING THE ANNUAL COMMUNITY SURVEY FOR PRIMARY (PUBLIC OPINION) DATA. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND A MEDICALLY UNDERSERVED POPULATION. COMMUNITY DEMOGRAPHICS (SANTA CRUZ COUNTY) -POPULATION 256,901 -DIVERSITY 61% CAUCASIAN, 30.8% HISPANIC, 4% ASIAN, .9% AFRICAN AMERICAN, .2% AMERICAN INDIAN/ ALASKA NATIVE, 3.10% OTHER -AVERAGE INCOME $50,605 -UNINSURED 22.3% -UNEMPLOYMENT 8.3% -NO HS DIPLOMA 6.2% -RENTERS 40.4% -CNI SCORE 2.9 -MEDICAID PATIENTS 14.3% -OTHER AREA HOSPITALS 2 FRENCH HOSPITAL MEDICAL CENTER (FHMC) - THE PRIMARY SERVICE AREA FOR FHMC IS SAN LUIS OBISPO, MORRO BAY, LOS OSOS, ATASCADERO AND PASO ROBLES. A SECONDARY SERVICE AREA IS IDENTIFIED AS ARROYO GRANDE, PISMO BEACH, GROVER BEACH, OCEANO, AND AVILA BEACH. FRENCH HOSPITAL MEDICAL CENTER CONDUCTED ITS NEEDS AND ASSETS ASSESSMENT FOR FY 2011/2012 FOR THE PRIMARY SERVICE AREA BY UTILIZING SECONDARY DATA FROM VARIOUS AGENCY REPORTS SUCH AS: ACTION FOR HEALTHY COMMUNITIES 2010 REPORT, CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS), CHILDREN'S NOW CALIFORNIA REPORT CARD 2010, CALIFORNIA CANCER FACTS AND FIGURES-2010, THE HEALTH STATUS REPORT SAN LUIS OBISPO COUNTY PUBLIC HEALTH DEPARTMENT 2010 AND, THE COMMUNITY NEEDS INDEX. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. COMMUNITY DEMOGRAPHICS (SAN LUIS OBISPO COUNTY) -POPULATION 265,577 -DIVERSITY 72.1% CAUCASIAN, 19.9% HISPANIC, 3% ASIAN, 2% AFRICAN AMERICAN, .6% AMERICAN INDIAN/ALASKA NATIVE 2.4% OTHER -AVERAGE INCOME $57365 -UNINSURED 22.7% -UNEMPLOYMENT 7.4% -NO HS DIPLOMA 7.3% -RENTERS 38.6% -CNI SCORE 3.5 -MEDICAID PATIENTS 11.1 % -OTHER AREA HOSPITALS 3 GLENDALE MEMORIAL HOSPITAL - THE HOSPITAL SERVES RESIDENTS FROM A BROAD GEOGRAPHIC AREA. ITS PRIMARY SERVICE AREA ENCOMPASSES 29 ZIP CODES IN THE COUNTY OF LOS ANGELES. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. IN 2010 FMA COMMUNITY HEALTH CONSULTING PREPARED THE ASSESSMENT ON BEHALF OF THE THREE NOT-FOR-PROFIT HOSPITALS SERVING THE GLENDALE COMMUNITY: GLENDALE MEMORIAL HOSPITAL AND HEALTH CENTER, GLENDALE ADVENTIST MEDICAL CENTER AND VERDUGO HILLS HOSPITAL. THREE APPROACHES, INCLUDING SECONDARY DATA AND INFORMATION, ASSET MAPPING AND QUALITATIVE AND QUANTITATIVE PRIMARY RESEARCH WERE UTILIZED. FMA COMMUNITY HEALTH CONSULTANTS SUMMARIZED KEY DEMOGRAPHIC, SOCIO-ECONOMIC AND HEALTH STATUS INDICATORS FOR EACH HOSPITAL'S SERVICE AREA. DEMOGRAPHIC INFORMATION WAS ANALYZED USING PUBLISHED INFORMATION FROM THE 2000 AND 2010 U.S. BUREAU OF THE CENSUS AND AS AVAILABLE THROUGH NIELSEN CLARITAS, INC., A PRIVATE VENDOR OF DEMOGRAPHIC AND OTHER RELATED INFORMATION, CREATED ON HEALTHYCITY.ORG. FURTHER INFORMATION WAS OBTAINED THROUGH MORE THAN 30 COMMUNITY-BASED SERVICE ORGANIZATIONS. COMMUNITY DEMOGRAPHICS (CITY OF GLENDALE) -POPULATION 192,190 -DIVERSITY 63.5% CAUCASIAN, 16.8% HISPANIC, 16.2% ASIAN, 1.7% AFRICAN AMERICAN, .1% AMERICAN INDIAN/ALASKA NATIVE, 1.7% OTHER -AVERAGE INCOME $54,577 -UNINSURED 28.9% -UNEMPLOYMENT 8.0% -NO HS DIPLOMA 6.1% -RENTERS 61% -CNI SCORE 4.3 -MEDICAID PATIENTS 28.2 % -OTHER AREA HOSPITALS 11 MARIAN MEDICAL CENTER - MARIAN MEDICAL CENTER, LOCATED IN NORTHERN SANTA BARBARA COUNTY, HAS THE SANTA MARIA VALLEY AS ITS LARGEST SERVICE AREA. THE FOUR LARGEST COMMUNITIES IN MARIAN'S PRIMARY SERVICE AREA ARE THE CITY OF SANTA MARIA, THE CITY OF GUADALUPE, THE UNINCORPORATED PORTION OF NORTH COUNTY THAT INCLUDES ORCUTT, SISQUOC AND TEPESQUET WITH NIPOMO, AN UNINCORPORATED COMMUNITY OF APPROXIMATELY 13,000 PEOPLE IN SOUTHERN SAN LUIS OBISPO COUNTY. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND A MEDICALLY UNDERSERVED POPULATION. MARIAN MEDICAL CENTER CONDUCTED ITS NEEDS AND ASSETS ASSESSMENT FOR FY 2011/2012 FOR THE PRIMARY SERVICE AREA BY UTILIZING SECONDARY DATA FROM VARIOUS OTHER AGENCIES SUCH AS: SANTA BARBARA COUNTY PUBLIC HEALTH DEPARTMENT COMMUNI
.   ST. BERNARDINE MEDICAL CENTER - THE PRIMARY SERVICE AREA ENCOMPASSES NINE CITIES COVERING 17 ZIP CODES THAT INCLUDE BLOOMINGTON, COLTON, CRESTLINE, FONTANA, HESPERIA, HIGHLAND, RIALTO, YUCAIPA AND SAN BERNARDINO. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. IN FY11 ST. BERNARDINE MEDICAL CENTER (SBMC), IN COLLABORATION WITH COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB), CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT. BIEL CONSULTING WAS ENGAGED TO CONDUCT THE ASSESSMENT FOR THE PRIMARY SERVICE AREA OF THE HOSPITAL. CHSB AND SBMC DEVELOPED A LIST OF 25 KEY STAKEHOLDERS (INDIVIDUALS, AGENCIES, ORGANIZATIONS, AND COALITIONS) WHO ARE WELL ALIGNED IN THE ONGOING MISSION AND COLLABORATION TO MEET THE UNMET NEEDS OF THE SERVICE AREA. BIEL CONSULTING USED THIS LIST TO COLLECT PRIMARY DATA THROUGH STAKEHOLDER INTERVIEWS. EXECUTIVE OFFICERS/ADMINISTRATORS WERE ALSO INTERVIEWED. 8 FOCUS GROUPS (6 ENGLISH AND 2 SPANISH) WERE CONDUCTED WITH 90 AREA RESIDENTS WHO ARE CLIENTS OF COMMUNITY ORGANIZATIONS IN THE SERVICE AREA AND 107 PUBLIC SURVEYS WERE COMPLETED BY HARD PAPER COPY OR VIA THE INTERNET THROUGH A SURVEY LINK POSTED ON THE SBMC WEBSITE. SECONDARY DATA WAS OBTAINED FROM SEVERAL RESOURCES, INCLUDING CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, ENVIRONMENTAL SYSTEMS RESEARCH INSTITUTE, INC. (ESRI), HOUSING AUTHORITY OF SAN BERNARDINO COUNTY, HUD, U.S. BUREAU OF THE CENSUS, CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT, CALIFORNIA DEPARTMENT OF EDUCATION, CALIFORNIA HEALTH INTERVIEW SURVEY AND NATIONAL CANCER INSTITUTE. COMMUNITY DEMOGRAPHICS (SAN BERNARDINO COUNTY) -POPULATION 2,005,287 -DIVERSITY 34.7% CAUCASIAN, 47.9% HISPANIC, 6% ASIAN, 8.5% AFRICAN AMERICAN, .4% AMERICAN INDIAN/ALASKA NATIVE, 2.5% OTHER -AVERAGE INCOME $54,845 -UNINSURED 25.1% -UNEMPLOYMENT 11.1% -NO HS DIPLOMA 12.1% -RENTERS 34.9% -CNI SCORE 4.4 -MEDICAID PATIENTS 27.7% -OTHER AREA HOSPITALS 8 ST. ELIZABETH COMMUNITY HOSPITAL - ST. ELIZABETH COMMUNITY HOSPITAL (SECH) IS LOCATED IN TEHAMA COUNTY. THE COUNTY IS BORDERED BY GLENN COUNTY TO THE SOUTH, TRINITY AND MENDOCINO COUNTIES TO THE WEST, SHASTA COUNTY TO THE NORTH, AND BUTTE AND PLUMAS COUNTIES TO THE EAST. THE COUNTY IS SITUATED IN THE NORTHERN PORTION OF THE SACRAMENTO VALLEY, AND IS DIVIDED IN HALF BY THE SACRAMENTO RIVER. THE HOSPITAL SERVICE AREA INCLUDES RED BLUFF, GERBER, CORNING, LOS MOLINOS AND COTTONWOOD. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. ST. ELIZABETH COMMUNITY HOSPITAL IS COMMITTED TO INVOLVING AND INFORMING THE RESIDENTS OF TEHAMA COUNTY IN A COMMUNITY NEEDS ASSESSMENT SURVEY PROCESS. THE SECH COMMUNITY BENEFIT TEAM UTILIZED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THROUGH A PARTNERSHIP WITH THE SIMPSON COLLEGE BACHELORS OF NURSING ASPIRE STUDENTS AND CALIFORNIA STATE UNIVERSITY, CHICO'S HEALTH SERVICES ADMINISTRATION PROGRAM. TO ENSURE THE BEST REPRESENTATION OF THE POPULATION SURVEYED, A MIXED METHODOLOGY WAS EMPLOYED VIA PAPER SURVEYS AND IDENTICAL WEB-BASED SURVEYS VIA SURVEY MONKEY.COM. THE SAMPLE DESIGN UTILIZED FOR THIS EFFORT CONSISTED OF A RANDOM SAMPLE OF 450 INDIVIDUALS LIVING IN TEHAMA COUNTY AGED 18 AND OLDER. THE SAMPLE OF 450 AREA RESIDENTS IS HIGHLY REPRESENTATIVE OF THE ADULT POPULATION AND PRESENTS A MAXIMUM STATISTICAL ERROR RATE OF +/-4% AT THE 95 PERCENT LEVEL OF CONFIDENCE. SURVEY RESPONSES FROM THE COMMUNITY WERE OBTAINED IN PERSON BY ATTENDING VARIOUS HEALTH AGENCY AND COMMITTEE MEETINGS, HEALTH AND EDUCATION FAIRS AND ONLINE THROUGH COMMUNITY EMAIL LISTS PROVIDED BY THE LOCAL CHAMBERS OF COMMERCE. ADDITIONALLY ANNOUNCEMENTS REGARDING THE SURVEY WERE MADE IN THE LOCAL NEWSPAPERS THAT INCLUDED THE ELECTRONIC LINK ADDRESS BY WHICH THE SURVEY WAS ACCESSED. ONCE DATA WAS OBTAINED, IT WAS THEN ANALYZED BY EVALUATING PUBLISHED REPORTS FROM NATIONAL SOURCES SUCH AS HEALTHY PEOPLE 2020 OR THE 2010 US CENSUS TO QUANTITATIVELY COMPARE DATA COLLECTED IN 2011 CHNA. DATA WAS THEN COMPARED QUALITATIVELY BY QUANTIFYING STATISTICS NUMERICALLY AND COMPARING AGAINST SECONDARY DATA SOURCES. COMMUNITY DEMOGRAPHICS (TEHAMA COUNTY) -POPULATION 62,575 -DIVERSITY 73.1% CAUCASIAN, 20.8% HISPANIC, 1.1% ASIAN, .6% AFRICAN AMERICAN, 1.6% AMERICAN INDIAN/ALASKA NATIVE, 2.8% OTHER -AVERAGE INCOME $38,137 -UNINSURED 27.9% -UNEMPLOYMENT 11.3% -NO HS DIPLOMA 11.9% -RENTERS 34.9% -CNI SCORE 4.2 -MEDICAID PATIENTS 24.3% -OTHER AREA HOSPITALS 6 ST. JOHN'S PLEASANT VALLEY HOSPITAL AND ST. JOHN'S REGIONAL MEDICAL CENTER - COMMUNITY IS DEFINED AS THE RESIDENT POPULATION WITHIN THE HOSPITALS' SERVICE AREAS. ST. JOHN'S PLEASANT VALLEY HOSPITAL IN CAMARILLO AND ST. JOHN'S REGIONAL MEDICAL CENTER IN OXNARD SERVE ALL OF VENTURA COUNTY. THE PRIMARY SERVICE AREAS INCLUDE CAMARILLO, OXNARD AND PORT HUENEME. THE HOSPITALS SERVE A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. THE ST. JOHN'S COMMUNITY ADVISORY BOARD PARTNERED WITH OTHER HEALTHCARE ORGANIZATIONS TO FORM THE COMMUNITY NEEDS ASSESSMENT COLLABORATIVE GROUP. THE INNOVATIVE RESEARCH GROUP WAS CONTRACTED TO CONDUCT TELEPHONE SURVEYS OF VENTURA COUNTY. A COMBINATION OF RANDOM SAMPLING AND SIMPLE RANDOM SAMPLING METHODS WERE USED. THE POPULATION WAS DIVIDED INTO TWENTY-THREE ZIP CODE AREAS FOR THE SURVEY. COMMUNITY DEMOGRAPHICS (VENTURA COUNTY) -POPULATION 809,080 -DIVERSITY 50.1 CAUCASIAN, 39% HISPANIC, 6.7% ASIAN, 1.6% AFRICAN AMERICAN, .2% AMERICAN INDIAN/ALASKA NATIVE, 2.4% OTHER -AVERAGE INCOME $75,348 -UNINSURED 21.2% -UNEMPLOYMENT 7.2% -NO HS DIPLOMA 7.8% -RENTERS 33.6% -CNI SCORE - SJPVH 3.4 -MEDICAID PATIENTS 8.7% -OTHER AREA HOSPITALS 5 COMMUNITY DEMOGRAPHICS (CITY OF OXNARD) -POPULATION 192,520 -DIVERSITY 15.6% CAUCASIAN, 66.9%, HISPANIC, 8.7% ASIAN, 3.2% AFRICAN AMERICAN, .2% NATIVE HAWAIIAN OR PACIFIC ISLANDER, .1% AMERICAN INDIAN/ALASKA NATIVE, 5.3% OTHER -AVERAGE INCOME $59,015 -UNINSURED 21.2% -UNEMPLOYMENT 8.2% -NO HS DIPLOMA 14% -RENTERS 44.4% -CNI SCORE - SJRMC 3.6 -MEDICAID PATIENTS 15.5% -OTHER AREA HOSPITALS 5 ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER - ST. JOSEPH'S HOSPITAL DRAWS APPROXIMATELY 90% OF ITS PATIENTS FROM MARICOPA COUNTY, 9% FROM OUTSIDE MARICOPA COUNTY BUT WITHIN ARIZONA, AND 4% FROM OUTSIDE THE STATE. (NOTE: 61% OF THE POPULATION OF THE STATE OF ARIZONA RESIDES WITHIN MARICOPA COUNTY.) THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER ASSESSES THE NEEDS OF THE COMMUNITY ON AN ONGOING BASIS AND USES THE ASSESSMENT CONDUCTED BY THE ARIZONA STATE UNIVERSITY CENTER FOR HEALTH INFORMATION AND RESEARCH (CHIR) AND OTHER SOURCES THROUGHOUT THE YEAR. CHIR UTILIZES THE ARIZONA HEALTH QUERY, A COMMUNITY HEALTH DATA SYSTEM CREATED BY THE VOLUNTARY PARTICIPATION OF HEALTH CARE INSURERS AND PROVIDERS. THE DATA COMBINES INFORMATION ABOUT MORE THAN SEVEN MILLION PERSONS PROVIDING INFORMATION ABOUT THE PRIMARY SERVICE AREA (MARICOPA COUNTY) AND THE SECONDARY SERVICE AREA (THE REST OF THE STATE OF ARIZONA. COMMUNITY DEMOGRAPHICS (MARICOPA COUNTY) -POPULATION 3,751,410 -DIVERSITY 59.7% CAUCASIAN, 29% HISPANIC, 3.3% ASIAN, 4.5% AFRICAN AMERICAN, 1.5% AMERICAN INDIAN/ALASKA NATIVE, 2.0% OTHER -AVERAGE INCOME $50,448 -UNINSURED 21% -UNEMPLOYMENT 7.7% -NO HS DIPLOMA 7.7% -RENTERS 33.7% -CNI SCORE 3.7 -MEDICAID PATIENTS 17.7% -OTHER AREA HOSPITALS 7 ST. JOSEPH'S MEDICAL CENTER/ST. JOSEPH'S BEHAVIORAL HEALTH CENTER - THE PRIMARY SERVICE AREA OF ST. JOSEPH'S MEDICAL CENTER (SJMC) AND ST. JOSEPH'S BEHAVIORAL HEALTH CENTER IS STOCKTON AND THE SECONDARY SERVICE AREA IS SAN JOAQUIN COUNTY. SJMC ALSO SERVES AS A REFERRAL FOR TERTIARY CARE FOR SURROUNDING COUNTIES, WHICH INCLUDE ALPINE, AMADOR, CALAVERAS, MARIPOSA, STANISLAUS AND TUOLUMNE COUNTIES. THE HOSPITALS SERVE A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. APPLIED SURVEY RESEARCH CONDUCTED THE 2011 NEEDS ASSESSMENT FOR A CONSORTIUM OF HOSPITALS AND AGENCIES IN THE STOCKTON SERVICE AREA, INCLUDING: ST. JOSEPH'S MEDICAL CENTER, DAMERON HOSPITAL, COMMUNITY PARTNERSHIP FOR FAMILIES OF SAN JOAQUIN, SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, SAN JOAQUIN COUNTY OFFICE OF EDUCATION, ST. MARY'S INTERFAITH COMMUNITY SERVICES, FIRST FIVE OF SAN JOAQUIN, COMMUNITY MEDICAL CENTERS, UNIVERSITY OF THE PACIFIC, HEALTH PLAN OF SAN JOAQUIN, KAISER PERMANENTE, SUTTER TRACY COMMUNITY HOSPITAL, HEALTHIER COMMUNITY COALITION OF SAN JOAQUIN AND THE BREAST FEEDING COALITION OF SAN JOAQUIN. PRIMARY DATA WERE OBTAINED FROM A TELEPHONE SURVEY AND FACE-TO-FACE SURVEY OF SAN JOAQUIN COUNTY RESIDENTS. SECONDARY DATA WERE COLLECTED FROM A VARIETY OF SOURCES, INCLUDING BUT NOT LIMITED TO: US CENSUS, FEDERAL, STATE AND LOCAL GOVERNMENT AGENCIES; ACADEMIC INSTITUTIONS; ECONOMIC DEVELOPMENT GROUPS; HEALTH CARE INSTITUTIONS; AND COMPUTERIZED SOURCES THROUGH ONLINE DATABASES AND THE INTERNET. COMMUNITY DEMOGRAPHICS (SAN JOAQUIN COUNTY) -POPULATION 673,613 -DIVERSITY 37.3% CAUCASIAN, 37.7% HISPANIC, 13.9% ASIAN, 6.9% AFRICAN AMERICAN,.5% AMERICAN INDIAN/ALASKA NATIVE, 3.7% OTHER -AVERAGE INCOME $54,341 -UNINS
Part VI, Line 5 - Promotion of community health   SEE FORM 990, PART III, 4A FOR A BRIEF INTRODUCTION OF CATHOLIC HEALTHCARE WEST USE OF SURPLUS FUNDS - AS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, CHW REINVESTS ALL ITS OPERATING AND INVESTMENT INCOME IN HOSPITAL IMPROVEMENTS, TECHNOLOGY ENHANCEMENTS, COMMUNITY HEALTH PROGRAMS, AND EMPLOYEE BENEFITS. THIS ACTIVE REINVESTMENT MAKES IT POSSIBLE FOR US TO DELIVER ON OUR MISSION, INCLUDING ENSURING THAT EVERYONE HAS ACCESS TO HEALTHCARE. OPEN MEDICAL STAFF - MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS GATHERS AND VERIFIES CREDENTIALS, ALLOWS THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND TO ULTIMATELY MAKE A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES. CREDENTIALS VERIFICATION IS THE DETERMINATION WHETHER A PRACTITIONER'S CREDENTIALS ARE AUTHENTIC AND VALID. THE ROLE OF THE BOARD - THE CHW BOARD OF DIRECTORS ESTABLISHES KEY MEASURES OF SYSTEM-WIDE COMMUNITY BENEFIT PERFORMANCE AND RECEIVES REGULAR REPORTS ON PROGRESS TOWARD ESTABLISHED GOALS. CHW HOSPITAL COMMUNITY BOARDS AND SUBSIDIARY BOARDS (COMMUNITY BOARDS), WHICH ARE RATIFIED BY THE CHW BOARD, ARE RESPONSIBLE FOR ENSURING THE HOSPITALS DEVELOP PROGRAMS TO ADDRESS THE DISPROPORTIONATE UNMET HEALTH-RELATED NEEDS OF THE COMMUNITIES THE HOSPITALS SERVE. IN ADDITION, COMMUNITY BOARDS ENSURE THE DEVELOPMENT OF COMMUNITY BENEFIT INITIATIVES TO PROMOTE THE BROADER HEALTH OF THE COMMUNITY. IN FULFILLING THESE RESPONSIBILITIES, THE COMMUNITY BOARD MAY DESIGNATE A COMMUNITY HEALTH COMMITTEE OF THE BOARD TO INCLUDE AT LEAST TWO BOARD MEMBERS, WITH A MAJORITY REPRESENTATION FROM A RANGE OF COMMUNITY STAKEHOLDERS WHO HAVE KNOWLEDGE OF THE COMMUNITY. THE COMMUNITY BOARD, OR BOARD COMMITTEE, PARTICIPATES IN THE PROCESS OF ESTABLISHING PROGRAM PRIORITIES BASED ON COMMUNITY NEEDS ASSESSMENTS AND DEVELOPING THE HOSPITAL'S COMMUNITY BENEFIT PLAN AND MONITORING PROGRESS TOWARD IDENTIFIED GOALS. IF APPLICABLE, MEMBERS OF THE COMMITTEE WILL ENSURE THAT THE COMMUNITY BOARD IS REGULARLY BRIEFED ON ACTIVITIES AND DEVELOPMENTS AND WILL ALSO ENSURE THAT THE COMMITTEE HAS INFORMATION FROM THE COMMUNITY BOARD AND MANAGEMENT NEEDED TO MAKE INFORMED DECISIONS. THE COMMUNITY BOARD IS ALSO RESPONSIBLE FOR REVIEW AND APPROVAL OF THE ANNUAL HOSPITAL COMMUNITY BENEFIT PLAN AND REPORT. CHW PROVIDES HOSPITAL SERVICES AND CARRIES OUT OUR MISSION AT THE FOLLOWING FACILITIES IN CALIFORNIA, ARIZONA AND NEVADA. FOR DETAILED INFORMATION ON THE SERVICES AND COMMUNITY BENEFITS PROVIDED AT THESE FACILITES, PLEASE VISIT THEIR INDIVIDUAL WEB SITES, WHICH ARE PROVIDED BELOW. ARROYO GRANDE COMMUNITY HOSPITAL HTTP://WWW.ARROYOGRANDEHOSPITAL.ORG/ CALIFORNIA HOSPITAL MEDICAL CENTER HTTP://WWW.CHMCLA.ORG/ CHANDLER REGIONAL HOSPITAL HTTP://WWW.CHANDLERREGIONAL.ORG/ DOMINICAN HOSPITAL HTTP://WWW.DOMINICANHOSPITAL.ORG FRENCH HOSPITAL MEDICAL CENTER HTTP://WWW.FRENCHMEDICALCENTER.ORG GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER HTTP://WWW.GLENDALEMEMORIAL.COM MARIAN REGIONAL MEDICAL CENTER HTTP://WWW.MARIANMEDICALCENTER.ORG/ MERCY GENERAL HOSPITAL HTTP://WWW.MERCYGENERAL.ORG/ MERCY GILBERT MEDICAL CENTER HTTP://WWW.MERCYGILBERT.ORG MERCY HOSPITAL OF FOLSOM HTTP://WWW.MERCYFOLSOM.ORG/ MERCY HOSPITAL OF BAKERSFIELD HTTP://WWW.MERCYBAKERSFIELD.ORG/ MERCY SOUTHWEST HOSPITAL HTTP://WWW.MERCYBAKERSFIELD.ORG/ MERCY MEDICAL CENTER MERCED HTTP://WWW.MERCYMERCEDCARES.ORG/INDEX.HTM MERCY MEDICAL CENTER MT. SHASTA HTTP://WWW.MERCYMTSHASTA.ORG/ MERCY MEDICAL CENTER REDDING HTTP://REDDING.MERCY.ORG/ MERCY SAN JUAN MEDICAL CENTER HTTP://WWW.MERCYSANJUAN.ORG/ METHODIST HOSPITAL OF SACRAMENTO HTTP://WWW.METHODISTSACRAMENTO.ORG/ NORTHRIDGE HOSPITAL MEDICAL CENTER HTTP://WWW.NORTHRIDGEHOSPITAL.ORG SAINT MARY'S REGIONAL MEDICAL CENTER HTTP://WWW.SAINTMARYSRENO.ORG/ SEQUOIA HOSPITAL HTTP://WWW.SEQUOIAHOSPITAL.ORG/ ST. BERNARDINE MEDICAL CENTER HTTP://WWW.STBERNARDINEMEDCTR.ORG/ ST. ELIZABETH COMMUNITY HOSPITAL HTTP://REDBLUFF.MERCY.ORG/ ST. JOHN'S PLEASANT VALLEY HOSPITAL HTTP://WWW.STJOHNSHEALTH.ORG/ ST. JOHN'S REGIONAL MEDICAL CENTER HTTP://WWW.STJOHNSHEALTH.ORG/ ST. JOSEPH'S BEHAVIORAL HEALTH CENTER HTTP://WWW.STJOSEPHSCANHELP.ORG/ ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER HTTP://WWW.STJOSEPHS-PHX.ORG ST. JOSEPH'S MEDICAL CENTER HTTP://WWW.STJOSEPHSCARES.ORG/ ST. MARY MEDICAL CENTER HTTP://WWW.STMARYMEDICALCENTER.ORG/ ST. MARY'S MEDICAL CENTER HTTP://WWW.STMARYSMEDICALCENTER.ORG/ ST. ROSE DOMINICAN HOSPITAL - ROSE DE LIMA CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ ST. ROSE DOMINICAN HOSPITAL - SAN MARTIN CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ ST. ROSE DOMINICAN HOSPITALS - SIENA CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ WOODLAND HEALTHCARE HTTP://WWW.WOODLANDHEALTHCARE.ORG
Part VI, Line 6 - Affiliated Healthcare System   Affiliates of CHW also promote the health of additional communities in Bakersfield, San Bernardino, San Francisco, San Andreas, and Grass Valley/Nevada City, California. These affiliates follow practices similar to those noted above in determining the unmet healthcare needs of their communities. Total unsponsored community benefit expense for CHW and its subordinate corporations for the year ended June 30, 2011, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 97,422 152,563,579 1.6% Unpaid Costs of Medicaid/Medi-Cal 1,035,601 444,972,896 4.7% Other Means-tested Programs 253,140 63,978,237 0.7% Community Services: Community Health Services 552,089 49,285,673 0.5% Health Professions Education 21,637 10,998,382 0.1% Subsidized Health Services 219,756 37,388,406 0.4% Donations 233,077 37,415,522 0.4% Community Building Activities 15,081 1,642,251 0.0% Community Benefit Operations 19,210 6,983,659 0.1% Total Community Services for the poor 1,060,850 143,713,893 1.5% Total Benefits for the Poor 2,447,013 805,228,605 8.5% Benefits for the Broader Community: Community Services: Community Health Services 2,004,902 23,003,029 0.2% Health Professions Education 52,255 65,128,468 0.7% Subsidized Health Services 124,290 11,026,699 0.1% Research 5,057 24,166,007 0.3% Donations 202,417 7,914,381 0.1% Community Building Activities 63,555 8,148,278 0.1% Community Benefit Operations 937 2,883,276 0.0% Total Benefits for the Broader Community 2,453,413 142,270,138 1.5% Total Community Benefits 3,562,475 571,626,794 10.0% Unpaid Costs of Medicare 1,109,062 429,356,656 4.5% Total Community Benefits including Cost of Medicare 6,009,488 1,376,855,399 14.5%
Part IV - Management Companies and Joint Ventures   Part IV, column (a) Entity 1: St Joseph's Outpatient Surgery Center LLC Entity 2: Southwest Orthopedic & Spine Hospital Real Estate LLC Entity 3: Surgery Center of Peoria, LLC Entity 4: Southwest Lithotripsy, LLC Entity 5: Surgery Center of Reno, LLC Entity 6: Reno Cyberknife, LLC Entity 7: St. Mary's Outpatient Surgery Center at Galena, LLC Entity 8: Reno Imaging Partners, LLC Entity 9: San Martin Surgery Center LLC Entity 10: Parkway Surgery Center LLC Entity 11: San Martin Investors Limited Partnership Entity 12: RBR Management, LLC Entity 13: Sacramento Midtown Endoscopy Center Part IV, columns (a), (b), (c) and (d) (continuation) Entity 14: Folsom Sierra Endoscopy Center, LP; (b) Surgery; (c) 51.00; (d) NONE; (e) 49.00 Entity 15: Folsom Outpatient Surgery Center LP; (b) Surgery; (c) 61.03; (d) NONE; (e) 38.97 Entity 16: Roseville Surgery Center LP; (b) Surgery; (c) 57.53; (d) NONE; (e) 18.31 Entity 17: Grass Valley Outpatient Surgery Center LP; (b) Surgery; (c) 45.61; (d) NONE; (e) 31.59 Entity 18: North State Surgery Centers LP ; (b) Surgery; (c) 62.33; (d) NONE; (e) 33.56 Entity 19: St. Joseph's Surgery Center, LP; (b) Surgery; (c) 80.00; (d) NONE; (e) 13.30 Entity 20: Millenium Surgery Center, Inc; (b) Surgery; (c) 60.00; (d) NONE; (e) 40.00 Entity 21: Santa Cruz Surgery Center; (b) Surgery; (c) 50.00; (d) NONE; (e) 50.00 Entity 22: Santa Cruz Comprehensive Imaging, LLC; (b) Imaging; (c) 50.00; (d) NONE; (e) 50.00 Entity 23: Dominican Breast Center, LLC; (b) Imaging; (c) 50.00; (d) NONE; (e) 50.00 Entity 24: Dominican Magnetic Resonance Imaging Center; (b) Imaging; (c) 80.00; (d) NONE; (e) 20.00 Entity 25: Coastal Surgical Specialists Inc; (b) Surgery; (c) 51.00; (d) NONE; (e) 49.00 Entity 26: Templeton Surgery Center, LLC; (b) Surgery; (c) 65.26; (d) NONE; (e) 34.74 Entity 27: Plaza Surgery Center, LP; (b) Surgery; (c) 51.00; (d) NONE; (e) 49.00 Entity 28: Mountain View Surgery Center; (b) Surgery; (c) 25.00; (d) NONE; (e) 75.00 Entity 29: Medical Pavilion at St. John's ; (b) Real Estate (Rent/Lease); (c) 25.00; (d) NONE; (e) 64.67 Entity 30: Radiation Oncology Centers of Ventura County ; (b) Imaging; (c) 50.00; (d) NONE; (e) 50.00 Entity 31: Outpatient Surgery Center LP; (b) Surgery; (c) 68.50; (d) NONE; (e) 29.50
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI AZ,CA,
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number
94-1196203
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) ALEXANDRIA HOUSE426 S Alexandria Ave
Los Angeles,CA90020 		94-4809755 501(c)(3) 17,000 0 N/A N/A Social Health
(2) ALLAN HANCOCK COLLEGE800 S COLLEGE DR
SANTA MARIA,CA93454 		52-1692042 GOVT 213,380 0 N/A N/A EDUCATIONAL SUPPORT
(3) ALLIANCE AGAINST FAMILY1921 19th St
Bakersfield,CA93302 		95-3604240 501(c)(3) 17,775 0 N/A N/A Social Health Friends Fore Golf
(4) ALLIANCE FOR HOUSING AND HEALING825 Colorado Blvd Ste 100
Los Angeles,CA90041 		95-4147364 501(c)(3) 15,000 0 N/A N/A Social Health
(5) ALLIANCE FOR PHARMACEUTICAL ACCESS221 TOWN Ctr WEST
SANTA MARIA,CA93458 		20-3117940 501(c)(3) 82,500 0 N/A N/A SERVICE FOR THE POOR
(6) ALPHA CRISIS PREGNANCY HELP Center645 W Olive Ave 321
Merced,CA95348 		77-0079754 501(c)(3) 24,000 0 N/A N/A Social Health
(7) AL-SHIFA CLINIC INC2034-B Mallory St
San Bernardino,CA92407 		33-0855769 501(c)(3) 25,000 0 N/A N/A Service for the Poor
(8) ALZHEIMER'S DISEASE ASSOC DESERT SW1028 E McDowell Rd
Phoenix,AZ85006 		86-0402582 501(c)(3) 45,000 0 N/A N/A Educational Support
(9) ALZHEIMER'S DISEASE ASSOC OF KERN COUNTY5500 Olive Dr Blg 1
Bakersfield,CA93308 		77-0017561 501(c)(3) 16,000 0 N/A N/A Quality of Life
(10) American Cancer Society4550 E Bell Road Ste 126
Phoenix,AZ85032 		84-1316555 501(c)(3) 14,000 0 N/A N/A Quality of Life
(11) American Cancer Society754 Mangrove Ave
Chico,CA95926 		94-1170350 501(c)(3) 48,024 0 N/A N/A Quality of Life
(12) AMERICAN HEART ASSOCiation100 MONTGOMERY ST Ste 1650
SAN FRANCISCO,CA91404 		13-5613797 501(c)(3) 403,484 0 N/A N/A PREVENTATIVE CARE
(13) AMERICAN LUNG ASSOCiation10615 Double R Blvd
Reno,NV89521 		86-0111676 501(c)(3) 45,500 0 N/A N/A Social Health
(14) American Red Cross85 2nd St 8th fl
San Francisco,CA94105 		94-3045430 501(c)(3) 29,000 0 N/A N/A Social Health
(15) Andre Agassi Foundation for Education3883 Howard Hughes Pkwy 8th Fl
Las Vegas,NV89169 		34-1759295 501(c)(3) 5,733 0 N/A N/A Educational Support
(16) Archdiocese of Los Angeles3424 Wilshire Blvd
Los Angeles,CA90010 		95-1642382 501(c)(3) 13,500 0 N/A N/A Social Health
(17) Archdiocese of San FranciscoOne Peter York Way
San Francisco,CA94109 		94-1156707 501(c)(3) 25,000 0 N/A N/A Educational Support
(18) Arizona Latin American Medical AssociationPO Box 24152
122
Tempe,AZ852854152 		86-0743958 501(c)(3) 5,900 0 N/A N/A Social Health
(19) ARMENIAN AMERICAN MEDICAL SOCIETY OF CALIF INCPO Box 32
Glendale,CA91209 		95-4108352 501(c)(3) 10,000 0 N/A N/A Preventative Care
(20) Arroyo Grande Foundation345 S Halcyon Rd
Arroyo Grande,CA93420 		20-6589199 501(c)(3) 221,187 0 N/A N/A Foundation Support
(21) Arthritis Foundation1313 East Osborn Ste 200
Phoenix,AZ85014 		58-1341679 501(c)(3) 6,000 0 N/A N/A Quality of Life
(22) Asia Society of Northern CA500 Washington St Ste 350
San Francisco,CA94111 		13-3234632 501(c)(3) 8,500 0 N/A N/A Social Health
(23) ASSISTANCE LEAGUE OF LONG BEACH6220 E Spring St
Long Beach,CA90815 		95-1660324 501(c)(3) 15,000 0 N/A N/A Social Health
(24) ASSISTANCE LEAGUE OF SAN BERNARDINO580 West 6th St
San Bernardino,CA92410 		95-6065105 501(c)(3) 25,000 0 N/A N/A Service for the Poor
(25) ASSISTANCE LEAGUE OF VENTURA COUNTY913 East Santa Clara St
Ventura,CA93001 		95-2100846 501(c)(3) 25,000 0 N/A N/A Social Health
(26) Kern Community College District1801 Panorama Drive
1200
Bakersfield,CA93307 		95-6006644 501(c)(3) 166,333 0 N/A N/A Educational Support
(27) BAKERSFIELD POLICE ACTIVITIES301 E 4th St
115
Bakersfield,CA93307 		77-0375436 501(c)(3) 35,000 0 N/A N/A Social Health Training Kits
(28) Bakersfield South Rotary FoundationPO Box 2021
Bakersfield,CA93303 		77-0360440 501(c)(3) 8,650 0 N/A N/A Scholarship Support
(29) Barrow Neurological Foundation350 W Thomas Rd
Phoenix,AZ85013 		86-0174371 501(c)(3) 2,602,985 0 N/A N/A Foundation Support
(30) Bay Area Council201 California St Ste 1450
San Francisco,CA94111 		23-7325853 501(c)(4) 24,100 0 N/A N/A Quality of Life
(31) BOARD OF REGENTS Nevada System of Higher Education1125 Nevada State Drive
1650
Henderson,NV89002 		88-6000024 501(c)(3) 155,000 0 N/A N/A Educational Support
(32) BOYS & GIRLS CLUB OF SANTA MARIA VALLEY901 N RAILROAD
SANTA MARIA,CA93458 		95-2468116 501(c)(3) 5,700 0 N/A N/A SOCIAL HEALTH
(33) Boys and Girls Club of the East Valley1405 E Guadalupe Rd 4
Tempe,AZ85283 		86-0550646 501(c)(3) 5,500 0 N/A N/A Quality of Life
(34) Cal State University Northridge18111 Nordoff St
Northridge,CA913308385 		95-4358677 GOVT 7,250 0 N/A N/A Educational Support
(35) CALAVERAS COUNTY OFFICE OF EDUPO Box 760
Angels Camp,CA95221 		94-1638758 govt 6,500 0 N/A N/A Preventative Care
(36) CALIF STATE UNIVERSITY-DOMINGUEZ HILLS1000 E VICTORIA ST
CARSON,CA90747 		93-1043787 GOVT 51,000 0 N/A N/A EDUCATIONAL SUPPORT
(37) California Health Foundation and Trust1215 K St Ste 800
Sacramento,CA95814 		94-1498697 501(c)(3) 21,564,355 0 N/A N/A Service for the Poor
(38) California Hospital Medical CTR Foundation1401 South Grand Ave
Los Angeles,CA90015 		95-4000909 501(c)(3) 1,445,857 0 N/A N/A Foundation Support
(39) California Primary Care ASSOC1231 I St Ste 400
Sacramento,CA95814 		94-3215565 501(c)(3) 10,000 0 N/A N/A Service for the Poor
(40) California State Conference of the NAACP1215 S St Ste 1609
Sacramento,CA95814 		95-4617376 501(c)(3) 10,000 0 N/A N/A Social Health
(41) California State University Stanislaus FndOne University Circle
Turlock,CA95382 		77-0492209 501(c)(3) 100,000 0 N/A N/A Educational Support
(42) CALIFORNIA THORACIC SOCIETY441 MacKay Drive
San Bernardino,CA92408 		94-0362650 501(c)(3) 9,500 0 N/A N/A Educational Support
(43) CALIFORNIA VETERANS ASSISTANCE729 Decatur St
Bakersfield,CA93308 		30-0186044 501(c)(3) 23,000 0 N/A N/A Preventative Care
(44) Cal State Bakersfield Foundation9001 Stockdale HYW
Bakersfield,CA93311 		95-2643086 501(c)(3) 11,560 0 N/A N/A Educational Support
(45) CAMARILLO BOYS & GIRLS CLUB1500 Temple Ave
Camarillo,CA93010 		95-6194547 501(c)(3) 8,000 0 N/A N/A Preventative Care
(46) CAMARILLO HOSPICE CORP400 Rosewood Ave 102
Camarillo,CA93010 		95-3347061 501(c)(3) 10,000 0 N/A N/A Service for the Poor
(47) CAPITOL COMMUNITY Health NETWORK4825 J St
Sacramento,CA95819 		68-0400624 501(c)(3) 40,000 0 N/A N/A Service for the Poor
(48) CARE CHEST OF SIERRA NEVADA7910 North Virginia St
c/o Kris Preston
Reno,NV89506 		94-3118373 501(c)(3) 50,000 0 N/A N/A Service for the Poor
(49) CARONDELET HEALTH NETWORK2202 N Forbee Blvd
Tucson,AZ85745 		53-0196617 501(c)(3) 12,000 0 N/A N/A Social Health
(50) CASA OF KERN COUNTY2000 24th St Ste 130
Bakersfield,CA93301 		77-0344298 501(c)(3) 15,000 0 N/A N/A Social Health
(51) CATHOLIC CHARITIES1450 North D St
San Bernardino,CA92405 		95-3516461 501(c)(3) 10,000 0 N/A N/A Social Health
(52) CATHOLIC CHARITIES DIOCESE OF STOCKTON1106 North El Dorado St
Stockton,CA95202 		95-2932124 501(c)(3) 25,000 0 N/A N/A Social Health
(53) CATHOLIC CHARITIES OF LA1531 James M Wood Blvd
Los Angeles,CA90015 		95-1690973 501(c)(3) 15,250 0 N/A N/A Social Health
(54) CATHOLIC CHARITIES OF LA-Santa Barbara CNTY609 East Haley St
Santa Barbara,CA93013 		95-1690097 501(c)(3) 15,000 0 N/A N/A Social Health
(55) Catholic Charities of Southern Nevada1501 Las Vegas Blvd N
Las Vegas,NV89101 		88-0059425 501(c)(3) 5,500 0 N/A N/A Religious Community
(56) CATHOLIC CHARITITES COMMUNITY4747 N 7th Ave
Phoenix,AZ85013 		86-0223999 501(c)(3) 50,000 0 N/A N/A Social Health
(57) Catholic Relief Services228 W Lexington St
Baltimore,MD21201 		13-5563422 501(c)(3) 25,000 0 N/A N/A Service for the Poor
(58) Celebrity Fight Night Foundation2111 E Highland Ave Ste 135
Phoenix,AZ85016 		86-0903119 501(c)(3) 169,000 0 N/A N/A SOCIAL HEALTH
(59) CENTRAL COAST COMMISSION FOR Senior Citizens528 South Broadway
Santa Maria,CA94355 		95-2943625 501(c)(3) 10,000 0 N/A N/A Preventative Care
(60) Chandler Chamber of Commerce475 S Dobson Road
Chandler,AZ85224 		86-0107200 501(c)(6) 10,000 0 N/A N/A Social Health
(61) CHANDLER CHRISTIAN COMMUNITY345 S California St
Chandler,AZ85225 		86-0428780 501(c)(3) 50,000 0 N/A N/A Social Health
(62) Chandler CTR for the Arts250 N Arizona Ave
Chandler,AZ85225 		74-2538528 501(c)(3) 7,500 0 N/A N/A Educational Support
(63) CHANDLER EDUCATION FOUNDATION1525 W Frye Road
Chandler,AZ85224 		86-0589677 501(c)(3) 25,000 0 N/A N/A Educational Support
(64) CHANDLER-GILBERT YMCA1655 West Frye Road
Chandler,AZ85224 		86-0096799 501(c)(3) 13,000 0 N/A N/A Preventative Care
(65) CHILD ABUSE PREVENTION COUNCIL OF SAN JOAQUIN COUN1655 West Frye Road
Chandler,AZ85224 		94-2497046 501(c)(3) 26,315 0 N/A N/A Social Health
(66) CHILD ADVOCATES OF NV COUNTY531 Uren St
Nevada City,CA95959 		68-0317841 501(c)(3) 15,271 0 N/A N/A Social Health
(67) CHILDREN'S HEALTH INIATIVE OF SLO COPO BOX 1737
SAN LUIS OBISPO,CA93406 		20-1489824 501(c)(3) 21,500 0 N/A N/A PREVENTATIVE CARE
(68) CHW Foundation East Valley1727 West Frye Rd Ste 230
Chandler,AZ85224 		74-2418514 501(c)(3) 1,682,381 0 N/A N/A Foundation Support
(69) CHW Medical Foundation3400 Data Drive
Sacramento,CA95670 		68-0220314 501(c)(3) 49,309,310 0 N/A N/A Medical Fnd Support
(70) CIRCLE THE CITY220 S 12th Ave
Phoenix,AZ85007 		26-2420730 501(c)(3) 52,396 0 N/A N/A Service for the Poor
(71) CITIZENS WHO CARE INC1260 Lake Blvd Ste 208
Davis,CA95616 		68-0154969 501(c)(3) 10,000 0 N/A N/A Quality of Life
(72) City of Reno Mental Health Triage CTRPO Box 678231
Reno,NV89501 		88-6000201 Govt 100,012 0 N/A N/A Service for the Poor
(73) CLARA'S HOUSE3319 J St
Sacramento,CA95816 		61-1591265 501(c)(3) 15,000 0 N/A N/A Social Health
(74) Clark County Public Education Foundation3360 W Sahara Ave Ste 160
Las Vegas,NV89102 		88-0275767 501(c)(3) 8,860 0 N/A N/A Educational Support
(75) COMMUNICARE HEALTH CTRSPO Box 1260
Davis,CA95617 		94-2188574 501(c)(3) 8,019 0 N/A N/A Preventative Care
(76) COMMUNITY ACTION COMMISSION5638 HOLLISTER AVE STE 230
GOLETA,CA93117 		95-2491790 501(c)(3) 5,500 0 N/A N/A SOCIAL HEALTH
(77) COMMUNITY BRIDGES236 Santa Cruz Ave
14th floor
Aptos,CA95003 		94-2460211 501(c)(3) 10,000 0 N/A N/A Preventative Care
(78) COMMUNITY BRIDGES1811 S Alma School Rd Ste 160
Mesa,AZ85210 		94-2880847 501(c)(3) 55,000 0 N/A N/A Service for the Poor
(79) COMMUNITY FOUNDATION OF MERCEDPO BOX 3856
Merced,CA95344 		86-1151358 501(c)(3) 15,000 0 N/A N/A Social Health
(80) Community Initiatives354 Pine St 700
San Francisco,CA94104 		94-3255070 501(c)(3) 15,000 0 N/A N/A Preventative Care
(81) COMMUNITY MEDICAL CTRS INC7210 Murray Drive
Stockton,CA95210 		94-2437106 501(c)(3) 20,000 0 N/A N/A Social Health
(82) COMMUNITY PRTNSHP FOR FAMILIES OF SAN JOAQUIN2044 Fair St
Stockton,CA95206 		68-0475602 501(c)(3) 22,000 0 N/A N/A Preventative Care
(83) COMMUNITY RECOVERY RESOURCES440 Henderson St
Grass Valley,CA95945 		94-2275091 501(c)(3) 19,729 0 N/A N/A Social Health
(84) Community Svc Education & Research Fund (CSERF)5380 Elvas Ave
Sacramento,CA95819 		23-7003581 501(c)(3) 15,000 0 N/A N/A Service for the Poor
(85) Congenital Heart Foundation350 W Thomas Rd
Phoenix,AZ85013 		26-3342554 501(c)(3) 143,768 0 N/A N/A Foundation Support
(86) Council for Spanish Speaking224 S Sutter St
Stockton,CA95203 		94-1677202 501(c)(3) 5,938 0 N/A N/A Social Health
(87) COUNCIL ON ALCOHOLISM & DRUG ABUSE526 E CHAPEL ST
SANTA MARIA,CA93454 		95-1878858 501(c)(3) 6,500 0 N/A N/A PREVENTATIVE CARE
(88) County of Sacramento827 7th St
Sacramento,CA95814 		94-6000529 GOVT 50,000 0 N/A N/A Social Health
(89) CTR for Community Health and Well Being Inc1900 T St
Sacramento,CA95811 		68-0248303 501(c)(3) 25,000 0 N/A N/A Service for the Poor
(90) CTR for Healthcare Decisions3400 Data Drive
Rancho Cordova,CA95670 		68-0441958 501(c)(3) 15,000 0 N/A N/A Social Health
(91) CUESTA COLLEGE FOUNDATIONPO BOX 8016
SAN LUIS OBISPO,CA93403 		23-7225601 501(c)(3) 15,000 0 N/A N/A Educational Support
(92) CURRY SENIOR CTR333 Turk St
San Francisco,CA94102 		23-7362588 501(c)(3) 10,000 0 N/A N/A Social Health
(93) DIOCESAN COUNCIL FOR SOCIETY420 W Watkins
600
Phoenix,CA85003 		86-0096789 501(c)(3) 50,000 0 N/A N/A Social Health
(94) DIOCESE OF LAS VEGAS336 Cathedral Way
Las Vegas,NV89109 		88-0059349 501(c)(3) 26,060 0 N/A N/A Social Health
(95) EASTER SEALS SIERRA NV INC6200 W Oakley Blvd
Las Vegas,NV89146 		94-2815686 501(c)(3) 40,000 0 N/A N/A Social Health
(96) Economic Alliance San Fernando5121 Van Nuys Blvd Ste 200
Sherman Oaks,CA914031497 		95-4524503 501(c)(3) 10,000 0 N/A N/A Social Health
(97) EL DORADO COUNTY COMMUNITY Health4327 Golden Ctr Dr
Placerville,CA95667 		42-1533531 501(c)(3) 98,000 0 N/A N/A Social Health
(98) EL HOGAR COMMUNITY SERVICES3780 Rosin Court Ste 240
Sacramento,CA95834 		68-0032730 501(c)(3) 98,000 0 N/A N/A Social Health
(99) EL RIO COMMUNITY HEALTH CTN829 W Congress
Tucson,AZ85745 		86-0816675 501(c)(3) 30,000 0 N/A N/A Social Health
(100) EMERGENCY FOOD BANK7 West Scotts Ave
Stockton,CA95203 		68-0002165 501(c)(3) 23,595 0 N/A N/A Social Health
(101) ENHANCEMENT INCPO Box 867
Morro Bay,CA93443 		77-0484448 501(c)(3) 5,680 0 N/A N/A Quality of Life
(102) ENRICHMENT WORKS5605 Woodman Ave Ste 207
Valley Glen,CA91401 		95-4754624 501(c)(3) 40,000 0 N/A N/A Educational Support
(103) FAMILY SERVICE AGENCY1347 Grant St
Red Bluff,CA96080 		94-1616456 501(c)(3) 13,720 0 N/A N/A Social Health
(104) FAMILY SERVICE AGENCY1820 J St
Sacramento,CA95811 		94-1713704 501(c)(3) 27,500 0 N/A N/A Social Health
(105) FAMILY SERVICE AGENCY OF San Mateo24 Second Ave
San Mateo,CA94401 		94-1186169 501(c)(3) 40,000 0 N/A N/A Social Health
(106) FOOD BANK OF NORTHERN NV INC550 Italy Drive
McCarran,NV89434 		94-2924979 501(c)(3) 48,250 0 N/A N/A Service for the Poor
(107) FOOD BANK OF SANTA BARBARA490 W Foster Rd
Santa Maria,CA93455 		77-0169214 501(c)(3) 14,500 0 N/A N/A Service for the Poor
(108) FOODSHARE4156 Southbank Rd
Oxnard,CA93036 		77-0018162 501(c)(3) 13,750 0 N/A N/A Social Health
(109) FOOTHILL FAMILY SERVICE2500 E Foothill Blvd Ste 300
Pasadena,CA91107 		95-1690990 501(c)(3) 23,000 0 N/A N/A Social Health
(110) FOUNDATION FOR SENIOR LIVING1201 E Thomas Rd
Phoenix,AZ85014 		86-0411904 501(c)(3) 40,000 0 N/A N/A Social Health
(111) FOUNDATION OF SANTA BARBARA110 Castilian
Goleta,CA93117 		81-0587227 501(c)(3) 15,000 0 N/A N/A Service for the Poor
(112) FRENCH HOSPITAL FOUNDATION1911 JOHNSON AVE
SAN LUIS OBISPO,CA93401 		20-3256125 501(c)(3) 726,710 0 N/A N/A Foundation Support
(113) Fresh Start1130 E McDowell Road
Phoenix,AZ85006 		86-0762610 501(c)(3) 5,300 0 N/A N/A Social Health related
(114) Friends of Mercy FoundationPO Box 119
Bakersfield,CA93302 		77-0201321 501(c)(3) 647,286 0 N/A N/A Foundation support
(115) Gifts to Share Inc915 I St 5th fl
Sacramento,CA95814 		94-2985546 501(c)(3) 30,200 0 N/A N/A Social Health
(116) Glaucoma Research & Education Group55 Stevenson St
San Francisco,CA94105 		94-3208182 501(c)(3) 7,500 0 N/A N/A Scholarship Support
(117) GLENDALE COMMUNITY FREE HEALTH134 N Kenwood St Rm 330
Glendale,CA91206 		87-0732681 501(c)(3) 19,239 0 N/A N/A Service for the Poor
(118) GLENDALE FIRE DEPT780 Flower St
Glendale,CA91201 		95-6068137 501(c)(3) 25,000 0 N/A N/A Social Health
(119) GLENDALE HEALTHY KIDSPO box 201
Glendale,CA91209 		95-4487466 501(c)(3) 15,000 0 N/A N/A Preventative Care
(120) Glendale Memorial Health Foundation1420 S Central Ave
Glendale,CA91204 		95-3625651 501(c)(3) 854,080 0 N/A N/A Foundation Support
(121) GOLDEN EMPIRE GLEANERS1326 30th St
Bakersfield,CA93301 		77-0084637 501(c)(3) 10,000 0 N/A N/A Social Health
(122) Golden Umbrella200 Mercy Oaks Drive
Redding,CA96003 		23-7115371 501(c)(3) 63,563 0 N/A N/A Quality of Life
(123) GOMPERS HABILITATION CTR6601 N 27th Ave
Phoenix,AZ85017 		86-0098909 501(c)(3) 15,000 0 N/A N/A Social Health
(124) GOOD NEWS RESCUE MISSION2842 South Market St
Redding,CA96001 		94-1652602 501(c)(3) 28,000 0 N/A N/A Social Health
(125) Goodwill900 W Pacific Coast Hwy
Long Beach,CA90808 		95-1644017 501(c)(3) 10,000 0 N/A N/A Social Health
(126) H STREET CLINIC1329 North H St
San Bernardino,CA92405 		20-8191393 501(c)(3) 145,000 0 N/A N/A Social Health
(127) Harold Pump Foundation13636 Ventura Blvd
Sherman Oaks,CA91432 		95-4807001 501(c)(3) 31,500 0 N/A N/A Social Health
(128) Health Care Without Harm12355 Sunrise Valley Dr Ste 680
Reston,VA20191 		52-2358837 501(c)(3) 88,050 0 N/A N/A Social Health
(129) HEALTH IMPROVEMENT PARTNERSHIP1600 Green Hills Rd Ste 101
Scotts Valley,CA95066 		01-0826156 501(c)(3) 25,000 0 N/A N/A Social Health
(130) Health Insight6830 W Oqendo Rd Ste 102
Las Vegas,NV89118 		87-0303872 501(c)(3) 50,000 0 N/A N/A Social Health
(131) HENRIETTA WEILL MEMORIAL3628 Stockdale Hwy
Bakersfield,CA93309 		95-1643391 501(c)(3) 25,000 0 N/A N/A Preventative Care
(132) HOMELESS SERVICES CTR115 Coral St
Santa Cruz,CA95060 		77-0126783 501(c)(3) 25,000 0 N/A N/A Service for the Poor
(133) HOPE COMMUNITY HEALTH CTR312 N Alma School Rd 9C
Chandler,AZ85224 		20-1526381 501(c)(3) 25,000 0 N/A N/A Social Health Barrow Neurological Institute
(134) HOPELINK178 Westminster Way
Henderson,NV89015 		94-3202139 501(c)(3) 15,274 0 N/A N/A Service for the Poor
(135) HOSPICE OF SANTA CRUZ COUNTY940 Disc Drive
Scotts Valley,CA95066 		94-2497618 501(c)(3) 15,000 0 N/A N/A Social Health
(136) Hospital ASSOC of Southern California1000 Town Ctr Dr Ste 300
Oxnard,CA93036 		95-1519378 501(c)(6) 59,784 0 N/A N/A Social Health
(137) HOSPITAL COUNCIL (SAN FRANCISCO HEALTH PLAN)201 Third St 7th fl
San Francisco,CA94103 		86-1174825 govt 41,000 0 N/A N/A Social Health
(138) Hospital Council of Northern & Central CA1215 K St Ste 730
Sacramento,CA95814 		94-2663197 501(c)(3) 49,414 0 N/A N/A Social Health
(139) HOSPITAL CONSORTIUM OF SAN MATEO222 W 39th Ave Ste A 309
San Mateo,CA94403 		94-2637032 501(c)(3) 43,333 0 N/A N/A Quality of Life
(140) ICA San Francisco Work Study Inc3625 24th St
San Francisco,CA94110 		26-4450576 N/A 14,500 0 N/A N/A Educational Support
(141) IMMANUEL PRESBYTERIAN CHURCH3300 Wilshire Blvd
Los Angeles,CA90010 		95-1643330 501(c)(3) 17,000 0 N/A N/A Social Health communities.
(142) Improving Chandler Area Neighborhoods201 S Washington St
Chandler,AZ85225 		86-0761030 501(c)(3) 32,685 0 N/A N/A Preventative Care
(143) Interfaith CTR on Corporate Responsibility475 Riverside Dr Ste 1842
New York,NY10114 		13-3235906 501(c)(3) 8,450 0 N/A N/A Social Health
(144) INTERNATIONAL RESCUE COMMITTEE5227 N 7th St
Phoenix,AZ85014 		13-5660870 501(c)(3) 25,000 0 N/A N/A Social Health
(145) IRISH IMMIGRATION PASTORAL CTR5340 Geary Blvd 206
San Francisco,CA94121 		94-3329015 501(c)(3) 6,066 0 N/A N/A Social Health
(146) Jewish Vocational & Career Counseling Service225 Bush St Ste 400
San Francisco,CA94104 		94-2213100 501(c)(3) 13,970 0 N/A N/A Educational Support
(147) JMJ MATERNITY HOMES435 West 21st St
Merced,CA95340 		20-5611546 501(c)(3) 24,000 0 N/A N/A Service for the Poor
(148) Juvenile Diabetes Research Foundation Intl4343 E Camelback Road 230
Phoenix,AZ85018 		23-1907729 501(c)(3) 11,500 0 N/A N/A Social Health
(149) Keep Memory Alive888 W Bonneville Ave
Las Vegas,NV89106 		88-0515534 501(c)(3) 8,000 0 N/A N/A Community Support
(150) Keogh Health Foundation1750 E Glendale Ave
Phoenix,AZ85020 		20-0251176 501(c)(3) 6,220 0 N/A N/A Quality of Life
(151) KOREAN AMERICAN FAMILY SRV CTR3727 W 6th St Ste 320
Los Angeles,CA90020 		95-3899329 501(c)(3) 17,000 0 N/A N/A Social Health
(152) Krewe of Helios9814 Kapalua Lane
Elk Grove,CA95624 		27-2011084 501(c)(3) 7,500 0 N/A N/A Quality of Life
(153) Leadership Conference of Women Religious of USA8808 Cameron St
Silver Springs,MD20910 		43-6033728 501(c)(3) 30,000 0 N/A N/A Religious Community
(154) LEGAL AID SOCIETY OF SAN BERNARDINO588 West Sixth St
San Bernardino,CA92410 		95-1997024 501(c)(3) 25,000 0 N/A N/A Social Health
(155) LEND A HAND INC400 Utah St
Boulder City,NV89005 		88-0250959 501(c)(3) 15,000 0 N/A N/A Social Health
(156) Leukemia & Lymphoma Society340 West Fallbrook Ave Ste 101
Fresno,CA93711 		13-5644916 501(c)(3) 9,630 0 N/A N/A Quality of Life
(157) LINKS FOR LIFE1706 Chester Ave 200
Bakersfield,CA93301 		93-1088003 501(c)(3) 32,600 0 N/A N/A Preventative Care
(158) LIVINGSTON MEMORIAL LIVING1996 Eastman Ave Ste 101
Ventura,CA93003 		95-1693538 501(c)(3) 10,000 0 N/A N/A Preventative Care
(159) LONG BEACH CARES2525 Grand Ave
Long Beach,CA90815 		33-0568621 501(c)(3) 10,246 0 N/A N/A Preventative Care
(160) LONG BEACH POLICE FOUNDATIONPO Box 18418
Long Beach,CA90815 		33-0835185 501(c)(3) 8,000 0 N/A N/A Social Health
(161) LOS ANGELES CHILD GUIDANCE3031 S Vermont Ave
Los Angeles,CA90007 		95-1690974 501(c)(3) 17,000 0 N/A N/A Preventative Care
(162) LOS ANGELES POLICE FOUNDATION515 South Flower St 1680
Los Angeles,CA90071 		95-4700442 501(c)(3) 23,000 0 N/A N/A Social Health
(163) MAGGIE'S PLACE1517 East McDowell Road
Phoenix,AZ85006 		86-0972675 501(c)(3) 36,000 0 N/A N/A Social Health
(164) March of Dimes4201 W Shaw Ave Ste 105
Fresno,CA93722 		13-1846366 501(c)(3) 30,320 0 N/A N/A Quality of Life
(165) MARE RIDING CTR18200 Johnson Road
Bakersfield,CA93314 		77-0297678 501(c)(3) 20,000 0 N/A N/A Social Health
(166) MARIAN MEDICAL CTR FOUNDATION1400 E CHURCH ST
SANTA MARIA,CA93454 		95-3818027 501(c)(3) 461,049 0 N/A N/A Foundation Support
(167) MARY MAGDALENE COMMUNITY SRV445 North San Joaquin Blvd
Stockton,CA95202 		68-0462814 501(c)(3) 20,000 0 N/A N/A Preventative Care grant)
(168) MARY'S MERCY CTRPO Box 7563
San Bernardino,CA92401 		33-0632426 501(c)(3) 25,000 0 N/A N/A Preventative Care
(169) MATERNAL & CHILD HEALTH ACCESS1111 W 6th St 4th fl
Los Angeles,CA90017 		95-4555879 501(c)(3) 17,000 0 N/A N/A Preventative Care
(170) MCCLOUD HEALTHCARE CLINICPO Box 1143
McCloud,CA96057 		68-0427383 501(c)(3) 11,549 0 N/A N/A Preventative Care
(171) MERCED LAO FAMILY COMMUNITY855 W 15th St
Merced,CA95340 		77-0268241 501(c)(3) 19,579 0 N/A N/A Preventative Care
(172) Mercy Foundation3400 Data Drive
Sacramento,CA95670 		23-7072762 501(c)(3) 2,891,084 0 N/A N/A Foundation Support
(173) Mercy Housing1999 Broadway Ste 1000
Denver,CO80202 		47-0646706 501(c)(3) 100,000 0 N/A N/A Quality of Life
(174) Mercy Leadership Development Program55 Fourth Ave
E Greenwich,RI02818 		52-1653282 501(c)(3) 25,000 0 N/A N/A Educational Support
(175) Mercy Medical CTR Merced Foundation301 East 13th St
Merced,CA95340 		77-0035928 501(c)(3) 343,488 0 N/A N/A Foundation Support
(176) MERCY SERVICES CORP3120 Freeboard Dr Ste 202
Sacramento,CA95691 		94-3081666 501(c)(3) 28,859 0 N/A N/A Preventative Care
(177) MISSION OF MERCY-AZ CLINICPO Box 102
Fairfield,PA17320 		86-0704883 501(c)(3) 27,320 0 N/A N/A Social Health
(178) MMC FOR CHILDREN & FAMILIES155 15th St 160A
Sacramento,CA95691 		37-1424390 501(c)(3) 135,000 0 N/A N/A Service for the Poor
(179) MOST HOLY REDEEMER CHURCH100 Diamond St
San Francisco,CA94114 		94-1156774 501(c)(3) 8,000 0 N/A N/A Quality of Life
(180) MT SHASTA COMMUNITY RESOURCE432 N Mt Shasta Blvd
Mt Shasta,CA96067 		20-2528991 501(c)(3) 6,000 0 N/A N/A Preventative Care
(181) MUSCULAR DYSTROPHY ASSOC402 E CARILLO ST STE C
SANTA BARBARA,CA93101 		13-1665552 501(c)(3) 5,200 0 N/A N/A PREVENTATIVE CARE opening
(182) Museum of African Diaspora685 Mission St
San Francisco,CA94105 		94-3338239 501(c)(3) 28,737 0 N/A N/A Quality of Life
(183) National Hispanic Health Foundation1411 K St NW Ste 1100
Washington,DC20005 		26-0051902 501(c)(3) 8,800 0 N/A N/A Foundation Support
(184) NATL MULTIPLE SCLEROSIS SOCIETy1880 30th St 105
W1B
Bakersfield,CA93301 		95-1727656 501(c)(3) 10,000 0 N/A N/A Preventative Care
(185) Nevada Health Care Coalition1775 E Plumb Ln Ste 107
Reno,NV89502 		88-0348643 501(c)(6) 5,946 0 N/A N/A Social Health
(186) NEVADA HEALTH CTRS INC4415 Spring Mountain Rd Ste 103
Las Vegas,NV89102 		94-3199117 501(c)(3) 50,000 0 N/A N/A Social Health
(187) NORTHERN CA CHILDREN'S THERAPY96 W Main St Ste B
Woodland,CA95695 		68-0309705 501(c)(3) 10,000 0 N/A N/A Social Health
(188) NORTHERN CALIF CTN FOR FAMILYPO Box 991473
Redding,CA96003 		68-0363217 501(c)(3) 22,000 0 N/A N/A Social Health
(189) NORTHERN CALIFORNIA CHILD DEV220 Sycarore St 200
Red Bluff,CA96080 		94-1642028 501(c)(3) 7,000 0 N/A N/A Preventative Care
(190) Northridge Hospital Foundation18300 Roscoe Blvd
Northridge,CA91328 		23-7444901 501(c)(3) 1,012,316 0 N/A N/A Foundation Support
(191) Not for Sale270 Capistrano Rd Ste 2
Half Moon Bay,CA94019 		20-5659783 501(c)(3) 20,000 0 N/A N/A Social Health
(192) Oakland Metropolitan Chamber of Commerce Foundatio475 14th St
Oakland,CA94612 		95-3217684 501(c)(3) 250,000 0 N/A N/A Social Health
(193) OPTION HOUSE INCPO Box 970
San Bernardino,CA92402 		95-3760212 501(c)(3) 17,000 0 N/A N/A Social Health
(194) PACIFIC CHRISTIAN CHURCH3435 SKYWAY DRIVE
SANTA MARIA,CA93455 		95-2409606 501(c)(3) 6,950 0 N/A N/A SOCIAL HEALTH
(195) PAJARO VALLEY COMMUNITY Health85 Nielson St
Watsonville,CA95076 		94-1149702 501(c)(3) 10,000 0 N/A N/A Preventative Care
(196) Panetta Institute100 Campus CNT Bldg 86E
Seaside,CA93955 		77-0495799 501(c)(3) 5,500 0 N/A N/A Social Health
(197) PATHWAYS HOSPICE FOUNDATION585 N Mary Ave
Sunnyvale,CA94085 		77-0280660 501(c)(3) 24,600 0 N/A N/A Quality of Life
(198) PATHWAYS VOLUNTEER HOSPICE3701 Michelson St
Lakewood,CA90712 		33-0241726 501(c)(3) 8,000 0 N/A N/A Social Health
(199) PENINSULA VOLUNTEERS INC800 Middle Ave
Menlo Park,CA94025 		94-1294939 501(c)(3) 25,000 0 N/A N/A Social Health
(200) Phoenix SymphonyOne N First St Ste 730
Phoenix,AZ85016 		86-6000134 501(c)(3) 42,800 0 N/A N/A Educational Support
(201) POWERHOUSE MINISTRIESPO Box 1611
Folsom,CA95630 		68-0020855 501(c)(3) 50,000 0 N/A N/A Service for the Poor
(202) Prevent Alcohol and Risk Related Trauma in YouthPO Box 1342
Folsom,CA95763 		91-1764812 501(c)(3) 10,500 0 N/A N/A Preventative Care
(203) PROMOTORAS Y PROMOTORES FOUNDATION1500 Camino Del Sol 18
Oxnard,CA93030 		42-1618670 501(c)(3) 15,000 0 N/A N/A Social Health
(204) REBUILDING TOGETHER PENINSULAPO Box 4031
Menlo Park,CA94026 		94-3106209 501(c)(3) 10,000 0 N/A N/A Social Health
(205) RESCUE MISSION ALLIANCE315 N A St
Oxnard,CA93030 		23-7278002 501(c)(3) 15,000 0 N/A N/A Social Health
(206) RIVERSIDE COUNTY PHYSICIANS MEMORIAL FND3993 Jurupa Av
Riverside,CA95206 		95-6080778 501(c)(3) 5,689 0 N/A N/A Quality of Life
(207) ROSEVILLE HOMESTART410 Riverside Ave
Roseville,CA95678 		91-1657990 501(c)(3) 50,000 0 N/A N/A Service for the Poor
(208) ROTACARE BAY AREA INCPO Box 18430
San Jose,CA95158 		77-0328723 501(c)(3) 25,000 0 N/A N/A Social Health
(209) SACRAMENTO DISTRICT DENTAL915 28th St
Sacramento,CA95816 		23-7067087 501(c)(3) 25,000 0 N/A N/A Preventative Care
(210) Sacramento Food Bank & Family Services3333 Third Ave
Sacramento,CA95817 		94-3315566 501(c)(3) 16,500 0 N/A N/A Quality of Life
(211) Sacramento Valley AIDS FundPO Box 160636
c/o Patti Bruno
Sacramento,CA95816 		68-0385175 501(c)(3) 15,000 0 N/A N/A Social Health
(212) Saint Mary's Foundation235 W 6th St
Reno,NV89520 		88-0188386 501(c)(3) 1,230,507 0 N/A N/A Foundation Support
(213) Saint Peter & Paul School706 Bay View Ave
Wilmington,CA90744 		95-2150449 501(c)(3) 15,000 0 N/A N/A Service for the Poor assistant
(214) SAMARITAN HOUSE4031 Pacific Boulevard
San Mateo,CA94403 		23-7416272 501(c)(3) 15,200 0 N/A N/A Social Health
(215) SAN BERNARDINO SEXUAL ASSAULT SERVICES444 N Arrowhead Ave Ste 101
San Bernardino,CA92401 		95-3543081 501(c)(3) 20,000 0 N/A N/A Social Health
(216) San Francisco NAACP1290 Fillmore St Ste 109
San Francisco,CA94115 		23-7177411 501(c)(3) 8,500 0 N/A N/A Scholarship Support
(217) SAN FRANCISCO SENIOR CTR890 Beach St
San Francisco,CA94109 		94-1212136 501(c)(3) 15,000 0 N/A N/A Social Health
(218) SAN JOAQUIN COUNTY OFFICE OF EDUCATIONPO Box 213030
Stockton,CA95213 		68-0006282 501(c)(3) 20,000 0 N/A N/A Preventative Care
(219) San Joaquin Delta College5151 N Pacific Ave
Stockton,CA95207 		94-1044400 Govt 6,000 0 N/A N/A Scholarship Support
(220) SANTA BARBARA COUNTY SHERIFFS RELIEF & BENEFIT ASS315 CAMINO DEL REMEDIO
SANTA BARBARA,CA93110 		23-7045577 501(c)(4) 60,000 0 N/A N/A PREVENTATIVE CARE
(221) SANTA MARIA VALLEY FISH MEALSPO Box 6526
Santa Maria,CA93456 		95-2757731 501(c)(3) 10,000 0 N/A N/A Quality of Life
(222) SANTA MARIA VALLEY YMCA3400 Skyway Drive
Santa Maria,CA93455 		95-2158363 501(c)(3) 8,500 0 N/A N/A Preventative Care
(223) SCOTT NEWMAN CTR23440 Hawthorne Blvd Bldg 2 Ste 250
Torrance,CA90505 		95-4145762 501(c)(3) 67,000 0 N/A N/A Social Health related
(224) SECOND HARVEST FOOD BANK800 Ohlone Parkway
Watsonville,CA95076 		94-1422471 501(c)(3) 35,000 0 N/A N/A Preventative Care
(225) SECOND HARVEST FOOD BANK OF san Mateo counties1051 Bing St
200
San Carlos,CA94070 		94-2614101 501(c)(3) 10,000 0 N/A N/A Social Health
(226) SELF HELP For Seniors407 Sansome St
San Francisco,CA94111 		94-1750717 501(c)(3) 59,220 0 N/A N/A Social Health
(227) Serotonin Surge Charity1955 Cowell Blvd
Davis,CA95618 		68-0411254 501(c)(3) 30,826 0 N/A N/A Preventative Care
(228) SERVANTS OF MARY MINISTERS TO the sick140 North G St
Oxnard,CA93030 		95-6054374 501(c)(3) 13,161 0 N/A N/A Service for the Poor
(229) Seton Catholic High School1150 N Dobson Road
Chandler,AZ85224 		86-0612015 501(c)(3) 5,700 0 N/A N/A Educational support
(230) SEXUAL ASSAULT & DOMESTIC VIOLENCE CTR933 Court St
Woodland,CA95695 		94-3027535 501(c)(3) 8,321 0 N/A N/A Social Health
(231) SHANTI PROJECT730 Polk St 3rd flr
San Francisco,CA94109 		94-2297147 501(c)(3) 10,000 0 N/A N/A Quality of Life
(232) Shasta Community Health CTR1035 Placer St
Redding,CA96001 		68-0165855 501(c)(3) 60,000 0 N/A N/A Social Health
(233) SHASTA COUNTY CHEMICAL PEOPLEPO Box 493777
Redding,CA96049 		68-0027888 501(c)(3) 15,000 0 N/A N/A Preventative Care
(234) SHASTA COUNTY CHILD ABUSE2280 Benton Dr Bdg C Ste B
Redding,CA96001 		68-0151867 501(c)(3) 16,000 0 N/A N/A Preventative Care
(235) Shasta County Dept of Public Health1855 Placer St Ste 201
Redding,CA96001 		94-6000535 GOVT 30,000 0 N/A N/A Social Health Children
(236) SHASTA FAMILY YMCA1155 N Court St
Redding,CA96001 		94-1212141 501(c)(3) 21,572 0 N/A N/A Preventative Care
(237) Shasta Senior Nutrition Program100 Mercy Oaks Drive
Redding,CA96003 		94-2650429 501(c)(3) 51,383 0 N/A N/A Community Support
(238) SHASTA WOMEN'S REFUGEPO Box 994211
Redding,CA96099 		94-2663045 501(c)(3) 15,000 0 N/A N/A Social Health
(239) SIERRA FAMILY MEDICAL CLINIC15301 Tyler Foote Rd
Nevada City,CA95959 		68-0320801 501(c)(3) 20,000 0 N/A N/A Social Health
(240) SIERRA FOREVER FAMILIES8928 Volunteer Ln Ste 100
Sacramento,CA95826 		68-0002878 501(c)(3) 16,547 0 N/A N/A Social Health
(241) SAN FRANCISCO PLANNING & URBAN RESEARCH ASSN SPUR312 Sutter St
San Francisco,CA94108 		94-1498232 501(c)(3) 49,000 0 N/A N/A Quality of Life
(242) Sisters of St Joseph3009 Grand Rte St John 6
New Orleans,LA70119 		04-3588640 501(c)(3) 35,000 0 N/A N/A Quality of Life
(243) San Luis Obispo NOOR FOUNDATION1428 Phillips Ln Ste B-4
San Luis Obispo,CA93401 		27-1412176 501(c)(3) 5,478 0 N/A N/A Service for the Poor
(244) SOCIETY FOR THE BLIND1238 S St
Sacramento,CA95811 		94-1384666 501(c)(3) 20,000 0 N/A N/A Social Health
(245) Southern Nevada Health District400 Shadow Ln Ste 101
Las Vegas,NV89106 		88-0161673 Govt 6,225 0 N/A N/A Community Support
(246) SPECIAL OLYMPICS SOUTHERN CALIFORNIA INC615 S MCCLELLAND
SANTA MARIA,CA93454 		95-4538450 501(c)(3) 5,650 0 N/A N/A QUALITY OF LIFE
(247) Spelman College350 Spelman LN SW Box 616
Atlanta,GA30314 		58-0566243 501(c)(3) 200,000 0 N/A N/A Educational Support
(248) ST ELIZABETH'S HEALTH CTR140 W Speedway Ste 100
Tucson,AZ85705 		86-0100880 501(c)(3) 50,000 0 N/A N/A Social Health
(249) ST PAUL OF THE SHIPWRECK1122 Jamestown Ave
San Francisco,CA94124 		91-1156797 501(c)(3) 20,000 0 N/A N/A Preventative Care
(250) St Rose Hospital Health Foundation2865 Siena Heights Dr Ste 300
Henderson,NV89052 		88-0455713 501(c)(3) 1,992,125 0 N/A N/A Foundation Support
(251) St Bernardine Medical CTR Foundation2101 N Waterman Ave
San Bernardino,CA92404 		23-7440086 501(c)(3) 1,057,326 0 N/A N/A Foundation Support
(252) St John's Healthcare Foundation1600 N Rose Ave
Oxnard,CA93010 		20-2865781 501(c)(3) 1,017,171 0 N/A N/A Foundation Support
(253) St Joseph's Foundation of San Joaquin1800 N California St
Stockton,CA95204 		51-0432777 501(c)(3) 1,031,226 0 N/A N/A Foundation Support
(254) St Joseph's Foundation350 W Thomas Rd
Phoenix,AZ85013 		94-2941245 501(c)(3) 1,367,986 0 N/A N/A Foundation Support
(255) St Mary Medical Ctr Foundation1050 Linden Ave
Long Beach,CA90813 		23-7153876 501(c)(3) 2,628,902 0 N/A N/A Foundation Support
(256) St Mary's Interfaith545 W Sonora
Stockton,CA95203 		94-2687280 501(c)(3) 0 6,000 FMV CLOTHING PROVISION FOR CLOTHING
(257) St Mary's Medical CTR Foundation450 Stanyan St
San Francisco,CA94117 		94-3336143 501(c)(3) 916,358 0 N/A N/A Foundation Support
(258) Stockton Crime FightersPO BOX 729
Stockton,CA95201 		94-2762087 501(c)(3) 20,000 0 N/A N/A Social Health
(259) Stockton Symphony Assoc1024 W Robinhood Dr 1
Stockton,CA95207 		94-1462758 501(c)(3) 8,600 0 N/A N/A Quality of Life
(260) Students Supporting Brain Tumor Research8390 E Via de Ventura Ste F-110
Scottsdale,AZ85258 		20-0345903 501(c)(3) 10,000 0 N/A N/A Social Health
(261) Susan G Komen for the Cure2040 W Bethany Home Rd Ste 120
Phoenix,AZ85015 		75-2845061 501(c)(3) 20,000 0 N/A N/A Quality of Life
(262) Special Olympics Northern California Inc3480 Buskirk Ave Ste 340
Pleasant Hill,CA94523 		68-0363121 501(c)(3) 22,000 0 N/A N/A Quality of Life
(263) SUSTAINABLE ECONOMIC ENTERPRISe6605 Hollywood Blvd 220
Los Angeles,CA90028 		95-4597000 501(c)(3) 20,000 0 N/A N/A Preventative Care
(264) TARZANA TREATMENT CTRS18646 Oxnard St
Tarzana,CA91356 		94-2219349 501(c)(3) 50,000 0 N/A N/A Social Health
(265) Teach for America Benefit22 Fourth St 7th fl
San Francisco,CA94103 		13-3541913 501(c)(3) 10,900 0 N/A N/A Educational Support
(266) The Necessary Economic Emergency Distribution ServPO BOX 933
Taft,CA93268 		65-1305502 501(c)(3) 20,992 0 N/A N/A Social Health
(267) THE RESOURCES CONNECTIONPO Box 919
San Andreas,CA95249 		94-2705790 501(c)(3) 11,500 0 N/A N/A Social Health
(268) The SALVATION ARMY400 Landau Blvd
Cathedral City,CA92234 		94-1156347 501(c)(3) 42,150 0 N/A N/A Social Health
(269) THE SHADE TREE INCPO Box 669
Las Vegas,NV89125 		88-0253276 501(c)(3) 25,000 0 N/A N/A Service for the Poor
(270) TRUE NORTHPO Box 242
Shingletown,CA96088 		68-0480331 501(c)(3) 24,996 0 N/A N/A Preventative Care
(271) UNION STATION HOMELESS SRV825 E Orange Grove Blvd
Pasadena,CA91104 		95-3958741 501(c)(3) 10,000 0 N/A N/A Service for the Poor
(272) UNIVERSITY CORPORATION7116 Sophia Ave
Van Nuys,CA91406 		95-1992732 501(c)(3) 20,000 0 N/A N/A Social Health
(273) ROSEMAN UNIVERSITY OF HEALTH SCIENCES11 Sunset Way
Henderson,NV89014 		88-0435559 501(c)(3) 38,500 2,860 FMV Educational supplies Scholarship Support
(274) UNLV Foundation Rebel Athletic Fund4505 Maryland Pkwy
Las Vegas,NV89154 		94-2790134 501(c)(3) 12,300 0 N/A N/A Educational Support
(275) VALLEY FAMILY CTR302 S Brand Blvd
San Fernando,CA91340 		95-4105054 501(c)(3) 15,760 0 N/A N/A Social Health
(276) VOLUNTEERS IN MEDICINE OF SOUTHERN NEVADA7437 S Eastern Ave 440
Las Vegas,NV89123 		39-2072453 501(c)(3) 50,000 0 N/A N/A Social Health
(277) VOLUNTEERS IN VICTIM'S ASSISTANCE2020 Hurley Way STE 265
Sacramento,CA95825 		68-0000542 501(c)(3) 35,000 0 N/A N/A Social Health
(278) WAKING THE VILLAGEPO Box 160085
Sacramento,CA95816 		68-0430603 501(c)(3) 50,000 0 N/A N/A Social Health
(279) WEAVE INC1900 K St
Sacramento,CA95811 		94-2493158 501(c)(3) 50,000 0 N/A N/A Social Health
(280) WELLCARE FOUNDATION55 E Lexington Ave
Phoenix,AZ85012 		86-0948883 501(c)(3) 52,000 0 N/A N/A Preventative Care
(281) WELLS HOUSE HOSPICE FOUNDATION245 Cherry Ave
Long Beach,CA90802 		31-1659365 501(c)(3) 15,000 0 N/A N/A Quality of Life
(282) Westcare Nevada IncPO Box 94738
690
Las Vegas,NV89123 		94-2778981 501(c)(3) 41,632 0 N/A N/A Community Support
(283) Woodland Memorial Hospital Foundation1321 Cottonwood St
Woodland,CA95695 		94-6167964 501(c)(3) 292,244 0 N/A N/A Foundation Support related
(284) Woodland United Way1017 Main St
Woodland,CA95695 		94-1651096 501(c)(3) 10,150 0 N/A N/A Quality of Life
(285) YOLO COMMUNITY CARE CONTINUUM168 College St
Woodland,CA95695 		94-2623205 501(c)(3) 10,000 0 N/A N/A Social Health related
(286) Yolo Family Resource CTR828 Court St
Woodland,CA95695 		47-0871252 501(c)(3) 22,212 0 N/A N/A Quality of Life
(287) YOLO FAMILIY SERVICE AGENCY455 1ST ST
WOODLAND,CA95695 		94-1452884 501(C)(3) 10,000 0 N/A N/A Social Health
(288) 2009 Senior Games Local Organizing Committee81 Encina Ave
PALO ALTO,CA94301 		20-2219189 501(C)(3) 75,000 0 N/A N/A Quality OF Life
(289) University of Michigan1135 Catherine
Ann Arbor,MI481092038 		38-6006309 501(c)(3) 20,022 0 N/A N/A Scholarship Support
(290) UNIVERSITY OF SOUTHERN CALIFORNIA2003 ZONAL AVE
LOS ANGELES,CA900899130 		95-1642394 501(C)(3) 36,000 0 N/A N/A SCHOLARSHIP SUPPORT
(291) MIDWESTERN UNIVERSITY555 31ST ST
DOWNERS GROVE,IL60515 		36-3377698 501(C)(3) 10,304 0 N/A N/A SCHOLARSHIP SUPPORT
(292) Western University of Health Sciences309 E 2ND ST
POMORA,CA91766 		95-3127273 501(C)(3) 90,765 0 N/A N/A SCHOLARSHIP SUPPORT
(293) San Jose State UniversityONE WASHINGTON SQUARE
SAN JOSE,CA95192 		77-0414438 GOVT 29,312 0 N/A N/A SCHOLARSHIP SUPPORT
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
288
3
Enter total number of other organizations ................................ . Bullet Image
6
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) CASH FOR CANCER PATIENTS TO PAY BILLS 150 77,783 0 N/A N/A
(2) SPONSORSHIP OF MEDICAL CONFERENCE 1 10,000 0 N/A N/A
(3) DIRECT CASH ASSISTANCE 1361 83,784 0 N/A N/A
(4) HOME HEALTH SERVICES 48 0 22,189 FMV MEDICAL SUPPlies
(5) IN-KIND DONATIONS TO LESS FORTUNATE 833 0 10,587 COST CLOTHING/GIFTS
(6) SCHOLARSHIPS 6 5,000 0 N/A N/A
(7) SHELTER MEALS 52949 0 149,733 COST MEALS
(8) PHARMACY CHARITY PRESCRIPTIONS 695 0 188,172 COST PHARMACEUTICALS

Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Part I, line 1   INCLUDED IN PART II ABOVE IS $4,067,289 RELATED TO The CHW Community Grants program. THIS PROGRAM IS one way in which CHW supports and enhances the advocacy, social justice and healthier communities efforts of its hospitals and religious sponsors. Begun in 1990, the program's initial objectives were: (1) to strengthen the bonds among our member hospitals; and (2) to partner with other nonprofit organizations that share our values and also work to improve the health status and quality of life of the communities we serve. Each of the grant recipients are required to submit an annual accountability report to CHW. The reports reflect activities performed, objectives and outcomes reached by the grant recipientS. All organizations that apply for these grants are required to be a Sec. 501 (c)(3) organization. OTHER GRANTS ARE PROVIDED BY CHW (AND ITS MEMBER HOSPITALS) TO NOT-FOR-PROFIT ORGANIZATIONS THAT FURTHER CHW'S EXEMPT PURPOSE. gRANTS ARE ALSO PROVIDED TO THE FUNDRAISING FOUNDATIONS THAT SUPPORT CHW AND ITS MEMBER HOSPITALS TO FUND THE OPERATIONS OF THOSE FOUNDATIONS. Grants are provided to individuals, primarily patients, due to financial need or urgent, unforeseen occurrences requiring immediate action. Examples of assistance include transportation costs to a hospital for treatment, pharmacy costs for indigent patients, and sheltered meals. The grants are approved by the hospital's Administration department or a designated committee reviews and approves grants to be awarded.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Lloyd H Dean (i)
(ii)		 1,322,045
0 		2,050,325
0 		534,976
0 		1,154,351
0 		75,186
0 		5,136,883
0 		509,948
0
(2) Michael D Blaszyk (i)
(ii)		 848,704
0 		1,349,501
0 		221,385
0 		471,958
0 		53,579
0 		2,945,127
0 		201,590
0
(3) Derek F Covert (i)
(ii)		 526,077
0 		553,216
0 		14,549
0 		64,451
0 		42,343
0 		1,200,636
0 		0
0
(4) William J Hunt (i)
(ii)		 857,772
0 		899,501
0 		199,419
0 		106,168
0 		52,461
0 		2,115,321
0 		0
0
(5) Diane Lee (i)
(ii)		 233,116
0 		98,588
0 		4,659
0 		26,231
0 		23,274
0 		385,868
0 		0
0
(6) Marvin O'Quinn (i)
(ii)		 853,766
0 		899,501
0 		302,200
0 		283,675
0 		47,942
0 		2,387,084
0 		0
0
(7) Elizabeth Shih (i)
(ii)		 593,641
0 		604,950
0 		185,829
0 		326,563
0 		46,554
0 		1,757,537
0 		174,625
0
(8) Keith Callahan (i)
(ii)		 334,184
0 		200,460
0 		10,067
0 		37,727
0 		28,321
0 		610,759
0 		0
0
(9) Gary F Conner (i)
(ii)		 530,852
0 		318,476
0 		19,234
0 		48,277
0 		32,285
0 		949,124
0 		0
0
(10) Mary Connick (i)
(ii)		 349,426
0 		208,061
0 		9,500
0 		38,905
0 		25,384
0 		631,276
0 		0
0
(11) Charles P Francis (i)
(ii)		 559,028
0 		697,363
0 		54,110
0 		212,334
0 		44,983
0 		1,567,818
0 		42,758
0
(12) Linda Hunt (i)
(ii)		 549,884
0 		274,709
0 		18,918
0 		53,818
0 		35,451
0 		932,780
0 		0
0
(13) Jeffrey W Land (i)
(ii)		 292,716
0 		172,971
0 		25,714
0 		33,583
0 		37,000
0 		561,984
0 		23,028
0
(14) Bernita McTernan (i)
(ii)		 438,364
0 		573,559
0 		33,927
0 		64,837
0 		45,691
0 		1,156,378
0 		0
0
(15) Timothy Moran (i)
(ii)		 393,852
0 		201,792
0 		13,184
0 		40,706
0 		39,131
0 		688,665
0 		0
0
(16) Karl Silberstein (i)
(ii)		 412,362
0 		242,230
0 		14,011
0 		44,108
0 		36,270
0 		748,981
0 		0
0
(17) LeAnne Trachok (i)
(ii)		 311,553
0 		191,396
0 		1,710
0 		35,899
0 		18,805
0 		559,363
0 		0
0
(18) Ernest H Urquhart (i)
(ii)		 545,474
0 		875,296
0 		341,531
0 		70,428
0 		25,766
0 		1,858,495
0 		240,635
0
(19) Herbert Vallier (i)
(ii)		 120,072
0 		350,297
0 		37,390
0 		69,528
0 		4,405
0 		581,692
0 		0
0
(20) Robert Wiebe MD (i)
(ii)		 577,145
0 		603,375
0 		7,400
0 		193,236
0 		26,706
0 		1,407,862
0 		0
0
(21) Benjamin R Williams (i)
(ii)		 467,684
0 		493,927
0 		3,962
0 		61,612
0 		34,126
0 		1,061,311
0 		0
0
(22) John M Wray (i)
(ii)		 449,236
0 		466,750
0 		5,976
0 		59,255
0 		37,964
0 		1,019,181
0 		0
0
(23) Lisa Zuckerman (i)
(ii)		 309,802
0 		189,826
0 		3,043
0 		36,139
0 		32,925
0 		571,735
0 		0
0
(24) Lishan Aklog MD (i)
(ii)		 575,166
0 		232,303
0 		59,200
0 		52,839
0 		24,408
0 		943,916
0 		0
0
(25) David Cleveland MD (i)
(ii)		 605,987
0 		122,304
0 		79,658
0 		41,010
0 		20,471
0 		869,430
0 		0
0
(26) Thomas Hennessy (i)
(ii)		 311,577
0 		252,401
0 		225,709
0 		36,437
0 		38,353
0 		864,477
0 		0
0
(27) Scott R Petersen MD (i)
(ii)		 589,404
0 		118,910
0 		83,191
0 		47,220
0 		27,206
0 		865,931
0 		0
0
(28) Dana G Seltzer MD (i)
(ii)		 279,918
0 		495,232
0 		61,015
0 		51,372
0 		21,661
0 		909,198
0 		0
0
(29) Saliba Salo (i)
(ii)		 330,512
0 		51,202
0 		15,401
0 		29,202
0 		13,247
0 		439,564
0 		0
0
(30) Mike Uboldi (i)
(ii)		 417,052
0 		173,055
0 		13,136
0 		40,621
0 		30,765
0 		674,629
0 		0
0
(31) William Fuchs (i)
(ii)		 0
0 		0
0 		569,524
0 		0
0 		0
0 		569,524
0 		569,524
0
(32) Jeff Winter (i)
(ii)		 0
0 		0
0 		673,378
0 		0
0 		0
0 		673,378
0 		673,378
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Sch J, PART I, LINES 1A, 4A, & 4B   Part I, 1a First Class travel, upgrades to such, or the equivalent at the total cost of $5,604 were provided on nine occasions to three officers and two key employees of the organization. No amounts have been included as reportable income as these travel expenses were incurred for business purposes. There was no charter travel in 2010. Part I, 1a Tax gross-up payments were provided to one key employee and one of the five highest paid employees related to relocation expenses. Tax gross-up payments were also provided to two officers of the organization related to forgiveness of relocation loans based on service requirements met. These gross up payments were included as income to these employees. Part I, 1a Club dues have been paid by CHW for business use only by one key employee and one former key employee whose current position does not meet the criteria of key employee. No amounts have been included as reportable income as expenses related to personal usage, if any, are paid by these employees. No amount has been paid for club dues for officers. CHW does not pay or reimburse for any health club memberships. Part I, 4a CHW's key employees and officers and certain highly compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 6 months to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Payments pursuant to the plan arrangement for two former key employees occurred during 2010 related to eliminated positions; W. Fuchs $565,608 and J. Winter $673,378. These amounts were reported as deferred compensation in 2009. Part I, 4b Certain officers and key employees participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW Retirement Plan whose benefits are affected by the limitations imposed by sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. Payments pursuant to the plan for two key employees occurred during 2010; E. Urquhart, $94,201 and W. Fuchs, $3,916. Part I, 4b CHW's key employees and certain officers and highly compensated employees are eligible to participate in one of two non-qualified 457(f) plans that are subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is for executives hired prior to June 30, 2006. The benefit is intended to bridge the difference, if any, between the benefit provided under the CHW Excess Benefit Plan had benefit service not been frozen at January 1, 2008, and the benefits provided from all other qualified and non-qualified plans. No benefit under this formula will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. The 2010 Executive Deferred Compensation Plan is for three officers and key employees who are not eligible to participate in the CHW Excess Benefit Plan or the 2007 Executive Deferred Compensation Plan described above. This benefit provides an annual accrual of 10% of total compensation and is payable annually on July 1 once vested, which is age 62 with 5 years of service. One payment of $23,028 to J. Land was made under the 2007 Executive Deferred Compensation Plan during 2010. Part I, 4b Certain listed persons participate in the CHW Key Employee Share Option Plan (KeySOP), which was frozen in May 2002. The KeySOP program was established in 2001 with the purpose of providing income deferral opportunities to employees eligible for the company's key employee retention program. No payments were made under this plan during 2010. Part I, 4b Certain officers and key employees participate in the CHW Supplemental Executive Retention/Retirement Plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the CHW Board of Directors and would be paid only if the executives stayed with the organization for a specified number of years as the primary purpose of this plan is to provide for the retention and retirement of the participants. The executive management team was recruited from stable careers in organizations from across the country and from various industries to engineer and lead a financial and operational turnaround after the organization had lost nearly $1 billion in net operating performance. The calculation for the payments to each executive is based on the value of a final average pay annuity benefit based on retirement age and service years to the organization. Distribution occurs each July 1 if the plan formula warrants a payment. Vested amounts are reported as deferred compensation in the year vesting occurs (Schedule J, Part II, column C) and are reflected again as reportable compensation in the year paid (Schedule J, Part II, column B(iii)). Payments made during 2010 pursuant to this plan include $509,948 to L. Dean, $201,590 to M. Blaszyk, $42,758 to C. Francis, $174,625 to E. Shih and $146,434 to E. Urquhart.
Sch J - PART II   CHW's executive compensation philosophy is designed to assist CHW in attracting and retaining the caliber of executives required to enable CHW to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities CHW serves, promoting patient and employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Human Resources and Compensation Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and CHW's commitment to serving the poor and disenfranchised in the communities it serves. Total compensation, which includes base salary, annual and long-term incentive compensation, targets the 75th percentile of the market in which CHW competes for executives, commensurate with the size and complexity of the organization.
SCHEDULE J-2, SUPPLEMENTAL INFORMATION   CHW does not compensate director Ken Mills for his services as a board member, but rather for administrative and medical director services provided at a CHW facility.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number
94-1196203
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FRT9 04-28-2004 470,300,483 Bond A: CUSIP 13033FRT9-SEE PRT V X     X   X
B THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816GY4 04-28-2004 259,114,410 Bond B: CUSIP 566816GY4-SEE PRT V   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 Bond C: CUSIP 425203BM7-SEE PRT V   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 Bond D: CUSIP 13033FTN0-SEE PRT V   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 0 0 0 0
2 Amount of bonds defeased . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . 472,398,949 267,914,848 171,860,312 136,994,286
4 Gross proceeds in reserve funds . . 12,910,625 8,557,000 4,165,552 0
5 Capitalized interest from proceeds. 0 0 5,184,771 0
6 Proceeds in refunding escrow. . . . . 428,246,051 74,718,546 48,745,447 0
7 Issuance costs from proceeds . . . 4,074,726 2,542,136 1,638,159 0
8 Credit enhancement from proceeds. 25,069,705 0 0 0
9 Working capital expenditures from proceeds . . 2,097,841 6,947,096 2,787,394 0
10 Capital expenditures from proceeds . . 0 158,912,634 109,338,989 136,994,286
11 Other spent proceeds . . 0 0 0 0
12 Other unspent proceeds. . . 0 16,237,436 0 0
13 Year of substantial completion . . . 2004 2006 2007 2007
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? X   X       X  
15 Were the bonds issued as part of an advance refunding issue? X     X X     X
16 Has the final allocation of proceeds been made? . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X   X   X   X  
b Are there any research agreements that may result in private business use of bond-financed property? . . X   X   X   X  
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X   X   X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0.015 % 0.061 % 0.081 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 % 0 % 1.267 %
6 Total of lines 4 and 5 . . .. . . . . . 0 % 0.015 % 0.061 % 1.348 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue? X   X   X   X  
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue? X   X   X     X
b Name of provider . CITIGROUP &JP MORGAN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . 21.2 5. 5.  
d Was the hedge superintegrated? .   X   X   X    
e Was a hedge terminated? . X   X   X      
4a Were gross proceeds invested in a GIC? . X   X   X     X
b Name of provider . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		 
 
c Term of GIC . . 22.2 22.2 23.2  
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . X   X   X      
5 Were any gross proceeds invested beyond an available temporary period? . X   X   X   X  
6 Did the bond issue qualify for an exception to rebate? . . .   X   X   X   X
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Sch K, Part V - Supplemental Information   When an arbitrage liability is determined to be applicable, Form 8038-T has been filed. Otherwise, no form is necessary. There are no outstanding arbitrage obligations as of June 30, 2011 as all previously reported amounts have been paid. BOND A: CUSIP 13033FRT9 Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. Part I, Column (f) Refund prior bond issues - California Health Facilities Financing Authority ("CHFFA") 1988 AB; CHFFA 1992 A; CHFFA (ST. JOSEPH'S) 1993 A; California Statewide Communities Development Authorities ("CSCDA") 1993 A Certificates of Participation ("COPs"); CHFFA 1994 AB; CHFFA 1996 B; CHFFA 1996 CD; CHFFA 1996 F; CHFFA 1997 ABC; CHFFA 1998 A. Part I, Column (g) CHFFA 2005 Series A-G, of which CHFFA 2005 Series A-F were exchanged for CHFFA 2008 Series FHIJKL. In October 2005, a defeasance escrow was established with proceeds of a taxable borrowing for the CHFFA 2004 Series H in the amount of $4.1 million. The first call date is July 1, 2011. Part IV, Line 3a Although at the time of sale of the above series of bonds, hedges were properly identified with respect to each such series, such hedges were deemed terminated April 25, 2008 (NV 2005 Series A bonds were retired with a draw on a taxable line of credit), May 16, 2008 (CHFFA 2004 Series B bonds and CHFFA 2005 Series ABCEF bonds were exchanged without a reissuance with fixed rate bonds) and November 12, 2009 (upon refinancing of the CHFFA 2005 Series D which were later exchanged for CHFFA 2008 Series F and AHFA 2005 Series A which were exchanged for AHFA 2008 Series D) as a result of either the refinancing of one or more of these series or the exchange (without a reissuance) and conversion of one or more of these series into long-term fixed -rate bonds. Part IV, Line 3e Although none of the interest rate swaps (each a "swap" and collectively the "swaps") entered into with respect to certain of the bond issues set forth in schedule k was actually terminated either by Catholic Healthcare West, which was the party to the swap), or by the counterparty to the particular swap, each swap was deemed terminated pursuant to section 1.148-4(h)(3)(iv)(a) of the treasury regulations at the time such swap ceased to be a "qualified hedge" with respect to the bonds with which it was associated. Part IV, Line 4a Although the debt service reserve funds for the above series were invested in GICs with Lehman Brothers as provider, the GICs with Lehman Brothers were subsequently terminated. As a result, the debt service reserve funds are no longer invested in GICs. BOND B: CUSIP 566816GY4 Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. Part I, Column (f) Refunding of prior bond issues - AZ 1993 A; AZ 1994 A; and new money to finance capital expenditures for construction of Mercy Gilbert and add a new tower at St. Joseph's Hospital and Medical Center. Part II, Line 13 The Industrial Development Authority of Maricopa County (IDAMC) 2004 SERIES AB construction fund proceeds were spent by 2006 on projects that were substantially completed by that date. In March 2009, the IDAMC 2004 Series B bonds were refinanced with a draw on a taxable line of credit, and in May 2009, a portion of the draw on the line was refinanced with tax-exempt debt. In March 2009, approximately $17 million was released from debt service reserve funds, a portion of which is allocable to the un-refinanced portion of the taxable line of credit and a portion of which is allocable to the May 2009 tax-exempt bonds. Such funds are currently unspent, and will be used either for capital projects or to redeem or defease May 2009 bonds. Part III, Line 3a Although there are management or service contracts that may generate private use, we have policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3b Although there are research agreements which may result in private use, we have policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Part IV, Line 3a Although at the time of sale of the above series of bonds, hedges were properly identified with respect to each such series, such hedges were deemed terminated April 25, 2008 (NV 2005 Series A bonds were retired with a draw on a taxable line of credit), May 16, 2008 (CHFFA 2004 Series B bonds and CHFFA 2005 Series ABCEF bonds were exchanged without a reissuance with fixed rate bonds) and November 12, 2009 (upon refinancing of the CHFFA 2005 Series D which were later exchanged for CHFFA 2008 Series F and AHFA 2005 Series A which were exchanged for AHFA 2008 Series D) as a result of either the refinancing of one or more of these series or the exchange (without a reissuance) and conversion of one or more of these series into long-term fixed -rate bonds. Part IV, Line 3e Although none of the interest rate swaps (each a "swap" and collectively the "swaps") entered into with respect to certain of the bond issues set forth in schedule k was actually terminated either by Catholic Healthcare West, which was the party to the swap), or by the counterparty to the particular swap, each swap was deemed terminated pursuant to section 1.148-4(h)(3)(iv)(a) of the treasury regulations at the time such swap ceased to be a "qualified hedge" with respect to the bonds with which it was associated. Part IV, Line 4a Although the debt service reserve funds for the above series were invested in GICs with Lehman Brothers as provider, the GICs with Lehman Brothers were subsequently terminated. As a result, the debt service reserve funds are no longer invested in GICs. BOND C: CUSIP 425203BM7 Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. Part I, Column (f) Refunding of prior bond issues NV 1994 a NV 1998 a and new money to finance capital expenditures for the construction of a new hospital, St. Rose Dominican Hospital - San Martin Campus. Part III, Line 3a Although there are management or service contracts that may generate private use, we have policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3b Although there are research agreements which may result in private use, we have policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. Part IV, Line 3a Although at the time of sale of the above series of bonds, hedges were properly identified with respect to each such series, such hedges were deemed terminated April 25, 2008 (NV 2005 Series A bonds were retired with a draw on a taxable line of credit), May 16, 2008 (CHFFA 2004 Series B bonds and CHFFA 2005 Series ABCEF bonds were exchanged without a reissuance with fixed rate bonds) and November 12, 2009 (upon refinancing of the CHFFA 2005 Series D which were later exchanged for CHFFA 2008 Series F and AHFA 2005 Series A which were exchanged for AHFA 2008 Series D) as a result of either the refinancing of one or more of these series or the exchange (without a reissuance) and conversion of one or more of these series into long-term fixed -rate bonds. Part IV, Line 3e Although none of the interest rate swaps (each a "swap" and collectively the "swaps") entered into with respect to certain of the bond issues set forth in schedule k was actually terminated either by Catholic Healthcare West, which was the party to the swap), or by the counterparty to the particular swap, each swap was deemed terminated pursuant to section 1.148-4(h)(3)(iv)(a) of the treasury regulations at the time such swap ceased to be a "qualified hedge" with respect to the bonds with which it was associated. Part IV, Line 4a Although the debt service reserve funds for the above series were invested in GICs with Lehman Brothers as provider, the GICs with Lehman Brothers were subsequently terminated. As a result, the debt service reserve funds are no longer invested in GICs. BOND D: CUSIP 13033FTN0 Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. The separate entities received $14 million of the $150 million of the CHFFA 2004 Series J and K pool bonds. Part I, Column (f) New money to fund various projects and medical equipment at numerous hospitals in California. Part III, Line 3a Although there are management or service contracts that may generate private use, we have policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3b Although there are research agreements which may result in private use, we have policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND E: CUSIP 13033FG46 Part I, Co
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) Bill Hunt
relocation loan 		  X 300,000 100,000   No   No Yes  
(2) Marvin O'Quinn
relocation loan 		  X 500,000 166,667   No   No Yes  
(3) Herb Vallier
relocation loan 		  X 600,000 600,000   No   No Yes  
Total ...............Small Bullet $ 866,667
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Wade Dean Family member of L Dean 60,230 Employment   No
(2) Kristin Anderson Family member-J Anderson 87,961 Employment   No
(3) SonoSite Inc R Hochman, BOD 421,606 Equipment and services   No
(4) Marianne Hyer Family member of J Hyer 97,067 Employment   No
(5) Mercy Doctors Medical Group K Mills, ownership int>5% 182,117 Lease payments   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art .... X 2 1,201 COMPARABLE SALE
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications .. X 13,066 COMPARABLE SALE
5 Clothing and household
goods ....... 		X 3,521 RESALE VALUE
6 Cars and other vehicles .. X 3 5,625 COST
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles ..... X 5 5,637 COMPARABLE SALE
19 Food inventory ... X 1 3,000 COMPARABLE SALE
20 Drugs and medical supplies . X 10 42,940 COMPARABLE SALE
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( LAND & BLDG IMPROVEMENTS ) X 9 1,657,390 COMPARABLE SALE
26 Other Right pointing arrow large image ( Medical Equipment ) X 8 173,687 COMPARABLE SALE
27 Other Right pointing arrow large image ( TOYS ) X 20 40,117 COMPARABLE SALE
28 Other Right pointing arrow large image ( OFFICE EQUIPMENT ) X 4 6,942 COMPARABLE SALE
Other Right pointing arrow large image ( SPORTING GOODS ) X 2 4,500 COMPARABLE SALE
Other Right pointing arrow large image ( WIGS ) X 1 2,586 COMPARABLE SALE
Other Right pointing arrow large image ( ENTERTAINMENT ) X 10 1,968 COMPARABLE SALE
Other Right pointing arrow large image ( ELECTRONICS ) X 2 1,433 COMPARABLE SALE
Other Right pointing arrow large image ( DENTAL SUPPLIES ) X 1 192 COMPARABLE SALE
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCH M, PART I, COLUMN B   THE ORGANIZATION IS REPORTING A COMBINATION OF EITHER THE NUMBER OF CONTRIBUTIONS OR THE NUMBER OF ITEMS RECEIVED.
Sch M, Part 1, Line 32b   CATHOLIC HEALHTCARE WEST IS SUPPORTED BY 32 FUNDRAISING FOUNDATIONS. AS SUPPORTING ORGANIZATIONs, THE FOUNDATIONS SOLICIT AND PROCESS NON-CASH CONTRIBUTIONS ON BEHALF OF CHW'S HOSPITALS.
Schedule M (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Identifier Return Reference Explanation
FORM 990, PART V, IRS FILINGS AND PART VI, GOVERNANCE AND MANAGEMENT DISCLOSURES FORM 990, PART V This Schedule O of Catholic Healthcare West's (CHW's) 2010 Form 990 includes an overview of CHW, required governance disclosures, and additional disclosures as required. The CHW Board of Directors has delegated the review of this Form 990 to the Audit and Compliance Committee. The Audit and Compliance Committee met with various personnel involved in the preparation of the return, including, but not limited to, the EVP/Chief Financial Officer, SVP/General Counsel, and VP/Compliance and Internal Audit. Compensation schedules and disclosures were presented to the Human Resources and Compensation Committee of the CHW Board of Directors by Executive Management. FORM 990, PART VI, SECTION A, LINE 2 Officer D. Covert has a family relationship with key employee M. Connick. FORM 990, PART VI, SECTION A, LINE 6 CHW's co-sponsors have specific governance rights and responsibilities, including the appointment of CHW's corporate members. CHW has six (6) classes of Corporate Members, each of which shall have and exercise specific reserved rights with respect to certain matters, as follows: (a) A Corporate Members. The A Corporate Members shall be two (2) members of the Sisters of Mercy of the Americas West Midwest Community, one each to be an individual associated with the Auburn and Burlingame Regional Communities prior to their assimilation into the West Midwest Community, as appointed by the President of the West Midwest Community or a governance body of the West Midwest Community delegated such authority by the Community Leadership Team. (b) B Corporate Member. The B Corporate Member shall be the Prioress of the Adrian Dominican Sisters or her designee, who shall be a member of the Adrian Dominican Sisters. (c) C Corporate Member. The C Corporate Member shall be the duly elected Prioress General of the Dominican Sisters of San Rafael or her designee who shall be a member of the Dominican Sisters of San Rafael. (d) D Corporate Member. The D Corporate Member shall be the duly elected General Superior of the Incarnate Word Sisters or her designee who shall be a member of the Incarnate Word Sisters. (e) E Corporate Member. The E Corporate Member shall be the duly elected Prioress of the Kenosha Dominicans or her designee who shall be a member of the Kenosha Dominicans. (f) F Corporate Member. The F Corporate Member shall be the duly elected Provincial Minister of the Redwood City Franciscans or her designee who shall be a member of the Redwood City Franciscans. FORM 990, PART VI, SECTION A, LINE 7a CHW is co-sponsored by six congregations that have specific governance rights and responsibilities, including the appointment of CHW's corporate members. FORM 990, PART VI, SECTION A, LINE 7b Reserved rights of the co-sponsors include THE adoption of, OR MATERIAL CHANGE IN, THE mission and philosophy statements OF CHW AND ITS SUBORDINATES, amendment or restatement of articles of incorporation and bylaws, SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS OF CHW, APPOINTMENT OR TERMINATION OF THE CHIEF EXECUTIVE OFFICER, CHANGE OF NAME OF CHW, ENTERING INTO OR MATERIALLY CHANGING ANY RELATIONSHIP WITH ANY ACUTE CARE HOSPITAL OR ADDING A NEW SPONSOR, AND ACQUISITION OR CONSTRUCTION OF A NEW ACUTE CARE FACILITY THAT WILL CONSTITUTE PROPERTY SUBJECT TO THE NORM OF CHURCH LAW, dissolution of the corporation, AND merger or consolidation with another corporation WITH CHW AS THE DISAPPEARING CORPORATION. FORM 990, PART VI, SECTION B, LINE 11A As noted above, the Board of Directors delegated the review of the Form 990 to the Audit and Compliance Committee. The organization's VP/Finance & Corporate Controller and the Senior Director of Financial Reporting, and the outside accounting firm it engaged to review the return, presented each section of the final draft of this Form 990 to the Audit and Compliance Committee. Compensation schedules and disclosures were presented to the Human Resources and Compensation Committee of the CHW Board of Directors by Executive Management. The Audit and Compliance Committee also met with various personnel involved in the preparation process of the return, including, but not limited to, the EVP/Chief Financial Officer, SVP/General Counsel, and VP/Compliance and Internal Audit. The review included an explanation of each schedule of the Form 990 and the pertinent information contained on each schedule. Subsequent to its review, the Audit and Compliance Committee reported back to the Board regarding its oversight of the Form 990 and a complete copy of the Form 990 was provided to the entire Board before the return was filed. FORM 990, PART VI, SECTION B, LINE 12C The Board of Directors delegated to the Audit and Compliance Committee responsibility for monitoring conflicts of interest disclosures and for addressing any potential or actual conflicts. CHW's Conflict of Interest Policy charges the SVP/General Counsel with responsibility for reviewing and validating disclosures, and maintaining adequate records of disclosures. Pursuant to the Conflicts of Interest Policy, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the Conflicts of Interest Policy; (2) has read the Policy and understands said Policy; and (3) agrees to comply with all requirements of the Policy, including completing the conflicts of interest disclosure statement. As required by the Policy, the President/CEO and SVP/General Counsel prepare annual reports of reported conflicts of interest which are provided to the Board of Directors, Committee Chairs, and key leaders of the organization to enable responsible individuals to monitor and manage disclosed conflicts of interest in the organization's best interests. The procedures for addressing any conflict of interest related to a proposed transaction include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) any conflicting issues arising during the course of a Board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. FORM 990, PART VI, SECTION B, LINE 15A & 15B Annually, the Board of Directors appoints a Human Resources and Compensation Committee, comprised solely of directors, who are independent with respect to executive compensation, to be accountable for setting reasonable compensation packages for each officer and key employee (including the President/CEO). The Human Resources and Compensation Committee approves, consistent with the organization's philosophy and principles, the annual performance goals and criteria to be used in determining merit increases and variable compensation criteria for officers and key employees. The Human Resources and Compensation Committee also engages outside legal counsel as necessary and a qualified independent compensation and benefits specialist (independent expert) to review, analyze and provide benchmarking data for the total compensation and benefits packages of officers and key executives. Appropriate comparability data is obtained from the independent experts, e.g., total economic benefits paid by similarly situated organizations (both taxable and tax-exempt) for similar job responsibilities. Key deliberations of the Committee are documented in meeting minutes which are approved at the next Committee meeting and provided to the Board of Directors. The documentation of the decision includes (a) the terms of the transaction that was approved and the date it was approved, (b) the members of the Committee who were present during discussion of the transaction that was approved and those who voted on it, and (c) the comparability data obtained and relied upon by the Committee and how the data was obtained.
FORM 990, PART VI, SECTION C, LINE 19   Federal tax laws do not require that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its consolidated financial statements available on its website and upon request.
FORM 990, PART XI - Reconciliation of Net Assets, Line 5   Change in unrealized gains; $372,374,451 Change in non-controlling interest; $(434,440) Change in additional minimum pension liability; $324,174,000 Investment in health related activities organized as corps/exempt organizations; $111,660,535 Market-to-market on interest rate swaps; $9,056,268 Interest in net assets of unconsolidated foundations/related entites; $27,412,515 Book/Tax difference K-1 investments; $(1,217,580) Other fund balance transfers; $2,831,212
FORM 990, PART XII - Financial Statements AND Reporting, LINE 3   The organization's federal awards were included in Catholic Healthcare West and Subordinate Corporations' consolidated OMB Circular A-133 audited Schedule of Federal Expenditures.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lloyd H Dean TITLE:Board Member, President/ CEO HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael D Blaszyk TITLE:EVP, Chief Financial Officer HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Derek F Covert TITLE:SVP, Legal Svcs/Gen Counsel HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:William J Hunt TITLE:EVP, Chief Operating Officer HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marvin O'Quinn TITLE:EVP, Chief Operating Officer HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth Shih TITLE:SVP, Chief Admin Officer/Asst HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary Connick TITLE:VP Finance, Corp Controller HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Linda Hunt TITLE:President & CEO of SJHMC HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bernita McTernan TITLE:SVP, Sponsorship, Mission Inte HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Timothy Moran TITLE:President & CEO of Methodist HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Karl Silberstein TITLE:VP, Financial Operations HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ernest H Urquhart TITLE:SVP, Chief HR Officer HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mike Uboldi TITLE:President and CEO SMRMC HOURS:2
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Catholic Healthcare West
 
Employer identification number

94-1196203
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) St John's Regional Imaging Center LLC
26250 Enterprise Court Suite 100
Lake Forest,CA92630
77-0483564 		OP Radiology CA 3,415,904 1,310,660 NA
 
(2) St Francis Foundation LLC
112 E Victoria Street
Santa Barbara,CA93101
42-1691710 		Real estate CA 0 1,591,894 NA
 
(3) Trinity Care LLC
901 Corporate Center Dr Ste 406
Monterey Park,CA91754
33-0805338 		Health care CA 11,380,960 1,136,797 NA
 
(4) CHWUSP OXNARD SURGERY CENTERS LLC
1700 N ROSE AVENUE STE 100
OXNARD,CA93030
20-0707388 		OP SURGERY CA 1,444,566 2,016,571 NA
 
(5) Northridge Gamma Knife LLC
18300 Roscoe Blvd
Northridge,CA91328
20-1616363 		Leasing CA 0 0 NA
 


Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Bakersfield Memorial Hospital

420 34TH Street

Bakersfield,CA93301
95-1802779 		Hospital CA 501(c)(3) 3 CHW
 
 
 
(2) CHW HPL Self-Insurance Trust

185 Berry Street

San Francisco,CA94107
94-3006034 		Administratio CA 501(c)(3) 11; Type 1 CHW
 
 
 
(3) CHW Workers' Comp Self-Insurance Trust

185 Berry Street

San Francisco,CA94107
94-6612446 		Administratio CA 501(c)(3) 11; Type 1 CHW
 
 
 
(4) CHW Medical Foundation

3400 Data Drive

Rancho Cordova,CA95670
68-0220314 		Multi-sp clin CA 501(c)(3) 11; Type 1 CHW
 
 
 
(5) Community Hospital of San Bernardino

1805 Medical Center Drive

San Bernardino,CA92411
95-1643373 		Hospital CA 501(c)(3) 3 CHW
 
 
 
(6) Dominican Health Services

1555 Soquel Drive

Santa Cruz,CA95065
77-0056778 		Community Hea CA 501(c)(3) 11; Type 1 CHW
 
 
 
(7) Dominican Oaks Corporation

1555 Soquel Drive

Santa Cruz,CA95065
77-0127719 		Sr Housing CA 501(c)(3) 9 DHS
 
 
 
(8) Golden Umbrella

200 Mercy Oaks Drive

Redding,CA96003
23-7115371 		Senior ctr CA 501(c)(3) 7 CHW
 
 
 
(9) Marian Community Clinics Inc

1400 E Church Street

Santa Maria,CA93454
77-0447575 		Clinic CA 501(c)(3) 3 CHW
 
 
 
(10) Mark Twain St Joseph's Healthcare Corpor

768 Mountain Ranch Road

San Andreas,CA95249
68-0127677 		Hospital CA 501(c)(3) 3 NA
 
 
 
(11) Mercy Senior Housing Inc

3865 J Street

Sacramento,CA95816
68-0117340 		SR HOUSING CA 501(c)(3) 9 CHW
 
 
 
(12) Saint Francis Memorial Hospital

900 Hyde Street

San Francisco,CA94109
94-1156295 		Hospital CA 501(c)(3) 3 CHW
 
 
 
(13) Saint Mary's Outpatient Surgery Center a

235 West Sixth Street

Reno,NV89520
80-0035199 		Outpatient su NV 501(c)(3) 3 CHW
 
 
 
(14) Shasta Senior Nutrition Program

100 Mercy Oaks Drive

Redding,CA96003
94-2650429 		Sr Meal CA 501(c)(3) 7 CHW
 
 
 
(15) Sierra Nevada Memorial-Miners Hospital

155 Glasson Way

Grass Valley,CA95945
94-1439787 		Hospital CA 501(c)(3) 3 CHW
 
 
 
(16) St Francis Hospital Support Corporation

601 E Micheltorena Street

Santa Barbara,CA93103
77-0022302 		INACTIVE CA 501(c)(3) 11; Type 1 CHW
 
 
 
(17) St Mary Catholic Housing Corporation

1050 Linden Avenue

Long Beach,CA90813
33-0007728 		Sr HOusing CA 501(c)(3) 1 CHW
 
 
 
(18) St Mary Professional Building Inc

1050 Linden Avenue

Long Beach,CA90813
23-7373088 		Provide offic CA 501(c)(3) 11; Type 1 CHW
 
 
 
(19) Arroyo Grande Community Hospital Foundat

345 S Halcyon Rd

Arroyo Grande,CA93420
20-3256066 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(20) Barrow Neurological Foundation

350 West Thomas Road

Phoenix,AZ85013
86-0174371 		FNDRSING FND AZ 501(c)(3) 11; Type 1 CHW
 
 
 
(21) California Hospital Medical Center Found

1401 South Grand Avenue

Los Angeles,CA90015
95-4000909 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(22) CHW Foundation East Valley

475 South Dobson Road

Chandler,AZ85224
74-2418514 		FNDRSING FND AZ 501(c)(3) 11; Type 1 CHW
 
 
 
(23) Community Hospital Foundation of San Ber

1805 Medical Center Drive

San Bernardino,CA92411
95-3051931 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHSB
 
 
 
(24) Dominican Hospital Foundation

1555 Soquel Drive

Santa Cruz,CA95065
94-2450442 		FNDRSING FND CA 501(C)(3) 11; Type 1 chw
 
 
 
(25) French Hospital Medical Center Foundatio

1911 Johnson Avenue

San Luis Obispo,CA93401
20-3256125 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(26) Glendale Memorial Health Foundation

1420 South Central Avenue

Glendale,CA91204
95-3625651 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(27) Marian Medical Center Foundation

1400 E Church Street

Santa Maria,CA93454
95-3818027 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(28) Mercy Foundation Bakersfield

PO Box 119

Bakersfield,CA93302
77-0201321 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(29) Mercy Foundation Sacramento

3400 Data Drive 3rd Flr

Rancho Cordova,CA95670
23-7072762 		FNDRSING FND CA 501(c)(3) 11; Type 1 NA
 
 
 
(30) Northridge Hospital Foundation

18300 Roscoe Blvd

Northridge,CA91328
23-7444901 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(31) Saint Mary's Foundation

520 West Sixth Street

Reno,NV89520
88-0188386 		FNDRSING FND NV 501(c)(3) 11; Type 1 CHW
 
 
 
(32) San Gabriel Valley Medical Center Founda

438 West Las Tunas Drive

San Gabriel,CA91776
95-3430341 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(33) Sequoia Hospital Foundation

170 Alameda de las Pulgas

Redwood City,CA94062
94-2909990 		FNDRSING FND CA 501(c)(3) 11; Type 3 NA
 
 
 
(34) St Bernardine Medical Center Foundation

2101 N Waterman Avenue

San Bernardino,CA92404
23-7440086 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(35) St Francis Foundation of Santa Barbara

2323 De La Vina St Suite 104

Santa Barbara,CA93105
23-7137119 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(36) St John's Healthcare Foundation

1600 North Rose Avenue

Oxnard,CA93030
20-2865781 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(37) St Joseph's Foundation

350 West Thomas Road

Phoenix,AZ85013
94-2941245 		FNDRSING FND AZ 501(c)(3) 11; Type 1 CHW
 
 
 
(38) St Joseph's Foundation of San Joaquin

1800 N California Street

Stockton,CA95204
51-0432777 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(39) St Mary Medical Center Foundation

1050 Linden Avenue

Long Beach,CA90813
23-7153876 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(40) St Mary's Medical Center Foundation

450 Stanyan Street

San Francisco,CA94117
94-3336143 		FNDRSING FND CA 501(c)(3) 11; Type 1 CHW
 
 
 
(41) St Rose Dominican Health Foundation

3001 St Rose Parkway

Henderson,CA89052
88-0349432 		FNDRSING FND NV 501(c)(3) 11; Type 1 CHW
 
 
 
(42) The Congenital Heart Foundation

350 W Thomas Road

Phoenix,AZ85013
26-3342554 		FNDRSING FND AZ 501(c)(3) 11; Type 1 CHW
 
 
 
(43) Barrow Foundation UK

350 West Thomas Road

Phoenix,AZ85013
31-1724184 		FNDRSING FND UK 501(c)(3) 11; Type 3 NA
 
 
 
(44) Woodland Memorial Hospital Foundation

1321 Cottonwood Street 305

Woodland,CA95695
94-6167964 		FNDRSING FND CA 501(c)(3) 7 NA
 
 
 
(45) Southwest Catholic Health Network Corpor

4350 E Cotton Center Blvd Bldg D

Phoenix,AZ85040
86-0527381 		Health Suppor AZ 501(c)(3) 11; Type 1 NA
 
 
 
(46) VILLA SERRA corporation

1555 Soquel Drive

Santa Cruz,CA95065
77-0226589 		INACTIVE CA 501(c)(3) 9 CHW
 
 
 
(47) St Mary's Hospital Guild

235 W 6TH STREET

RENO,NV89503
88-6004507 		FUNDRAISING NV 501(c)(3) 11; Type 1 na
 
 
 
(48) MERCY MEDICAL CENTER MERCED FOUNDATION

2740 M Street

Merced,CA95340
77-0035928 		FNDRSING FND CA 501(c)(3) 7 CHW
 
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) CHW Nevada Imaging Company LLC

2835 S Jones Blvd No 3
Las Vegas,NV89146
26-3322792 		Imaging Cntr NV NA
  		RELATED -6,164,622 14,039,189   No 0 Yes   75.000 %
(2) CHWUSP Phoenix II LLC

15305 Dallas Parkway Suite 1600 LB
Addison,TX75001
54-2105660 		Surgery TX NA
  		related 616,470 8,300,172   No 0   No 50.100 %
(3) CHWUSP Sacramento Surgery Centers LLC

15305 Dallas Parkway Suite 1600 LB
Addison,TX75001
20-2468509 		Surgery TX NA
  		related 3,040,741 17,099,794   No 0   No 50.100 %
(4) CHWUSP Las Vegas Surgery Centers LLC

15305 Dallas Parkway Suite 1600 LB
Addison,TX75001
20-2999237 		Surgery TX NA
  		related 677,492 4,938,427   No 0   No 50.100 %
(5) Dominican Magnetic Resonance Imaging Cen

1545 Soquel Drive
Santa Cruz,CA94065
77-0095477 		Medical labs CA NA
  		related -29,511 374,618   No 0 Yes   80.000 %
(6) Folsom Sierra Endoscopy Center LP

1650 Creekside Drive 1600
Folsom,CA95630
68-0482416 		Ambulatory lab CA NA
  		related 1,366,195 486,063   No 0 Yes   51.000 %
(7) NICU Oper CO of Santa Cruz LLC

1555 Soquel Drive
Santa Cruz,CA95065
46-0502935 		Neonatal Hlthcre CA NA
  		related 5,696,584 6,751,723   No 0   No 51.000 %
(8) Plaza Surgery Center LP

525 E Plaza Drive Suite 100
Santa Maria,CA93454
77-0573567 		Surgery CA MHS
  		RELATED 432,532 958,957   No 0 Yes   50.390 %
(9) Santa Cruz Land & Building LP

1555 Soquel Drive
Santa Cruz,CA95065
77-0285236 		Real Estate CA DHS
  		RELATED 87,222 1,274,853   No 0 Yes   86.210 %
(10) St Joseph's Surgery Center LP

15305 Dallas Parkway Suite 1600 LB
Addison,TX75001
20-1019390 		Surgery TX na
  		related 1,165,123 3,163,275   No 0 Yes   79.760 %
(11) CHWUSP Phoenix Surgery Centers LLC

15305 Dallas Parkway Suite 1600 LB
Addison,TX75001
13-4248908 		Surgery TX NA
  		related 411,216 14,634,145   No 0   No 50.100 %
(12) Boston Common Intl Social Index fund LLC

84 State Street Suite 1000
Boston,MA02109
03-0491645 		INVESTMENTs MA NA
  		investment 1,478,126 46,309,022   No 0   No 86.300 %
(13) St Mary's Surgery Center at Galena LLC

235 West Sixth Street
Reno,NV89520
26-4094998 		SURGERY NV NA
  		related -46,817 525,176   No 0   No 60.270 %
(14) St John's Outpatient Surgery Center LP

1700 N ROSE AVENUE STE 110
OXNARD,CA93030
20-0707388 		Surgery CA CHWUSP
  		RELATED -445,706 1,807,694   No 0   No 68.500 %
(15) Mercy Davis Cancer Ctr Mgmt Co

2740 M Street
Merced,CA95340
94-3358445 		Cancer Ctr Mgmt CA Na
  		related 784,145 5,066,231   No 0 Yes   50.000 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) CDS of Nevada Inc
1510 Meadowland Lane
Reno,NV89502
88-0202496 		3rd Prty administ NV Saint Mary's HF
  		C Corp 4,256,621 679,236 100.000 %
(2) COASTAL SURGICAL SPECIALISTS INC
921 Oak Park Blvd Suite 101
Pismo Beach,CA93449
74-3000596 		Ambulatory Surger CA NA
  		S Corp 1,010,469 1,061,979 51.000 %
(3) Glendale Memorial SVCS corp
1420 South Central Avenue
Glendale,CA91204
95-4051021 		Hlth Care Mgmt CA NA
  		C Corp 0 287,085 100.000 %
(4) Inland Health Organization of Southern C
1980 Orange Tree Lane Ste 200
Redlands,CA92374
33-0578944 		Hlth Care Mgmt CA NA
  		C Corp 2,721,086 4,895,205 100.000 %
(5) Management Services Organization of Sant
1400 E Church Street
Santa Maria,CA93454
77-0318135 		Hlth Mgmt Svcs CA NA
  		C Corp 0 0 100.000 %
(6) Marian Health Services Inc
1400 E Church Street
Santa Maria,CA93454
77-0074057 		Health Services CA NA
  		C Corp 432,532 1,249,792 100.000 %
(7) Primary Care Plus
1625 Prater Way Suite 102
Sparks,NV89434
11-3763590 		clinics NV Saint Mary's HF
  		C Corp 5,559,549 3,066,802 100.000 %
(8) Saint Mary's Healthfirst
1510 Meadowland Lane
Reno,NV89502
88-0293082 		Insurance Provide NV NA
  		C Corp 85,466,700 40,629,142 100.000 %
(9) Saint Mary's Preferred Health Insurance
1510 Meadowland Lane
Reno,NV89502
88-0193357 		Insurance Provide NV Saint Mary's HF
  		C Corp 87,397,057 27,666,468 100.000 %
(10) St Mary Health Ventures Inc
1050 Linden Avenue
Long Beach,CA90813
95-1912528 		Retail Pharmacy CA NA
  		C Corp 1,991,700 2,597,520 100.000 %
(11) Trinity Care Infusion services
18440 Roscoe Boulevard
Northridge,CA91325
33-0828794 		Home Care Med svc CA NA
  		C Corp 2,498,869 672,114 100.000 %
(12) CHW Insurance Ltd (Cayman Island Corp)
PO BOX 1051 KY1-1102
Grand Cayman    
CJ
SELF-INSu fund CJ NA
  		C CORP 95,000 36,728,582 100.000 %
(13) MILLENIUM SURGERY CENTER inc
9300 Stockdale Hwy 200
Bakersfield,CA93311
77-0513445 		OP Surgery Sv CA BMH
  		S Corp 1,441,906 12,377,544 60.069 %
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Arroyo Grande Hospital Foundation

 b 221,187  
(2) Arroyo Grande Hospital Foundation

 c 200,000  
(3) Arroyo Grande Hospital Foundation

 n 98,159  
(4) Bakersfield Memorial Hospital

 k 14,490,040  
(5) Bakersfield Memorial Hospital

 o 383,683  
(6) Bakersfield Memorial Hospital

 p 287,063  
(7) Bakersfield Memorial Hospital

 r 17,503,106  
(8) Barrow Neurological Foundation

 b 1,008,730  
(9) Barrow Neurological Foundation

 c 8,083,688  
(10) Barrow Neurological Foundation

 n 1,541,305  
(11) Boston Common Intl Social Index fund LLC

 r 252,277  
(12) California Hospital Foundation

 b 1,445,857  
(13) California Hospital Foundation

 c 1,833,390  
(14) California Hospital Foundation

 n 839,259  
(15) CDS of Nevada

 r 53,612  
(16) CHW - Hospital & Professional Liability Self-

 k 8,312,190  
(17) CHW - Hospital & Professional Liability Self-

 q 60,676,452  
(18) CHW Foundation East Valley

 b 276,804  
(19) CHW Foundation East Valley

 c 2,096,062  
(20) CHW Foundation East Valley

 n 449,821  
(21) CHW Foundation East Valley

 o 953,717  
(22) CHW Medical Foundation

 i 2,138,136  
(23) CHW Medical Foundation

 k 58,966,576  
(24) CHW Medical Foundation

 o 726,019  
(25) CHW Medical Foundation

 r 8,555,268  
(26) CHW Medical Foundation

 a 287,442  
(27) CHW Nevada Imaging Company LLC

 d 2,100,000  
(28) CHW Worker's Compensation Self-Insurance Trst

 k 1,014,501  
(29) CHW Worker's Compensation Self-Insurance Trst

 q 10,966,429  
(30) CHWUSP Phoenix II LLC

 d 3,336,402  
(31) CHWUSP Sacramento Surgery Center LLC

 r 3,475,645  
(32) CHWUSP Sacramento Surgery Center LLC (Folsom

 o 2,364,511  
(33) CHWUSP Sacramento Surgery Center LLC (Rosevi

 o 462,124  
(34) Community Hospital of San Bernardino

 k 10,042,154  
(35) Community Hospital of San Bernardino

 r 45,570,107  
(36) Congenital Heart Foundation

 n 109,801  
(37) Dominican Foundation

 c 1,100,146  
(38) Dominican Foundation

 n 59,996  
(39) Dominican Foundation

 i 19,626  
(40) Dominican MRI

 i 100,545  
(41) Dominican Oaks Corporation

 r 2,794,779  
(42) Folsom Sierra Endoscopy Center

 o 4,254,692  
(43) Folsom Sierra Endoscopy Center

 p 630,883  
(44) Folsom Sierra Endoscopy Center

 r 1,256,640  
(45) French Hosptial Medical Center Foundation

 b 465,711  
(46) French Hosptial Medical Center Foundation

 c 387,317  
(47) French Hosptial Medical Center Foundation

 n 220,999  
(48) Friends of Mercy Foundation

 b 645,886  
(49) Friends of Mercy Foundation

 c 2,080,967  
(50) Glendale Memorial Health Foundation

 c 207,651  
(51) Glendale Memorial Health Foundation

 n 311,239  
(52) Glendale Memorial Health Foundation

 p 542,841  
(53) Golden Umbrella

 a 110,798  
(54) Golden Umbrella

 b 63,563  
(55) Inland Health Organization of Southern Califo

 k 1,331,973  
(56) Inland Health Organization of Southern Califo

 o 1,067,913  
(57) Inland Health Organization of Southern Califo

 r 536,633  
(58) Marian Community Clinics

 p 224,520  
(59) Marian Health Services

 p 508,891  
(60) Marian Medical Center Foundation

 b 233,498  
(61) Marian Medical Center Foundation

 c 2,122,112  
(62) Marian Medical Center Foundation

 n 226,951  
(63) Mark Twain St Joseph's Healthcare Corporatio

 k 3,774,287  
(64) Mark Twain St Joseph's Healthcare Corporatio

 r 3,288,671  
(65) Mercy Medical Center Merced Foundation

 b 343,488  
(66) Mercy Medical Center Merced Foundation

 c 751,302  
(67) Mercy Senior Housing Inc dba Mercy McMahon

 r 646,626  
(68) Mercy Surgery Center

 a 383,779  
(69) Mercy Surgery Center

 d 287,500  
(70) NICU Operating Company of Santa Cruz LLC

 r 7,104,870  
(71) Northridge Foundation

 b 1,003,016  
(72) Northridge Foundation

 c 2,945,841  
(73) Preferred Health Insurance Corporation

 r 105,821  
(74) Saint Francis Memorial Hospital

 k 11,698,213  
(75) Saint Francis Memorial Hospital

 r 5,923,664  
(76) Saint Mary's Foundation

 b 1,230,507  
(77) Saint Mary's Foundation

 c 10,136,914  
(78) Saint Mary's Multi-Specialty Clinic Inc

 r 90,786  
(79) Sequoia Hospital Foundation

 c 1,438,267  
(80) Sequoia Hospital Foundation

 o 1,337,109  
(81) Shasta Senior Nutrition Program

 a 157,242  
(82) Shasta Senior Nutrition Program

 b 51,383  
(83) Sierra Nevada Miners Hospital

 k 3,751,711  
(84) Sierra Nevada Miners Hospital

 r 3,200,585  
(85) St Bernardine Medical Center Foundation

 b 1,057,326  
(86) St Bernardine Medical Center Foundation

 c 2,375,492  
(87) St Bernardine Medical Center Foundation

 n 594,589  
(88) St John's Healthcare Foundation

 b 891,671  
(89) St John's Healthcare Foundation

 c 763,977  
(90) St John's Healthcare Foundation

 n 125,500  
(91) St Joseph's Foundation of San Joaquin

 b 1,880,565  
(92) St Joseph's Foundation of San Joaquin

 c 5,083,088  
(93) St Joseph's Foundation of San Joaquin

 i 38,900  
(94) St Joseph's Foundation of San Joaquin

 n 1,295,421  
(95) St Joseph's Surgery Center LP

 i 439,712  
(96) St Joseph's Surgery Center LP

 k 136,003  
(97) St Joseph's Surgery Center LP

 n 5,142,795  
(98) St Mary Catholic Housing Corporation

 r 449,640  
(99) St Mary Health Ventures

 a 130,375  
(100) St Mary Health Ventures

 n 1,204,160  
(101) St Mary Health Ventures

 p 956,876  
(102) St Mary Medical Center Foundation

 b 1,091,555  
(103) St Mary Medical Center Foundation

 c 3,290,099  
(104) St Mary Medical Center Foundation

 n 1,537,347  
(105) St Mary Professional Building Inc

 a 187,273  
(106) St Mary Professional Building Inc

 k 91,968  
(107) St Mary Professional Building Inc

 o 284,052  
(108) St Mary Professional Building Inc

 r 881,503  
(109) SAINT Mary's Health First

 r 2,119,081  
(110) St Mary's Medical Center Foundation

 b 397,559  
(111) St Mary's Medical Center Foundation

 c 2,684,545  
(112) St Mary's Medical Center Foundation

 n 483,677  
(113) St Rose Dominican Health Foundation

 b 960,630  
(114) St Rose Dominican Health Foundation

 c 3,606,082  
(115) St Rose Dominican Health Foundation

 n 1,031,495  
(116) Woodland Healthcare Foundation

 b 292,244  
(117) Woodland Healthcare Foundation

 c 626,366  
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Schedule R, Part V, Line 2 column (c)   PART V, LINE 1A - CHW RECEIVED INTEREST FROM VARIOUS RELATED ORGANIZATIONS DURING THE YEAR IN THE FORM OF CASH. THE INTEREST RATES WERE AT MARKET RATES AND ARE INTENDED TO COVER THE ACTUAL COST OF THE BORROWING. PART V, LINE 1B, AND 1C - CHW AND ITS RELATED ORGANIZATIONS ARE SUPPORTED BY 27 FUNDRAISING FOUNDATIONS. AS SUPPORTING ORGANIZATIONS, THE FOUNDATIONS OPERATE FOR THE BENEFIT OF, TO RAISE FUNDS FOR, OR TO CARRY OUT THE PURPOSES OF CHW AND ITS RELATED ORGANIZATIONS' HOSPITALS. AS A RESULT, PAYMENTS ARE MADE DIRECTLY TO THE SUPPORTED ORGANIZATIONS FROM THE FOUNDATIONS OR DIRECTLY TO THE FOUNDATIONS FROM CHW. AMOUNTS REPORTED UNDER TRANSACTION TYPE "B" REPRESENT FUNDS CHW TRANSFERRED TO THE FOUNDATIONS FOR OPERATIONAL EXPENSES. AMOUNTS REPORTED AS TRANSACTION TYPE "C" REPRESENT FUNDS RECEIVED FROM THE FOUNDATIONS AS GRANTS TO CHW. PART V, LINE 1D - CHW MADE LOANS AND LOAN GUARANTEES FOR VARIOUS RELATED ORGANIZATIONS. AMOUNTS REPORTED AS TRANSACTION TYPE "D" REPRESENT THE FAIR MARKET VALUE OF THE LOANS AND GUARANTEES. PART V, LINE 1I - CHW LEASES FACILITIES OR EQUIPMENT TO CERTAIN RELATED ORGANIZATIONS (FOUNDATIONS, JOINT VENTURES AND MEDICAL FOUNDATIONS). AMOUNTS REPORTED AS TRANSACTION TYPE "I" REPRESENT THE AMOUNTS CHARGED FOR SUCH LEASES. SUCH CHARGES REPRESENT FAIR MARKET VALUE OF THE LEASES. PART V, LINE 1K - CHW FACILITIES PERFORM VARIOUS SERVICES FOR OTHER RELATED ORGANIZATIONS. BELOW IS A SUMMARY OF THE TRANSACTIONS AMONG RELATED ORGANIZATIONS FOR SUCH ACTIVITIES. 1. SYSTEM OFFICE ALLOCATIONS - CHW'S CONTROLLED ENTITIES ARE ASSESSED AN AMOUNT TO COVER THE SYSTEM OFFICE OPERATIONS. IN ADDITION, AN EXPENSE IS ALSO ASSESSED TO COVER CENTRALIZED INFORMATION TECHNOLOGY COSTS OF THE ORGANIZATION, CENTRALIZED ACCOUNTS PAYABLE AND PAYROLL SERVICES, AND CERTAIN OTHER MANAGEMENT SERVICES. AMOUNTS REPORTED UNDER TRANSACTION TYPE "K" FOR THE ITEMS DESCRIBED ABOVE TOTALED $62.2 MILLION FOR THE YEAR ENDED JUNE 30, 2011. 2. PHYSICIAN CLINIC SUPPORT SERVICES FOR CHW MEDICAL FOUNDATION ("CHWMF") - CHWMF OPERATES CLINICS WITH LOCATIONS THROUGHOUT NORTHERN CALIFORNIA. THE OPERATIONS OF THE MEDICAL FOUNDATIONS ARE FUNDED THROUGH THE PARTICIPATING CHW HOSPITALS. AMOUNTS REPORTED UNDER TRANSACTION TYPE "K" TOTALING $49.3 MILLION REPRESENT THE TOTAL FUNDING SUPPORT BY THE PARTICIPATING CHW HOSPITALS FOR THE SERVICES PERFORMED BY CHWMF. CHWMF SERVICES ARE PROVIDED IN THE COMMUNITIES SERVED BY THOSE HOSPITALS. 3. CHW HOSPITALS ALSO PERFORM SERVICES FOR OTHER RELATED ORGANIZATIONS. SERVICES INCLUDE PLANT MAINTENANCE, LAUNDRY SERVICES, PATIENT FINANCIAL SERVICES MANAGEMENT, CENTRAL STERILIZATION SERVICES, CATERING SERVICES FOR PATIENT NOURISHMENT, AND OTHER SERVICES AS DEEMED NECESSARY. THE SERVICES PERFORMED ARE REIMBURSED AT COST. PART V, LINE 1L - CHW IS SELF INSURED FOR WORKERS' COMPENSATION BENEFITS AND FOR HOSPITAL PROFESSIONAL AND GENERAL LIABILITY RISKS. CHW MAINTAINS SEPARATE TRUSTS FOR THESE PROGRAMS FROM WHICH CLAIMS AND RELATED EXPENSES AND COSTS OF ADMINISTERING THE PLANS ARE PAID. CHW HOSPITALS FUND THE TRUSTS, SUCH THAT OVER TIME, ASSETS HELD EQUAL LIABILITIES FOR CLAIMS INCURRED. THE AMOUNTS REPORTED UNDER TRANSACTION TYPE "L" TOTALING $71.6 MILLION REPRESENT THE CASH TRANSFERRED FROM CHW TO THE TRUSTS FOR THE FY11 FUNDING OF THE SELF INSURANCE PROGRAMS. PART V, LINE 1M - FACILITIES ARE SHARED BETWEEN THE ORGANIZATION AND A FEW OF ITS SUPPORTING ORGANIZATIONS. THE AMOUNTS REPORTED AS TRANSACTION "M" REPRESENT THE VALUE OF THE EQUIVALENT RENT FOR THE FACILITIES SHARED. PART V, LINE 1N - CHW'S FUNDRAISING FOUNDATIONS DO NOT EMPLOY PERSONNEL DIRECTLY. CHW EMPLOYS INDIVIDUALS THAT ARE DEDICATED TO PERFORM DUTIES FOR ITS FOUNDATIONS (SUPPORTING ORGANIZATIONS). THE AMOUNTS REPORTED AS TRANSACTION TYPE "N" REPRESENT THE COSTS INCURRED (SALARIES AND BENEFITS) BY CHW FOR SUCH EMPLOYEES. PART V, LINE 1O, AND 1P - INTERCOMPANY ACTIVITY IS COMMON AMONG CHW AND ITS RELATED ORGANIZATIONS. REIMBURSEMENTS FOR EXPENSES INCURRED BY THE ORGANIZATIONS ARE REPORTED AS TRANSACTION TYPES "O" AND "P". AMOUNTS REIMBURSED ARE AT COST. PART V, LINE 1R - AS THE PARENT ORGANIZATION, CHW RECEIVES FUNDING FOR VARIOUS EXPENDITURES OF THE ORGANIZATION. AMOUNTS REPORTED UNDER TRANSACTION TYPE "R" REPRESENT FUNDING FOR ITEMS DESCRIBED BELOW. 1. PENSION FUNDING - CHW MAINTAINS DEFINED BENEFIT RETIREMENT PLANS THAT COVER SUBSTANTIALLY ALL ELIGIBLE EMPLOYEES OF CHW. CHW'S FUNDING POLICY REQUIRES THAT EACH PARTICIPATING HOSPITAL FUND ITS PRORATA SHARE OF THE TOTAL ANNUAL FUNDING REQUIREMENT OF THE PLANS. THE PENSION FUNDING REPORTED UNDER TRANSACTION TYPE "R" TOTALED $18.0 MILLION FOR THE YEAR ENDED JUNE 30, 2011, FOR SEPARATE LEGAL ENTITIES CONTROLLED BY CHW. 2. DEBT (INTEREST AND PRINCIPAL) FUNDING - CHW HAS A CENTRALIZED DEBT MANAGEMENT SYSTEM. THE CONTROLLED ENTITIES FUND TOTAL DEBT PAYMENTS (INTEREST AND PRINCIPAL) THROUGH INTERCOMPANY BORROWING. THE DEBT FUNDING IS REPORTED UNDER TRANSACTION TYPE "R" FOR THE SEPARATE LEGAL ENTITIES 3. JOINT VENTURES - K-1 DISTRIBUTIONS - CHW HAS PARTNERSHIPS (JOINT VENTURES) WITH OTHER ORGANIZATIONS. THE AMOUNTS REPORTED UNDER TRANSACTION TYPE "R" FOR THESE PARTNERSHIPS REFLECT DISTRIBUTIONS AS REPORTED ON SCHEDULE K-1 OF THE PARTNERSHIPS' TAX RETURNS. 4. OTHER AMOUNTS REPORTED UNDER TRANSACTION TYPE "R" INCLUDE THE FAIR MARKET VALUE OF THE SERVICES, CASH, AND OTHER ASSETS PROVIDED TO OR FROM THE FILING ORGANIZATION DURING ITS TAX YEAR.
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