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
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
DIGNITY HEALTH
 
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 $ 12,991,201,476
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.dignityhealth.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 MediumBullet  
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: DIGNITY HEALTH IS COMMITTED TO FURTHERING THE HEALING MINISTRY OF JESUS THROUGH THE DELIVERY OF HIGH-QUALITY, AFFORDABLE HEALTHCARE, ADVOCACY FOR THE POOR AND DISENFRANCHISED, AND COMMUNITY PARTNERSHIPS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 52,583
6 Total number of volunteers (estimate if necessary) .... 6 7,446
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 24,917,698
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -3,024,875
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 97,147,541 112,863,395
9 Program service revenue (Part VIII, line 2g) ......... 8,779,351,242 8,999,136,668
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 285,531,034 320,401,740
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 49,678,394 52,366,029
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 9,211,708,211 9,484,767,832
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 104,771,301 171,669,107
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) 4,423,096,831 4,540,284,595
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet209,975    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 4,173,204,334 4,619,989,956
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 8,701,072,466 9,331,943,658
19 Revenue less expenses. Subtract line 18 from line 12....... 510,635,745 152,824,174
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 11,364,399,198 11,602,501,370
21 Total liabilities (Part X, line 26)............. 7,233,832,220 8,080,888,449
22 Net assets or fund balances. Subtract line 21 from line 20..... 4,130,566,978 3,521,612,921
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
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: Dignity Health is 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 vibrant, national health care system known for service, chosen for clinical excellence, standing in partnership with patients, employees and physicians to improve the health of all communities served. Our values: Dignity Health 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 f
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 organization’s program service accomplishments for each of its three largest program services, as measured 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 $ 8,299,124,630 including grants of $ 171,669,107 ) (Revenue $ 8,976,263,281 )
Dignity Health, Formerly Catholic Healthcare West, is a California nonprofit public benefit corporation headquartered in San Francisco, California. Dignity Health, together with its subsidiary corporations, is one of the largest not-for-profit acute healthcare delivery systems in the United States as measured by annual revenue. Dignity Health operated 40 hospitals throughout major California markets and in the Phoenix, Arizona and Las Vegas and Reno, Nevada metropolitan markets during the year ended June 30, 2012. Dignity Health's and its subordinate corporations' facilities included approximately 8,400 licensed acute care beds and approximately 800 licensed skilled nursing beds as of 6/30/12. Dignity Health 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, Dignity Health's California operations are well dispersed throughout the state. Dignity Health'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.
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$ 8,299,124,630
Form 990 (2011)
Form 990 (2011)
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 IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 temporarily restricted endowments, permanent endowments, 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, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? 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
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization 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 list of attachments
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 employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? 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...........................
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
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 (2011)
Form 990 (2011)
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
5,721
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
52,583
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 , UK , BD
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
 
 
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 (2011)
Form 990 (2011)
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
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
9
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
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
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
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
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
Yes
 
11a
Has the organization provided a complete 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
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
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 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Morgan Clayton
Board Member
 2.0 X           0 0 0
(4) Mark DeMichele
Board Member
 2.0 X           0 0 0
(5) James M Givens CFA
Board Member
 2.0 X           0 0 0
(6) Peter G Hanelt CPA
Board Member
 2.0 X           0 0 0
(7) Lillian Anne Healy CCVI
Board Member
 2.0 X           0 0 0
(8) Rodney F Hochman MD
Board Member
 2.0 X           0 0 0
(9) Julie Hyer OP
Board Member
 2.0 X           0 0 0
(10) Maureen McInerney OP
Board Member
 2.0 X           0 0 0
(11) Kenneth Mills MD
Board Member/Medical Director
 8.0 X           35,610 0 0
(12) Patricia Rayburn OSF
Board Member
 2.0 X           0 0 0
(13) Susan Snyder OP
Board Member
 2.0 X           0 0 0
(14) Jarrett Anderson Esq
Board Chair
 8.0 X   X       0 0 0
(15) Judy Carle RSM
Board Vice Chair
 2.0 X   X       0 0 0
(16) Caretha Coleman
Board Chairperson
 2.0 X   X       0 0 0
(17) Tessie Guillermo
Board Secretary
 2.0 X   X       0 0 0
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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       4,882,756 0 1,127,670
(19) Michael D Blaszyk
SEVP Chief Financial Officer
 40.0     X       2,266,439 0 633,670
(20) Derek F Covert
EVP General Counsel
 40.0     X       1,230,665 0 118,738
(21) William J Hunt
EVP Chief Operating Officer
 40.0     X       2,415,727 0 127,564
(22) Diane Lee
VP/Assoc Gen Counsel/Secretary
 40.0     X       351,458 0 51,647
(23) Marvin O'Quinn
SEVP Chief Operating Officer
 40.0     X       2,991,707 0 441,153
(24) Elizabeth Shih
EVP Chief Admin Officer
 40.0     X       1,703,310 0 154,085
(25) Keith Callahan
VP Supply Chain Mgmt/E-commerc
 40.0       X     536,802 0 58,573
(26) Gary F Conner
VP Financial Operations
 40.0       X     172,770 0 14,598
(27) Mary Connick
VP Finance Corp Controller
 40.0       X     578,433 0 66,982
(28) Rodney A Davis
SVP Operations - Nevada
 40.0       X     736,378 0 78,656
(29) Charles P Francis
SEVP Chief Strategy Officer
 40.0       X     1,555,319 0 221,844
(30) Linda Hunt
SVP Operations - Arizona
 40.0       X     912,528 0 96,637
(31) Jeffrey W Land
VP Corporate Real Estate
 40.0       X     477,513 0 75,097
(32) Bernita McTernan
EVP/Sponsorship/Mission Integr
 40.0       X     1,181,716 0 122,563
(33) Mark A Meyers
SVP Operations - Los Angeles
 40.0       X     702,349 0 87,081
(34) Timothy Moran
Hospital President/CEO
 40.0       X     606,055 0 26,412
(35) Karl Silberstein
SVP Financial Operations
 40.0       X     800,229 0 90,529
(36) Michael Taylor
SVP Operations - Sac/San Joaqu
 40.0       X     882,129 0 44,276
(37) LeAnne Trachok
SVP Revenue Services
 40.0       X     522,273 0 56,082
(38) Herbert Vallier
EVP/Chief HR Officer
 40.0       X     1,779,534 0 117,876
(39) Glenna L Vaskelis
SVP Operations - Bay Area
 40.0       X     643,864 0 88,764
(40) Robert Wiebe MD
EVP CMO
 40.0       X     1,336,440 0 250,894
(41) Benjamin R Williams
SVP Chief Information Officer
 40.0       X     1,535,004 0 39,362
(42) Deanna Wise
EVP Chief Information Officer
 40.0       X     414,295 0 77,682
(43) John M Wray
SVP Managed Care
 40.0       X     1,034,939 0 107,671
(44) Lisa Gamshad Zuckerman
VP Treasury Services
 40.0       X     511,943 0 73,761
(45) Marwan Ghazoul MD
Physician
 40.0         X   706,219 0 66,911
(46) John G Bibby
Hospital President and CEO
 40.0         X   736,185 0 51,157
(47) Naftaly Attias MD
Physician
 40.0         X   743,122 0 72,316
(48) Scott R Petersen MD
Physician
 40.0         X   713,588 0 75,816
(49) Dana G Seltzer MD
Chairman - Orthopedics
 40.0         X   803,685 0 75,873
(50) Saliba Salo
Former Key Empoyee
             X 421,975 0 45,125
(51) Mike Uboldi
Former Key Empoyee
             X 690,990 0 78,483
(52) Ernest H Urquhart
Former Key Empoyee
             X 300,000 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 37,913,949 0 4,915,548
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet9,626
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
KITCHELL CONTRACTORS INC
1707 E HIGHLAND AVE SUITE 200
PHOENIX,AZ85016 		CONTRACTOR 74,787,169
DPR CONSTRUCTION INC
2480 NATOMAS PARK DR STE 100
SACRAMENTO,CA95833 		CONTRACTOR 38,774,147
HUNT CONSTRUCTION GROUP INC
6720 N SCOTTSDALE RD SUITE 300
SCOTTSDALE,AZ85253 		CONTRACTOR 36,406,945
ANGELICA TEXTILE SERVICES
925 S 8TH ST
COLTON,CA92324 		LAUNDRY SERVICES 21,905,601
CLARK CONSTRUCTION GROUP
575 ANTON BLVD
COSTA MESA,CA92626 		CONTRACTOR 18,304,736
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1,091
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 78,865,559
e Government grants (contributions)1e 23,231,551
f All other contributions, gifts, grants, and
similar amounts not included above1f 		10,766,285
g Noncash contributions included in lines 1a-1f:$ 1,240,785
h Total. Add lines 1a-1f.......MediumBullet 112,863,395
Program Service Revenue Business Code
2a PATIENT NET OF CHARITY 900,099 5,319,891,274 5,319,891,274    
b MEDICARE/MEDICAID PAYMENTS 900,099 3,454,213,210 3,454,213,210    
c MANAGEMENT SERVICES 541,610 77,686,043 77,686,043    
d MEANINGFUL USE INCENTIVES 900,099 50,468,675 50,468,675    
e MED OFFICE BLDG 621,300 14,858,275 14,858,275    
f All other program service revenue . 82,019,191 59,145,804 22,873,387  
g Total. Add lines 2a–2f........MediumBullet 8,999,136,668
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 113,814,934 0 -338,100 114,153,034
4 Income from investment of tax-exempt bond proceeds..MediumBullet 148,529     148,529
5 Royalties............MediumBullet 387,256     387,256
(i) Real (ii) Personal
6a Gross rents 1,701,634  
b Less: rental expenses 136,874  
c Rental income or (loss) 1,564,760  
d Net rental income or (loss).......MediumBullet 1,564,760     1,564,760
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 3,708,948,803 3,786,244
b Less: cost or other basis and sales expenses 3,505,707,668 589,102
c Gain or (loss) 203,241,135 3,197,142
d Net gain or (loss)..........MediumBullet 206,438,277     206,438,277
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 22,724,612     22,724,612
b PARKING LOT 812,930 3,122,388   181,032 2,941,356
c CHILD CARE 624,410 1,472,197   824,705 647,492
d All other revenue .... 23,094,816   1,376,674 21,718,142
e Total. Add lines 11a–11d ......MediumBullet 50,414,013
12 Total revenue. See Instructions....MediumBullet 9,484,767,832 8,976,263,281 24,917,698 370,723,458
Form 990 (2011)
Form 990 (2011)
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).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 170,121,544 170,121,544
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 1,547,563 1,547,563
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 40,319,470 18,828,455 21,491,015  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 305,138 131,805 173,333  
7 Other salaries and wages 3,454,699,137 3,165,368,982 289,157,663 172,492
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 263,355,894 249,957,361 13,398,533  
9 Other employee benefits ....... 533,815,708 513,421,664 20,381,807 12,237
10 Payroll taxes ........... 247,789,248 241,137,225 6,640,485 11,538
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 16,214,551 5,073 16,209,478  
c Accounting ........... 8,152,738   8,152,738  
d Lobbying ........... 1,348,500 205,064 1,143,436  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 19,467,558   19,467,558  
g Other .......... 782,083,183 564,012,167 218,070,614 402
12 Advertising and promotion .... 26,565,958 2,248,453 24,317,505  
13 Office expenses ....... 207,860,300 175,595,992 32,260,785 3,523
14 Information technology ...... 141,547,721 21,829,992 119,717,729  
15 Royalties .. 0      
16 Occupancy ........... 106,437,019 86,522,349 19,914,670  
17 Travel ............ 15,707,585 6,033,242 9,667,936 6,407
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 6,595,503 2,521,527 4,073,126 850
20 Interest ........... 297,520,430 297,520,430    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 374,710,797 264,185,357 110,525,440  
23 Insurance .............. 150,442,156 109,850,940 40,591,216  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 1,072,580,576 1,072,580,576 0 0
b BAD DEBT 827,350,057 827,350,057 0 0
c MEDI-CAL PROVIDER FEE 283,449,324 283,449,324 0 0
d UNRELATED BUSINESS INC TAXES 31,817 31,817 0 0
e
f All other expenses 281,924,183 224,667,671 57,253,986 2,526
25 Total functional expenses. Add lines 1 through 24f 9,331,943,658 8,299,124,630 1,032,609,053 209,975
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 209,628 1 201,754
2 Savings and temporary cash investments ....... 1,366,641,634 2 1,771,651,215
3 Pledges and grants receivable, net ......... 15,845,346 3 14,545,124
4 Accounts receivable, net ......... 1,103,971,165 4 1,110,544,285
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 866,667 5 700,000
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 81,007,175 7 70,021,497
8 Inventories for sale or use .............. 143,678,916 8 142,416,302
9 Prepaid expenses and deferred charges ............ 447,266,947 9 536,058,758
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 7,667,004,990
b Less: accumulated depreciation. ..... 10b 3,997,414,811 3,610,676,976 10c 3,669,590,179
11 Investments—publicly traded securities .......... 3,169,224,216 11 2,662,145,617
12 Investments—other securities. See Part IV, line 11 ...... 605,767,197 12 723,927,824
13 Investments—program-related. See Part IV, line 11 .. 752,252,844 13 814,818,481
14 Intangible assets ......... 6,197,886 14 6,182,886
15 Other assets. See Part IV, line 11 ........... 60,792,601 15 79,697,448
16 Total assets. Add lines 1 through 15 (must equal line 34)... 11,364,399,198 16 11,602,501,370
Liabilities 17 Accounts payable and accrued expenses . 1,686,427,192 17 1,916,503,335
18 Grants payable .......... 2,848,549 18 0
19 Deferred revenue .......... 193,634,991 19 31,741,234
20 Tax-exempt bond liabilities .......... 3,542,101,637 20 3,784,811,560
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 574,590,964 23 580,465,085
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 1,234,228,887 25 1,767,367,235
26 Total liabilities. Add lines 17 through 25..... 7,233,832,220 26 8,080,888,449
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 ..... 3,975,743,442 27 3,312,717,706
28 Temporarily restricted net assets ..... 122,431,687 28 176,171,790
29 Permanently restricted net assets ..... 32,391,849 29 32,723,425
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 ..... 4,130,566,978 33 3,521,612,921
34 Total liabilities and net assets/fund balances ..... 11,364,399,198 34 11,602,501,370
Form 990 (2011)
Form 990 (2011)
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
9,484,767,832
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
9,331,943,658
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
152,824,174
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
4,130,566,978
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-761,778,231
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
3,521,612,921
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 (2011)
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
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

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
2011
Name of organization
DIGNITY HEALTH
 
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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
DIGNITY HEALTH
  		Employer identification number

94-1196203
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total 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)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
DIGNITY HEALTH
  		Employer identification number

94-1196203
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
DIGNITY HEALTH
  		Employer identification number

94-1196203
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  
Use duplicate copies of Part III if additional space is needed
(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) (2011)

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
2011
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, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
DIGNITY HEALTH
 
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 in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$ 1,350
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
$ 135
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$ 0
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 function 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) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(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
 
57,526
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
367,151
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
236,295
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
687,528
j
Total. Add lines 1c through 1i ...............................
1,348,500
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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible 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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
PART I-B, LINE 4B   During the year, Dignity Health paid membership dues to Rancho Cordova Chamber of Commerce, Greater Bakersfield Chamber of Commerce, Las Vegas Chamber of Commerce and The Chamber ("the Chambers"). The invoices provided for voluntary contributions to the Chambers' Political Action Committees (PACs). The check requests for annual dues inadvertently included an amount for voluntary contributions to the PACs. Dignity Health 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. Copies of the refund checks, dated 12/4/2012, 11/15/2012, 12/18/2012 and 12/20/2012 evidencing that $1,350.00 has been recovered have been attached to Form 4720. 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 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. 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) 2011

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

Schedule D (Form 990) 2011
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 .... 114,824,736 92,617,477 78,739,233 89,391,160
b Contributions ........ 5,904,333 9,388,271 12,468,055 1,411,823
c Net investment earnings, gains, and losses ... -1,307,763 14,666,246 7,851,317 -10,569,881
d Grants or scholarships ..... 216,638 304,610 87,952 0
e Other expenditures for facilities
and programs ........ 		6,527,010 1,542,648 6,353,176 1,493,869
f Administrative expenses .... 0 0 0 0
g End of year balance ...... 112,677,658 114,824,736 92,617,477 78,739,233
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet14.000 %
b
Permanent endowment SchDMd Bullet86.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
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
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   194,416,612 194,416,612
b Buildings ................   3,606,061,038 1,751,410,802 1,854,650,236
c Leasehold improvements ............   50,079,726 28,257,680 21,822,046
d Equipment ................   3,035,792,008 2,146,210,663 889,581,345
e Other .................   780,655,606 71,535,666 709,119,940
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 3,669,590,179
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
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 		723,927,824 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 723,927,824
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 136,777,568 F
(2) INVESTMENTS IN HEALTH RELATED 678,040,913 F







Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 814,818,481
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must 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) Book value
Federal Income Taxes 50,000
DEFERRED COMPENSATION 25,648,655
OTHER NON-CURRENT LIABILITIES 16,535,533
ASSET RETIREMENT OBLIGATIONS 28,390,965
DUE TO RELATED PARTIES 291,948,494
PENSION & OTHER RETIREMENT OBL 1,404,793,588




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,767,367,235
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) 2011

Schedule D (Form 990) 2011
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 through 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 must 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 must 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   DIGNITY HEALTH 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, DIGNITY HEALTH's HOSPITALs. DIGNITY HEALTH'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) 2011

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
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
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 its grants
and other 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 its grants and other
assistance 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 V 72,638
Central America and the Caribbean 0 0 Investments N/A 258,865
Central America and the Caribbean 0 0 Investments N/A 594,484,103
Europe (Including Iceland and Greenland) 0 0 Investments N/A 24,874,698
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 619,690,304
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 619,690,304
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
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) 2011
Schedule F (Form 990) 2011Page 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) 2011
Schedule F (Form 990) 2011
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) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
Part I, Line 3 (1)   DIGNITY HEALTH 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. DIGNITY HEALTH'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 in 2011, AND KNOWING THAT THE WORK IN ESQUIPULAS WAS FAR FROM COMPLETE, DIGNITY HEALTH 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 DIGNITY HEALTH TEAM MEMBERS. THE CLINICAL EDUCATION AND TRAINING FOCUSED ON "SHADOWING" MEDICAL STUDENTS, NURSES, MIDWIVES AND PASTORAL HEALTH CARE WORKERS WHO WORKED IN THE FIELD AND IN THE LOCAL HOSPITALS AND CLINICS. BY "SHADOWING," THIS WILL ASSIST IN BETTER UNDERSTANDING THE SKILLS AND PRACTICAL KNOWLEDGE THE COMMUNITY IS SEEKING AND DEEPEN THE RELATIONSHIPS WITH THE LEADERS WITHIN THE LOCAL CLINICAL COMMUNITY, ENABLING THE DEVELOPMENT OF SPECIFIC CURRICULUM, RESOURCES AND MATERIALS TO BEST MEET THE COMMUNITY'S NEEDS.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
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
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
Employer identification number

94-1196203
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance 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 discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did 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
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
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 Financial Assistance at cost
(from Worksheet 1) .. 		  94,977 172,911,115 721,367 172,189,748 2.030 %
b Medicaid (from Worksheet 3, column a) .....   920,928 1,971,413,497 1,420,754,944 550,658,553 6.480 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .   268,762 88,199,001 32,927,842 55,271,159 0.650 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		  1,284,667 2,232,523,613 1,454,404,153 778,119,460 9.160 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		784 1,052,343 84,022,398 7,504,365 76,518,033 0.900 %
f Health professions education
(from Worksheet 5) .. 		127 68,408 78,405,498 9,371,603 69,033,895 0.810 %
g Subsidized health services
(from Worksheet 6) .. 		64 157,106 31,899,120 5,010,542 26,888,578 0.320 %
h Research (from Worksheet 7) 26 26,281 30,070,016 48,446 30,021,570 0.350 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 253 282,361 35,812,034 198,858 35,613,176 0.420 %
jTotal Other Benefits ... 1,254 1,586,499 260,209,066 22,133,814 238,075,252 2.800 %
kTotal. Add lines 7d and 7j. .. 1,254 2,871,166 2,492,732,679 1,476,537,967 1,016,194,712 11.960 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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 1,143 2,086,910 1,337,749 749,161 0.010 %
2 Economic development 4 3,072 134,636 0 134,636 0 %
3 Community support 29 4,932 762,759 478 762,281 0.010 %
4 Environmental improvements 4 1,669 53,667 6,886 46,781 0 %
5 Leadership development and training for community members 17 2,903 364,081 960 363,121  
6 Coalition building 41 30,808 865,855 0 865,855 0.010 %
7 Community health improvement advocacy 24 1,117 437,309 0 437,309 0.010 %
8 Workforce development 5 786 1,118,253 0 1,118,253 0.010 %
9 Other            
10 Total 130 46,430 5,823,470 1,346,073 4,477,397 0.050 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did 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........
2
178,188,832
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance 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
1,726,653,831
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
2,136,684,120
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-410,030,289
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(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 %
1St Joseph's Outpatie
  		Surgery 52.700 % 0 % 35.000 %
2Southwest Orthopedic
  		Real Estate 11.630 % 0 % 88.370 %
3Chandler Endoscopy A
  		Surgery 51.000 % 0 % 49.000 %
4Southwest Lithotrips
  		Litho/Kidney 9.000 % 0 % 79.000 %
5BNI Management LLC
  		Mgmt services 25.000 % 0 % 75.000 %
6Surgery Center of Re
  		Surgery 14.072 % 0 % 73.475 %
7Reno Cyberknife LLC
  		Imaging 20.000 % 0 % 33.330 %
8St Mary's Outpatien
  		Surgery 48.270 % 0 % 37.794 %
9Reno Imaging Partner
  		Imaging 51.000 % 0 % 49.000 %
10San Martin Surgery C
  		Surgery 30.130 % 0 % 36.590 %
11Parkway Surgery Cent
  		Surgery 27.050 % 0 % 43.000 %
12San Martin Investors
  		Real Estate (Rent/Lease) 4.700 % 0 % 33.150 %
13North State Surgery
  		Surgery 63.170 % 0 % 33.650 %
14Sacramento Midtown E
  		Surgery 20.000 % 0 % 80.000 %
15Folsom Sierra Endosc
  		Surgery 51.000 % 0 % 38.972 %
16Folsom Outpatient Su
  		Surgery 60.530 % 0 % 39.470 %
17Roseville Surgery Ce
  		Surgery 56.530 % 0 % 18.310 %
18Grass Valley Outpati
  		Surgery 45.610 % 0 % 31.594 %
19St Joseph's Surgery
  		Surgery 79.760 % 0 % 13.000 %
20Santa Cruz Surgery C
  		Surgery 50.000 % 0 % 50.000 %
21Santa Cruz Comprehen
  		Imaging 50.000 % 0 % 50.000 %
22Dominican Breast Cen
  		Imaging 50.000 % 0 % 50.000 %
23Dominican Magnetic R
  		Imaging 80.000 % 0 % 20.000 %
24Coastal Surgical Spe
  		Surgery 51.000 % 0 % 49.000 %
25Templeton Surgery Ce
  		Surgery 65.260 % 0 % 15.260 %
26Plaza Surgery Center
  		Surgery 52.370 % 0 % 47.630 %
27Renaissance Imaging
  		Imaging 49.000 % 0 % 30.350 %
28Inland Endoscopy Cen
  		Surgery 25.000 % 0 % 75.000 %
29Medical Pavilion at
  		Real Estate (Rent/Lease) 25.000 % 0 % 75.000 %
30Radiation Oncology C
  		Imaging 50.000 % 0 % 50.000 %
31SimonMed Imaging LLC
  		Imaging 83.900 % 0 % 16.100 %
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size 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 General Hospital
4001 J st
Sacramento,CA95819 		X X   X     X    
3 Mercy San Juan Medical Center
6501 Coyle Ave
Carmichael,CA95608 		X X         X    
4 St Joseph's Medical Center of Stockton
1800 N California St
Stockton,CA95204 		X X   X     X    
5 Mercy Medical Center Redding
2175 Rosaline Ave
Redding,CA96001 		X X   X     X    
6 Mercy BAKERSFIELD
2215 Truxtun Ave
Bakersfield,CA93301 		X X         X    
7 Northridge Hospital Medical Center
1830 Roscoe Blvd
Northridge,CA91328 		X X   X     X    
8 Dominican Hospital
1555 Soquel dr
Santa Cruz,CA95065 		X X         X    
9 California Hospital Medical Center
1401 South Grand Ave
Los Angeles,CA90015 		X X   X     X    
10 Chandler Regional Hospital
475 South Dobson rd
Chandler,AZ85224 		X X         X    
11 St Rose Dominican Hospital - Siena
3001 St Rose Parkway
Henderson,NV89052 		X X         X    
12 St Bernardine Medical Center
2101 N Waterman Ave
San Bernardino,CA92404 		X X         X    
13 St John's Regional Medical Center
1600 North Rose Ave
Oxnard,CA93030 		X X         X    
14 Mercy Medical Center Merced
333 Mercy Avenue
Merced,CA95340 		X X   X     X    
15 Sequoia Hospital
170 Alameda de las Pulgas
Redwood City,CA94062 		X X         X    
16 Marian Regional Medical Center
1400 E Church st
Santa Maria,CA93454 		X X         X    
17 St Mary Medical Center
1050 Linden Ave
Long Beach,CA90813 		X X   X     X    
18 Mercy Gilbert Medical Center
3555 S Val Vista Dr
Gilbert,AZ85297 		X X         X    
19 Methodist Hospital of Sacramento
7500 Hospital Dr
Sacramento,CA95823 		X X   X     X    
20 St Mary's Medical Center
450 Stanyan St
San Francisco,CA94117 		X X   X     X    
21 Glendale Memorial Hospital and Health Ce
1420 South Central Ave
Glendale,CA91204 		X X         X    
22 Mercy Hospital of Folsom
1650 Creekside Dr
Folsom,CA95630 		X X         X    
23 St Rose Dominican Hospital - San Martin
8280 West Warm Springs Rd
Las Vegas,NV89113 		X X         X    
24 Woodland Memorial Hospital
1325 Cottonwood St
Woodland,CA95695 		X X         X    
25 St Rose Dominican Hospital -Rose de Lima
102 E Lake Mead Dr
Henderson,NV89015 		X X         X    
26 French Hospital Medical Center
1911 Johnson Ave
San Luis Obispo,CA93401 		X X         X    
27 St Elizabeth Community Hospital
2550 Sister Mary Columba Dr
Red Bluff,CA96080 		X X         X    
28 St John's Pleasant Valley Hospital
2309 Antonio Ave
Camarillo,CA93010 		X X         X    
29 Arroyo Grande Community Hospital
345 S Halcyon rd
Arroyo Grande,CA93420 		X X         X    
30 Mercy Medical Center Mt Shasta
914 Pine St
Mt Shasta,CA96067 		X X     X   X    
31 Orthopedic & Surgical Specialty Co LLC
2905 West Warner Road
Chandler,AZ85224 		X               For-profit hospital operated through a joint venture
32 St Josephs Behavioral Health Center
2510 N California St
Stockton,CA95204 		X                
33 SAINT MARY'S REGIONAL MEDICAL CENTER
235 West Sixth St
RENO,CA89503 		X X         X    
34 Southwest Orthopedic and Spine Hospital
750 North 40th Street
PHOENIX,AZ85008 		X               For-profit hospital operated through a joint venture
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Joseph's Hospital and Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy General Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy San Juan Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Joseph's Medical Center of Stockton
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy Medical Center Redding
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy BAKERSFIELD
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Northridge Hospital Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Dominican Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
California Hospital Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Chandler Regional Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Rose Dominican Hospital - Siena
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Bernardine Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St John's Regional Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy Medical Center Merced
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Sequoia Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Marian Regional Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Mary Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy Gilbert Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Methodist Hospital of Sacramento
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Mary's Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Glendale Memorial Hospital and Health Ce
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy Hospital of Folsom
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Rose Dominican Hospital - San Martin
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Woodland Memorial Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Rose Dominican Hospital -Rose de Lima
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
French Hospital Medical Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Elizabeth Community Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St John's Pleasant Valley Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Arroyo Grande Community Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Mercy Medical Center Mt Shasta
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Orthopedic & Surgical Specialty Co LLC
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
St Josephs Behavioral Health Center
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
SAINT MARY'S REGIONAL MEDICAL CENTER
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
Southwest Orthopedic and Spine Hospital
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?74
Name and address Type of Facility (describe)
1 Court Street Surgery Center
2184 Court Street
Redding,CA96001 		Surgery Center
2 Mercy Surgery Center
2175 Rosaline Ave Suite A
Redding,CA96001 		Surgery Center
3 Folsom Outpatient Surgery Center
1651 Creekside Drive
Folsom,CA95630 		Surgery Center
4 NICU Operating CO of Santa Cruz LLC
1555 Soquel dr
Santa Cruz,CA95065 		Neonatal Healthcare
5 Simon Med - Greenfield
1425 S Greenfield Suite 114
Mesa,AZ85206 		Imaging Center
6 USP Surgery Center - Parkway
100 N Green Valley Pkwy 125
Henderson,NV89074 		Surgery Center
7 Simon Med - Thunderbird III
5410 W Thunderbird Road Suites 1001
Glendale,AZ85306 		Imaging Center
8 Simon Med - Mountain View
9201 E Mountain View Road Suite 150
Scottsdale,AZ85258 		Imaging Center
9 Simon Med - Dobson III
235 S Dobson Suite 1 and 1870 W Fry
Chandler,AZ85224 		Imaging Center
10 Simon Med - Avondale
10815 W McDowell Rd Suite 102
Avondale,AZ85323 		Imaging Center
11 Simon Med - Spectrum
2680 S Val Vista Drive Bldg 7 Suite
Gilbert,AZ85295 		Imaging Center
12 Simon Med - San Francisco
325 Sacramento Street
San Francisco,CA94104 		Imaging Center
13 21st Century Oncology (Mt Shasta)
902 Pine St
Mt Shasta,CA96067 		Oncology
14 21st Century Oncology (Redding)
963 Butte Street
Redding,CA96001 		Oncology
15 USP Surgery Center - Durango
8530 W Sunset Rd
Las Vegas,NV89113 		Surgery Center
16 Simon Med - Sun City West
13624 W Camino Del Sol Suite 300
Sun City West,AZ85375 		Imaging Center
17 Simon Med - Baywood
130 S 63rd St Bldg 4
Mesa,AZ85206 		Imaging Center
18 Simon Med - SunCity - Peoria
9403 W Thunderbird Road
Peoria,AZ95381 		Imaging Center
19 Simon Med - Fiesta
1457 W Southern Ave Suite 26
Mesa,AZ85202 		Imaging Center
20 Simon Med - Desert Ridge
20830 N Tatum Blvd Suite 190
Phoenix,AZ85050 		Imaging Center
21 CHW Nevada Imaging Center Spring Valley
5495 S Rainbow Blvd 101 103 203
Las Vegas,NV89118 		Imaging Center
22 Santa Cruz Surgery Center
3003 Paul Sweet Rd
Santa Cruz,CA95065 		Surgery Center
23 Simon Med - Daly City
455 Hickey Blvd Suite 200
Daly City,CA94015 		Imaging Center
24 Warner Park Ambulatory Surgical
604 West Warner Road Bldg A
Chandler,AZ85225 		Surgery Center
25 Sacramento Midtown Endoscopy
3941 J St
Sacramento,CA95819 		Surgery Center
26 Simon Med - Deer Valley
20414 N 27th Avenue
Phoenix,AZ85027 		Imaging Center
27 Simon Med - Queen Creek
36297 N Gantzel Road Suite 101
Queen Creek,AZ85140 		Imaging Center
28 Renaissance Imaging Center at Northridge
18436 Roscoe Blvd
Northridge,CA91328 		Imaging Center
29 Simon Med - Palm Valley
13657 W McDowell Rd Suite 207
Goodyear,AZ85338 		Imaging Center
30 Simon Med - Fashion Square
6740 E Camelback Road Suites 100
Scottsdale,AZ85251 		Imaging Center
31 Roseville USP Surgery Center
1420 E Roseville Parkway No 100
Roseville,CA95661 		Surgery Center
32 Redding Surgery Center
2439 Sonoma
Redding,CA96001 		Surgery Center
33 Simon Med - Prescott Valley
3033 N Windsong Drive Suite 102
Prescott Valley,AZ86314 		Imaging Center
34 CHW Nevada Imaging Center Siena
861 Coronada Center Drive 101
Henderson,NV89052 		Imaging Center
35 Simon Med -Stand Up MRI of Beverly Hills
8370 Wilshire Blvd Suite 110
Beverly Hills,CA90211 		Imaging Center
36 Simon Med - Surprise Stadium Village
14823 W Bell Road Suite 110
Surprise,AZ85374 		Imaging Center
37 Simon Med - Redwood City
345 Convention Way Suite D1
Redwood City,CA94063 		Imaging Center
38 Folsom Sierra Endoscopy Center
1600 Creekside Drive
Folsom,CA95630 		Endoscopy Center
39 Simon Med - Burlingame
1860 El Camino Real Suite 101
Burlingame,CA94010 		Imaging Center
40 Crockett School Family Practice Clinic
4825 E Roosevelt Street
Phoenix,AZ85008 		Clinic
41 Simon Med - Mesa Drive
456 N Mesa Drive
Mesa,AZ85201 		Imaging Center
42 Simon Med - San Rafael
4144 Redwood Highway Suite B
San Rafael,CA94903 		Imaging Center
43 Simon Med - 19th Avenue
6707 N 19th Ave Suite 108
Phoenix,AZ85015 		Imaging Center
44 Dominican Breast Center
1661 Soquel Drive Bldg G
Santa Cruz,CA95065 		Imaging Center
45 Plaza Surgery Center
525 E Plaza 100
Santa Maria,CA93454 		Surgery Center
46 Simon Med - Maryvale
4616 N 51st Avenue Suite 104
Phoenix,AZ85031 		Imaging Center
47 Huger Mercy Living Center
2345 W Orangewood
Phoenix,AZ85021 		Asst Living Facility
48 Santa Cruz Comprehensive Imaging LLC
1685 Commercial Way
Santa Cruz,CA95065 		Imaging Center
49 Templeton Surgery Center
1310 Las Tablas Road Suite 104
Templeton,CA93465 		Surgery Center
50 Simon Med - Metro III
3201 W Peoria Ave Suite B301 B402
Phoenix,AZ85029 		Imaging Center
51 Trinity Care Infusion Services
18440 Roscoe Boulevard
Northridge,CA91325 		Infusion Center
52 Simon Med - San Francisco - MRI
50 Francisco Street Suite 105
San Francisco,CA94133 		Imaging Center
53 St Joseph's Medical Group Maternal Fetal
1727 W Frye Ste 210
Chandler,AZ85224 		Clinic
54 Dominican Magnetic Resonance Imaging Cen
1545 Soquel Dr
Santa Cruz,CA95065 		Imaging Center
55 Simon Med - Payson
117 E Main Street Suite D100
Payson,AZ85541 		Imaging Center
56 Woodland Adult Day Health
20 N Cottonwood St
Woodland,CA95695 		Health Center
57 St Joseph's Outpatient Surgergy Center
240 West thomas Road
Phoenix,AZ85013 		Surgery Center
58 Simon Med - Thompson Peak
7304 E Deer Valley Road Bldg E
Scottsdale,AZ85255 		Imaging Center
59 St Joseph's Medical Group Adult Cardiova
1727 W Frye Ste 210
Chandler,AZ85224 		Clinic
60 Surgery Center of Peoria
13260 North 94th Drive Suite 200
Peoria,AZ85381 		Surgery Center
61 Simon Med - Peoria Women's Center
9125 W Thunderbird Road Suite 100
Peoria,AZ85381 		Imaging Center
62 St Joseph's Medical Group Peoria North C
7727 W Deer Valley Rd
Peoria,AZ85382 		Clinic
63 The Barbara Greenspun Women's Care Cente
100 N Green Valley Pkwy Suite 330
Henderson,NV89074 		Health Center
64 Surgery Center of Scottsdale
8962 East Desert Cove Drive
Scottsdale,AZ85260 		Surgery Center
65 Radiation Oncology Center of Ventura Cou
1700 N Rose Ave 120
OxnardCamarillo,CA93030 		Surgery Center
66 Radiation Oncology Center of Ventura Cou
5301 Mission Oaks Boulevard Suite A
Camarillo,CA93012 		Surgery Center
67 Southwest Lithotripsy
100 W Third Ave Suite 350
Columbus,OH43201 		Lithotripsy
68 Northern Arizona Congenital Heart Center
1330 Rim Drive Ste A
Flagstaff,AZ86001 		Clinic
69 Simon Med - Ahwatukee
15810 S 45th St Suite 110
Phoenix,AZ85048 		Imaging Center
70 Metro Surgery Center LP
3131 W Peoria Ave
Phoenix,AZ95381 		Surgery Center
71 Chandler Endoscopy Center
2095 W Pecos Road Suite 1
Chandler,AZ85224 		Surgery Center
72 Desert Ridge Outpatient Surgery Center
20940 North Tatum Boulevard Suite 1
Phoenix,AZ85050 		Surgery Center
73 CHWUSP Oxnard Surgery Centers LLC
1700 N ROSE AVENUE STE 100
Oxnard,CA93030 		Surgery Center
74 St John's Regional Imaging Center LLC
1700 N Rose Ave 110
Oxnard,CA93030 		Imaging center
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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 TAX-EXEMPT 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. DIGNITY HEALTH 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). DIGNITY HEALTH'S FINANCIAL STATEMENTS ARE POSTED ON DIGNITY HEALTH'S EXTERNAL WEB SITE. SUMMARIES OF THE INDIVIDUAL HOSPITALS' REPORTS ARE POSTED ONLINE AND FULL REPORTS ARE AVAILABLE BY REQUEST.
Part I, Line 7b, 7g and 7i   Part I, Line 7b Included in community benefit expense for Medicaid, column (c), is $283.4 million of quality assurance fees assessed to Dignity Health in accordance with the California provider fee programs. Included in direct offsetting revenue for Medicaid, column (d), is $492.6 million in supplemental payments received under these programs. Part I, Line 7g DIGNITY HEALTH REPORTED $5,592,140 OF SUBSIDIZED HEALTH SERVICES ASSOCIATED WITH PHYSICIAN CLINICS AS THESE SERVICES ARE PROVIDED TO THE COMMUNITIES AT A FINANCIAL LOSS. IF DIGNITY HEALTH 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 7i Included in cash and in-kind contributions for community benefit is $17.3 million in grants to a fund established by the California Health Foundation and Trust ("CHFT"). CHFT was established for several purposes, including aggregating and distributing financial resources to support charitable activities at various hospitals and health systems in California.
Part I, Line 7, column (f)   THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) IS $827,350,057 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, DIGNITY HEALTH USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO PATIENTS. 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 AGGREGATED FOR EACH PATIENT BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH SERVICES PROVIDED TO EACH PATIENT. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF PAYMENT 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 PAYMENT 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 II - COMMUNITY BUILDING ACTIVITIES   AT DIGNITY HEALTH, EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE GO BEYOND PROVIDING HEALTH SERVICES. DIGNITY HEALTH'S ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND SERVICES OF THE ORGANIZATION. DIGNITY HEALTH 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 DIGNITY HEALTH COMMUNITY INVESTMENT PROGRAM, LOW INTEREST LOANS AND LINES OF CREDIT ARE PROVIDED TO NON-PROFITS THAT 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, DIGNITY HEALTH 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. DIGNITY HEALTH 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. DIGNITY HEALTH 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, EFFORTS TO RECRUIT 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 DIGNITY HEALTH 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. IN ADDITION, DIGNITY HEALTH'S DOMINICAN HOSPITAL IN SANTA CRUZ SUBSIDIZES LOW INCOME HOUSING. COMMUNITY BUILDING - ECONOMIC DEVELOPMENT o LEADERSHIP STAFF MEMBERS OF SEVERAL DIGNITY HEALTH 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 DIGNITY HEALTH 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 DIGNITY HEALTH TO IMPROVE AND SUSTAIN OUR ENVIRONMENT IS CODIFIED BY POLICIES, INCLUDING A PURCHASING POLICY WHICH PURSUES MULTIPLE ENVIRONMENTAL GOALS. FIRST, DIGNITY HEALTH SEEKS 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, DIGNITY HEALTH ATTEMPTS 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, DIGNITY HEALTH FOCUSES ON REUSE WITHIN THE HOSPITAL, TRANSFER TO ANOTHER USER (SUCH AS COMMUNITY ORGANIZATIONS), RECYCLING, AND FINALLY, 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 DIGNITY HEALTH 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 DIGNITY HEALTH MISSION STATEMENT SPECIFICALLY CALLS UPON US "TO PARTNER WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE." DIGNITY HEALTH 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 DIGNITY HEALTH 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 DIGNITY HEALTH 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 DIGNITY HEALTH 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. DIGNITY HEALTH SUPPORTS THE TRAINING AND RECRUITMENT OF UNDERREPRESENTED MINORITIES AND PARTICIPATES IN COMMUNITY WORKFORCE BOARDS AND PARTNERSHIPS o SEVERAL DIGNITY HEALTH 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 PAYMENT 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. DIGNITY HEALTH PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS AT OR BELOW 200% OR 500%, RESPECTIVELY, OF THE FEDERAL POVERTY LEVEL. DIGNITY HEALTH 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. DIGNITY HEALTH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR PAYMENT ASSISTANCE UPON ADMISSION. DIGNITY HEALTH'S PAYMENT 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, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, 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. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR PAYMENT 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 PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC 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, DIGNITY HEALTH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY. THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2012, 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. DIGNITY HEALTH REGULARLY REVIEWS ACCOUNTS AND CONTRACTS AND PROVIDES APPROPRIATE CONTRACTUAL ALLOWANCES, RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS THAT ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. MANAGEMENT PERIODICALLY REVIEWS THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORICAL EXPERIENCE, TRENDS IN HEALTH CARE COVERGE, AND OTHER COLLECTION INDICATORS.
Part III, Section B, Line 8   DIGNITY HEALTH 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. DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL OF $520.0 MILLION, AS REPORTED BELOW IN PART VI, LINE 6, WHICH IS NET OF PRIOR YEAR COST REPORT SETTLEMENTS OF $53.9 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 DIGNITY HEALTH 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 $410.0 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 DIGNITY HEALTH'S HOSPITALS.
Part III, Section C, Line 9b   DIGNITY HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. DIGNITY HEALTH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR PAYMENT ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE DIGNITY HEALTH FACILITY OR BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED PAYMENT ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'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, DIGNITY HEALTH 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. DIGNITY HEALTH 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 PAYMENT ASSISTANCE DEPARTMENT. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, DIGNITY HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.
PART V, SECTION B - FACILITY POLICIES AND PRACTICES   LINE 10 DIGNITY HEALTH OPERATES TWO FOR-PROFIT HOSPITALS THROUGH JOINT VENTURE ARRANGEMENTS. THESE HOSPITALS ARE SPECIALTY HOSPITALS THAT PRIMARILY PROVIDE ELECTIVE SURGERY TO PATIENTS. SOUTHWEST ORTHOPEDIC AND SPINE HOSPITAL PROVIDES A 35% DISCOUNT TO ALL SELF-PAY PATIENTS. LINE 13G SEE BELOW FOR PART VI, LINE 3 - PATIENT EDUCATION ON ELIGIBILITY FOR ASSISTANCE FOR ADDITIONAL DISCLOSURES RELATED TO DIGNITY HEALTH'S PAYMENT ASSISTANCE PROGRAM. ADDITIONAL MEASURES TAKEN TO PUBLICIZE DIGNITY HEALTH'S PAYMENT ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS, A COPY OF THE CHARITY CARE APPLICATION, A TELEPHONE NUMBER FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM, AVAILABLITY OF INFORMATION IN LANGUAGES OTHER THAN ENGLISH, CONTACT INFORMATION FOR FINANCIAL COUNSELORS OR OTHER REPRESENTATIVES WHO CAN PROVIDE INFORMATION, AND THE FACILITY'S WEBPAGE ADDRESS WHERE ADDITIONAL INFORMATION AND APPLICATIONS CAN BE ACCESSED. LINE 19D AT ALL OF DIGNITY HEALTH'S TAX-EXEMPT HOSPITALS, PATIENTS WHO ARE APPLYING FOR DISCOUNTS UNDER THE DISCOUNT PROVISION POLICY WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES. PATIENTS WHOSE INCOME IS ABOVE 350% BUT NOT MORE THAN 500% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT 135% OF THE AVERAGE RATES OF PAYMENT THE DIGNITY HEALTH FACILITY WOULD RECEIVE FOR PROVIDING SERVICES TO PATIENTS COVERED BY MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFITS IN WHICH THE HOSPITAL PARTICIPATES, WHICHEVER IS GREATER. SOUTHWEST ORTHOPEDIC AND SPINE HOSPITAL DOES NOT HAVE A LIMIT ON THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR DISCOUNTED EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AS A MAJORITY OF THE CARE PROVIDED IS ELECTIVE RATHER THAN EMERGENCY OR OTHER MEDICALLY NECESSARY, HOWEVER, A 35% DISCOUNT IS PROVIDED TO ALL SELF-PAY PATIENTS. THOSE ELIGIBLE FOR CHARITY CARE ARE NOT CHARGED ANY AMOUNT.
PART VI, LINE 2 - NEEDS ASSESSMENT   IN ACCORDANCE WITH DIGNITY HEALTH POLICY AND CALIFORNIA STATE SENATE BILL 697, ALL OF DIGNITY HEALTH'S TAX-EXEMPT 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 DIGNITY HEALTH SERVES. MANY DIGNITY HEALTH HOSPITALS CONDUCT ASSESSMENTS THROUGH THE AUSPICES OF MULTI-HOSPITAL CONSORTIA. OTHER DIGNITY HEALTH 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. DIGNITY HEALTH 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, DIGNITY HEALTH, IN PARTNERSHIP WITH THOMSON REUTERS (FORMERLY SOLUCIENT), DEVELOPED A COMMUNITY NEED INDEX (CNI), WHICH PROVIDES AN AGGREGATE SCORE OF THE SOCIOECONOMIC 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 DIGNITY HEALTH 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 DIGNITY HEALTH'S WEBSITE: HTTP://WWW.DIGNITYHEALTH.ORG/WHO_WE_ARE/COMMUNITY_HEALTH/STGSS044508
PART VI, LINE 3 - PATIENT EDUCATION ON ELIGIBILITY FOR ASSISTANCE   COMMUNICATION OF THE PAYMENT ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC FOR DIGNITY HEALTH'S WHOLLY OWNED HOSPITALS: INFORMATION ABOUT DIGNITY HEALTH'S PAYMENT ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S PAYMENT ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. PAYMENT ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE DIGNITY HEALTH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES DIGNITY HEALTH'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 PAYMENT 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 DIGNITY HEALTH'S WEBSITE AT WWW.DIGNITYHEALTH.ORG. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S PAYMENT ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. UNINSURED PATIENTS RECEIVE COPIES OF THE PAYMENT ASSISTANCE AND MEDICAID APPLICATIONS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. IT IS DIGNITY HEALTH'S POLICY THAT AT THE TIME OF PATIENT BILLING, DIGNITY HEALTH FACILITIES PROVIDE TO ALL UNINSURED PATIENTS THE SAME BILLING INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT DIGNITY HEALTH FACILITIES. IF PAYMENT 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 PAYMENT ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR PAYMENT ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF DIGNITY HEALTH REQUIRE ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S PAYMENT ASSISTANCE PROGRAM AND A COPY OF THE PAYMENT ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE DIGNITY HEALTH FACILITY STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR PAYMENT ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR PAYMENT ASSISTANCE.
PART VI, LINE 4 - COMMUNITY INFORMATION   DIGNITY HEALTH DELIVERS CARE TO DIVERSE COMMUNITIES ACROSS ARIZONA,CALIFORNIA AND NEVADA. FOLLOWING IS A SUMMARY OF THE COMMUNITIES SERVED BY DIGNITY HEALTH, INCLUDING THE DEMOGRAPHICS OF EACH COMMUNITY. DIGNITY HEALTH HOSPITALS DEFINE THE COMMUNITY AS THE GEOGRAPHIC AREA SERVED BY THE HOSPITAL, CONSIDERED ITS PRIMARY SERVICE AREA. THIS IS BASED ON A PERCENTAGE OF HOSPITAL DISCHARGES AND IS ALSO USED IN VARIOUS OTHER DEPARTMENTS OF THE SYSTEM AND HOSPITAL, INCLUDING STRATEGY AND PLANNING: 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 CONDUCTED 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. ARROYO GRANDE COMMUNITY DEMOGRAPHICS -POPULATION 76,494 -DIVERSITY 67% CAUCASIAN, 26.4% HISPANIC, 3.0% ASIAN, 0.7% AFRICAN AMERICAN, 2.9% OTHER -AVERAGE INCOME $76,346 -UNINSURED 15.14% -UNEMPLOYMENT 4.1% -NO HS DIPLOMA 12% -RENTERS 29.4% -CNI SCORE 3.4 -MEDICAID PATIENTS 8.5% -OTHER AREA HOSPITALS 2 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. CALIFORNIA HOSPITAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 1,278,702 -DIVERSITY 5.1% CAUCASIAN, 64.7% HISPANIC, 5.6% ASIAN, 22.9% AFRICAN AMERICAN, 1.7% OTHER -AVERAGE INCOME $44,966 -UNINSURED 40.66% -UNEMPLOYMENT 7.5% -NO HS DIPLOMA 42.20% -RENTERS 66% -CNI SCORE 5 -MEDICAID PATIENTS 33.35% -OTHER AREA HOSPITALS 6 CHANDLER REGIONAL MEDICAL CENTER - A 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 DIGNITY HEALTH CNI, THE U.S. CENSUS BUREAU, AND THE ARIZONA DISEASE CONTROL AND PREVENTIONS BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND A MEDICALLY UNDERSERVED POPULATION IN SEVERAL ZIP CODES OF THE SERVICE AREA. CHANDLER REGIONAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 853,712 -DIVERSITY 59.48% CAUCASIAN, 25.10% HISPANIC, 5.30% ASIAN, 4.80% AFRICAN AMERICAN, 5.32% OTHER -AVERAGE INCOME $73,599 -UNINSURED 19.39% -UNEMPLOYMENT 5.8% -NO HS DIPLOMA 11.60% -RENTERS 31.9% -CNI SCORE 2.8 -MEDICAID PATIENTS 17.76% -OTHER AREA HOSPITALS 2 PRIMARY SERVICE AREA -OTHER SERVICE HOSPITALS 12 SECONDARY SERVICE AREA DOMINICAN HOSPITAL - THE PRIMARY SERVICE AREA IS SANTA CRUZ COUNTY WHICH COVERS 441 SQUARE MILES, AND IS A RELATIVELY 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. DOMINICAN HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 230,387 -DIVERSITY 55.1% CAUCASIAN, 36.9% HISPANIC, 4% ASIAN, 0.9% AFRICAN AMERICAN, 3.1% OTHER -AVERAGE INCOME $84,016 -UNINSURED 15.85% -UNEMPLOYMENT 5.6% -NO HS DIPLOMA 17.4% -RENTERS 38.3% -CNI SCORE 2.9 -MEDICAID PATIENTS 14.50% -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. FRENCH HOSPITAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 233,399 -DIVERSITY 70.3% CAUCASIAN, 21.0% HISPANIC, 3.4% ASIAN, 2.1% AFRICAN AMERICAN, 3.2% OTHER -AVERAGE INCOME $71,165 -UNINSURED 19.27% -UNEMPLOYMENT 4.8% -NO HS DIPLOMA 11.50% -RENTERS 35.1% -CNI SCORE 3.4 -MEDICAID PATIENTS 10.84% -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, SOCIOECONOMIC 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. GLENDALE MEMORIAL HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 1,147,351 -DIVERSITY 32.8% CAUCASIAN, 48.1% HISPANIC, 13.3% ASIAN, 3.5% AFRICAN AMERICAN, 2.3% OTHER -AVERAGE INCOME $61,822 -UNINSURED 27.74% -UNEMPLOYMENT 6.8% -NO HS DIPLOMA 26.60% -RENTERS 59.2% -CNI SCORE 4.6 -MEDICAID PATIENTS 22.79% -OTHER AREA HOSPITALS 2 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 POPUL
.   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. EIGHT FOCUS GROUPS (SIX ENGLISH AND TWO 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. ST. BERNARDINE MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 1,127,424 -DIVERSITY 28.9% CAUCASIAN, 55.7% HISPANIC, 4.5% ASIAN, 8.5% AFRICAN AMERICAN, 2.4% OTHER -AVERAGE INCOME $59,401 -UNINSURED 25.43% -UNEMPLOYMENT 8.0% -NO HS DIPLOMA 25.90% -RENTERS 31.60% -CNI SCORE 4.5 -MEDICAID PATIENTS 23.59% -OTHER AREA HOSPITALS 5 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. 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. 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. ST. ELIZABETH HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 86,414 -DIVERSITY 68.9% CAUCASIAN, 24.7% HISPANIC, 1.4% ASIAN, 0.5% AFRICAN AMERICAN, 4.5% OTHER -AVERAGE INCOME $49,847 -UNINSURED 29.24% -UNEMPLOYMENT 5.6% -NO HS DIPLOMA 20.90% -RENTERS 33.8% -CNI SCORE 4.4 -MEDICAID PATIENTS 23.22% -OTHER AREA HOSPITALS 1 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. ST. JOHN'S PLEASANT VALLEY HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 222,842 -DIVERSITY 27.0% CAUCASIAN, 60.8% HISPANIC, 8.2% ASIAN, 1.9% AFRICAN AMERICAN, 2.1% OTHER -AVERAGE INCOME $ 83,468 -UNINSURED 12.01% -UNEMPLOYMENT 6.2% -NO HS DIPLOMA 28.40% -RENTERS 36.2% -CNI SCORE 3.5 -MEDICAID PATIENTS 15.84% -OTHER AREA HOSPITALS 4 ST. JOHN'S REGIONAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 236,827 -DIVERSITY 16.1% CAUCASIAN, 72.8% HISPANIC, 6.9% ASIAN, 2.3% AFRICAN AMERICAN, 1.9% OTHER -AVERAGE INCOME $70,214 -UNINSURED 12.86% -UNEMPLOYMENT 6.2% -NO HS DIPLOMA 34.50% -RENTERS 41.1% -CNI SCORE 4.1 -MEDICAID PATIENTS 16.96% -OTHER AREA HOSPITALS 5 ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER - ST. JOSEPH'S HOSPITAL DRAWS APPROXIMATELY 90% OF ITS PATIENTS FROM MARICOPA COUNTY WITH THE REMAINDER DRAWING FROM FROM OUTSIDE MARICOPA COUNTY BUT WITHIN ARIZONA, OR 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). ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 3,262,225 -DIVERSITY 51.4% CAUCASIAN, 36.1% HISPANIC, 3.4% ASIAN, 5.2% AFRICAN AMERICAN, 3.9% OTHER -AVERAGE INCOME $62,976 -UNINSURED 19.39% -UNEMPLOYMENT 6.2% -NO HS DIPLOMA 18.4% -RENTERS 32.2% -CNI SCORE 3.8 -MEDICAID PATIENTS 17.76% -OTHER AREA HOSPITALS 38 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. ST. JOSEPH'S HOSPITAL / ST. JOSEPH'S BEHAVIORAL HEALTH CENTER COMMUNITY DEMOGRAPHICS -POPULATION 362,584 -DIVERSITY 39.5% CAUCASIAN, 40.0% HISPANIC, 11.4% ASIAN, 5.4% AFRICAN AMERICAN, 3.7% OTHER -AVERAGE INCOME $57,497 -UNINSURED 28.03% -UNEMPLOYMENT 9.9% -NO HS DIPLOMA 29.40% -RENTERS 40.2% -CNI SCORE 4.6 -MEDICAID PATIENTS 27.60% -OTHER AREA HOSPITALS 7 ST. MARY MEDICAL CENTER, LONG BEACH - ST. MARY MEDICAL CENTER IS LOCATED IN LONG BEACH, CA, THE SECOND LARGEST CITY IN LOS ANGELES COUNTY AND 34TH IN THE NATION. ST. MARY MEDICAL CENTER ALSO SERVES
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH   USE OF SURPLUS FUNDS - AS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, DIGNITY HEALTH REINVESTS ALL OF ITS SURPLUS FUNDS FROM ITS OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR US TO DELIVER ON OUR MISSION, INCLUDING ENSURING THAT EVERYONE IN THE COMMUNITIES WE SERVE 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 DIGNITY HEALTH BOARD OF DIRECTORS ESTABLISHES KEY MEASURES OF SYSTEM-WIDE COMMUNITY BENEFIT PERFORMANCE AND RECEIVES REGULAR REPORTS ON PROGRESS TOWARD ESTABLISHED GOALS. DIGNITY HEALTH HOSPITAL COMMUNITY BOARDS AND SUBSIDIARY BOARDS (COMMUNITY BOARDS), WHICH ARE RATIFIED BY THE DIGNITY HEALTH 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 ENSURE THAT THE COMMUNITY BOARD IS REGULARLY BRIEFED ON ACTIVITIES AND DEVELOPMENTS AND 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. DIGNITY HEALTH 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 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 DIGNITY HEALTH 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 DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 2012, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 108,530 188,380,000 2.0% Unpaid Costs of Medicaid/Medi-Cal 1,060,508 571,491,000 6.0% Other Means-tested Programs 280,517 66,067,000 0.7% Community Services: Community Health Services 525,831 53,467,000 0.6% Health Professions Education 86 27,000 0.0% Subsidized Health Services 193,751 28,297,000 0.3% Donations 155,219 33,140,000 0.3% Community Building Activities 12,811 1,623,000 0.0% Community Benefit Operations 3,884 8,911,000 0.1% Total Community Services for the poor 891,582 125,465,000 1.3% Total Benefits for the Poor 2,341,137 951,403,000 10.0% Benefits for the Broader Community: Community Services: Community Health Services 585,949 17,034,000 0.2% Health Professions Education 68,974 69,132,000 0.7% Subsidized Health Services 9,430 2,210,000 0.0% Research 26,281 30,049,000 0.3% Donations 165,149 7,584,000 0.1% Community Building Activities 38,641 3,138,000 0.0% Community Benefit Operations 87 1,446,000 0.0% Total Benefits for the Broader Community 894,511 130,593,000 1.3% Total Community Benefits 3,235,648 1,081,996 11.3% Unpaid Costs of Medicare 1,116,214 519,981,000 5.4% Total Community Benefits including Cost of Medicare 4,351,862 1,601,977,000 16.7%
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CA,NV,
Schedule H (Form 990) 2011
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
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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) 1736 Family Crisis Center2116 Arlington Ave Ste 200
Los Angeles,CA90018 		95-3989251 501(c)(3) 18,008   N/A N/A Social Health
(2) About Care Inc600 W Ray Rd
Chandler,AZ85225 		34-2047687 501(c)(3) 12,672   N/A N/A Quality of Life
(3) Access to Healthcare Network Inc4001 S Virginia Street Ste F
Reno,NV89502 		72-1619489 501(c)(3) 25,000   N/A N/A Service for the Poor Friends Fore Golf
(4) ALLAN HANCOCK COLLEGE800 S COLLEGE DR
SANTA MARIA,CA93454 		52-1692042 Govt 215,000   N/A N/A Educational Support
(5) Alliance for Housing and Healing825 Colorado Blvd Suite 100
Los Angeles,CA90041 		95-4147364 501(c)(3) 15,015   N/A N/A Social Health
(6) Alliance for Pharmaceutical Access Inc237 Town Center West 122
Santa Maria,CA93458 		20-3117940 501(c)(3) 78,750   N/A N/A Service for the Poor
(7) Al-Shifi Clinic Inc2034-B Mallory St
San Bernardino,CA92407 		33-0855769 501(c)(3) 20,000   N/A N/A Service for the Poor
(8) Alzheimer's Disease And Related Disorders Assoc9213 Archibald Ave
Rancho Cucamonga,CA91730 		95-3718119 501(c)(3) 10,000   N/A N/A Quality of Life
(9) Alzheimer's Disease Assoc of Kern County5500 Olive Dr Bldg 1
Bakersfield,CA93308 		77-0017561 501(c)(3) 45,858   N/A N/A Quality of Life
(10) American Cancer Society Inc1523 California Ave
Bakersfield,CA93304 		94-1170350 501(c)(3) 8,500   N/A N/A Social Health
(11) American Heart Association Inc4445 S Jones Suite B-1
Las Vegas,NV89141 		13-5613797 501(c)(3) 180,106   N/A N/A Social Health
(12) American Lung Assoc of the Southwest Inc10615 Double R Boulevard
Reno,NV89521 		86-0111676 501(c)(3) 31,251   N/A N/A Social Health
(13) American Lung Association in California441 Mackay Drive
San Bernardino,CA92408 		94-0362650 501(c)(3) 15,000   N/A N/A Educational Support
(14) American Red Cross1355 Ohio Avenue
Los Angeles,CA90025 		53-0196605 501(c)(3) 10,160   N/A N/A Social Health
(15) AMERICAN RED CROSS85 2ND ST 8TH Fl
SAN FRANCISCO,CA94105 		94-3045430 501(c)(3) 100,000   N/A N/A Social Health
(16) ANDRE AGASSI FOUNDAtion for Education3960 HOWARD HUGHES PKWY STE 750
LAS VEGAS,NV89109 		34-1759295 501(c)(3) 11,390   N/A N/A Educational Support
(17) Arizona Facts of Life Inc1122 E Buckeye Road Ste A-4
Phoenix,AZ85034 		86-1078466 501(c)(3) 25,000   N/A N/A Social Health
(18) Arizona State University Foundation300 E University Drive
Tempe,AZ85281 		86-6051042 501(c)(3) 51,100   N/A N/A educational support
(19) Arizona's Children Association2833 N 3rd Street
Phoenix,AZ85004 		86-0096772 501(c)(3) 50,000   N/A N/A Social Health
(20) ARROYO GRANDE COMMUNITY HOSP FOUNDATION345 S Halcyon Rd
ARROYO GRANDE,CA93406 		20-3256066 501(c)(3) 237,712   N/A N/A Foundation Support
(21) ARTHRITIS FOUNDATION2261 LAS POSITAS
SANTA BARBARA,CA93105 		95-1885447 501(c)(3) 22,500   N/A N/A Preventative Care
(22) Asian Pacific Community in Action6741 N 7th Street
Phoenix,AZ85014 		75-3040117 501(c)(3) 20,880   N/A N/A Social Health
(23) Asian Pacific Self-Development & Residential3830 N Alvarado Ave Suite C
Stockton,CA95204 		68-0224100 501(c)(3) 24,000   N/A N/A Social Health
(24) ASIAN WEEK FOUNDATION564 MARKET ST
SAN FRANCISCO,CA94104 		20-1719535 501(c)(3) 11,000   N/A N/A Quality of Life
(25) Assistance League of San Bernardino580 West 6th St
San Bernardino,CA92410 		95-6065105 501(c)(3) 22,500   N/A N/A Service for the Poor
(26) Atwater Police Activities League750 Bellevue Road
1200
Atwater,CA95301 		77-0451403 501(c)(3) 10,000   N/A N/A Social Health
(27) Bakersfield College1801 Panorama Drive
115
Bakersfield,CA93307 		95-6006644 Govt 130,145   N/A N/A Educational Support Training Kits
(28) Bakersfield Sports FoundationPO Box 13221
Bakersfield,CA93389 		27-0198735 501(c)(3) 20,000   N/A N/A Quality of Life
(29) Barrow Foundation UK350 W Thomas Rd
Phoenix,AZ85013 		31-1724184 501(c)(3) 142,799   N/A N/A Foundation Support
(30) Barrow Neurological Foundation350 W Thomas Rd
Phoenix,AZ85013 		86-0174371 501(c)(3) 2,497,161   N/A N/A Foundation Support
(31) BAY AREA COUNCIL201 CALIFORNIA ST 1450
SAN FRANCISCO,CA94111 		23-7325853 501(c)(4) 50,000   N/A N/A Quality of Life
(32) Bayview Hunters Point Multipurpose Senior Ctr Inc1706 Yosemite Ave
San Francisco,CA94134 		94-2186268 501(c)(3) 20,000   N/A N/A Social Health
(33) Behavioral Health Services Inc15519 Crenshaw Boulevard
Gardena,CA90249 		95-2838006 501(c)(3) 15,240   N/A N/A Social Health
(34) Bishop Gallegos Maternity Home6423 Lang Avenue
Sacramento,CA95823 		68-0315971 501(c)(3) 45,000   N/A N/A Social Health
(35) Black Nurses Association Inc5060 N 19th Ave 210
Phoenix,AZ85015 		95-3543065 501(c)(3) 25,000   N/A N/A Preventative Care
(36) Board Of Regents Nevada System Of Higher Education1664 N Virginia St
Reno,NV89557 		88-6000024 Govt 59,910   N/A N/A educational support
(37) Boys & Girls Club of Camarillo1500 Templar Avenue
Camarillo,CA93010 		95-6194547 501(c)(3) 10,000   N/A N/A social health
(38) Boys & Girls Club of Greater Oxnard & Port Hueneme1900 W 5th Street
Oxnard,CA93030 		95-1785162 501(c)(3) 19,000   N/A N/A Social Health
(39) Boys & Girls Club of Merced615 W 15th Street
Merced,CA95340 		77-0357487 501(c)(3) 17,000   N/A N/A Social Health
(40) Boys & Girls Club of Redlands Inc1251 Clay Street
Redlands,CA92374 		95-6187083 501(c)(3) 13,000   N/A N/A Social Health
(41) BOYS & GIRLS CLUB OF SANTA MARIA VALLEY901 N RAILROAD
SANTA MARIA,CA93458 		95-2468116 501(c)(3) 7,560   N/A N/A Social Health
(42) Boys & Girls Club of Southern Nevada6330 S Sandhill Rd Ste 3
Las Vegas,NV89120 		88-0095779 501(c)(3) 7,500   N/A N/A Social Health
(43) Cabrillo College Foundation6500 Soquel Dr
Aptos,CA95003 		94-6121953 501(c)(3) 10,000   N/A N/A Social Health
(44) Cal State Bakersfield Foundation9001 Stockdale Hwy
Bakersfield,CA93311 		95-2643086 501(c)(3) 6,000   N/A N/A Educational Support
(45) Calaveras Mentoring Foundation150 Big Trees Road Ste D
Murphys,CA95247 		80-0512251 501(c)(3) 8,677   N/A N/A Service for the Poor
(46) California Dragon Boat Association268 Bush St 888
San Francisco,CA94104 		52-2153488 501(c)(3) 10,000   N/A N/A Quality of Life
(47) California Health Foundation and Trust1215 K Street Ste 800
Sacramento,CA95814 		94-1498697 501(c)(3) 17,337,428   N/A N/A Service for the Poor
(48) California Hospital Medical Ctr Foundation1401 South Grand Ave
Los Angeles,CA90015 		95-4000909 501(c)(3) 1,607,919   N/A N/A Foundation Support
(49) CALIFORNIA MED ASSOCIATION FOUNDATION3835 N FREEWAY BLVD STE 100
SACRAMENTO,CA95834 		94-6062822 501(c)(3) 35,000   N/A N/A Social Health
(50) California State University StanislausOne University Circle
Turlock,CA95382 		77-0207337 Govt 9,500   N/A N/A Scholarship Support
(51) California State University Stanislaus FndOne University Circle
Turlock,CA95382 		77-0492209 501(c)(3) 100,000   N/A N/A Educational Support
(52) Camarillo Health Care District3639 E Las Posas Rd Ste 117
Camarillo,CA93010 		95-2834854 Govt 10,000 0 N/A N/A Social Health
(53) Camarillo Hospice Corp400 Rosewood Avenue Ste 102
Camarillo,CA93010 		95-3347061 501(c)(3) 10,000   N/A N/A Service for the Poor
(54) Cancer Support Community-Santa Monica1990 S Bundy Drive 100
Los Angeles,CA90025 		33-0287070 501(c)(3) 18,008   n/a n/a Social Health
(55) Cancer Well Fit Inc6699 Bay Laurel Place
Avila Beach,CA93424 		27-3635992 501(c)(3) 14,300   N/A N/A Social Health
(56) CARE Chest of Sierra Nevada7910 N Virginia Street
Reno,NV89506 		94-3118373 501(c)(3) 27,455   N/A N/A Service for the Poor
(57) Carenow8000 McConnell Ave
los angeles,CA90045 		27-2984870 501(c)(3) 50,000   N/A N/A Preventative Care
(58) Catholic Charities CYO of the Archdiocese2255 HAYES ST
SAN FRANcISCO,CA94117 		94-1498472 501(c)(3) 23,250   N/A N/A Quality of Life
(59) Catholic Charities of LA123 East 14th Street
Long Beach,CA90813 		95-1690973 501(c)(3) 8,500   N/A N/A Service for the Poor
(60) Catholic Charities of Stockton1106 N El Dorado Street
Stockton,CA95202 		94-1629114 501(c)(3) 25,000   N/A N/A Service for the Poor
(61) Catholic Charities San Bernardino Riverside1450 North D St
San Bernardino,CA92411 		95-3516461 501(c)(3) 17,500   N/A N/A Social Health
(62) Catholic Relief Services228 W Lexington St
Baltimore,MD21201 		13-5563422 501(c)(3) 500,000   N/A N/A Service for the poor
(63) Celebrity Fight Night Foundation Inc2111 E Highland Ave Ste 135
Phoenix,AZ85016 		86-0903119 501(c)(3) 81,000   N/A N/A Preventative Care
(64) Center for Community Health and Well-Being1900 T Street
Sacramento,CA95811 		68-0248303 501(c)(3) 35,800   N/A N/A Service for the Poor
(65) Center for Healthcare Decisions3400 Data Drive
Rancho Cordova,CA95670 		68-0441958 501(c)(3) 15,000   N/A N/A Social Health
(66) Center for Healthy Aging11 Fillmore Way
Reno,NV89519 		37-1581035 501(c)(3) 9,840   N/A N/A Preventative Care
(67) CENTRAL COAST COMMISSION FOR SENIOR CITIZENS528 SOUTH BROADWAY
SANTA MARIA,CA93434 		95-2943625 501(c)(3) 5,457   N/A N/A Social Health
(68) CENTRAL COAST RESCUE MISSION1207 N MCCLELLAND ST
SANTA MARIA,CA93454 		23-7278002 501(c)(3) 5,457   N/A N/A Service for the Poor
(69) Cerebral Palsy Association of Merced County632 W 13th Street
Merced,CA95340 		94-1494854 501(c)(3) 8,000   N/A N/A Social Health
(70) Chandler Chamber of Commerce475 S Dobson Road
Chandler,AZ85224 		86-0107200 501(c)(6) 6,188   N/A N/A Social Health
(71) Chandler Education Foundation Inc1525 W Frye Road
Chandler,AZ85224 		86-0589677 501(c)(3) 50,000   N/A N/A Educational Support
(72) Child Advocates of Nevada County200 Providence Mine Rd Ste 208
Nevada City,CA95959 		68-0317841 501(c)(3) 10,000   N/A N/A Quality of life
(73) Child Crisis Center817 N Country Club Dr
Mesa,AZ85201 		86-0407090 501(c)(3) 12,000   N/A N/A Social Health
(74) Children's Dental Foundation455 E Columbia St Ste 32
Long Beach,CA90806 		95-2111124 501(c)(3) 15,000   N/A N/A Social Health
(75) Children's Heart Foundation3006 S Maryland Pkwy
Las Vegas,NV89109 		88-0405506 501(c)(3) 5,500   N/A N/A Preventative care
(76) Citizens Who Care Inc1017 Main Street
Woodland,CA95695 		68-0154969 501(c)(3) 7,500   N/A N/A Quality of Life
(77) Clark County Medical Society Auxiliary2590 Russell Road
Las Vegas,NV89120 		23-7290810 501(c)(3) 6,400   N/A N/A Quality of Life
(78) Clinic by the Bay4877 Mission Street
San Francisco,CA94618 		26-2593712 501(c)(3) 10,000   N/A N/A Preventative Care
(79) Community Action Partnership of San Luis Obispo Co1030 Southwood Dr
San Luis Obispo,CA93401 		95-2410253 501(c)(3) 5,500   N/A N/A Service for the Poor
(80) Community Bridges236 Santa Cruz Avenue
Aptos,CA95003 		94-2460211 501(c)(3) 48,495   N/A N/A Preventative Care
(81) Community Medical Center Inc7210 Murray Drive
Stockton,CA95210 		94-2437106 501(c)(3) 55,000   N/A N/A Social Health
(82) Community Service Education and Research Fund5380 Elvas Avenue
Sacramento,CA95819 		23-7003581 501(c)(3) 15,000   N/A N/A Service for the Poor
(83) County of Santa Cruz701 Ocean St Suite 340
Santa Cruz,CA95060 		94-6000534 Govt 16,310   N/A N/A Social Health
(84) Court Appointed Special Advocates Of Kern County2000 24th St Ste 130
Bakersfield,CA93301 		77-0344298 501(c)(3) 40,000   N/A N/A Social Health
(85) CUESTA COLLEGE FOUNDATIONPO BOX 8016
SAN LUIS OBISPO,CA93403 		23-7225601 501(c)(3) 30,000   N/A N/A Educational Support
(86) Curry Senior Center333 Turk Street
San Francisco,CA94102 		23-7362588 501(c)(3) 12,240   N/A N/A Social Health
(87) Dientes Community Dental Care1830 Commercial Way
Santa Cruz,CA95065 		77-0311752 501(c)(3) 10,000   N/A N/A Preventative Care
(88) Dignity Health Foundation East Valley1727 West Frye Rd
Chandler,AZ85224 		74-2418514 501(c)(3) 1,479,462   N/A N/A Foundation Support
(89) Dignity Health Medical Foundation3400 Data Drive
Rancho Cordova,CA95670 		68-0220314 501(c)(3) 99,164,931   N/A N/A Medical Fnd Support
(90) Dignity's Alcove Inc141 S California Street
Stockton,CA95202 		51-0574997 N/A 25,000   N/A N/A Social Health
(91) Domestic Violence and Sexual Assault Coalition Inc960 McCourtney Rd Ste E
Grass Valley,CA95949 		94-2688893 501(c)(3) 10,000   N/A N/A Social Health
(92) DOMINICAN HOSPITAL FOUNDATION1555 SOQUEL DRIVE
SANTA CRUZ,CA95065 		94-2450442 501(C)(3) 776,340   N/A N/A FOUNDATION SUPPORT
(93) DOMINICAN UNIVERSITY OF CAlifornia50 ACACIA AVE
600
SAN RAFAEL,CA94901 		94-1156525 501(c)(3) 6,000   N/A N/A Educational Support
(94) Easter Seals Nevada6200 W Oakey Blvd
Las Vegas,NV89146 		94-2815686 501(c)(3) 40,000   N/A N/A Social Health
(95) Effort Inc1820 J Street
Sacramento,CA95811 		94-1713704 501(c)(3) 241,344   N/A N/A Quality of Life
(96) El Centrito Family Learning Center937 W 5th Street
Oxnard,CA93032 		31-1652255 501(c)(3) 10,000   N/A N/A Service for the Poor
(97) El Dorado County Community Health4327 Golden Ctr Dr
Placerville,CA95667 		42-1533531 501(c)(3) 45,000   N/A N/A Social Health
(98) El Hogar Community Services Inc3780 Rosin Crt Ste 110
Sacramento,CA95834 		68-0032730 501(c)(3) 90,000   N/A N/A Quality of Life
(99) El Nido Family Centers10200 Sepulveda Blvd Ste 350
Mission Hills,CA91345 		95-3186429 501(c)(3) 25,000   N/A N/A Social Health
(100) El Sol Neighborhood Educational Center1717 W 5th Street
San Bernardino,CA92411 		33-0552297 501(c)(3) 19,305   N/A N/A Social Health
(101) Enrichment Works5605 Woodman Ave Ste 207
Valley Glen,CA91401 		95-4754624 501(c)(3) 18,008   N/A N/A Quality of Life
(102) Esperanza Inc1911 W Earl Drive
Phoenix,AZ85015 		23-7087997 501(c)(3) 50,000   N/A N/A Service for the poor
(103) Families First Inc2100 Fifth Street
Davis,CA95618 		94-2295953 501(c)(3) 10,000   N/A N/A Social Health
(104) Family Service Agency of Tehama County1347 Grant Street
Red Bluff,CA96080 		94-1616456 501(c)(3) 13,960   N/A N/A Social Health
(105) First 5 Shasta1135 Pine Street Ste 21
Redding,CA96001 		68-0475361 Govt 35,000   N/A N/A Social Health
(106) Food Bank of Northern Nevada Inc550 Italy Drive
McCarran,NV89434 		94-2924979 501(c)(3) 50,000   N/A N/A Service for the Poor
(107) Food bank of Santa Barbara County490 West Foster Road
Santa Maria,CA93455 		77-0169214 501(c)(3) 10,250   N/A N/A Service for the Poor
(108) FOOD Share Inc4156 Southband Road
Oxnard,CA93036 		77-0018162 501(c)(3) 20,000   N/A N/A Social Health
(109) For the Child Inc4565 California Avenue
Long Beach,CA90807 		95-3601230 501(c)(3) 15,000   N/A N/A Quality of Life
(110) FOUNDATION OF THE SANTA BARBARA REGIONAL HEALTH AU4050 CALLE REAL
SANTA BARBARA,CA93110 		81-0587227 501(c)(3) 5,457   N/A N/A Preventative Care
(111) FRENCH HOSPITAL MEDICAL CENTER FOUNDATION1911 JOHNSON AVE
SAN LUIS OBISPO,CA93405 		20-3256125 501(c)(3) 552,201   N/A N/A Foundation Support
(112) Fresh Start Women's Foundation1130 E McDowell Road
Phoenix,AZ85006 		86-0762610 501(c)(3) 9,250   N/A N/A Social Health
(113) GET OFF THE COUCH POTATO SPORTS PRODUCTIONSPO BOX 13959
SAN LUIS OBISPO,CA93406 		27-2625758 N/A 12,000   N/A N/A Social Health related
(114) Gifts to Share Inc1231 I Street 400
Sacramento,CA95814 		94-2985546 501(c)(3) 51,000   N/A N/A Quality of Life
(115) Girl Scouts Heart of California6601 Elvas Avenue
Sacramento,CA95819 		94-1582429 501(c)(3) 10,000   N/A N/A Preventative Care
(116) Girls Inc of the Northern Sacramento Valley332 Pine Street Ste H
Red Bluff,CA96080 		54-2192527 501(c)(3) 9,570   N/A N/A Social Health
(117) Glaucoma Research & Education Group Inc55 Stevenson Street
San Francisco,CA94105 		94-3208182 501(c)(3) 26,000   N/A N/A Educational Support
(118) Glendale Association for the Retarded6512 San Fernando Road
Glendale,CA91201 		95-1976088 501(c)(3) 13,000   N/A N/A Social Health
(119) Glendale Community Free Health Clinic134 N Kenwood St Rm 330
Glendale,CA91206 		87-0732681 501(c)(3) 16,000   N/A N/A Service for the Poor
(120) Glendale Healthy Kids223 N JACKSON ST B-17
Glendale,CA91209 		95-4487466 501(c)(3) 20,000   N/A N/A Preventative Care
(121) Glendale Memorial Health Foundation1420 S Central Ave
Glendale,CA91204 		95-3625651 501(c)(3) 909,553   N/A N/A Foundation Support
(122) Glide Foundation300 Ellis Street
San Francisco,CA94102 		94-1156481 501(c)(3) 50,000   N/A N/A Service for the Poor
(123) Golden Umbrella200 Mercy Oaks Drive
Redding,CA96003 		23-7115371 501(c)(3) 120,291   N/A N/A Service for the Poor
(124) Good News Rescue Mission2842 South Market St
Redding,CA96001 		94-1652602 501(c)(3) 7,744   N/A N/A Social Health
(125) Good Samaritan Shelter731 South Lincoln St
Santa Maria,CA93458 		77-0133375 501(c)(3) 26,732   N/A N/A Quality of Life
(126) H Street Clinic1329 North H St
San Bernardino,CA92405 		20-8191393 501(c)(3) 139,740   N/A N/A Social Health
(127) HAROLD PUMP FOUNDATION13636 VENTURA BLVD
SHERMAN OAKS,CA91432 		95-4807001 501(c)(3) 36,680   N/A N/A Social Health
(128) Haven Hills Inc6918 Owensmouth Ave
Canoga Park,CA91303 		95-3196247 501(c)(3) 30,000   N/A N/A Quality of Life
(129) Health Access Washoe County Inc1450 Ridgeview Dr 200
Reno,NV89519 		88-0293149 501(c)(3)   203,643 Book Medical equipment Quality of Life
(130) Health for All Inc4201 I Street Ste 7
Sacramento,CA95814 		94-2747710 501(c)(3) 50,000   N/A N/A Service for the Poor
(131) Health Improvement Partnership of Santa Cruz Count1600 Green Hills Rd
Scotts Valley,CA95066 		01-0826156 501(c)(3) 66,000   N/A N/A Social Health
(132) Health Insight of Nevada6830 W Oquendo Rd Ste 102
Las Vegas,NV89118 		52-2347096 501(c)(3) 50,000   N/A N/A Preventative Care
(133) HEALTHCARE WITHOUT HARM12355 SUNRISE VALLEY DR
RESTON,VA20191 		52-2358837 501(c)(3) 19,183   N/A N/A Social Health Barrow Neurological Institute
(134) Holy Family High School College Preparatory400 E Lomita Avenue
Glendale,CA91205 		95-6188587 501(c)(3) 15,000   N/A N/A Educational Support
(135) Homeless Services Center115 Coral Street
Santa Cruz,CA95060 		77-0126783 501(c)(3) 20,000   N/A N/A Service for the Poor
(136) Hope Community Health Center312 N Alma School Rd Ste 9C
Chandler,AZ85224 		20-1526381 501(c)(3) 50,000   N/A N/A Social Health
(137) Hospice of Santa Cruz County940 Disc Drive
Scotts Valley,CA95066 		94-2497618 501(c)(3) 10,000   N/A N/A Social Health
(138) Hospital Association of Southern California1000 Town Ctr Dr Ste 300
Oxnard,CA93036 		95-1519378 501(c)(6) 59,784   N/A N/A Educational Support
(139) Hospital Consortium Of San Mateo County222 W 39th Ave 3A09
San Mateo,CA94403 		94-2637032 501(c)(3) 46,267   N/A N/A Quality of Life
(140) Hospital Council of Northern & Central CA1215 K Street Ste 730
Sacramento,CA95814 		94-2663197 n/a 43,042   N/A N/A Social Health
(141) Immanuel Presbyterian Church3300 Wilshire Blvd
Los Angeles,CA90010 		95-1643330 501(c)(3) 18,008   N/A N/A Quality of Life communities.
(142) Improving Chandler Area Neighborhoods650 E MORELOS ST
Chandler,AZ85248 		86-0761030 501(c)(3) 34,000   N/A N/A Preventative Care
(143) InnVision Shelter Network1580A Maple Street
Redwood City,CA94063 		77-0160469 501(c)(3)   38,046 cost Food Service for the Poor
(144) Interval House6615 E Pacific Coast Hwy 170
Long Beach,CA90803 		95-3389113 501(c)(3) 15,000   N/A N/A Quality of Life
(145) Jewish Family & Children's Service Of Long Beach3801 E Willow Street
Long Beach,CA90815 		95-2273033 501(c)(3) 9,250   N/A N/A Social Health
(146) Juvenile Diabetes Research Foundation Intl1522-18th Steet 206
Bakersfield,CA93301 		23-1907729 501(c)(3) 10,200   N/A N/A Preventative Care
(147) Keep Memory Alive888 W Bonneville Ave
Las Vegas,NV89106 		88-0515534 501(c)(3) 9,500   N/A N/A Quality of Life
(148) Keogh Health Foundation1750 E Glendale Ave
Phoenix,AZ85020 		20-0251176 501(c)(3) 50,000   N/A N/A Service for the Poor
(149) Kern Adult Literacy Council Laubach Method Inc331 18th Street
Bakersfield,CA93301 		23-7312722 501(c)(3) 6,650   N/A N/A Quality of Life
(150) Kern Assistive Technology Center3101 Sillect Ave 115
Bakersfield,CA93308 		80-0073571 501(c)(3) 34,276   N/A N/A Quality of Life
(151) Korean American Family Service Center3727 W 6th St 320
Los Angeles,CA90020 		95-3899329 501(c)(3) 18,008   N/A N/A Social Health
(152) LA Child Guidance Clinic3031 S Vermont Avenue
Los Angeles,CA90007 		95-1690974 501(c)(3) 18,008   N/A N/A Preventative Care
(153) Legal Aid Society of San Bernardino588 West Sixth St
San Bernardino,CA92410 		95-1997024 501(c)(3) 22,500   N/A N/A Social Health
(154) Lend a Hand Boulder City400 Utah Street
Boulder City,NV89005 		88-0250959 501(c)(3) 10,000   N/A N/A Social Health
(155) Leukemia & Lymphoma Society Inc340 West Fallbrook Avenue Suite 10
Fresno,CA93711 		13-5644916 501(c)(3) 7,250   N/A N/A Preventative Care
(156) Links for Life Inc1706 Chester Ave 200
Bakersfield,CA93301 		93-1088003 501(c)(3) 29,650   N/A N/A Preventative Care
(157) Livingston Memorial Visiting Nurse Assoc1996 Eastman Ave Ste 101
Ventura,CA93003 		95-1693538 501(c)(3) 15,000   N/A N/A Preventative Care
(158) LivingWell Medical Clinic113 Presley Way Ste 4
Grass Valley,CA95945 		68-0081566 501(c)(3) 10,000   N/A N/A Preventative Care
(159) Los Angeles Fire Department Foundation1875 Century Park East 200
Los Angeles,CA90067 		27-2007326 501(c)(3) 8,000   N/A N/A Quality of Life
(160) March of Dimes Foundation4201 W Shaw Avenue Ste 105
Fresno,CA93722 		13-1846366 501(c)(3) 50,350   N/A N/A Quality of Life
(161) Marian Medical Center Foundation1400 E Church St
Santa Maria,CA93454 		95-3818027 501(c)(3) 516,166   N/A N/A Foundation Support
(162) Maricopa County Asthma Coalition1919 E Thomas Road
Phoenix,AZ85016 		74-2421549 Govt 18,440   N/A N/A Quality of Life
(163) Mary's Mercy Center641 N Roberds Ave
San Bernardino,CA92411 		33-0632426 501(c)(3) 23,200   N/A N/A Preventative Care
(164) McCloud Healthcare Clinic Inc116 W Minnesota Ave
McCloud,CA96057 		68-0427383 501(c)(3) 14,570   N/A N/A Preventative Care
(165) Meals on Wheels of Long Beach Inc241 Cedar Ave
Long Beach,CA90802 		95-2829715 501(c)(3) 9,249   N/A N/A Quality of Life
(166) Medshare International2937 Alvarado Street
San Leandro,CA94577 		58-2433968 501(c)(3)   109,112 Book Medical supplies Medical supplies
(167) Mentor Kids USA15333 North Pima Rd Ste 305
Scottsdale,AZ85260 		86-0865368 501(c)(3) 25,000   N/A N/A Social Health grant)
(168) Merced County Health Care Consortium3605 Hospital Road H
Atwater,CA95301 		20-3530014 501(c)(3) 24,519   N/A N/A Social Health
(169) Mercy Foundation3400 Data Drive
Rancho Cordova,CA95670 		23-7072762 501(c)(3) 3,176,009   N/A N/A Foundation Support
(170) Mercy Foundation BakersfieldPO Box 119
Bakersfield,CA93302 		77-0201321 501(c)(3) 694,795   N/A N/A Foundation Support
(171) Mercy Foundation North2400 Washington Ave Ste 410
Redding,CA96001 		94-3136799 501(c)(3) 881,775   N/A N/A Foundation Support
(172) Mercy Housing California1360 Mission St Ste 300
San Francisco,CA94103 		94-3081666 501(c)(3) 53,490   N/A N/A Quality of Life
(173) Mercy Housing Inc4802 E Ray Rd
Phoenix,AZ85044 		47-0646706 501(c)(3) 20,000   N/A N/A Quality of Life
(174) Mercy Medical Center Merced Foundation301 East 13th Street
Merced,CA95340 		77-0035928 501(c)(3) 530,365   N/A N/A Foundation Support
(175) Mind Matters Clinic150 Big Trees Road Ste D
Murphys,CA95247 		26-1442370 501(c)(3) 5,400   N/A N/A Social Health
(176) Mission of Mercy1741 E Morten Ave Ste C-2
Phoenix,AZ85020 		86-0704883 501(c)(3) 28,000   N/A N/A Social Health
(177) MMC for Children & Families155 15th Street Ste 160A
West Sacramento,CA95691 		37-1424390 501(c)(3) 75,000   N/A N/A Social Health
(178) Most Holy Redeemer Church100 Diamond Street
San Francisco,CA94114 		94-1156774 501(c)(3) 10,000   N/A N/A Quality of Life
(179) Mt Shasta Gymnastics225 Sunrise Drive
Mt Shasta,CA96067 		68-0009235 501(c)(3) 8,233   N/A N/A Social Health
(180) MUSEUM OF AFRICAN DIASPORA685 MISSION ST 3RD FL
SAN FRANCISCO,CA94105 		94-3338239 501(c)(3) 506,300   N/A N/A Operational/programs support
(181) National Alliance on Mental Health14545 Sherman Circle
Van Nuys,CA91405 		95-3952653 501(c)(3) 6,000   N/A N/A Social Health opening
(182) NATIONAL ASSOC OF HEALTH SERVICE EXEC Inc1050 CONNECTICUT AVE NW 10TH
WASHINGTON,DC20036 		62-1312239 501(c)(3) 44,300   N/A N/A Operational/programs support
(183) National Council Of The United States Society Of S608 University Avenue
Sacramento,CA95825 		13-5562362 501(c)(3) 5,510   N/A N/A Service for the Poor
(184) National Multiple Sclerosis Society1700 Owens Street Ste 190
W1B
San Francisco,CA94158 		94-1294935 501(c)(3) 31,000   N/A N/A Quality of Life
(185) Native American Community Health Ctr Inc4520 N Central Ave 620
Phoenix,AZ85012 		94-2540194 501(c)(3) 25,000   N/A N/A Preventative Care
(186) Native American Connections Inc4520 N Central Ave Ste 600
Phoenix,AZ85012 		86-0293585 501(c)(3) 25,000   N/A N/A Quality of Life
(187) NATL ASSOC FOR THE ADVANCEMENT OF COLORED PEOPLE1215 K ST STE 1609
SACRAMENTO,CA95814 		95-4617376 501(c)(3) 15,000   N/A N/A Social Health
(188) Neighborhood Legal Svcs of Los Angeles County13327 Van Nuys Boulevard
Pacoima,CA91331 		95-2408642 501(c)(3) 20,000   N/A N/A Service for the Poor
(189) Nevada Diabetes Assoc For Children And Adults Inc1005 Terminal Way 170
Reno,NV89502 		88-0386000 501(c)(3) 15,960   N/A N/A Service for the Poor
(190) Nevada State College Foundation1125 Nevada State Drive
Henderson,NV89002 		88-0464591 501(c)(3) 50,000   N/A N/A Educational Support
(191) NEWCASTLE UNITED FOOTBALL CLUB1042 N MOUNTAIN AVE STE 110
UPLAND,CA91786 		90-0807845 N/A 6,500   N/A N/A Social Health
(192) Northern NV HIV Outpatient Prog Edu & Svc467 Ralston Street
Reno,NV89503 		86-0865357 501(c)(3) 27,500   N/A N/A Quality of Life
(193) Northern Valley Catholic Social Svcs Inc220 Sycamore Street
Red Bluff,CA96080 		20-0984601 501(c)(3) 24,570   N/A N/A Social Health
(194) NORTHRIDGE HOSPITAL FOUNDATION18300 ROSCOE BLVD
NORTHRIDGE,CA91328 		23-7444901 501(c)(3) 1,187,190   N/A N/A Foundation Support
(195) NOT FOR SALE Fund270 CAPISTRANO RD
HALF MOON BAY,CA94019 		20-5659783 501(c)(3) 20,000   N/A N/A Social Health
(196) OAKLAND METROPOLITAN CHAMBER OF COMMERCE Fndtn475 14TH ST
OAKLAND,CA94612 		95-3217684 501(c)(3) 25,000   N/A N/A Community support
(197) P O P S I C L E Center Inc8711 E Pinnacle Peak Road 290
Scottsdale,AZ85255 		20-8095826 501(c)(3) 8,000   N/A N/A Quality of Life
(198) PANETTA INSTITUTE FOR PUBLIC POLICY100 CAMPUS CNT
SEASIDE,CA93955 		77-0495799 501(c)(3) 6,250   N/A N/A Social Health
(199) PARTNERS IN CARE FOUNDATION15030 VENTURA BLVD 19-812
SHERMAN OAKS,CA91403 		95-3954057 501(c)(3) 7,100   N/A N/A Quality of Life
(200) Pathways Hospice Foundation585 N Mary Ave
Sunnyvale,CA94085 		77-0280660 501(c)(3) 24,600   N/A N/A Quality of Life
(201) Peninsula Family Service24 Second Avenue
San Mateo,CA94401 		94-1186169 501(c)(3) 61,267   N/A N/A Social Health
(202) Peninsula Volunteers Inc800 Middle Avenue
Menlo Park,CA94025 		94-1294939 501(c)(3) 25,000   N/A N/A Social Health
(203) People for Leisure and Youth Inc615 South McClelland St
Santa Maria,CA93454 		77-0469844 501(c)(3) 18,500   N/A N/A Quality of Life
(204) People Reaching Out Inc5299 Auburn Boulevard
Sacramento,CA95841 		94-2795430 501(c)(3) 50,000   N/A N/A Social Health
(205) Phoenix Indian Center Inc4520 N Central Ave Ste 250
Phoenix,AZ85012 		86-6006566 501(c)(3) 25,000   N/A N/A Social Health
(206) Phoenix Symphony AssociationOne North First St Ste 200
Phoenix,AZ85004 		86-6000134 501(c)(3) 27,800   N/A N/A Quality of Life
(207) Powerhouse Ministries Inc311 Market Street
Folsom,CA95630 		68-0020855 501(c)(3) 50,000   N/A N/A Social Health
(208) Prevent Alcohol and Risk Related Trauma in YouthPO Box 1342
Folsom,CA95763 		91-1764812 501(c)(3) 10,000   N/A N/A Educational Support
(209) PRIDE Industries10030 Foothills Blvd
Roseville,CA95747 		94-1650529 501(c)(3) 30,000   N/A N/A Quality of Life
(210) Raising Special Kids5025 E Washington St 204
Phoenix,AZ85034 		86-0517082 501(c)(3) 10,000   N/A N/A Social Health
(211) Rebuilding Together Valley of the Sun2123 S Priest Ste 213
Tempe,AZ85282 		86-0680607 501(c)(3) 10,000   N/A N/A Social Health
(212) Regents of the University of Cal Berkeley2195 HEARST AVE RM 120 MC 1104
BERKELEY,CA94720 		94-6002123 501(c)(3) 116,667   N/A N/A Educational Support
(213) Regents Of The University Of California2101 E Earhard Ave Ste 200
Stockton,CA95206 		94-6036494 501(c)(3) 25,000   N/A N/A Educational Support assistant
(214) Remote Area Medical Foundation950 Reserve Dr Ste 120
Roseville,CA95678 		45-2408171 501(c)(3) 10,000   N/A N/A Preventative Care
(215) Roman Catholic Archbishop Of Los Angeles3424 WILSHIRE BLVD
LOS ANGELES,CA90010 		95-1642382 501(c)(3) 22,600   N/A N/A Social Health
(216) Roman Catholic Archbishop Of San Francisco1122 Jamestown Ave
San Francisco,CA94124 		94-1156707 501(c)(3) 95,500   N/A N/A Religious Community
(217) Roman Catholic Bishop Of Las Vegas215 Palo Verde Drive
Henderson,NV89009 		88-0059349 501(c)(3) 22,300   N/A N/A Social Health
(218) Roseville Home Start410 Riverside Avenue
Roseville,CA95678 		91-1657990 501(c)(3) 40,000   N/A N/A Social Health
(219) RotaCare Bay Area Inc3190 S Bascom Ave Ste 170
San Jose,CA95158 		77-0328723 501(c)(3) 25,000   N/A N/A Social Health
(220) Sacramento Children's Home2750 Sutterville Road
Sacramento,CA95820 		94-1156588 501(c)(3) 50,000   N/A N/A Social Health
(221) Sacramento District Dental Foundation915 28th Street
Sacramento,CA95816 		23-7067087 501(c)(3) 40,000   N/A N/A Preventative Care
(222) Saint Mary's Foundation235 W 6th Street
Reno,NV89520 		88-0188386 501(c)(3) 1,227,202   N/A N/A Foundation Support
(223) Samaritan House4031 Pacific Boulevard
San Mateo,CA94403 		23-7416272 501(c)(3) 8,050   N/A N/A Social Health
(224) San Bernardino Sexual Assault Services Inc444 N Arrowhead Ave Ste 101
San Bernardino,CA92401 		95-3543081 501(c)(3) 10,000   N/A N/A Social Health
(225) SAN FRANCISCO EVENT COMMITTEE325 Sharon Park Drive 308
200
Menlo Park,CA94025 		94-3001337 501(c)(3) 10,000   N/A N/A Community Support
(226) SAN FRANCISCO PLANNING & URBAN RESEARCH ASSOc654 MISSION ST
SAN FRANCISCO,CA94105 		94-1498232 501(c)(3) 24,750   N/A N/A Quality of Life
(227) SAN FRANCISCO SHANGHAI Friendship Committee809 SACRAMENTO ST
SAN FRANCISCO,CA94108 		94-2878895 501(c)(3) 7,000   N/A N/A Social Health
(228) San Joaquin County Office of Education FoundationPO Box 213030
Stockton,CA95213 		68-0342748 501(c)(3) 35,000   N/A N/A Educational support
(229) SANTA BARBARA COUNTY EDUCATION OFFICEPO BOX 6307
SANTA BARBARA,CA93160 		95-6000940 Govt 5,499   N/A N/A Quality of Life
(230) Santa Barbara County Sheriffs Relief & Benefit Ass315 CAMINO DEL REMEDIO
SANTA BARBARA,CA93110 		23-7045577 501(c)(4) 84,000   N/A N/A Preventative Care
(231) SANTA MARIA ROTARY OF SANTA MARIAPO BOX 1518
SANTA MARIA,CA93456 		95-3376523 501(c)(4) 8,250   N/A N/A Social Health
(232) Santa Maria Valley FISHPO Box 6526
Santa Maria,CA93456 		95-2757731 501(c)(3) 10,000   N/A N/A Quality of Life
(233) Santa Maria Valley YMCA3400 Skyway Drive
Santa Maria,CA93455 		95-2158363 501(c)(3) 16,000   N/A N/A Social Health
(234) Second Harvest Food Bank of Santa Cruz County800 Ohlone Parkway
Watsonville,CA95076 		77-0326685 501(c)(3) 25,000   N/A N/A Quality of Life
(235) Self Help for the Elderly407 Sansome Street
San Francisco,CA94111 		94-1750717 501(c)(3) 10,000   N/A N/A Social Health Children
(236) Senior Citizens Legal Services501 Soquel Ave Suite F
Santa Cruz,CA95062 		94-2280258 501(c) (3) 11,670   N/A N/A Service for the Poor
(237) Sequoia Hospital Foundation170 Alameda de Las Pulgas
Redwood City,CA94062 		94-2909990 501(c)(3) 1,395,447   N/A N/A Foundation Support
(238) Serotonin Surge Charities1955 Cowell Boulevard
Davis,CA95618 		68-0411254 501(c)(3) 35,000   N/A N/A Preventative Care
(239) Servant of Mary Ministers to the Sick140 North G Street
Oxnard,CA93030 		95-6054374 501(c)(3) 20,636   N/A N/A Service for the Poor
(240) Shanti Project Inc730 Polk St 3rd Fl
San Francisco,CA94109 		94-2297147 501(c)(3) 20,000   N/A N/A Quality of Life
(241) Shasta Community Health Center1035 Placer Street
Redding,CA96001 		68-0165855 501(c)(3) 50,000   N/A N/A Social Health
(242) Shasta County Dept of Public Health1855 Placer St Ste 201
Redding,CA96001 		94-6000535 Govt 20,000   N/A N/A Social Health
(243) Shasta Senior Nutrition Program100 Mercy Oaks Drive
Redding,CA96003 		94-2650429 501(c)(3) 115,645   N/A N/A Service for the Poor
(244) SMOOTH Inc240 East Roemer Way
Santa Maria,CA93454 		95-3059115 501(c)(3) 10,000   N/A N/A Social Health
(245) Southwest Human Development2850 N 24th Street
Phoenix,AZ85008 		86-0407179 501(c)(3) 32,000   N/A N/A Quality of Life
(246) Special Olympics Southern California Inc3200 N Sillect Avenue
Bakersfield,CA93308 		95-4538450 501(c)(3) 17,570   N/A N/A Social Health
(247) SPELMAN COLLEGE350 SPELMAN LN SW BOX 616
ATLANTA,GA30314 		58-0566243 501(c)(3) 200,000   N/A N/A Educational Support
(248) ST ANTHONY FOUNDATION121 GOLDEN GATE AVE
SAN FRANCISCO,CA94102 		94-1513140 501(c)(3) 200,000   N/A N/A Quality of Life
(249) St Barnabas School3980 Marron Ave
Long Beach,CA90807 		33-0527343 501(c)(3) 7,500   N/A N/A Educational support
(250) St Bernardine Medical Center Foundation2101 N Waterman Ave
San Bernardino,CA92404 		23-7440086 501(c)(3) 914,005   N/A N/A Foundation Support
(251) St John's Healthcare Foundation1600 N Rose Ave
Oxnard,CA93030 		20-2865781 501(c)(3) 1,121,167   N/A N/A Foundation Support
(252) St John's Retirement Village135 Woodland Avenue
Woodland,CA95965 		94-1636507 501(c)(3) 7,500   N/A N/A Quality of Life
(253) ST JOSEPH HIGH SCHOOL4120 S BRADLEY RD
SANTA MARIA,CA93455 		95-2315939 501(c)(3) 5,361   N/A N/A Educational Support
(254) St Joseph's Foundation350 W Thomas Rd
Phoenix,AZ85013 		94-2941245 501(c)(3) 1,680,147   N/A N/A Foundation Support
(255) St Joseph's Foundation of San Joaquin1800 N California Street
Stockton,CA95204 		51-0432777 501(c)(3) 1,001,429   N/A N/A Foundation Support
(256) St Mary Medical Center Foundation1050 Linden Avenue
Long Beach,CA90813 		23-7153876 501(c)(3) 2,065,845   N/A N/A Foundation Support
(257) St Mary's Interfaith Community Services545 W Sonora Street
Stockton,CA95203 		94-2687280 501(c)(3) 11,342   N/A N/A Service for the Poor
(258) St Mary's Medical Center Foundation450 Stanyan Street
San Francisco,CA94117 		94-3336143 501(c)(3) 871,307   N/A N/A Foundation Support
(259) St Rose Dominican Health Foundation2865 Siena Heights Dr Ste 300
Henderson,NV89052 		88-0455713 501(c)(3) 2,094,035   N/A N/A Foundation support
(260) St Vincent de Paul Stores Inc316 Baker Street
Bakersfield,CA93305 		95-1853364 501(c)(3) 36,000   N/A N/A Service for the Poor
(261) ST VINCENT'S SANTA BARBARA4200 CALLE REAL
SANTA BARBARA,CA93110 		95-1643367 501(c)(3) 5,457   N/A N/A Religious Community
(262) Stockton Symphony Association Inc1024 W Robinhood Drive Ste 1
Stockton,CA95207 		94-1462758 501(c)(3) 8,600   N/A N/A Quality of Life
(263) Tarzana Treatment Centers Inc18646 Oxnard Street
Tarzana,CA91356 		94-2219349 501(c)(3) 44,918 0 N/A N/A Social Health
(264) The Congenital Heart Foundation350 W Thomas Rd
Phoenix,AZ85013 		26-3342554 501(c)(3) 134,836   N/A N/A Foundation Support
(265) The Friendship Club138 New Mohawk Road Ste 272
Nevada City,CA95959 		68-0262000 501(c)(3) 7,500   N/A N/A Social Health
(266) The NETWORK801 PENNSYLVANIA AVE STE 460
WASHINGTON,DC20003 		52-0984255 501(c)(3) 40,000   N/A N/A Service for the Poor
(267) The Salvation Army30-400 Landau Blvd
Cathedral City,CA92234 		94-1156347 501(c)(3) 61,865   N/A N/A Social Health
(268) The Shade Tree Inc1 West Owens Ave
North Las Vegas,NV89030 		88-0253276 501(c)(3) 50,000   N/A N/A Service for the Poor
(269) The UC Davis FoundationPO BOX 179001
SACRAMENTO,CA95817 		94-6081352 501(c)(3) 55,756   N/A N/A Educational support
(270) The Valley Economic Alliance5121 VAN NUYS BLVD STE 200
SHERMAN OAKS,CA914031497 		95-4524503 501(c)(3) 10,000   N/A N/A Social Health
(271) Thrift Shop-cancer Aid317 South Auburn St
Grass Valley,CA95945 		23-7153211 501(c)(3) 10,000   N/A N/A Social Health
(272) Tiger mountain Foundation836 E South mountain Ave
Phoenix,AZ85042 		27-0806147 501(c)(3) 25,000   N/A N/A Quality of Life
(273) Trauma Intervention Programs IncPO Box 93202
Las Vegas,NV89193 		33-0317893 501(c)(3) 8,800   N/A N/A Preventative Care
(274) Trinity Hospital60 Easter Ave
Weaverville,CA96093 		20-8236808 Govt 50,000   N/A N/A Social Health
(275) United Iu-Mien Community6000 Lemon Hill Avenue
Sacramento,CA95824 		68-0364879 501(c)(3) 50,000   N/A N/A Social Health
(276) United States Veterans Initiative800 W 6th St Ste 1506
Los Angeles,CA90017 		95-4382752 501(c)(3) 13,000   N/A N/A Social Health
(277) United Way of Merced County Inc658 West Main Street
Merced,CA95340 		94-2633265 501(c)(3) 25,000   N/A N/A Preventative Care
(278) United Way of Santa Cruz County4450 Capitola Road 106
Capitola,CA95010 		94-1422471 501(c)(3) 63,250   N/A N/A Preventative Care
(279) University Foundation at Sacramento State6000 J Street
Sacramento,CA95819 		94-3001359 501(c)(3) 100,000   N/A N/A Educational Support
(280) University of Arizona100 W Washington 13th Fl
Phoenix,AZ85003 		74-2652689 Govt 15,300,000   N/A N/A research/teaching/
(281) University Of Nevada Las Vegas Foundation4505 Maryland Pkwy
Las Vegas,NV89154 		94-2790134 501(c)(3) 70,000   N/A N/A Educational Support
(282) UNIVERSITY OF VIRGINIA ALUMNI ASSOCIATION211 EMMET ST S
690
CHARLOTTESVILLE,VA22904 		54-0485595 501(c)(3) 10,000   N/A N/A Educational Support
(283) Vetfund Foundation1227 O ST
SACRAMENTO,CA95814 		20-5195691 501(c)(3) 10,050   N/A N/A Social Health related
(284) Volunteers in Medicine of So Nevada Inc4770 Harrison Dr 105
Las Vegas,NV89121 		39-2072453 501(c)(3) 50,000   N/A N/A Social Health
(285) Weave Inc1900 K Street
Sacramento,CA95811 		94-2493158 501(c)(3) 50,000   N/A N/A Social Health related
(286) West Side Community Resource Center915 N 10th Street 20
Taft,CA93268 		65-1305502 501(c)(3) 24,888   N/A N/A Social Health
(287) Westcare Nevada IncPO Box 94738
Las Vegas,NV89123 		94-2778981 501(c)(3) 23,017   N/A N/A Community Support
(288) Westside Neighborhood Clinic2125 San Fe Avenue
Long Beach,CA90810 		95-2973364 501(c)(3) 15,000   N/A N/A Social Health
(289) WOMEN TO WOMEN INTERNATIONAL4455 CONNECTICUT AVE STE 200
WASHINGTON,DC20008 		52-1838756 501(c)(3) 50,000   N/A N/A Quality of Life
(290) Women's Center Youth and Family Center620 N San Joaquin Street
Stockton,CA95202 		94-2341360 501(c)(3) 5,040   N/A N/A Service for the Poor
(291) Womenshelter of Long BeachPO Box 32107
Long Beach,CA90813 		95-1644058 501(c)(3) 9,249   N/A N/A Social Health
(292) Woodland Memorial Hospital Foundation1321 Cottonwood Street
Woodland,CA95670 		94-6167964 501(c)(3) 295,342   N/A N/A Foundation Support
(293) Worksite Wellness LA595 S Western Avenue
Los Angeles,CA90047 		55-0802354 501(c)(3) 18,008   N/A N/A Service for the Poor
(294) YMCA1655 Frye Road
Chandler,AZ85224 		86-0096799 501(c)(3) 19,275 0 N/A N/A Preventative Care
(295) YMCA Of Metropolitan Los Angeles6901 Lennox Avenue
Van Nuys,CA91405 		95-1644052 501(c)(3) 40,000 0 N/A N/A Preventative Care
(296) Yolo Community Care Continuum168 College Street
Woodland,CA95695 		94-2623205 501(c)(3) 10,000 0 N/A N/A Social Health
(297) Yolo Family Resource Center828 Court Street
Woodland,CA95695 		47-0871252 501(c)(3) 31,113 0 N/A N/A Quality of Life
(298) Yolo Family Service Agency455 First Street
Woodland,CA95695 		94-1452884 501(c)(3) 10,000   N/A N/A Quality of Life
(299) Yolo Wayfarer Center Christian Mission207 4th Street
Woodland,CA95776 		68-0059409 501(c)(3) 8,843   N/A N/A Quality of Life
(300) Youth Violence Prevention Council for Shasta Count1700 Pine Street Ste 250
Redding,CA96001 		68-0381728 501(c)(3) 10,000   N/A N/A Social Health
(301) Zen Hospice Project Inc44 Gough St Ste 303
San Francisco,CA94103 		94-3155375 501(c)(3) 25,000   N/A N/A Quality of Life
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
292
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
9
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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) DIRECT CASH ASSISTANCE 723 96,094   N/A N/A
(2) FINANCIAL ASSISTANCE TO NEEDY 605 50,470   N/A N/A
(3) FINANCIAL ASSISTANCE TO PATIENTS 2788 111,588   N/A N/A
(4) SCHOLARSHIP 15 16,250   N/A N/A
(5) SPONSORSHIP OF MEDICAL CONFERENCE 1 10,000   N/A N/A
(6) DONATION OF CLOTHING/GIFTS TO NEEDY 3055   24,180 COST Clothing and gifts
(7) PROVISION OF FOOD/MEALS 71428   272,413 COST Food
(8) MEDICAL SUPPLIES/EQUIPMENT TO INDIGENTS 3555   821,533 book Medical supplies
(9) OTHER IN-KIND DONATIONS TO NEEDY 639   6,247 COST Car seats/ diapers
(10) PHARMACY CHARITY PRESCRIPTION 1010   137,687 COST Pharmaceuticals
(11) PROVISION OF SCHOOL SUPPLIES 229   1,100 COST School supplies

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 $4,050,855 RELATED TO The Dignity Health Community Grants program. THIS PROGRAM IS one way in which Dignity Health supports and enhances the advocacy, social justice and healthier communities efforts of its hospitals and the religious sponsors of our Catholic hospitals. 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 Dignity Health. 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 501(c)(3) organization. OTHER GRANTS ARE PROVIDED BY Dignity Health (AND ITS MEMBER HOSPITALS) TO NOT-FOR-PROFIT ORGANIZATIONS THAT FURTHER Dignity Health'S EXEMPT PURPOSE. GRANTS ARE ALSO PROVIDED TO THE FUNDRAISING FOUNDATIONS THAT SUPPORT Dignity Health AND ITS MEMBER HOSPITALS TO FUND THE OPERATIONS OF THOSE FOUNDATIONS. Several grants are provided to other organizations in which Dignity Health supports community efforts. In addition, 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) 2011


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
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
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 or provision 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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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 Regulations 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) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Lloyd H Dean (i)
(ii)		 1,387,651
0 		2,510,407
0 		984,698
0 		1,052,285
0 		75,385
0 		6,010,426
0 		960,524
0
(2) Michael D Blaszyk (i)
(ii)		 865,377
0 		1,099,787
0 		301,275
0 		576,026
0 		57,644
0 		2,900,109
0 		280,662
0
(3) Derek F Covert (i)
(ii)		 535,662
0 		676,397
0 		18,606
0 		73,182
0 		45,556
0 		1,349,403
0 		0
0
(4) William J Hunt (i)
(ii)		 649,215
0 		570,038
0 		1,196,474
0 		77,332
0 		50,232
0 		2,543,291
0 		0
0
(5) Diane Lee (i)
(ii)		 239,322
0 		107,567
0 		4,569
0 		27,385
0 		24,262
0 		403,105
0 		0
0
(6) Marvin O'Quinn (i)
(ii)		 869,909
0 		1,817,959
0 		303,839
0 		390,406
0 		50,747
0 		3,432,860
0 		0
0
(7) Elizabeth Shih (i)
(ii)		 623,398
0 		788,373
0 		291,539
0 		104,121
0 		49,964
0 		1,857,395
0 		253,744
0
(8) Keith Callahan (i)
(ii)		 264,386
0 		173,676
0 		98,740
0 		33,188
0 		25,385
0 		595,375
0 		0
0
(9) Gary F Conner (i)
(ii)		 72,554
0 		75,000
0 		25,216
0 		8,525
0 		6,073
0 		187,368
0 		0
0
(10) Mary Connick (i)
(ii)		 357,087
0 		211,306
0 		10,040
0 		40,070
0 		26,912
0 		645,415
0 		0
0
(11) Rodney A Davis (i)
(ii)		 448,399
0 		263,200
0 		24,779
0 		48,672
0 		29,984
0 		815,034
0 		0
0
(12) Charles P Francis (i)
(ii)		 568,968
0 		830,376
0 		155,975
0 		174,403
0 		47,441
0 		1,777,163
0 		143,300
0
(13) Linda Hunt (i)
(ii)		 561,972
0 		330,012
0 		20,544
0 		58,451
0 		38,186
0 		1,009,165
0 		0
0
(14) Jeffrey W Land (i)
(ii)		 298,797
0 		175,670
0 		3,046
0 		34,552
0 		40,545
0 		552,610
0 		0
0
(15) Bernita McTernan (i)
(ii)		 481,999
0 		662,634
0 		37,083
0 		73,451
0 		49,112
0 		1,304,279
0 		0
0
(16) Mark A Meyers (i)
(ii)		 431,768
0 		252,591
0 		17,990
0 		47,217
0 		39,864
0 		789,430
0 		0
0
(17) Timothy Moran (i)
(ii)		 130,013
0 		0
0 		476,042
0 		12,226
0 		14,186
0 		632,467
0 		0
0
(18) Karl Silberstein (i)
(ii)		 503,589
0 		279,775
0 		16,865
0 		52,152
0 		38,377
0 		890,758
0 		0
0
(19) Michael Taylor (i)
(ii)		 55,769
0 		721,000
0 		105,360
0 		44,276
0 		0
0 		926,405
0 		0
0
(20) LeAnne Trachok (i)
(ii)		 327,150
0 		193,246
0 		1,877
0 		35,367
0 		20,715
0 		578,355
0 		0
0
(21) Herbert Vallier (i)
(ii)		 560,612
0 		718,750
0 		500,172
0 		73,744
0 		44,132
0 		1,897,410
0 		0
0
(22) Glenna L Vaskelis (i)
(ii)		 402,198
0 		224,850
0 		16,816
0 		43,210
0 		45,554
0 		732,628
0 		0
0
(23) Robert Wiebe MD (i)
(ii)		 590,330
0 		737,725
0 		8,385
0 		223,760
0 		27,134
0 		1,587,334
0 		0
0
(24) Benjamin R Williams (i)
(ii)		 146,571
0 		264,533
0 		1,123,900
0 		27,534
0 		11,828
0 		1,574,366
0 		0
0
(25) Deanna Wise (i)
(ii)		 313,461
0 		100,000
0 		834
0 		68,567
0 		9,115
0 		491,977
0 		0
0
(26) John M Wray (i)
(ii)		 446,331
0 		570,679
0 		17,929
0 		65,993
0 		41,678
0 		1,142,610
0 		0
0
(27) Lisa Gamshad Zuckerman (i)
(ii)		 315,945
0 		192,788
0 		3,210
0 		37,202
0 		36,559
0 		585,704
0 		0
0
(28) Marwan Ghazoul MD (i)
(ii)		 586,046
0 		118,303
0 		1,870
0 		40,374
0 		26,537
0 		773,130
0 		0
0
(29) John G Bibby (i)
(ii)		 228,519
0 		174,585
0 		333,081
0 		29,677
0 		21,480
0 		787,342
0 		0
0
(30) Naftaly Attias MD (i)
(ii)		 252,492
0 		489,745
0 		885
0 		50,074
0 		22,242
0 		815,438
0 		0
0
(31) Scott R Petersen MD (i)
(ii)		 589,083
0 		118,910
0 		5,595
0 		47,932
0 		27,884
0 		789,404
0 		0
0
(32) Dana G Seltzer MD (i)
(ii)		 279,818
0 		519,907
0 		3,960
0 		53,564
0 		22,309
0 		879,558
0 		0
0
(33) Saliba Salo (i)
(ii)		 339,352
0 		64,574
0 		18,049
0 		30,934
0 		14,191
0 		467,100
0 		0
0
(34) Mike Uboldi (i)
(ii)		 426,672
0 		250,342
0 		13,976
0 		46,114
0 		32,369
0 		769,473
0 		0
0
(35) Ernest H Urquhart (i)
(ii)		 300,000
0 		0
0 		0
0 		0
0 		0
0 		300,000
0 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 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 and upgrades to such are treated on an exception basis according to Dignity Health policy. Such travel totaling $28,704 was provided to 9 officers, directors and key employees. No amounts have been included as reportable compensation as these travel expenses were incurred for business purposes. There was no charter travel in 2011. PART I, 1A Tax gross-up payments were provided to two key employees related to relocation expenses. Tax gross-up payments were also provided to two officers and one key employee of the organization related to forgiveness of relocation loans based on service requirements met. These gross up payments were included as taxable compensation to the listed persons. PART I, 1A Club dues have been paid by Dignity Health for business use by two key employees. 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. Dignity Health does not pay or reimburse for any health club memberships. PART I, 4A Dignity Health'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 one officer, two key employees and one highest compensated employee occurred during 2011 related to both eliminated positions and involuntary terminations; W. Hunt $1,000,000; T. Moran $445,544; B. Williams $1,043,783 and J. Bibby $295,944. PART I, 4B Certain officers and key employees participate in the Dignity Health Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the Dignity Health 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. No payments were made under this plan during 2011. PART I, 4B Dignity Health'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 Dignity Health 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 certain officers and key employees who are not eligible to participate in the Dignity Health 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. No payments were made under this plan during 2011. PART I, 4B Certain listed persons participate in the Dignity Health 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 2011. PART I, 4B Certain officers and key employees participate in the Dignity Health Supplemental Executive Retention/Retirement Plan, a nonqualified supplemental benefit plan which in 2002 was offered to members of the executive management team by the Dignity Health 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 2011 pursuant to this plan include $960,524 to L. Dean, $280,662 to M. Blaszyk, $143,300 to C. Francis and $253,744 to E. Shih.
Sch J - PART II   SCH J - PART II Dignity Health's executive compensation philosophy is designed to assist Dignity Health in attracting and retaining the caliber of executives required to enable Dignity Health 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 Dignity Health 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 Dignity Health'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 Dignity Health competes for executives, commensurate with the size and complexity of the organization.
Schedule J (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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 VI 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 VI   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 BOND C: CUSIP 425203BM7-SEE PRT VI   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 BOND D: CUSIP 13033FTN0-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FG46 11-10-2005 351,135,742 BOND E: CUSIP 13033FG46-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FYE4 11-10-2005 200,000,000 BOND F: CUSIP 13033FYE4-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507GL3 11-10-2005 224,000,000 BOND G: CUSIP 040507GL3-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DH7 04-26-2007 400,000,000 BOND H: CUSIP 130795DH7-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DR5 04-26-2007 276,250,000 BOND I: CUSIP 130795DR5-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816HP2 04-26-2007 178,702,052 BOND J: CUSIP 566816HP2-SEE PRT VI   X   X   X
CITY OF RENO NEVADA
  		88-6000201 759835AA9 04-26-2007 98,635,589 BOND K: CUSIP 759835AA9-SEE PRT VI X     X   X
CITY OF HENDERSON NEVADA
  		88-6000720 425203CF1 04-26-2007 200,626,751 BOND L: CUSIP 425203CF1-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LAZ0 05-14-2009 457,778,078 BOND M: CUSIP 13033LAZ0-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816JJ4 05-14-2009 127,153,706 BOND N: CUSIP 566816JJ4-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LEQ6 11-12-2009 235,106,175 BOND O: CUSIP 13033LEQ6-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MJ1 11-12-2009 75,689,293 BOND P: CUSIP 040507MJ1-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		88-0445263 566816JL9 07-14-2011 115,008,059 BOND Q: CUSIP 566816JL9-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LSZ1 11-09-2011 515,217,012 BOND R: CUSIP 13033LSZ1-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MU6 11-09-2011 125,000,601 BOND S: CUSIP 040507MU6-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LUD7 06-27-2012 140,000,000 BOND T: CUSIP 13033LUD7-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MV4 06-27-2012 75,000,000 BOND U: CUSIP 040507MV4-SEE PRT VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 45,900,000 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 472,399,331 267,956,955 171,862,421 136,994,286
4 Gross proceeds in reserve funds . . . . . . . . 7,910,067 8,557,073 4,163,061 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 5,184,771 0
6 Proceeds in refunding escrows . . . . . . . . . . . 428,246,052 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 . . . . . . . 7,098,781 6,947,963 2,791,994 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 16,278,603 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     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) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 0.00000% 0% 0% 0%
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 0.00000% 0.00000% 0.00000% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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 qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . CITIGROUP & JPMORGN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . . . . . . . 21.2 5. 5. 34.2
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . . X   X   X   X  
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X   X   X     X
b Name of provider . . . . . . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		0
 
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
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
BOND A: CUSIP 13033FRT9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND B: CUSIP 566816GY4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND C: CUSIP 425203BM7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND D: CUSIP 13033FTN0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND E: CUSIP 13033FG46 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(c)2005 SERIES exchanged forSERIES FHIJKL. CONTINUED ON SCH O.
BOND F: CUSIP 13033FYE4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND G: CUSIP 040507GL3 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND H: CUSIP 130795DH7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND I: CUSIP 130795DR5 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND J: CUSIP 566816HP2 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND K: CUSIP 759835AA9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND L: CUSIP 425203CF1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND M: CUSIP 13033LAZ0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND N: CUSIP 566816JJ4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 PRt I,(f) Repay line of credit. CONTINUED ON SCHEDULE O.
BOND O: CUSIP 13033LEQ6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund BOND SERIES. CONTINUED ON SCH O.
BOND P: CUSIP 040507MJ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund 2008 Series D bonds. CONTINUED ON SCH O.
BOND Q: CUSIP 566816JL9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (F) Refund 1992 & 1998 Series A bonds. CONTINUED ON SCH O.
BOND R: CUSIP 13033LSZ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND S: CUSIP 040507MU6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND T: CUSIP 13033LUD7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (f) Refund 2009 Series BC & G bonds. CONTINUED ON SCHEDULE O.
BOND U: CUSIP 040507MV4 - 0 Prt I, (f) Refund 2009 Series B & E bonds. CONTINUED ON SCHEDULE O.
Schedule K (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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 VI 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 VI   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 BOND C: CUSIP 425203BM7-SEE PRT VI   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 BOND D: CUSIP 13033FTN0-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FG46 11-10-2005 351,135,742 BOND E: CUSIP 13033FG46-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FYE4 11-10-2005 200,000,000 BOND F: CUSIP 13033FYE4-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507GL3 11-10-2005 224,000,000 BOND G: CUSIP 040507GL3-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DH7 04-26-2007 400,000,000 BOND H: CUSIP 130795DH7-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DR5 04-26-2007 276,250,000 BOND I: CUSIP 130795DR5-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816HP2 04-26-2007 178,702,052 BOND J: CUSIP 566816HP2-SEE PRT VI   X   X   X
CITY OF RENO NEVADA
  		88-6000201 759835AA9 04-26-2007 98,635,589 BOND K: CUSIP 759835AA9-SEE PRT VI X     X   X
CITY OF HENDERSON NEVADA
  		88-6000720 425203CF1 04-26-2007 200,626,751 BOND L: CUSIP 425203CF1-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LAZ0 05-14-2009 457,778,078 BOND M: CUSIP 13033LAZ0-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816JJ4 05-14-2009 127,153,706 BOND N: CUSIP 566816JJ4-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LEQ6 11-12-2009 235,106,175 BOND O: CUSIP 13033LEQ6-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MJ1 11-12-2009 75,689,293 BOND P: CUSIP 040507MJ1-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		88-0445263 566816JL9 07-14-2011 115,008,059 BOND Q: CUSIP 566816JL9-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LSZ1 11-09-2011 515,217,012 BOND R: CUSIP 13033LSZ1-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MU6 11-09-2011 125,000,601 BOND S: CUSIP 040507MU6-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LUD7 06-27-2012 140,000,000 BOND T: CUSIP 13033LUD7-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MV4 06-27-2012 75,000,000 BOND U: CUSIP 040507MV4-SEE PRT VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 45,900,000 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 472,399,331 267,956,955 171,862,421 136,994,286
4 Gross proceeds in reserve funds . . . . . . . . 7,910,067 8,557,073 4,163,061 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 5,184,771 0
6 Proceeds in refunding escrows . . . . . . . . . . . 428,246,052 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 . . . . . . . 7,098,781 6,947,963 2,791,994 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 16,278,603 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     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) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 0.00000% 0% 0% 0%
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 0.00000% 0.00000% 0.00000% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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 qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . CITIGROUP & JPMORGN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . . . . . . . 21.2 5. 5. 34.2
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . . X   X   X   X  
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X   X   X     X
b Name of provider . . . . . . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		0
 
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
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
BOND A: CUSIP 13033FRT9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND B: CUSIP 566816GY4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND C: CUSIP 425203BM7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND D: CUSIP 13033FTN0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND E: CUSIP 13033FG46 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(c)2005 SERIES exchanged forSERIES FHIJKL. CONTINUED ON SCH O.
BOND F: CUSIP 13033FYE4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND G: CUSIP 040507GL3 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND H: CUSIP 130795DH7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND I: CUSIP 130795DR5 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND J: CUSIP 566816HP2 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND K: CUSIP 759835AA9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND L: CUSIP 425203CF1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND M: CUSIP 13033LAZ0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND N: CUSIP 566816JJ4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 PRt I,(f) Repay line of credit. CONTINUED ON SCHEDULE O.
BOND O: CUSIP 13033LEQ6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund BOND SERIES. CONTINUED ON SCH O.
BOND P: CUSIP 040507MJ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund 2008 Series D bonds. CONTINUED ON SCH O.
BOND Q: CUSIP 566816JL9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (F) Refund 1992 & 1998 Series A bonds. CONTINUED ON SCH O.
BOND R: CUSIP 13033LSZ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND S: CUSIP 040507MU6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND T: CUSIP 13033LUD7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (f) Refund 2009 Series BC & G bonds. CONTINUED ON SCHEDULE O.
BOND U: CUSIP 040507MV4 - 0 Prt I, (f) Refund 2009 Series B & E bonds. CONTINUED ON SCHEDULE O.
Schedule K (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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 VI 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 VI   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 BOND C: CUSIP 425203BM7-SEE PRT VI   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 BOND D: CUSIP 13033FTN0-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FG46 11-10-2005 351,135,742 BOND E: CUSIP 13033FG46-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FYE4 11-10-2005 200,000,000 BOND F: CUSIP 13033FYE4-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507GL3 11-10-2005 224,000,000 BOND G: CUSIP 040507GL3-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DH7 04-26-2007 400,000,000 BOND H: CUSIP 130795DH7-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DR5 04-26-2007 276,250,000 BOND I: CUSIP 130795DR5-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816HP2 04-26-2007 178,702,052 BOND J: CUSIP 566816HP2-SEE PRT VI   X   X   X
CITY OF RENO NEVADA
  		88-6000201 759835AA9 04-26-2007 98,635,589 BOND K: CUSIP 759835AA9-SEE PRT VI X     X   X
CITY OF HENDERSON NEVADA
  		88-6000720 425203CF1 04-26-2007 200,626,751 BOND L: CUSIP 425203CF1-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LAZ0 05-14-2009 457,778,078 BOND M: CUSIP 13033LAZ0-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816JJ4 05-14-2009 127,153,706 BOND N: CUSIP 566816JJ4-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LEQ6 11-12-2009 235,106,175 BOND O: CUSIP 13033LEQ6-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MJ1 11-12-2009 75,689,293 BOND P: CUSIP 040507MJ1-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		88-0445263 566816JL9 07-14-2011 115,008,059 BOND Q: CUSIP 566816JL9-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LSZ1 11-09-2011 515,217,012 BOND R: CUSIP 13033LSZ1-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MU6 11-09-2011 125,000,601 BOND S: CUSIP 040507MU6-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LUD7 06-27-2012 140,000,000 BOND T: CUSIP 13033LUD7-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MV4 06-27-2012 75,000,000 BOND U: CUSIP 040507MV4-SEE PRT VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 45,900,000 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 472,399,331 267,956,955 171,862,421 136,994,286
4 Gross proceeds in reserve funds . . . . . . . . 7,910,067 8,557,073 4,163,061 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 5,184,771 0
6 Proceeds in refunding escrows . . . . . . . . . . . 428,246,052 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 . . . . . . . 7,098,781 6,947,963 2,791,994 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 16,278,603 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     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) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 0.00000% 0% 0% 0%
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 0.00000% 0.00000% 0.00000% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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 qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . CITIGROUP & JPMORGN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . . . . . . . 21.2 5. 5. 34.2
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . . X   X   X   X  
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X   X   X     X
b Name of provider . . . . . . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		0
 
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
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
BOND A: CUSIP 13033FRT9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND B: CUSIP 566816GY4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND C: CUSIP 425203BM7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND D: CUSIP 13033FTN0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND E: CUSIP 13033FG46 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(c)2005 SERIES exchanged forSERIES FHIJKL. CONTINUED ON SCH O.
BOND F: CUSIP 13033FYE4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND G: CUSIP 040507GL3 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND H: CUSIP 130795DH7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND I: CUSIP 130795DR5 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND J: CUSIP 566816HP2 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND K: CUSIP 759835AA9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND L: CUSIP 425203CF1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND M: CUSIP 13033LAZ0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND N: CUSIP 566816JJ4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 PRt I,(f) Repay line of credit. CONTINUED ON SCHEDULE O.
BOND O: CUSIP 13033LEQ6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund BOND SERIES. CONTINUED ON SCH O.
BOND P: CUSIP 040507MJ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund 2008 Series D bonds. CONTINUED ON SCH O.
BOND Q: CUSIP 566816JL9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (F) Refund 1992 & 1998 Series A bonds. CONTINUED ON SCH O.
BOND R: CUSIP 13033LSZ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND S: CUSIP 040507MU6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND T: CUSIP 13033LUD7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (f) Refund 2009 Series BC & G bonds. CONTINUED ON SCHEDULE O.
BOND U: CUSIP 040507MV4 - 0 Prt I, (f) Refund 2009 Series B & E bonds. CONTINUED ON SCHEDULE O.
Schedule K (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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 VI 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 VI   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 BOND C: CUSIP 425203BM7-SEE PRT VI   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 BOND D: CUSIP 13033FTN0-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FG46 11-10-2005 351,135,742 BOND E: CUSIP 13033FG46-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FYE4 11-10-2005 200,000,000 BOND F: CUSIP 13033FYE4-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507GL3 11-10-2005 224,000,000 BOND G: CUSIP 040507GL3-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DH7 04-26-2007 400,000,000 BOND H: CUSIP 130795DH7-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DR5 04-26-2007 276,250,000 BOND I: CUSIP 130795DR5-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816HP2 04-26-2007 178,702,052 BOND J: CUSIP 566816HP2-SEE PRT VI   X   X   X
CITY OF RENO NEVADA
  		88-6000201 759835AA9 04-26-2007 98,635,589 BOND K: CUSIP 759835AA9-SEE PRT VI X     X   X
CITY OF HENDERSON NEVADA
  		88-6000720 425203CF1 04-26-2007 200,626,751 BOND L: CUSIP 425203CF1-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LAZ0 05-14-2009 457,778,078 BOND M: CUSIP 13033LAZ0-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816JJ4 05-14-2009 127,153,706 BOND N: CUSIP 566816JJ4-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LEQ6 11-12-2009 235,106,175 BOND O: CUSIP 13033LEQ6-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MJ1 11-12-2009 75,689,293 BOND P: CUSIP 040507MJ1-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		88-0445263 566816JL9 07-14-2011 115,008,059 BOND Q: CUSIP 566816JL9-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LSZ1 11-09-2011 515,217,012 BOND R: CUSIP 13033LSZ1-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MU6 11-09-2011 125,000,601 BOND S: CUSIP 040507MU6-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LUD7 06-27-2012 140,000,000 BOND T: CUSIP 13033LUD7-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MV4 06-27-2012 75,000,000 BOND U: CUSIP 040507MV4-SEE PRT VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 45,900,000 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 472,399,331 267,956,955 171,862,421 136,994,286
4 Gross proceeds in reserve funds . . . . . . . . 7,910,067 8,557,073 4,163,061 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 5,184,771 0
6 Proceeds in refunding escrows . . . . . . . . . . . 428,246,052 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 . . . . . . . 7,098,781 6,947,963 2,791,994 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 16,278,603 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     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) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 0.00000% 0% 0% 0%
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 0.00000% 0.00000% 0.00000% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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 qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . CITIGROUP & JPMORGN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . . . . . . . 21.2 5. 5. 34.2
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . . X   X   X   X  
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X   X   X     X
b Name of provider . . . . . . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		0
 
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
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
BOND A: CUSIP 13033FRT9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND B: CUSIP 566816GY4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND C: CUSIP 425203BM7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND D: CUSIP 13033FTN0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND E: CUSIP 13033FG46 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(c)2005 SERIES exchanged forSERIES FHIJKL. CONTINUED ON SCH O.
BOND F: CUSIP 13033FYE4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND G: CUSIP 040507GL3 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND H: CUSIP 130795DH7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND I: CUSIP 130795DR5 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND J: CUSIP 566816HP2 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND K: CUSIP 759835AA9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND L: CUSIP 425203CF1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND M: CUSIP 13033LAZ0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND N: CUSIP 566816JJ4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 PRt I,(f) Repay line of credit. CONTINUED ON SCHEDULE O.
BOND O: CUSIP 13033LEQ6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund BOND SERIES. CONTINUED ON SCH O.
BOND P: CUSIP 040507MJ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund 2008 Series D bonds. CONTINUED ON SCH O.
BOND Q: CUSIP 566816JL9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (F) Refund 1992 & 1998 Series A bonds. CONTINUED ON SCH O.
BOND R: CUSIP 13033LSZ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND S: CUSIP 040507MU6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND T: CUSIP 13033LUD7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (f) Refund 2009 Series BC & G bonds. CONTINUED ON SCHEDULE O.
BOND U: CUSIP 040507MV4 - 0 Prt I, (f) Refund 2009 Series B & E bonds. CONTINUED ON SCHEDULE O.
Schedule K (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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 VI 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 VI   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 BOND C: CUSIP 425203BM7-SEE PRT VI   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 BOND D: CUSIP 13033FTN0-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FG46 11-10-2005 351,135,742 BOND E: CUSIP 13033FG46-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FYE4 11-10-2005 200,000,000 BOND F: CUSIP 13033FYE4-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507GL3 11-10-2005 224,000,000 BOND G: CUSIP 040507GL3-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DH7 04-26-2007 400,000,000 BOND H: CUSIP 130795DH7-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DR5 04-26-2007 276,250,000 BOND I: CUSIP 130795DR5-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816HP2 04-26-2007 178,702,052 BOND J: CUSIP 566816HP2-SEE PRT VI   X   X   X
CITY OF RENO NEVADA
  		88-6000201 759835AA9 04-26-2007 98,635,589 BOND K: CUSIP 759835AA9-SEE PRT VI X     X   X
CITY OF HENDERSON NEVADA
  		88-6000720 425203CF1 04-26-2007 200,626,751 BOND L: CUSIP 425203CF1-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LAZ0 05-14-2009 457,778,078 BOND M: CUSIP 13033LAZ0-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816JJ4 05-14-2009 127,153,706 BOND N: CUSIP 566816JJ4-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LEQ6 11-12-2009 235,106,175 BOND O: CUSIP 13033LEQ6-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MJ1 11-12-2009 75,689,293 BOND P: CUSIP 040507MJ1-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		88-0445263 566816JL9 07-14-2011 115,008,059 BOND Q: CUSIP 566816JL9-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LSZ1 11-09-2011 515,217,012 BOND R: CUSIP 13033LSZ1-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MU6 11-09-2011 125,000,601 BOND S: CUSIP 040507MU6-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LUD7 06-27-2012 140,000,000 BOND T: CUSIP 13033LUD7-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MV4 06-27-2012 75,000,000 BOND U: CUSIP 040507MV4-SEE PRT VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 45,900,000 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 472,399,331 267,956,955 171,862,421 136,994,286
4 Gross proceeds in reserve funds . . . . . . . . 7,910,067 8,557,073 4,163,061 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 5,184,771 0
6 Proceeds in refunding escrows . . . . . . . . . . . 428,246,052 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 . . . . . . . 7,098,781 6,947,963 2,791,994 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 16,278,603 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     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) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 0.00000% 0% 0% 0%
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 0.00000% 0.00000% 0.00000% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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 qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . CITIGROUP & JPMORGN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . . . . . . . 21.2 5. 5. 34.2
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . . X   X   X   X  
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X   X   X     X
b Name of provider . . . . . . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		0
 
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
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
BOND A: CUSIP 13033FRT9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND B: CUSIP 566816GY4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND C: CUSIP 425203BM7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND D: CUSIP 13033FTN0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND E: CUSIP 13033FG46 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(c)2005 SERIES exchanged forSERIES FHIJKL. CONTINUED ON SCH O.
BOND F: CUSIP 13033FYE4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND G: CUSIP 040507GL3 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND H: CUSIP 130795DH7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND I: CUSIP 130795DR5 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND J: CUSIP 566816HP2 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND K: CUSIP 759835AA9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND L: CUSIP 425203CF1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND M: CUSIP 13033LAZ0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND N: CUSIP 566816JJ4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 PRt I,(f) Repay line of credit. CONTINUED ON SCHEDULE O.
BOND O: CUSIP 13033LEQ6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund BOND SERIES. CONTINUED ON SCH O.
BOND P: CUSIP 040507MJ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund 2008 Series D bonds. CONTINUED ON SCH O.
BOND Q: CUSIP 566816JL9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (F) Refund 1992 & 1998 Series A bonds. CONTINUED ON SCH O.
BOND R: CUSIP 13033LSZ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND S: CUSIP 040507MU6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND T: CUSIP 13033LUD7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (f) Refund 2009 Series BC & G bonds. CONTINUED ON SCHEDULE O.
BOND U: CUSIP 040507MV4 - 0 Prt I, (f) Refund 2009 Series B & E bonds. CONTINUED ON SCHEDULE O.
Schedule K (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
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 VI 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 VI   X   X   X
C CITY OF HENDERSON NEVADA
  		88-6000720 425203BM7 04-28-2004 166,163,811 BOND C: CUSIP 425203BM7-SEE PRT VI   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1598225 13033FTN0 05-19-2004 150,000,000 BOND D: CUSIP 13033FTN0-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FG46 11-10-2005 351,135,742 BOND E: CUSIP 13033FG46-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033FYE4 11-10-2005 200,000,000 BOND F: CUSIP 13033FYE4-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507GL3 11-10-2005 224,000,000 BOND G: CUSIP 040507GL3-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DH7 04-26-2007 400,000,000 BOND H: CUSIP 130795DH7-SEE PRT VI   X   X   X
CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITIES
  		68-0164610 130795DR5 04-26-2007 276,250,000 BOND I: CUSIP 130795DR5-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816HP2 04-26-2007 178,702,052 BOND J: CUSIP 566816HP2-SEE PRT VI   X   X   X
CITY OF RENO NEVADA
  		88-6000201 759835AA9 04-26-2007 98,635,589 BOND K: CUSIP 759835AA9-SEE PRT VI X     X   X
CITY OF HENDERSON NEVADA
  		88-6000720 425203CF1 04-26-2007 200,626,751 BOND L: CUSIP 425203CF1-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LAZ0 05-14-2009 457,778,078 BOND M: CUSIP 13033LAZ0-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		86-0445263 566816JJ4 05-14-2009 127,153,706 BOND N: CUSIP 566816JJ4-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LEQ6 11-12-2009 235,106,175 BOND O: CUSIP 13033LEQ6-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MJ1 11-12-2009 75,689,293 BOND P: CUSIP 040507MJ1-SEE PRT VI   X   X   X
THE INDUSTRIAL DEVLPMT AUTH OF CNTY OF MARICOPA AZ
  		88-0445263 566816JL9 07-14-2011 115,008,059 BOND Q: CUSIP 566816JL9-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LSZ1 11-09-2011 515,217,012 BOND R: CUSIP 13033LSZ1-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MU6 11-09-2011 125,000,601 BOND S: CUSIP 040507MU6-SEE PRT VI   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY
  		52-1643828 13033LUD7 06-27-2012 140,000,000 BOND T: CUSIP 13033LUD7-SEE PRT VI   X   X   X
ARIZONA HEALTH FACILITIES AUTHORITY
  		86-0453292 040507MV4 06-27-2012 75,000,000 BOND U: CUSIP 040507MV4-SEE PRT VI   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 45,900,000 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 4,100,000 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 472,399,331 267,956,955 171,862,421 136,994,286
4 Gross proceeds in reserve funds . . . . . . . . 7,910,067 8,557,073 4,163,061 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 5,184,771 0
6 Proceeds in refunding escrows . . . . . . . . . . . 428,246,052 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 . . . . . . . 7,098,781 6,947,963 2,791,994 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 16,278,603 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     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) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any 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 0.00000% 0% 0% 0%
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 0.00000% 0.00000% 0.00000% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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 qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . CITIGROUP & JPMORGN
  		JP MORGAN
  		CITIGROUP
  		 
 
c Term of hedge . . . . . . . . 21.2 5. 5. 34.2
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . . X   X   X   X  
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X   X   X     X
b Name of provider . . . . . . LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		LEHMAN BROTHERS
  		0
 
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
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
BOND A: CUSIP 13033FRT9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND B: CUSIP 566816GY4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND C: CUSIP 425203BM7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND D: CUSIP 13033FTN0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND E: CUSIP 13033FG46 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(c)2005 SERIES exchanged forSERIES FHIJKL. CONTINUED ON SCH O.
BOND F: CUSIP 13033FYE4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND G: CUSIP 040507GL3 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND H: CUSIP 130795DH7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND I: CUSIP 130795DR5 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND J: CUSIP 566816HP2 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND K: CUSIP 759835AA9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND L: CUSIP 425203CF1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND M: CUSIP 13033LAZ0 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND N: CUSIP 566816JJ4 - ADDITIONAL SCHEDULES ARE INCLUDED 0 PRt I,(f) Repay line of credit. CONTINUED ON SCHEDULE O.
BOND O: CUSIP 13033LEQ6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund BOND SERIES. CONTINUED ON SCH O.
BOND P: CUSIP 040507MJ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(f) Refund 2008 Series D bonds. CONTINUED ON SCH O.
BOND Q: CUSIP 566816JL9 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (F) Refund 1992 & 1998 Series A bonds. CONTINUED ON SCH O.
BOND R: CUSIP 13033LSZ1 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND S: CUSIP 040507MU6 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I,(e)difference due to investment earnings. CONTINUED ON SCH O.
BOND T: CUSIP 13033LUD7 - ADDITIONAL SCHEDULES ARE INCLUDED 0 Prt I, (f) Refund 2009 Series BC & G bonds. CONTINUED ON SCHEDULE O.
BOND U: CUSIP 040507MV4 - 0 Prt I, (f) Refund 2009 Series B & E bonds. CONTINUED ON SCHEDULE O.
Schedule K (Form 990) 2011

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
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
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) Marvin O'Quinn
relocation loan 		  X 600,000 400,000   No   No Yes  
(2) Herb Vallier
relocation loan 		  X 300,000 300,000   No   No Yes  
Total ...............Small Bullet $ 700,000
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) 2011
Schedule L (Form 990 or 990-EZ) 2011
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 63,281 Employment   No
(2) Kristin Anderson Family member-J Anderson 98,235 Employment   No
(3) SonoSite Inc R Hochman, BOD 402,710 Equipment and services   No
(4) Marianne Hyer Family member of J Hyer 36,681 Employment   No
(5) Mercy Doctors Medical Group K Mills, ownership int>5% 171,639 Lease payments   No
(6) Ashley Olson Family member of M Uboldi 11,817 Employment   No
(7) Jason Olson Family member of M Uboldi 44,932 Employment   No
(8) Paige Gemuenden Famly membr of M Callahan 50,192 Employment   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) 2011

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
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
Employer identification number

94-1196203
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art .... X 91 44,841 COMPARABLE SALE
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		X 279,957 RESALE VALUE
6 Cars and other vehicles ..        
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 4 519,400 COMPARABLE SALE
19 Food inventory ...        
20 Drugs and medical supplies . X 11 70,550 COMPARABLE SALE
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( LAND & BLDG IMPROVEMENTS ) X 12 99,418 COST
26 Other Right pointing arrow large image ( ELECTRONICS ) X 2 68,998 COMPARABLE SALE
27 Other Right pointing arrow large image ( FURNITURE & FIXTURES ) X 48 46,145 COMPARABLE SALE
28 Other Right pointing arrow large image ( TOYS ) X 77 44,712 COMPARABLE SALE
Other Right pointing arrow large image ( Medical Equipment ) X 3 26,631 COMPARABLE SALE
Other Right pointing arrow large image ( ENTERTAINMENT ) X 4 22,643 COMPARABLE SALE
Other Right pointing arrow large image ( DENTAL SUPPLIES ) X 1 10,055 COMPARABLE SALE
Other Right pointing arrow large image ( FOOD & WINE ) X 1 2,072 COMPARABLE SALE
Other Right pointing arrow large image ( WIGS ) X 1 1,926 COMPARABLE SALE
Other Right pointing arrow large image ( BLANKETS ) X 1 1,500 COMPARABLE SALE
Other Right pointing arrow large image ( SEASONAL FLOWERS ) X 1 960 COMPARABLE SALE
Other Right pointing arrow large image ( CRYSTAL STEMWARE ) X 1 922 COMPARABLE SALE
Other Right pointing arrow large image ( OFFICE EQUIPMENT ) X 1 55 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 noncash
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) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. 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   DIGNITY HEALTH IS SUPPORTED BY VARIOUS FUNDRAISING FOUNDATIONS. AS SUPPORTING ORGANIZATIONS, THE FOUNDATIONS SOLICIT AND PROCESS NON-CASH CONTRIBUTIONS ON BEHALF OF DIGNITY HEALTH'S HOSPITALS.
Schedule M (Form 990) 2011
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
2011
Open to Public
Inspection
Name of the organization
DIGNITY HEALTH
 
Employer identification number

94-1196203
Identifier Return Reference Explanation
PART VI, GOVERNANCE AND MANAGEMENT DISCLOSURES   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 4 In January 2012, the Corporation implemented a governance restructuring and announced its name change to Dignity Health. The governance restructuring was implemented through revisions to Catholic Healthcare West's corporate documents, including Restated Articles of Incorporation and Restated Bylaws. Dignity Health transitioned to a self-perpetuating Board of Directors structure from the prior structure where the Board of Directors was appointed by Corporate Members, which had been comprised of women religious appointed by the religious orders that sponsored the organization. There was no change to the ownership, use of the corporation's assets or federal tax identification number, nor did the governance restructuring impact the corporation's management structure or nonprofit status. Dignity Health has received an IRS determination letter to maintain its 501(c)(3) tax-exempt status, retroactive to the application date in December 2011. See line 7b below for reserved powers of co-sponsors. FORM 990, PART VI, SECTION A, LINES 6 AND 7a Prior to the January 2012 governance restructuring and name change noted above, the organization was co-sponsored by six congregations ("co-sponsors") that had specific governance rights and responsibilities, including the appointment of the organization's Corporate Members which were automatically on the Board of Directors. Subsequent to the restructuring, Dignity Health transitioned to a self-perpetuating Board of Directors structure with significant reserved powers held by the former members as described herein. FORM 990, PART VI, SECTION A, LINE 7b Prior to the January 2012 governance restructuring and name change noted above, reserved rights of the Corporate Members (and in some instances the Corporate Members and the co-sponsors separate and apart from the Corporate Members) included the adoption of, or material change in, the mission and philosophy statements of the organization and its subordinates, amendment or restatement of articles of incorporation and bylaws, sale or disposition of all or substantially all assets of the organization, appointment or termination of the chief executive officer, change of name of the organization, 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 constitutes property subject to the norm of church law, dissolution of the Corporation, and merger or consolidation with another corporation with the organization as the disappearing corporation. In its governance restructuring, pursuant to the legacy of the co-sponsors, the Corporation committed in its bylaws to continue a healing ministry based on the life and works of Jesus in the provision of healthcare services in the communities it serves ("the healing ministry.") To further the healing ministry, the rights formerly reserved to the co-sponsors of Dignity Health were preserved post-restructuring as follows. A Sponsorship Council was formed pursuant to the Bylaws, composed of members of the co-sponsoring organizations, and responsible for overseeing and acting upon issues of Catholic identity for Catholic-sponsored facilities, and informing the healing ministry of the Corporation, including both Catholic-sponsored and non-Catholic sponsored facilities, through the right to appoint three of seven members of the Mission Integrity Committee of the Board and to approve any changes in the Statement of Common Values. The Mission Integrity Committee is responsible for evaluation and resolution of management, operational, and patient care issues that impact conformance with the mission and values of the healing ministry in the operations of the Corporation; approving policies and procedures with respect to implementation and conformance to the mission and values of the healing ministry; establishing and maintaining systems for monitoring compliance with the mission and values of the healing ministry; the operational integrity of the Statement of Common Values and the Ethical and Religious Directives; the operational integrity of mission integration standards; pastoral care and education programs; and ministry leadership formation programs. In addition, the Mission Integrity Committee shall have the power and responsibility to review and monitor the System's labor practices and pension administration. The Mission Committee may propose changes to the Statement of Common Values, provided the proposal is first reviewed with the Sponsorship Council, which has the sole power to veto any such changes before they are presented to the Corporation's Board for final approval. In addition to working through the Sponsorship Council, at least two members of the Dignity Health Board continue to be women religious, serving as individuals, not as representatives of their congregations. Finally, each individual sponsoring congregation would continue to have the right to the approval of the sale or closure of its sponsored Catholic hospitals or disposition of its other stable patrimony, or the change of name of such Catholic hospital. FORM 990, PART VI, SECTION B, LINE 11A The Board of Directors delegated the review of the Form 990 to the Audit and Compliance Committee. The organization's SVP/Finance & Corporate Controller and the VP/Financial Services and 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 Dignity Health 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 SEVP/Chief Financial Officer 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 the 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. Dignity Health's policies related to conflicts of interest charge the EVP/General Counsel with responsibility for reviewing and validating disclosures, and maintaining adequate records of disclosures. Pursuant to these policies, 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 policy applicable to their position; (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 EVP/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) the transaction or action must be approved by a majority of disinterested persons, based on certain criteria; and (6) any conflicting issues arising during the course of a Board meeting which cannot be resolved may be referred to an independent committee of the Board of Directors. FORM 990, PART VI, SECTION B, LINE 15A & 15B 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 B, LINE 19 Federal tax laws do not require that the organization's governing documents, policies related to conflicts of interest and financial statements be made available for public inspection. The organization makes its consolidated financial statements available on its website and upon request. The financial statements are also attached to this Form 990.
FORM 990, PART VII, SECTION A   Dignity Health does not compensate Director Ken Mills for his services as a board member, but rather for administrative and medical director services provided at a Dignity Health facility.
FORM 990, PART XI - Reconciliation of Net Assets, Line 5   Change in unrealized gains/(losses); $(196,549,413) Change in non-controlling interest; $502,587 Change in additional minimum pension liability; $(582,711,000) Investment in health related activities organized as corps/exempt Organizations; $41,885,234 Mark-to-market on interest rate swaps; $2,682,936 Interest in net assets of unconsolidated foundation/related entities; $(1,832,061) Book/tax difference k-1 investments; $(26,391,121) Change in ownership interest-JV; $(291,911) Other fund balance transfers; $926,518
FORM 990, PART XII - Financial Statements AND Reporting, LINE 3   The organization's federal awards were included in Dignity Health and Subordinate Corporations' consolidated OMB Circular A-133 audited schedule of federal expenditures.
SCHEDULE K   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) $4.1 million of the CHFFA 2004 H was defeased in 2005. The first call date is 7/1/2011. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contract be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Arbitrage calculations were performed by our arbitrage consultants and reviewed by Dignity Health (formerly Catholic Healthcare West). Such consultants determined that there was no rebatable arbitrage liability; accordingly, no Form 8038-T was required to be filed. 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 bonds which were later exchanged for CHFFA 2008 Series F and AHFA 2005 Series A bonds 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 were actually terminated by either Dignity Health, 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, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Arbitrage calculations were performed by our arbitrage consultants and reviewed by Dignity Health. Such consultants determined that there was no rebatable arbitrage liability; accordingly, no Form 8038-T was required to be filed. 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 were actually terminated by either Dignity Health, 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, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Arbitrage calculations were performed by our arbitrage consultants and reviewed by Dignity Health. Such consultants determined that there was no rebatable arbitrage liability; accordingly, no Form 8038-T was required to be filed. 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 were actually terminated by either Dignity Health, 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, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Arbitrage calculations were performed by our arbitrage consultants and reviewed by Dignity Health. Such consultants determined that there was no rebatable arbitrage liability; accordingly, no Form 8038-T was required to be filed. BOND E: CUSIP 13033FG46 Part I, Column (c) California Health Facilities Financing Authority (CHFFA) 2005 SERIES A-G, of which CHFFA 2005 SERIES A-F were exchanged for CHFFA 2008 SERIES FHIJKL. The CUSIP number noted on Schedule K '13033FG46' is the CUSIP from the original Form 8038 filed for the 2005 Series A-G bonds, all of which were issued on November 10, 2005. On May 16, 2008, the CHFFA series 2005 A-F bonds were exchanged pursuant to IRS Notice 2008-41, without causing a reissuance, for CHFFA 2008 series FHIJKL, of which the longest maturity, within series J (maturing July 1, 2032), was CUSIP number '13033F3D0.' 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 - CHFFA 1988 A; CHFFA 1995 H; CHFFA 1997 A; CHFFA 1998 A; CSCDA 1999 and new money for capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has 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 were actually terminated by either Dignity Health, 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. BOND F: CUSIP 13033FYE4 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 $37 million of the $200 million of the CHFFA 2005 Series H and I pool bonds. Part I, Column (f) New money to finance capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47.
.   BOND G: CUSIP 040507GL3 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 (c) Arizona Health Facility Authority (AHFA) 2005 Series BCDE, of which AHFA 2005 Series CDE were exchanged for AHFA 2008 Series ABC, of which AHFA 2008 Series C was exchanged for AHFA 2009 Series F. The CUSIP number noted on Schedule K '040507GL3' is the CUSIP from the original Form 8038 filed for the 2005 Series BCDE Bonds, all of which were issued on November 10, 2005. On May 16, 2008, the AHFA 2005 CDE Bonds were exchanged, pursuant to IRS Notice 2008-41, without causing a reissuance, for AHFA 2008 Series ABC. The AHFA 2008 Series C Bonds were later exchanged, pursuant to IRS Notice 2008-41, without causing a reissuance, for the AHFA 2009 Series F Bonds on November 12, 2009. All the series noted above have the same maturity of July 1, 2035. The CUSIPs of the outstanding bonds are AHFA 2005 Series B '040507GM1', AHFA 2008 A '040507JT3', AHFA 2008 B '040507JU0' and AHFA 2009 Series F '040507MK8.' Part I, Column (f) New money to finance capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. 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 were actually terminated by either Dignity Health, 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. BOND H: CUSIP 130795DH7 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 - CA 1995 A; CA 1996 A; and CA 1999 A; and new money for capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has 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 CSCDA 2007 Series ABC, such hedges were deemed terminated May 16, 2008 (CSCDA 2007 Series A were later exchanged for CSCDA 2008 Series C fixed rate bonds), May 14, 2009 (CSCDA 2007 Series C were exchanged without a reissuance for CSCDA 2008 Series G and later refinanced to CHFFA 2009 Series A fixed rate bonds) and November 12, 2009 (CSCDA 2007 Series B were exchanged without a reissuance for CSCDA 2008 Series F and later refinanced with CHFFA 2009 Series G put bonds) as a result of either the refinancing of these bonds or the exchange (without a reissuance) and conversion of these bonds into long-term fixed-rate bonds. The CSCDA DEF bonds are still outstanding and continue to have hedges associated with them. 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 were actually terminated by either Dignity Health, 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. BOND I: CUSIP 130795DR5 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 (c) California Statewide Community Development Authority (CSCDA) 2007 Series G-L, of which CSCDA 2007 Series G-J were exchanged for CSCDA 2008 Series ABDE. The CUSIP number noted on Schedule K '130795DR5' is the CUSIP from the original Form 8038 filed for the 2007 Series G-L Bonds, all of which were issued on November 10, 2005. On May 16, 2008, the CSCDA 2007 Series GHIJ Bonds were exchanged, pursuant to IRS Notice 2008-41, without causing a reissuance, for CSCDA 2008 Series ABDE, and there was an interest rate conversion on the CSCDA 2007 Series KL Bonds. The latest maturities on the currently outstanding exchanged bonds are the CSCDA 2007 Series KL Bonds, both of which have a final maturity date of July 1, 2041. The CUSIPs are '130795TV9' for the CSCDA 2007 Series K Bonds and '130795TW7' for the CSCDA Series 2007 L Bonds. Part I, Column (f) New money to finance capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47.
.   BOND J: CUSIP 566816HP2 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 1999 A; and new money for capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND K: CUSIP 759835AA9 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) Repayment of line of credit used to retire prior outstanding bonds and new money for an emergency room expansion and medical equipment. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. Part VI - Supplemental Information Although the City of Reno, Nevada, health facility revenue bonds (Catholic Healthcare West), 2007 Series A (the "2007 Reno bonds"), are shown on line 1 of Part I of this Schedule K, Dignity Health (formerly Catholic Healthcare West) and the City of Reno, Nevada (the "City"), took appropriate remedial action with respect to all of the 2007 Reno bonds, under section 1.141-12(d) of the treasury regulations, on September 24, 2012, by defeasing a pro rata portion of the 2007 Reno bonds, in the principal amount of $42,085,000, within 90 days of the sale by Dignity Health of Saint Mary's Regional Medical Center ("SMRMC"), in Reno, Nevada. Such defeasance will cause such portion of the 2007 Reno bonds to be redeemed on their first optional redemption date of July 1, 2017. Because the consideration for the sale of SMRMC was exclusively cash, pursuant to section 1.141-12(d)(2) of the treasury regulations, Dignity Health and the City were permitted to meet, and met, the requirements of section 1.141-12(d) of the treasury regulations with respect to all of the 2007 Reno bonds by applying the "disposition proceeds" received from the sale of SMRMC to the defeasance of a pro rata portion of the 2007 Reno bonds through their first optional redemption date of July 1, 2017. Such pro rata portion of the 2007 Reno bonds was determined to have a principal amount of $42,085.000. BOND L: CUSIP 425203CF1 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 1998 A; NV 1999 A; NV 2004 Series B; and new money for capital expenditures at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND M: CUSIP 13033LAZ0 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 California Health Facilities Financing Authority 2008 Series CDE; and California Statewide Communities Development Authority 2008 Series G issued on May 16, 2008; and new money to finance capital projects at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND N: CUSIP 566816JJ4 Part I, Column (f) Repay line of credit used to retire Industrial Development Authority of Maricopa County Arizona 2004 Series B bonds issued on April 28, 2004. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND O: CUSIP 13033LEQ6 Part I, Column (f) Refund California Health Facilities Financing Authority 2008 Series ABF; and California Statewide Communities Development Authority 2008 Series F bonds issued on May 16, 2008. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47.
.   BOND P: CUSIP 040507MJ1 Part I, Column (f) Refund Arizona Health Facilities Authority 2008 Series D bonds issued on May 16, 2008. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND Q: CUSIP 566816JL9 Part I, Column (f) Refund Industrial Development Authority of Maricopa County Arizona 1992 Series A bonds issued on September 1, 1992 and Industrial Development Authority of Maricopa County Arizona 1998 Series A bonds issued on December 3, 1998. BOND R: CUSIP 13033LSZ1 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 CHFFA 1993 Series A bonds issued on March 17, 1993, CHFFA 1996 Series E bonds issued on December 12, 1996, CHFFA 1997 Series A bonds issued on October 15, 1997 and CHFFA 1998 Series A bonds Issued On December 3, 1998. Repay line of credit used to retire CHFFA 2004 Series H bonds issued on April 28, 2004. New money to finance capital projects at various hospital facilities. Part II, Line 11 Bond proceeds were used to pay off the CHFFA 2004 Series H put bond that came due on 7/1/2011 that was financed with a draw on the working line of credit. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND S: CUSIP 040507MU6 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) New money to finance capital projects at various hospital facilities. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND T: CUSIP 13033LUD7 Part I, Column (f) Refund CHFFA 2009 Series BC bonds issued on May 14, 2009 and CHFFA 2009 Series G bonds issued on November 12, 2009. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47. BOND U: CUSIP 040507MV4 Part I, Column (f) Refund Industrial Development Authority of Maricopa County Arizona 2009 Series B bonds issued on May 14, 2009 and Arizona Health Facilities Financing Authority 2009 Series E bonds issued on November 12, 2009. Part III, Line 3a Although there are management or service contracts that may generate private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 97-13. Part III, Line 3c Although there are research agreements which may result in private use, Dignity Health has policies and procedures in place that require such contracts be in compliance with Revenue Procedure 2007-47.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

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
2011
Open to Public Inspection
Name of the organization
DIGNITY HEALTH
 
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) Arizona Care Network LLC
350 W Thomas Rd
Phoenix,AZ85013
45-4494682 		Care Network AZ 0 0 Dignity Hlth
 
(2) CHMC Hope Street Family Center Property
1401 South Grand Avenue
Los Angeles,CA90015
27-0967098 		Real Property CA 0 0 Dignity Hlth
 
(3) CHW Nevada Imaging Company LLC
5495 South Rainbow Blvd Suite 203
Las Vegas,NV89118
26-3322792 		Imaging Svc NV 25,509,188 12,831,166 Dignity Hlth
 
(4) CHWUSP Oxnard Surgery Centers LLC
1700 N ROSE AVENUE STE 100
OXNARD,CA93030
20-0707388 		OP Surgery CA 440,716 1,287,915 SJOSC
 
(5) Dignity Health Purchasing Network LLC
3033 North Third Avenue
Phoenix,AZ85013
45-5555133 		Group Purchas CA 0 0 Dignity Hlth
 
(6) Southern California Integrated Care Netw
2101 NORTH WATERMAN AVENUE
San Bernardino,CA92404
45-5566171 		Care Network CA 0 0 Dignity Hlth
 
(7) St John's Regional Imaging Center LLC
26250 Enterprise Court Suite 100
Lake Forest,CA92630
77-0483564 		OP Radiology CA 3,129,626 954,428 Dignity Hlth
 
(8) St Francis Foundation LLC
112 E Victoria Street
Santa Barbara,CA93101
42-1691710 		Leasing CA 0 1,568,094 Dignity Hlth
 
(9) St Rose Quality Care Network LLC
102 E Lake Mead Drive
Henderson,NV89015
46-2147857 		Care Network NV 0 0 Dignity Hlth
 
(10) Trinity Care LLC
901 Corporate Center Drive Suite 40
Monterey Park,CA91754
33-0805338 		Health care CA 12,544,725 1,763,719 Dignity Hlth
 
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 DIGNITY HLTH
 
Yes
 
(2) Dignity Health HPL Self-Insurance Trust

185 Berry Street

San Francisco,CA94107
94-3006034 		Administratio CA 501(c)(3) 11A DIGNITY HLTH
 
Yes
 
(3) DIGNITY HEALTH Workers' Comp SELF-INS

185 Berry Street

San Francisco,CA94107
94-6612446 		Administratio CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(4) DIGNITY HEALTH Medical Foundation

3400 Data Drive

Rancho Cordova,CA95670
68-0220314 		Multi-sp clin CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(5) Community Hospital of San Bernardino

1805 Medical Center Drive

San Bernardino,CA92411
95-1643373 		Hospital CA 501(C)(3) 3 DIGNITY HLTH
 
Yes
 
(6) Dominican Health Services

1555 Soquel Drive

Santa Cruz,CA95065
77-0056778 		Community Hea CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(7) Dominican Oaks Corporation

1555 Soquel Drive

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

200 Mercy Oaks Drive

Redding,CA96003
23-7115371 		Senior ctr CA 501(C)(3) 7 DIGNITY HLTH
 
Yes
 
(9) Marian Community Clinics Inc

1400 E Church Street

Santa Maria,CA93454
77-0447575 		Clinic CA 501(C)(3) 3 DIGNITY HLTH
 
Yes
 
(10) Mark Twain St Joseph's Healthcare Corp

768 Mountain Ranch Road

San Andreas,CA95249
68-0127677 		Hospital CA 501(C)(3) 3 NA
 
 
No
(11) Mercy Senior Housing Inc

3865 J Street

Sacramento,CA95816
68-0117340 		SR HOUSING CA 501(C)(3) 9 DIGNITY HLTH
 
Yes
 
(12) Saint Francis Memorial Hospital

900 Hyde Street

San Francisco,CA94109
94-1156295 		Hospital CA 501(C)(3) 3 DIGNITY HLTH
 
Yes
 
(13) Saint Mary's Outpatient Surgery Center

235 West Sixth Street

Reno,NV89520
80-0035199 		OP surgery NV 501(C)(3) 3 DIGNITY HLTH
 
Yes
 
(14) Shasta Senior Nutrition Program

100 Mercy Oaks Drive

Redding,CA96003
94-2650429 		Sr Meal CA 501(C)(3) 7 DIGNITY HLTH
 
Yes
 
(15) Sierra Nevada Memorial-Miners Hospital

155 Glasson Way

Grass Valley,CA95945
94-1439787 		Hospital CA 501(C)(3) 3 DIGNITY HLTH
 
Yes
 
(16) St Francis Hospital Support Corporation

601 E Micheltorena Street

Santa Barbara,CA93103
77-0022302 		INACTIVE CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(17) St Mary Catholic Housing Corporation

1050 Linden Avenue

Long Beach,CA90813
33-0007728 		Sr HOusing CA 501(C)(3) 1 DIGNITY HLTH
 
Yes
 
(18) St Mary Professional Building Inc

1050 Linden Avenue

Long Beach,CA90813
23-7373088 		Provide offic CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(19) Arroyo Grande Community Hospital Foundat

345 S Halcyon Rd

Arroyo Grande,CA93420
20-3256066 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(20) Barrow Neurological Foundation

350 West Thomas Road

Phoenix,AZ85013
86-0174371 		FNDRSING FND AZ 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(21) California Hospital Medical Center Found

1401 South Grand Avenue

Los Angeles,CA90015
95-4000909 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(22) DIGNITY HEALTH Foundation East Valley

475 South Dobson Road

Chandler,AZ85224
74-2418514 		FNDRSING FND AZ 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(23) Community Hospital Foundation of San Ber

1805 Medical Center Drive

San Bernardino,CA92411
95-3051931 		FNDRSING FND CA 501(C)(3) 11A CHSB
 
Yes
 
(24) Dominican Hospital Foundation

1555 Soquel Drive

Santa Cruz,CA95065
94-2450442 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(25) French Hospital Medical Center Foundatio

1911 Johnson Avenue

San Luis Obispo,CA93401
20-3256125 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(26) Glendale Memorial Health Foundation

1420 South Central Avenue

Glendale,CA91204
95-3625651 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(27) Marian Medical Center Foundation

1400 E Church Street

Santa Maria,CA93454
95-3818027 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(28) Mercy Foundation Bakersfield

PO Box 119

Bakersfield,CA93302
77-0201321 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(29) Mercy Foundation Sacramento

3400 Data Drive 3rd Flr

Rancho Cordova,CA95670
23-7072762 		FNDRSING FND CA 501(C)(3) 11A NA
 
 
No
(30) Northridge Hospital Foundation

18300 Roscoe Blvd

Northridge,CA91328
23-7444901 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(31) Saint Mary's Foundation

520 West Sixth Street

Reno,NV89520
88-0188386 		FNDRSING FND NV 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(32) San Gabriel Valley Medical Center Founda

438 West Las Tunas Drive

San Gabriel,CA91776
95-3430341 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(33) Sequoia Hospital Foundation

170 Alameda de las Pulgas

Redwood City,CA94062
94-2909990 		FNDRSING FND CA 501(C)(3) 11D NA
 
 
No
(34) St Bernardine Medical Center Foundation

2101 N Waterman Avenue

San Bernardino,CA92404
23-7440086 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(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) 11A DIGNITY HLTH
 
Yes
 
(36) St John's Healthcare Foundation

1600 North Rose Avenue

Oxnard,CA93030
20-2865781 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(37) St Joseph's Foundation

350 West Thomas Road

Phoenix,AZ85013
94-2941245 		FNDRSING FND AZ 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(38) St Joseph's Foundation of San Joaquin

1800 N California Street

Stockton,CA95204
51-0432777 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(39) St Mary Medical Center Foundation

1050 Linden Avenue

Long Beach,CA90813
23-7153876 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(40) St Mary's Medical Center Foundation

450 Stanyan Street

San Francisco,CA94117
94-3336143 		FNDRSING FND CA 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(41) St Rose Dominican Health Foundation

3001 St Rose Parkway

Henderson,CA89052
88-0349432 		FNDRSING FND NV 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(42) The Congenital Heart Foundation

350 W Thomas Road

Phoenix,AZ85013
26-3342554 		FNDRSING FND AZ 501(C)(3) 11A DIGNITY HLTH
 
Yes
 
(43) Barrow Foundation UK

350 West Thomas Road

Phoenix,AZ85013
31-1724184 		FNDRSING FND UK 501(C)(3) 11D NA
 
 
No
(44) Woodland Memorial Hospital Foundation

1321 Cottonwood Street 305

Woodland,CA95695
94-6167964 		FNDRSING FND CA 501(C)(3) 7 NA
 
 
No
(45) Southwest Catholic Health Network Corpor

4350 E Cotton Center Blvd Bldg D

Phoenix,AZ85040
86-0527381 		Health Suppor AZ 501(C)(3) 11A NA
 
 
No
(46) St Mary's Hospital Guild

235 W 6TH STREET

RENO,NV89503
88-6004507 		FUNDRAISING NV 501(C)(3) 11A na
 
 
No
(47) MERCY MEDICAL CENTER MERCED FOUNDATION

301 E 13th Street

Merced,CA95340
77-0035928 		FNDRSING FND CA 501(C)(3) 7 DIGNITY HLTH
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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) Boston Common Intl Social Index fund LLC

84 State Street Suite 1000
Boston,MA02109
03-0491645 		Investment MA Dignity Health
  		Investment 1,694,919 40,277,873   No 0   No 86.300 %
(2) CHW Nevada Imaging Company LLC

2835 S Jones Blvd No 3
Las Vegas,NV89146
26-3322792 		Imaging Ctr NV Dignity Health
  		Related -4,514,717 11,088,950   No 0 Yes   75.000 %
(3) CHWUSP Las Vegas Surgery Centers LLC

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75001
20-2999237 		Surgery TX Dignity Health
  		Related 1,250,386 5,694,508   No 0   No 50.100 %
(4) CHWUSP Phoenix II LLC

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75001
54-2105660 		Surgery TX Dignity Health
  		Related 1,009,761 8,794,871   No 0   No 50.100 %
(5) CHWUSP Phoenix Surgery Centers LLC

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75001
13-4248908 		Surgery TX Dignity Health
  		Related -7,725,055 39,103,144   No 0   No 50.100 %
(6) CHWUSP Sacramento Surgery Centers LLC

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75001
20-2468509 		Surgery TX Dignity Health
  		Related 3,307,757 17,307,962   No 0   No 50.100 %
(7) Dominican Magnetic Resonance Imaging Cen

1545 Soquel Drive
Santa Cruz,CA94065
77-0095477 		Imaging Center CA Dignity Health
  		Related -12,189 429,521   No 0 Yes   80.000 %
(8) Folsom Sierra Endoscopy Center LP

1650 Creekside Drive 1600
Folsom,CA95630
68-0482416 		Endoscopy Center CA Dignity Health
  		Related 1,734,434 380,695   No 0 Yes   51.000 %
(9) Mercy Davis Cancer Center Management Co

2740 M Street
Merced,CA95340
94-3358445 		cancer ctr mgmt CA Dignity Health
  		Related 402,767 5,591,028   No 0 Yes   50.000 %
(10) NICU Operating CO of Santa Cruz LLC

1555 Soquel Drive
Santa Cruz,CA95065
46-0502935 		Neonatal Hlth CA Dignity Health
  		Related 2,720,301 7,665,514   No 0   No 51.000 %
(11) Plaza Surgery Center LP

525 E Plaza Drive Suite 100
Santa Maria,CA93454
77-0573567 		Surgery CA Marian Hlth Svc
  		Related 0 0   No 0 Yes   61.900 %
(12) Santa Cruz Land & Building LP

1555 Soquel Drive
Santa Cruz,CA95065
77-0285236 		Real estate CA Dominican Hlth
  		Related 0 0   No 0 Yes   86.210 %
(13) SMI Imaging LLC

6740 E Camelback Road Ste 101
Scottsdale,AZ85251
26-4000683 		Imaging Ctr CA Dignity Health
  		Related -738,585 34,493,013   No 0   No 55.730 %
(14) St Joseph's Surgery Center LP

15305 Dallas Pkwy Ste 1600 LB 28
Addison,TX75001
20-1019390 		Surgery TX Dignity Health
  		Related 1,324,183 3,124,485   No 0 Yes   79.760 %
(15) St John's Outpatient Surgery Center LP

1700 N ROSE AVENUE STE110
Oxnard,CA93030
20-0707477 		Surgery CA CHWUSP
  		Related -409,942 2,561,857   No 0   No 68.500 %
(16) Templeton Surgery Center LLC

1310 Las Tablas Road Suite 104
Templeton,CA94365
20-2246616 		Surgery CA Dignity Health
  		Related 193,831 2,258,108   No 0 Yes   65.260 %
(17) Dominican Breast Center LLC

1661 SOQUEL DIRVE SUITE G
SANTA CRUZ,CA95065
77-0419106 		IMAGING CA DIGNITY HEALTH
  		RELATED -39,640 262,094   No 0 Yes   50.000 %
(18) Radiation Oncology Centers of Ventura Co

1700 N ROSE AVENUE SUITE 120
OXNARD,CA93030
77-0191706 		IMAGING CA DIGNITY HEALTH
  		RELATED 568,301 346,710   No 0 Yes   50.000 %
(19) Santa Cruz Surgery Center LLC

3003 PAUL SWEET ROAD
SANTA CRUZ,CA95065
77-0194916 		SURGERY CA DIGNITY HEALTH
  		RELATED 712,555 1,119,864   No 0 Yes   50.000 %
(20) Sacramento Midtown Endoscopy Center

3941 J STREET SUITE 460
SACRAMENTO,CA95819
68-0125513 		SURGERY CA DIGNITY HEALTH
  		RELATED 538,889 337,768   No 0 Yes   20.000 %
(21) SHARED CLARITY

4425 EAST COTTON CENTER BLVD
PHOENIX,AZ85040
45-4233576 		SURGERY AZ DIGNITY HEALTH
  		RELATED 0 0   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 Party Admin NV Saint Mary's HF
  		C Corp 4,315,310 778,726 100.000 %
(2) Coastal Surgical Specialists Inc
921 Oak Park Blvd Suite 101
Pismo Beach,CA93449
74-3000596 		Ambulatory Surger CA Dignity Health
  		S Corp 1,412,459 3,121,775 51.000 %
(3) Dignity Health Insurance Ltd
PO Box 1051 KY1-1102
Grand Cayman Islands    
CJ
98-1065338 		Self Ins Fund CJ Dignity Health
  		C Corp 88,584 26,139,162 100.000 %
(4) Glendale Memorial Services Corporation
1420 South Central Avenue
Glendale,CA91204
95-4051021 		Hlth Care Mgt CA Dignity Health
  		C Corp 0 287,085 100.000 %
(5) Inland Health Organization of Southern C
1980 Orange Tree Lane Ste 200
Redlands,CA92374
33-0578944 		Hlth Care Mgt CA Dignity Health
  		C Corp 1,919,414 1,910,278 100.000 %
(6) Management Services Organization of Sant
1400 E Church Street
Santa Maria,CA93454
77-0318135 		Health Mgmt Svc CA Dignity Health
  		C Corp 0 0 100.000 %
(7) Marian Health Services Inc
1400 E Church Street
Santa Maria,CA93454
77-0074057 		Health Services CA Dignity Health
  		C Corp 333,254 1,507,514 100.000 %
(8) Millenium Surgery Center Inc
9300 Stockdale Hwy 200
Bakersfield,CA93311
77-0513445 		OP Surgery Svc CA BMH
  		S Corp 1,519,526 12,747,852 59.856 %
(9) Saint Mary's Multi-specialty clinic inc
1625 Prater Way Suite 102
Sparks,NV89434
11-3763590 		Clinics NV Saint Mary's HF
  		C Corp 9,607,266 6,720,284 100.000 %
(10) Saint Mary's Healthfirst
1510 Meadowland Lane
Reno,NV89502
88-0293082 		Insurance Provide NV Dignity Health
  		C Corp 87,792,750 33,725,842 100.000 %
(11) Saint Mary's Preferred Health Insurance
1510 Meadowland Lane
Reno,NV89502
88-0193357 		Insurance Provide NV Saint Mary's HF
  		C Corp 100,065,409 24,018,153 100.000 %
(12) St Mary Health Ventures Inc
1050 Linden Avenue
Long Beach,CA90813
95-1912528 		Retail Pharmacy CA Dignity Health
  		C Corp 2,130,935 2,370,138 100.000 %
(13) Trinity Care Infusion Services
18440 Roscoe Boulevard
Northridge,CA91325
33-0828794 		Home Care Med Svc CA Dignity Health
  		C Corp 1,669,800 432,128 100.000 %
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related 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 Community Hospital Foundation

 c 350,000 See Part VII
(2) Arroyo Grande Community Hospital Foundation

 b 237,037 See Part VII
(3) Bakersfield Memorial Hospital

 k 16,075,764 See Part VII
(4) Bakersfield Memorial Hospital

 r 237,975 See Part VII
(5) Bakersfield Memorial Hospital

 l 331,113 See Part VII
(6) Bakersfield Memorial Hospital

 c 337,584 See Part VII
(7) Barrow Neurological Foundation

 c 11,617,487 See Part VII
(8) Barrow Neurological Foundation

 b 2,589,971 See Part VII
(9) Boston Common Intl Social Index fund LLC

 r 272,749 See Part VII
(10) California Hospital Medical Center Foundation

 c 10,065,267 See Part VII
(11) California Hospital Medical Center Foundation

 b 1,607,919 See Part VII
(12) CDS

 k 556,767 See Part VII
(13) CHWUSP Phoenix II LLC

 d 6,122,747 See Part VII
(14) CHWUSP Sacramento Surgery Center LLC

 l 3,145,158 See Part VII
(15) CHWUSP Sacramento Surgery Center LLC

 r 3,581,938 See Part VII
(16) Community Hospital San Bernardino

 k 11,530,862 See Part VII
(17) Community Hospital San Bernardino

 r 876,754 See Part VII
(18) Dignity Health Foundation East Valley

 k 81,728 See Part VII
(19) Dignity Health Foundation East Valley

 c 2,128,625 See Part VII
(20) Dignity Health Foundation East Valley

 b 1,477,812 See Part VII
(21) Dignity Health Hospital Prof Liab Self-Insura

 k 8,339,678 See Part VII
(22) Dignity Health Hospital Prof Liab Self-Insura

 l 147,439,080 See Part VII
(23) Dignity Health Medical Foundation

 b 99,164,932 See Part VII
(24) Dignity Health Medical Foundation

 k 11,108,480 See Part VII
(25) Dignity Health Medical Foundation

 a 479,795 See Part VII
(26) Dignity Health Medical Foundation

 l 14,302,968 See Part VII
(27) Dignity Health Workers' Comp Self-Insurance T

 k 642,762 See Part VII
(28) Dignity Health Workers' Comp Self-Insurance T

 l 23,096,088 See Part VII
(29) Dominican Hospital Foundation

 c 1,105,982 See Part VII
(30) Dominican Hospital Foundation

 b 776,340 See Part VII
(31) Dominican MRI

 a 101,022 See Part VII
(32) Dominican MRI

 r 68,219 See Part VII
(33) Folsom Sierra Endoscopy Center

 k 1,584,486 See Part VII
(34) Folsom Sierra Endoscopy Center

 l 5,489,543 See Part VII
(35) Folsom Sierra Endoscopy Center

 r 1,680,450 See Part VII
(36) French Hospital Medical Center Foundation

 c 1,069,040 See Part VII
(37) French Hospital Medical Center Foundation

 b 550,751 See Part VII
(38) Glendale Memorial Health Foundation

 b 1,447,101 See Part VII
(39) Golden Umbrella

 a 145,757 See Part VII
(40) Golden Umbrella

 b 120,291 See Part VII
(41) Inland Health Organization

 k 217,699 See Part VII
(42) Inland Health Organization

 b 1,112,228 See Part VII
(43) Marian Medical Center Foundation

 c 7,149,092 See Part VII
(44) Marian Medical Center Foundation

 b 516,166 See Part VII
(45) Mark Twain Healthcare Corporation

 k 4,304,328 See Part VII
(46) Mercy Foundation Bakersfield dba Friends of M

 c 1,479,214 See Part VII
(47) Mercy Foundation Bakersfield dba Friends of M

 b 694,795 See Part VII
(48) Mercy Foundation Sacramento

 b 3,176,008 See Part VII
(49) Mercy Foundation Sacramento

 c 3,502,030 See Part VII
(50) Mercy Medical Center Merced Foundation

 b 530,365 See Part VII
(51) Mercy Medical Center Merced Foundation

 c 1,461,016 See Part VII
(52) Mercy Surgery Center

 a 391,454 See Part VII
(53) NICU Operating Company of Santa Cruz LLC

 r 1,851,721 See Part VII
(54) Northridge Hospital Foundation

 k 60,948 See Part VII
(55) Northridge Hospital Foundation

 c 2,492,746 See Part VII
(56) Northridge Hospital Foundation

 b 1,187,190 See Part VII
(57) Preferred Health Insurance Corporation

 k 1,155,293 See Part VII
(58) Saint Francis Memorial Hospital

 k 13,052,712 See Part VII
(59) Saint Francis Memorial Hospital

 r 889,279 See Part VII
(60) Saint Mary's Foundation

 c 10,722,030 See Part VII
(61) Saint Mary's Foundation

 b 1,227,202 See Part VII
(62) Saint Mary's Health First

 k 2,905,337 See Part VII
(63) Saint Mary's Health First

 b 24,000,000 See Part VII
(64) Saint Mary's Multi-Specialty Clinic Inc (Pri

 a 331,338 See part VII
(65) Saint Mary's Multi-Specialty Clinic Inc (Pri

 k 910,444 See Part VII
(66) Saint Mary's Outpatient Surgery Center Galena

 c 8,425,489 See Part VII
(67) Sequoia Hospital Foundation

 c 1,452,445 See Part VII
(68) Sequoia Hospital Foundation

 b 1,395,447 See Part VII
(69) Shasta Senior Nutrition Program

 a 272,484 See Part VII
(70) Shasta Senior Nutrition Program

 b 115,645 See Part VII
(71) Sierra Nevada Memorial Miners Hospital

 k 3,980,673 See Part VII
(72) St John's Healthcare Foundation

 c 303,830 See Part VII
(73) St John's Healthcare Foundation

 b 336,791 See Part VII
(74) St Bernardine Medical Center Foundation

 b 919,005 See Part VII
(75) St Bernardine Medical Center Foundation

 c 2,587,398 See Part VII
(76) St John's Healthcare Foundation

 k 85,848 See Part VII
(77) St John's Healthcare Foundation

 c 3,346,594 See Part VII
(78) St John's Healthcare Foundation

 b 784,376 See Part VII
(79) St Joseph's Foundation

 c 3,492,324 See Part VII
(80) St Joseph's Foundation

 b 1,680,147 See Part VII
(81) St Joseph's Foundation of San Joaquin

 b 1,001,427 See Part VII
(82) St Joseph's Foundation of San Joaquin

 a 38,400 See Part VII
(83) St Joseph's Foundation of San Joaquin

 c 1,983,589 See Part VII
(84) St Joseph's Foundation of San Joaquin

 k 69,528 See Part VII
(85) St Joseph's Surgery Center LP

 a 448,506 See Part VII
(86) St Joseph's Surgery Center LP

 k 5,224,900 See Part VII
(87) St Mary Health Ventures Inc

 a 35,109 See Part VII
(88) St Mary Health Ventures Inc

 k 1,715,695 See Part VII
(89) St Mary Medical Center Foundation

 k 140,509 See Part VII
(90) St Mary Medical Center Foundation

 c 3,953,713 See Part VII
(91) St Mary Medical Center Foundation

 b 2,065,845 See Part VII
(92) St Mary Professional Building

 a 214,689 See Part VII
(93) St Mary Professional Building

 k 376,007 See Part VII
(94) St Mary's Medical Center Foundation

 c 3,105,497 See Part VII
(95) St Mary's Medical Center Foundation

 b 871,307 See Part VII
(96) St Rose Dominican Health Foundation

 k 125,369 See Part VII
(97) St Rose Dominican Health Foundation

 b 2,094,035 See Part VII
(98) St Rose Dominican Health Foundation

 c 3,815,169 See Part VII
(99) The Congenital Heart Foundation

 b 134,836 See Part VII
(100) Woodland Memorial Hospital Foundation

 b 295,342 See Part VII
(101) Woodland Memorial Hospital Foundation

 c 466,239 See Part VII
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 - DIGNITY HEALTH LEASES FACILITIES AND/OR EQUIPMENT TO CERTAIN RELATED ORGANIZATIONS (FOUNDATIONS, JOINT VENTURES AND MEDICAL FOUNDATION). AMOUNTS REPORTED AS TRANSACTION TYPE "A" REPRESENT THE AMOUNTS CHARGED FOR SUCH AGREEMENTS. SUCH CHARGES REPRESENT FAIR MARKET VALUE OF THE AGREEMENTS. PART V, LINE 1B, AND 1C - DIGNITY HEALTH AND ITS RELATED ORGANIZATIONS ARE SUPPORTED BY VARIOUS FUNDRAISING FOUNDATIONS. AS SUPPORTING ORGANIZATIONS, THE FOUNDATIONS OPERATE FOR THE BENEFIT OF, TO RAISE FUNDS FOR, OR TO CARRY OUT THE PURPOSES OF DIGNITY HEALTH 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 DIGNITY HEALTH. AMOUNTS REPORTED UNDER TRANSACTION TYPE "B" REPRESENT FUNDS EXPENDED BY DIGNITY HEALTH ON BEHALF OF THE FOUNDATIONS FOR OPERATIONAL EXPENSES. AMOUNTS REPORTED AS TRANSACTION TYPE "C" REPRESENT FUNDS RECEIVED FROM THE FOUNDATIONS AS GRANTS TO DIGNITY HEALTH HOSPITALS. PHYSICIAN CLINIC SUPPORT SERVICES FOR DIGNITY HEALTH MEDICAL FOUNDATION ("DHMF") - DHMF OPERATES CLINICS WITH LOCATIONS THROUGHOUT CALIFORNIA AND NEVADA. THE OPERATIONS OF THE MEDICAL FOUNDATIONS ARE FUNDED THROUGH THE PARTICIPATING DIGNITY HEALTH HOSPITALS. AMOUNTS REPORTED UNDER TRANSACTION TYPE "B" TOTALING $99.2 MILLION REPRESENT THE TOTAL FUNDING SUPPORT BY THE PARTICIPATING DIGNITY HEALTH HOSPITALS FOR THE OPERATIONS OF DHMF. DHMF OPERATES IN THE COMMUNITIES SERVED BY THOSE HOSPITALS. PART V, LINE 1D - DIGNITY HEALTH 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 1K - DIGNITY HEALTH 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 - DIGNITY HEALTH'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 $71.5 MILLION FOR THE YEAR ENDED JUNE 30, 2012. 2. DIGNITY HEALTH 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 - 1. PHYSICIAN CLINIC SUPPORT SERVICES BY DIGNITY HEALTH MEDICAL FOUNDATION ("DHMF") - DHMF OPERATES CLINICS WITH LOCATIONS THROUGHOUT NORTHERN CALIFORNIA AND NEVADA. AMOUNTS REPORTED UNDER TRANSACTION TYPE "L" REPRESENT THE PAYMENTS MADE TO THE MEDICAL FOUNDATION FOR THE HOSPITALISTS AND RISK POOL PROGRAMS. 2. DIGNITY HEALTH IS SELF INSURED FOR WORKERS' COMPENSATION BENEFITS AND FOR HOSPITAL PROFESSIONAL AND GENERAL LIABILITY RISKS. DIGNITY HEALTH MAINTAINS SEPARATE TRUSTS FOR THESE PROGRAMS FROM WHICH CLAIMS AND RELATED EXPENSES AND COSTS OF ADMINISTERING THE PLANS ARE PAID. DIGNITY HEALTH HOSPITALS FUND THE TRUSTS, SUCH THAT OVER TIME, ASSETS HELD EQUAL LIABILITIES FOR CLAIMS INCURRED. THE AMOUNTS REPORTED UNDER TRANSACTION TYPE "L" REPRESENT THE CASH TRANSFERRED FROM DIGNITY HEALTH TO THE TRUSTS FOR THE FY13 FUNDING OF THE SELF INSURANCE PROGRAMS. PART V, LINE 1R - AS THE PARENT ORGANIZATION, DIGNITY HEALTH RECEIVES FUNDING FOR VARIOUS EXPENDITURES OF THE ORGANIZATION. AMOUNTS REPORTED UNDER TRANSACTION TYPE "R" REPRESENT FUNDING FOR ITEMS DESCRIBED BELOW. 1. JOINT VENTURES - K-1 DISTRIBUTIONS - DIGNITY HEALTH 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. 2. JOINT VENTURES - ADDITIONAL CAPITAL FUNDING - DIGNITY HEALTH HAS PARTNERSHIPS (JOINT VENTURES) WITH OTHER ORGANIZATIONS. THE AMOUNTS REPORTED UNDER TRANSACTION TYPE "R" FOR THESE PARTNERSHIPS REFLECT ADDITIONAL CAPITAL CONTRIBUTIONS TO THESE JOINT VENTURES. 3. SEISMIC RISK POOL FUNDING FROM RELATED ENTITIES DURING THE YEAR IS REPORTED AS TRANSACTION TYPE "R".
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