TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) AARON ADAMS........................................................................ CFO, ABSMC	1.0 .......................40.0	X	X				0	395,167	160,730
(2) TONI ADAMS........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(3) TOM BONAS........................................................................ ADMIN DIRECTOR, ABSMC	1.0 .......................40.0	X					0	238,720	38,717
(4) BARBARA D'ANNEO........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(5) CHARLES MANCE........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(6) CAMDEN MCEFEE........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(7) JULIE PETRINI........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(8) DAVID PREUSS........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(9) CHARLES PROSPER........................................................................ CEO, ABSMC	1.0 .......................40.0	X	X				0	489,908	353,494
(10) JACK RIPSTEEN........................................................................ TRUSTEE, CHAIR	1.0 .......................0.0	X	X				0	0	0
(11) DONALD SHIMER........................................................................ TRUSTEE	1.0 .......................0.0	X					0	0	0
(12) AMY CELLA........................................................................ VP & REGIONAL COUNSEL, EB	1.0 .......................40.0		X				0	347,717	209,753
(13) STEVEN WRIGHT........................................................................ ADMINISTRATOR, ATC	40.0 .......................0.0			X			0	231,895	34,660
(14) JENNIFER SHALLAT........................................................................ DIRECTOR OPERATIONS, ATC	40.0 .......................0.0				X		135,038	0	32,289
(15) BRIAN HUNTER........................................................................ VP SHARED SRVCS, SUTTER HEALTH	0.0 .......................0.0					X	0	573,053	321,541
(16) ROBERT PETRINA........................................................................ CFO, SEBH	0.0 .......................0.0					X	0	173,833	0

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	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
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 ....	231,895		231,895
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	2,575,563	2,419,212	139,047	17,304
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	1,042,358	898,209	137,724	6,425
10	Payroll taxes ...........	281,357	242,448	37,175	1,734
11	Fees for services (non-employees):
a	Management ......	23,100	23,100
b	Legal .........	0
c	Accounting ...........	16,500		16,500
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	4,855		4,855
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	765,496	661,266	104,230
12	Advertising and promotion ....	0
13	Office expenses .......	79,721	46,062	33,659
14	Information technology ......	190	190
15	Royalties ..	0
16	Occupancy ...........	259,426	238,441	20,985
17	Travel ............	19,475	14,455	5,020
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	12,318	9,164	3,154
20	Interest ...........	40	40
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	121,805	121,805
23	Insurance ..............	33,185	33,185
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	OTHER SUPPLIES	177,329	161,276	16,053
b	MEDICAL SUPPLIES	174,874	174,874
c	REPAIRS & MAINTENANCE	111,632	111,632
d	PURCHASED SERVICES	46,457	46,457
e	All other expenses	242,887	227,039	15,848
25	Total functional expenses. Add lines 1 through 24e	6,220,463	5,428,855	766,145	25,463
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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	0	1	0
2	Savings and temporary cash investments .........	461,173	2	628,544
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	1,117,859	4	1,404,528
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	6,490	8	6,552
9	Prepaid expenses and deferred charges ..........	9,715	9	22,648
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,032,602
b	Less: accumulated depreciation .....	10b	810,383	333,024	10c	222,219
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)......	1,928,261	16	2,284,491
	17	Accounts payable and accrued expenses .........	748,149	17	957,419
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other 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 ..	0	23	0
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....................	33,928	25	30,737
26	Total liabilities. Add lines 17 through 25.........	782,077	26	988,156
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	1,146,184	27	1,296,335
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	1,146,184	33	1,296,335
34	Total liabilities and net assets/fund balances ........	1,928,261	34	2,284,491

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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.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of 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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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 monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization ADOLESCENT TREATMENT CENTERS INC

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization ADOLESCENT TREATMENT CENTERS INC

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

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

(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

(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

(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

(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) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

2012

Open to Public Inspection

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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.

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 XIII, the text of the footnote to its financial statements that describes these items.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII 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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................
b	Buildings ................	33,333	23,782	9,551
c	Leasehold improvements ............	645,122	448,926	196,196
d	Equipment ................	354,147	337,675	16,472
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				222,219

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
INSURANCE LIABILITIES		30,737








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		30,737
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	5,931,282
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 XIII.) ............	2d	24,617
e	Add lines 2a through 2d .....................			2e	24,617
3	Subtract line 2e from line 1.....................			3	5,906,665
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	4,854
b	Other (Describe in Part XIII.) ...........	4b	11,000
c	Add lines 4a and 4b.......................			4c	15,854
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	5,922,519

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	6,240,226
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 XIII.) ............	2d	24,617
e	Add lines 2a through 2d......................			2e	24,617
3	Subtract line 2e from line 1.....................			3	6,215,609
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	4,854
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................			4c	4,854
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	6,220,463

Part XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ASC 740 (FIN 48) AUDIT FOOTNOTE	PART X, LINE 2	THIS ORGANIZATION WAS PART OF A CONSOLIDATED FINANCIAL SYSTEM AUDIT. THE ASC 740 AUDIT FOOTNOTE DISCLOSURE FOR THE SUTTER SYSTEM IS AS FOLLOWS: SUTTER HEALTH, THE LEGAL ENTITY, AND MOST AFFILIATES HAVE BEEN DETERMINED TO BE EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE, (PURSUANT TO INTERNAL REVENUE CODE SECTION 501(C)(3)), AND THE CALIFORNIA FRANCHISE TAX BOARD (PURSUANT TO CALIFORNIA REVENUE AND TAXATION CODE 23701(D)) AND, GENERALLY, ARE NOT SUBJECT TO TAXES ON INCOME. CERTAIN ACTIVITIES OF SUTTER ARE SUBJECT TO INCOME TAXES; HOWEVER, SUCH ACTIVITIES ARE NOT SIGNIFICANT TO THE COMBINED FINANCIAL STATEMENTS. WITH RESPECT TO ITS TAXABLE ACTIVITIES, SUTTER RECORDS INCOME TAXES USING THE LIABILITY METHOD, UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASIS OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR SETTLED. SUTTER RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. SUTTER RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT DECEMBER 31, 2012 AND 2011, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS.
OTHER REVENUE ON BOOKS BUT NOT ON RETURN	PART XII, QUESTIONS 2D	PROVISIONS FOR BAD DEBT NETTED WITH PATIENT SERVICE REVENUE $ 15,691 FUNDRAISING EXPENSE 8,926 -------- TOTAL 24,617 ========
OTHER REVENUE ON RETURN BUT NOT ON BOOKS	PART XII, QUESTION 4B	CONTRIBUTION FROM RELATED ENTITY TREATED AS AN EQUITY TRANSFER ON AFS $ 11,000
OTHER EXPENSES ON BOOKS BUT NOT ON RETURN	PART XIII, QUESTION 2D	PROVISIONS FOR BAD DEBT NETTED WITH PATIENT SERVICE REVENUE $ 15,691 FUNDRAISING EXPENSES 8,926 -------- TOTAL 24,617 ========

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

2012

Open to Public Inspection

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 250 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining 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, as a factor in determining eligibility for free or discounted care.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

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) ..			378,660		378,660	6.090 %
b	Medicaid (from Worksheet 3, column a) ....
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .			378,660		378,660	6.090 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4) ..
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..	1	2,222	6,224,534	5,416,760	807,774	12.990 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	1	2,222	6,224,534	5,416,760	807,774	12.990 %
k	Total. Add lines 7d and 7j .	1	2,222	6,603,194	5,416,760	1,186,434	19.080 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

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
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

12,401

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

Enter Medicare allowable costs of care relating to payments on line 5.....

Subtract line 6 from line 5. This is the surplus (or shortfall)........

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	THUNDER ROAD CHEMICAL DEPENDENCY HOSP 390 40TH STREET OAKLAND,CA94609 WWW.SUTTERHEALTH.ORG	X

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	THUNDER ROAD CHEMICAL DEPENDENCY HOSP
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 250.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following 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)
17	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?..........	17		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)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2012

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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
PART I, QUESTION 3C		TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 200% OF FPG. PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES APPLIES TO UNINSURED PATIENTS WHOSE FAMILY INCOMES ARE BETWEEN 201% AND 400%. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: - SPECIAL CIRCUMSTANCES CHARITY CARE: FOR UNINSURED PATIENTS WHO DO NOT MEET THE FINANCIAL ASSISTANCE CRITERIA SET FORTH BY THE ORGANIZATION, A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, ELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE ORGANIZATION'S CHARITY CARE ELIGIBILITY CRITERIA. - CATASTROPHIC CHARITY CARE: PARTIAL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 30% OF THE PATIENT'S FAMILY INCOME. PATIENTS THAT MEET THE CRITERIA WILL RECEIVE A FULL WRITE-OFF OF UNDISCOUNTED CHARGES THAT EXCEED 30% OF THEIR FAMILY INCOME. - HIGH MEDICAL COST CHARITY CARE (FOR INSURED PATIENTS): PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES FOR PATIENTS WHOSE FAMILY INCOME IS LESS THAN 350% OF FPG, MEDICAL EXPENSES EXCEED 10% OF THE PATIENT'S FAMILY INCOME, AND THE PATIENT'S INSURER HAS NOT PROVIDED A DISCOUNT. - UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAT THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. - PROMPT PAYMENT DISCOUNT: PARTIAL WRITE-OFF AVAILABLE TO UNINSURED PATIENTS WHO PAY PROMPTLY, CONSISTING OF AT LEAST A 10% DISCOUNT FOR THOSE WHO PAY WITHIN 30 DAYS OF FINAL BILLING, OR A 20% DISCOUNT IF 50% OF THE ESTIMATED BILL IS PAID PRIOR TO DISCHARGE.
PART I, QUESTION 7		COSTING METHODOLOGY USED: COST TO CHARGE RATIO UTILIZING WORKSHEET 2 METHODOLOGY.
PART II	COMMUNITY BUILDING ACTIVITIES	THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL DOES NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES TO REPORT IN 2012.
PART III, QUESTION 2		METHODOLOGY FOR CALCULATING BAD DEBT (AT COST) THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.
PART III, QUESTION 3		METHODOLOGY FOR DETERMINING THE AMOUNT OF BAD DEBT LIKELY ATTRIBUTABLE TO CHARITY CARE AMOUNTS MAY BE INCLUDED IN BAD DEBT PENDING A CHARITY CARE DETERMINATION. UPON ELIGIBILITY THESE AMOUNTS WOULD BE RECLASSIFIED AS CHARITY CARE.
PART III, QUESTION 4		THE ORGANIZATION MAKES EVERY EFFORT TO QUALIFY THOSE ELIGIBLE FOR CHARITY CARE. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS. AUDIT FOOTNOTE THE ORGANIZATION IS AN AFFILIATE OF SUTTER HEALTH WHICH UNDERWENT A SYSTEM-WIDE AUDIT. THE AUDIT REPORT DOES NOT INCLUDE A BAD DEBT EXPENSE FOOTNOTE. PROVISION FOR BAD DEBTS IS LISTED ON A SEPARATE LINE ITEM IN THE FINANCIAL STATEMENTS. THE AUDIT DOES INCLUDE FOOTNOTES FOR PATIENT ACCOUNTS RECEIVABLE AND PATIENT SERVICE REVENUES LISTED BELOW. PATIENT ACCOUNTS RECEIVABLE AUDIT FOOTNOTE: SUTTER'S PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. SUTTER MANAGES THE RECEIVABLES BY REGULARLY REVIEWING ITS PATIENT ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE ESTIMATED BASED UPON AN EVALUATION OF HISTORICAL PAYMENTS, NEGOTIATED CONTRACTS AND GOVERNMENTAL REIMBURSEMENTS. SUTTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 89% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012. ADJUSTMENTS AND CHANGES IN ESTIMATES ARE RECORDED IN THE PERIOD IN WHICH THEY ARE DETERMINED. SIGNIFICANT CONCENTRATIONS OF GROSS PATIENT ACCOUNTS RECEIVABLE ARE AS FOLLOWS: MEDICARE 27% AS OF 12/31/11 29% AS OF 12/31/12 MEDI-CAL 21% AS OF 12/31/11 23% AS OF 12/31/12 DURING 2011 AND 2012, CERTAIN AFFILIATES COLLECTED ON ACCOUNTS THAT WERE PREVIOUSLY DEEMED UNCOLLECTIBLE AND RESERVED. SUCH RECOVERIES ARE RECOGNIZED IN THE PERIOD THAT CASH IS RECEIVED AND WERE NOT MATERIAL. DUE TO THE INHERENT VARIABILITY IN THIS AREA OF PATIENT RECEIVABLE COLLECTIONS, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. PATIENT SERVICE REVENUES FOOTNOTE: PATIENT SERVICE REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT PROGRAMS WITH THIRD-PARTY PAYERS. ESTIMATED SETTLEMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, PRIMARILY AS A RESULT OF FINAL COST REPORT SETTLEMENTS WITH GOVERNMENTAL AGENCIES. SUTTER HAD NO CHANGES IN ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES IN 2012.
PART III, QUESTION 7	MEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY:	MEDICARE COST REPORTS THAT THE ORGANIZATION FILES DO NOT INCLUDE ALL OF THE COSTS REQUIRED TO TREAT MEDICARE PATIENTS. PART III, QUESTION 8 COSTING METHODOLOGY MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO.
PART III, QUESTION 9B		COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS WILL BE GIVEN AN APPLICATION WHICH WILL DOCUMENT THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 30 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
PART V, SECTION B, QUESTION 14G	MEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY:	A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED ON THE HOSPITAL'S FACILITY'S WEBSITE, WAS ATTACHED TO BILLING INVOICES, WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY/WAITING ROOM, WAS POSTED IN THE HOSPITAL'S ADMISSIONS OFFICE, WAS PROVIDED IN WRITING ON ADMISSION TO THE HOSPITAL, AND WAS AVAILABLE ON REQUEST. PART V, SECTION B, QUESTION 18E THE ORGANIZATION MADE NO SUCH EFFORTS.
PART V, SECTION B, QUESTION 20D	AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS:	THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR DIFFERENT LEVELS OF ASSISTANCE FOR PATIENTS BASED ON VARIOUS ELIGIBILITY REQUIREMENTS INCLUDING, BUT NOT LIMITED TO (1) FULL CHARITY CARE, (2) PARTIAL CHARITY CARE, (3) SPECIAL CIRCUMSTANCES CHARITY CARE, (4) CATASTROPHIC CHARITY CARE, (5) HIGH COST MEDICAL CHARITY CARE, (6) UNINSURED PATIENT DISCOUNT, AND (7) PROMPT PAYMENT DISCOUNT. THE MAXIMUM AMOUNT BILLED TO THE PATIENT IS CALCULATED DIFFERENTLY DEPENDING ON THE CATEGORY OF FINANCIAL ASSISTANCE FOR WHICH THEY ARE ELIGIBLE.
NEEDS ASSESSMENT	PART VI, QUESTION 2	THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL WORKS IN COLLABORATION WITH ALTA BATES SUMMIT MEDICAL CENTER ON THEIR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE ALTA BATES SUMMIT MEDICAL CENTER'S (ABSMC) CURRENT CHNA IS BASED UPON AN EXTENSIVE COLLECTION OF BOTH QUANTITATIVE AND QUALITATIVE DATA. THE QUANTITATIVE ASSESSMENTS USED TO COMPLETE THE CHNA INCLUDE, THE ALAMEDA COUNTY HEALTH STATUS REPORT, 2008 ENTITLED "LIFE AND DEATH FROM UNNATURAL CAUSES," THE "CITY OF BERKELEY, HEALTH STATUS REPORT 2007," "HEALTHY PEOPLE 2010," AND "THE HEALTH OF ALAMEDA COUNTY CITIES AND PLACES" PREPARED BY ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT AND COMMISSIONED BY ALTA BATES SUMMIT AND OTHER MEMBER HOSPITALS OF THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA. IN ADDITION TO SEEKING QUANTITATIVE ANALYSIS, THE MEDICAL CENTER CONVENED NINE FOCUS GROUPS THROUGHOUT BERKELEY AND OAKLAND SEEKING PERCEPTIONS OF COMMUNITY HEALTH. ABSMC CAREFULLY SELECTED REPRESENTATION NOT ONLY FROM VARIOUS ETHNIC AND CULTURAL BACKGROUNDS, BUT ALSO SOCIOECONOMIC, AGE, GENDER AND THE DISABLED COMMUNITY. HEALTH CARE PROFESSIONALS, COMMUNITY LEADERS AND ELECTED OFFICIALS ALSO PARTICIPATED. ABSMC COLLABORATED WITH MULTIPLE HOSPITALS TO CONDUCT THE CHNA INCLUDING KAISER PERMANENTE, CHILDREN'S HOSPITAL, WASHINGTON HOSPITAL, EDEN MEDICAL CENTER, VALLEY CARE, AND ALAMEDA COUNTY. ABSMC COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION IS BASED ON A SPECIFIC SET OF CRITERIA, INCLUDING: 1) COMMUNITY NEED - ABSMC WILL FOCUS ON CURRENT AND DOCUMENTED COMMUNITY NEEDS; 2) POPULATIONS - VULNERABLE AND AT-RISK POPULATIONS IN ALTA BATES SUMMIT SERVICE AREA; 3) SERVICE CRITERIA - POTENTIAL FOR MAKING A MEASURABLE DIFFERENCE IN HEALTH STATUS; 4) SERVICE PRIORITIES - PREVENTION, EARLY DETECTION AND TREATMENT; 5) COLLABORATION - OPPORTUNITY TO COLLABORATE WITH OTHER COMMUNITY AGENCIES AND ORGANIZATIONS; 6) ABSMC EXPERTISE - HIGHEST PRIORITY GIVEN TO OPTIONS THAT LEVERAGE ALTA BATES SUMMIT'S TALENTS, EXPERTISE AND CAPABILITIES; AND 7) RESOURCES - HIGHEST PRIORITY GIVEN TO OPTIONS THAT LEVERAGE ALTA BATES SUMMIT'S FINANCIAL RESOURCES. THE MAIN GOAL OF THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL IS TO ASSIST YOUTH AND THEIR FAMILIES IN THEIR RECOVERY FROM THE ABUSE OF DRUGS AND ALCOHOL. IT IS REPORTED THAT ONE OUT OF TEN TEENS WHO NEED SUBSTANCE ABUSE TREATMENT DO NOT RECEIVE SERVICES. 35% OF TEENS 12 OR OLDER WHO NEED TREATMENT DO NOT HAVE THE HEALTH INSURANCE TO AFFORD THE COST OF CARE. THUNDER ROAD'S COMMUNITY BENEFIT OBJECTIVE IS TO INCREASE THE SERVICES FOR THOSE AT RISK CHEMICALLY DEPENDENT YOUTH. LASTLY, A CRITICAL OBJECTIVE OF THUNDER ROAD IN 2011 WAS TO CONTINUE TO WORK CLOSELY WITH LOCAL REFERRAL SOURCES TO INFORM, EDUCATE AND SERVE THE DIVERSE FAMILIES OF THE EAST BAY REGION. ONE OF THE MOST OFTEN REPORTED REASONS FOR NOT RECEIVING SUBSTANCE ABUSE SERVICES AND SUPPORT IS NOT KNOWING WHERE TO GO FOR TREATMENT.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI, QUESTION 3	THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL FOLLOWS A SUTTER HEALTH SYSTEM-WIDE CHARITY CARE POLICY, WHICH INCLUDES THE FOLLOWING DETAILS OF HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. FOR A MORE DETAILED LOOK AT OUR CHARITY CARE POLICIES BY REGION, PLEASE VISIT THE OFFICE OF STATEWIDE AND HEALTH PLANNING'S WEBSITE AT HTTP://SYFPHR.OSHPD.CA.GOV. COMMUNICATIONS OF FINANCIAL ASSISTANCE AVAILABILITY A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL AFFILIATES SHALL PROVIDE: A. ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS) B. PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, "STATEMENT OF FINANCIAL CONDITION" 2. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL AFFILIATES SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION FORM, "STATEMENT OF FINANCIAL CONDITION" B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS. 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE SUTTER HEALTH WEBSITE AND EACH HOSPITAL AFFILIATE WEBSITE, IF ANY. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE, COLLECTION PRACTICES, HOSPITAL AFFILIATE THIRD-PARTY LIENS, AND AFFILIATE DISPUTE INITIATION POLICY (FINANCE POLICY 14-227). C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL AFFILIATES SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGE(S) OF THE AFFILIATE'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATIONS TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL PROVIDE THE PATIENT WITH AN ESTIMATE OF THE AMOUNT THE HOSPITAL AFFILIATE WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS.
COMMUNITY INFORMATION	PART VI, QUESTION 4	THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL'S PRIMARY SERVICE AREA INCLUDES ALAMEDA COUNTY AND CERTAIN ZIP CODES IN CONTRA COSTA COUNTY. ALAMEDA COUNTY ALAMEDA COUNTY IS AN EXCEPTIONALLY LARGE COUNTY RANKING AS THE 7TH MOST POPULOUS COUNTY IN THE STATE WITH A 2010 POPULATION OF 1,510,271 CONSISTING OF 49% MEN AND 51% WOMEN WITH A MEDIAN AGE OF 36.6 YEARS. THE POPULATION DENSITY WAS 2,043.6 PEOPLE PER SQUARE MILE IN 2010 WHICH IS OVER EIGHT TIMES LARGER THAN THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. ALAMEDA'S POPULATION IS DIVERSE WITH 43% BEING WHITE, 26.1% ASIAN AND 22.5% HISPANIC OR LATINO. OVER HALF (63.2%) OF RESIDENTS SPEAK ENGLISH AT HOME WHILE 14.3% SPEAK SPANISH AT HOME (9% OF WHICH DO NOT SPEAK ENGLISH AT ALL) AND 15.2% SPEAK ASIAN OR PACIFIC ISLAND. THE MEDIAN HOUSEHOLD SIZE IS 2.72 PEOPLE WITH A 2010 AVERAGE INCOME OF $69,384 AND A MEDIAN HOUSE VALUE OF $590,900. A LARGE PORTION (85.9%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 40.3% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN ALAMEDA THE POVERTY LEVEL IN 2010 WAS AT 11.4% OF RESIDENTS, BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 10.8% IN APRIL 2010 WHICH WAS BELOW THE CALIFORNIA LEVEL OF 12.4% HOWEVER IT WAS RIGHT ABOVE THE FEDERAL LEVEL OF 9.9%. FOOD IS READILY AVAILABLE WITH 364 GROCERY STORES, 5 SUPERCENTERS/CLUB STORES, AND OVER 1,299 FULL SERVICE RESTAURANTS. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 30.5% OF ADULTS BEING OBESE, 7.8% OF ADULTS WITH DIABETES AND ALMOST THREE IN TEN ADULTS HAVING HIGH BLOOD PRESSURE. FROM 2006 TO 2008 THERE WERE 27,728 DEATHS IN ALAMEDA COUNTY AND OF THOSE, THE THREE LEADING CAUSES WERE HEART DISEASE, CANCER AND STROKE. IN 2008 THERE WERE 20,797 BIRTHS HOWEVER THE INFANT MORTALITY RATE WAS 4.5 PER 1,000 BIRTHS. FROM 2006 - 2008 LIFE EXPECTANCY AT BIRTH WAS 81.4 YEARS WHICH IS NEARLY THE SAME AS THE CALIFORNIA LIFE EXPECTANCY. IN 2010 13.3% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS BELOW BOTH THE STATE LEVEL OF 18.5% AND FEDERAL LEVEL OF 15.5%. IN ALAMEDA COUNTY 61.9% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 23.5% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE. CONTRA COSTA ACCORDING TO THE U.S. CENSUS BUREAU, CONTRA COSTA COUNTY HAS A POPULATION OF 1,049,025 CONSISTING OF 48.8% MEN AND 51.2% WOMEN WITH A MEDIAN AGE OF 36.4 YEARS. THE POPULATION DENSITY WAS 1,465.2 PEOPLE PER SQUARE MILE IN 2010 WHICH IS OVER SIX TIMES THAT OF THE CALIFORNIA STATE DENSITY OF 239.1. CONTRA COSTA'S POPULATION CONSISTS OF 58.6% WHITE RESIDENTS, 24.4% HISPANIC OR LATINO AND 14.4% ASIAN RESIDENTS. ALMOST THREE QUARTERS (74%) OF RESIDENTS SPEAK ENGLISH WHILE 13.1% SPEAK SPANISH AT HOME (9% OF WHICH DO NOT SPEAK ENGLISH AT ALL). THE MEDIAN HOUSEHOLD SIZE IS 2.75 PEOPLE WITH A 2010 AVERAGE INCOME OF $78,385 AND A MEDIAN HOUSE VALUE OF $548,200. THE MAJORITY 88.4% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 38.2% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN CONTRA COSTA THE POVERTY LEVEL IN 2010 WAS AT 9% OF RESIDENTS, BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 11% IN APRIL 2010 WHICH WAS BELOW THE CALIFORNIA LEVEL OF 12.4% YET ABOVE THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES ARE CONSISTENT WITH THE SIZE OF THE COUNTY WITH 181 GROCERY STORES, 5 SUPERCENTERS AND CLUB STORES AND 683 FULL SERVICE RESTAURANTS. IN 2007, HEALTH ISSUES IN THIS COUNTY INCLUDED 22.2% OF ADULTS BEING OBESE AND 7.1% OF ADULTS WITH DIABETES. IN 2007 THERE WERE 6,872 DEATHS AND OF THOSE THE THREE LEADING CAUSES WERE CANCER, HEART DISEASE AND STROKE. IN 2007 THERE WERE 13,487 BIRTHS WITH 56 INFANT DEATHS OCCURRING THAT YEAR. THE LIFE EXPECTANCY AT BIRTH IS 81.4 YEARS WHICH IS NEARLY THE SAME AS THE CALIFORNIA LIFE EXPECTANCY. IN 2009 17.3% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS BELOW THE STATE LEVEL OF 18.5% YET RIGHT ABOVE THE FEDERAL LEVEL OF 15.5%. IN CONTRA COSTA COUNTY 62.4% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 11.3% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE.
PROMOTION OF COMMUNITY HEALTH	PART VI, QUESTION 5	SUTTER HEALTH'S MISSION IS TO "ENHANCE THE WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE, THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES." SUTTER HEALTH'S MISSION REACHES BEYOND THE WALLS OF OUR HOSPITALS AND FACILITIES. OUR AFFILIATES FURTHER THEIR TAX-EXEMPT PURPOSE BY: - BUILDING RELATIONSHIPS OF TRUST BY WORKING COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS; - SUPPORTING NONPROFIT ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICES AND EMPLOYEE VOLUNTEERISM; AND - PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS RUN BY A COMMUNITY BOARD. A FEW HIGHLIGHTS OF THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL'S PROGRAMS IN 2012: THE SHORT TERM PROGRAM IS DESIGNED FOR YOUTH BETWEEN THE AGES OF 13 AND 18 WHO ARE INVOLVED IN THE HABITUAL ABUSE OF NICOTINE, ALCOHOL, OR DRUGS. CLIENTS PARTICIPATE IN FAMILY COUNSELING, THERAPY GROUPS, ANGER MANAGEMENT AND RELAPSE PREVENTION CLASSES, 12-STEP PROGRAMS, AND GENDER-SPECIFIC GROUPS. THE LONG-TERM RESIDENTIAL PROGRAM AND DAY TREATMENT SERVICES ACCEPTS REFERRALS FROM COUNTY GOVERNMENT AGENCIES FOR YOUTH WHO ARE INVOLVED IN THE CHRONIC ABUSE OF NICOTINE, ALCOHOL, OR DRUGS AND WHO NEED TO MAKE FUNDAMENTAL IMPROVEMENTS IN THEIR SOCIAL, EMOTIONAL AND BEHAVIORAL FUNCTIONING. CLIENTS PARTICIPATE IN THE SAME TYPES OF GROUPS AND PROGRAM ACTIVITIES AS SHORT-TERM INPATIENT CLIENTS. THUNDER ROAD'S COMPREHENSIVE INTENSIVE OUTPATIENT PROGRAM (IOP) MEETS 10 EVENING HOURS PER WEEK. THE PROGRAM COMBINES INDIVIDUAL, FAMILY AND GROUP SESSIONS THAT FOCUS ON IMPROVING BEHAVIORS AND RECOVERY FROM THE ABUSE OF ALCOHOL, DRUGS AND NICOTINE. THUNDER ROAD PROVIDES SUBSTANCE ABUSE TREATMENT SERVICES AND SUPPORT FOR YOUTH WHO ARE INVOLVED IN THE JUVENILE JUSTICE PROGRAMS AT CAMP SWEENEY IN SAN LEANDRO. THE ALAMEDA COUNTY PROVIDER NETWORK FOR TOBACCO DEPENDENCE TREATMENT AND CESSATION IS A SPECIAL PROJECT BASED AT THUNDER ROAD. THIS PROJECT PROVIDES CLINICAL STAFF TRAINING AND TECHNICAL ASSISTANCE TO ADULT AND ADOLESCENT TREATMENT PROVIDERS ON HOW TO EFFECTIVELY ADDRESS AND TREAT THE DEADLY AND ADDICTIVE EFFECTS OF TOBACCO AND NICOTINE ABUSE. AS YOUNG PEOPLE TRANSITION FROM MORE INTENSIVE SERVICES, THEY HAVE THE OPTION TO PARTICIPATE IN ONGOING WEEKLY SUPPORT RECOVERY SERVICES. CONTINUING CARE GROUPS MEET REGULARLY AND PARENTS AND CAREGIVERS ARE WELCOME TO REMAIN CONNECTED THROUGH THUNDER ROAD'S ALUMNI PROGRAMS.
AFFILIATED HEALTH CARE SYSTEM	PART VI, QUESTION 6	THUNDER ROAD CHEMICAL DEPENDENCY RECOVERY HOSPITAL IS AFFILIATED WITH SUTTER HEALTH, A NOT-FOR-PROFIT NETWORK OF 48,000 PHYSICIANS, EMPLOYEES, AND VOLUNTEERS WHO CARE FOR MORE THAN 100 NORTHERN CALIFORNIA TOWNS AND CITIES. TOGETHER, WE'RE CREATING A MORE INTEGRATED, SEAMLESS AND AFFORDABLE APPROACH TO CARING FOR PATIENTS. IT'S BETTER FOR PATIENTS: WE BELIEVE THIS COMMUNITY-OWNED, NOT-FOR-PROFIT APPROACH TO HEALTH CARE BEST SERVES OUR PATIENTS AND OUR COMMUNITIES - FOR MULTIPLE REASONS. FIRST OF ALL, IT'S GOOD FOR PATIENTS. ACCORDING TO THE JOURNAL OF GENERAL INTERNAL MEDICINE (APRIL 2000), PATIENTS TREATED AT FOR-PROFIT OR GOVERNMENT-OWNED HOSPITALS WERE TWO-TO-FOUR TIMES MORE LIKELY TO SUFFER PREVENTABLE ADVERSE EVENTS THAN PATIENTS TREATED AT NOT-FOR-PROFIT INSTITUTIONS. OUR STOCKHOLDERS ARE OUR COMMUNITIES: INVESTOR-OWNED, FOR-PROFIT HEALTH SYSTEMS HAVE A FINANCIAL INCENTIVE TO AVOID CARING FOR UNINSURED AND UNDERINSURED PATIENTS. THEY ALSO HAVE A FINANCIAL INCENTIVE TO AVOID HARD-TO-SERVE POPULATIONS AND "UNDESIRABLE" GEOGRAPHIC AREAS SUCH AS RURAL AREAS. FOR MANY NORTHERN CALIFORNIA'S UNDERSERVED RURAL LOCALES, SUTTER HEALTH IS THE ONLY PROVIDER OF HOSPITAL AND EMERGENCY MEDICAL SERVICES IN THE COMMUNITY. PROVIDING CHARITY CARE AND SPECIAL PROGRAMS TO COMMUNITIES: OUR COMMUNITIES' SUPPORT HELPS US EXPAND SERVICES, INTRODUCE NEW PROGRAMS AND IMPROVE MEDICAL TECHNOLOGY. ACROSS OUR NETWORK, EVERY SUTTER HOSPITAL, PHYSICIAN ORGANIZATION AND CLINIC HAS A SPECIAL STORY TO TELL ABOUT FULFILLING VITAL COMMUNITY NEEDS. OUR COMMITMENT TO COMMUNITY BENEFIT: MEETING THE HEALTH CARE NEEDS OF OUR COMMUNITIES IS THE CORNERSTONE OF SUTTER HEALTH'S NOT-FOR-PROFIT MISSION. THIS INCLUDES DIRECTLY SERVING THOSE WHO CANNOT AFFORD TO PAY FOR HEALTH CARE AND SUPPORTING PROGRAMS AND SERVICES THAT HELP THOSE IN FINANCIAL NEED. SUTTER HEALTH NOW PROVIDES $2.9 MILLION IN CHARITY CARE PER WEEK. IN 2012, OUR NETWORK OF PHYSICIAN ORGANIZATIONS, HOSPITALS AND OTHER HEALTH CARE PROVIDERS INVESTED $795 MILLION IN HEALTH CARE PROGRAMS, SERVICES AND BENEFITS FOR THE POOR AND UNDERSERVED. THIS INCLUDES: - THE COST OF PROVIDING CHARITY CARE - THE UNPAID COSTS OF PARTICIPATING IN MEDI-CAL - INVESTMENTS IN MEDICAL RESEARCH, HEALTH EDUCATION AND COMMUNITY-BASED PUBLIC BENEFIT PROGRAMS SUCH AS SCHOOL-BASED CLINICS AND PRENATAL CARE FOR PATIENTS. SUTTER HEALTH'S COMMITMENT TO DELIVERING CHARITY CARE TO PATIENTS CONTINUED TO GROW, REACHING ANOTHER ALL-TIME HIGH OF $153 MILLION IN 2012 - OR AN AVERAGE OF NEARLY $3 MILLION PER WEEK. * SERVICES FOR THE POOR AND UNDERSERVED INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, AS WELL AS THE COSTS OF PUBLIC PROGRAMS TREATING MEDI-CAL AND INDIGENT BENEFICIARIES. COSTS ARE COMPUTED BASED ON A RELATIONSHIP OF COSTS TO CHARGES. SERVICES FOR THE POOR AND UNDERSERVED ALSO INCLUDE THE COST OF OTHER SERVICES FOR INDIGENT POPULATIONS, AND CASH DONATIONS ON BEHALF OF THE POOR AND NEEDY. ** BENEFITS FOR THE BROADER COMMUNITY INCLUDE COSTS OF PROVIDING THE FOLLOWING SERVICES: HEALTH SCREENINGS AND OTHER HEALTH-RELATED SERVICES, TRAINING HEALTH PROFESSIONALS, EDUCATING THE COMMUNITY WITH VARIOUS SEMINARS AND CLASSES, THE COST OF PERFORMING MEDICAL RESEARCH AND THE COSTS ASSOCIATED WITH PROVIDING FREE CLINICS AND COMMUNITY SERVICES. BENEFITS FOR THE BROADER COMMUNITY ALSO INCLUDE CONTRIBUTIONS SUTTER HEALTH MAKES TO COMMUNITY AGENCIES TO FUND CHARITABLE ACTIVITIES. COSTS ASSOCIATED WITH PROVIDING FREE CLINICS AND COMMUNITY SERVICES. BENEFITS FOR THE BROADER COMMUNITY ALSO INCLUDE CONTRIBUTIONS SUTTER HEALTH MAKES TO COMMUNITY AGENCIES TO FUND CHARITABLE ACTIVITIES.
STATE FILING OF COMMUNITY BENEFIT REPORT	PART VI, QUESTION 7	CALIFORNIA

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

2012

Open to Public Inspection

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 of the expenses described above? If "No," complete Part III to explain....

Yes

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? .......

Yes

Indicate which, if any, of the following the filing organization used 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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Yes

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2012

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 (E) amounts for that individual.

(A) Name and Title		(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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)AARON ADAMSCFO, ABSMC	(i) (ii)	0 303,535	0 91,140	0 492	0 143,242	0 17,488	0 555,897	0 91,140
(2)TOM BONASADMIN DIRECTOR, ABSMC	(i) (ii)	0 207,892	0 21,669	0 9,159	0 20,959	0 17,758	0 277,437	0 13,758
(3)AMY CELLAVP & REGIONAL COUNSEL, EB	(i) (ii)	0 275,739	0 67,023	0 4,955	0 196,155	0 13,598	0 557,470	0 67,023
(4)CHARLES PROSPERCEO, ABSMC	(i) (ii)	0 432,216	0 50,895	0 6,797	0 335,358	0 18,136	0 843,402	0 61,675
(5)STEVEN WRIGHTADMINISTRATOR, ATC	(i) (ii)	0 184,240	0 10,920	0 36,735	0 14,006	0 20,654	0 266,555	0 0
(6)JENNIFER SHALLATDIRECTOR OPERATIONS, ATC	(i) (ii)	125,838 0	0 0	9,200 0	8,156 0	24,133 0	167,327 0	0 0
(7)BRIAN HUNTERVP SHARED SRVCS, SUTTER HEALTH	(i) (ii)	0 470,894	0 65,800	0 36,359	0 303,839	0 17,702	0 894,594	0 92,544
(8)ROBERT PETRINACFO, SEBH	(i) (ii)	0 0	0 0	0 173,833	0 0	0 0	0 173,833	0 173,833

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation
RELEVANT INFORMATION REGARDING COMPENSATION ITEMS	PART I, QUESTION 1A	TAX INDEMNIFICATION: STANDARD POLICY FOR ALL SUTTER HEALTH EMPLOYEES IS THAT NON-CASH GIFTS AND AWARDS ARE GROSSED-UP FOR TAX PURPOSES. THE AMOUNT OF THE GROSS-UP IS ADDED TO THE EMPLOYEE'S WAGES AND TAXED ACCORDINGLY.
SUPPLEMENTAL COMPENSATION INFORMATION	PART I, QUESTION 3	THE CEO OF THE ORGANIZATION IS AN EMPLOYEE OF SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION. THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ENSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION.
NONQUALIFIED RETIREMENT PLAN	PART I, QUESTION 4B	THE PURPOSE OF THE NONQUALIFIED RETIREMENT PLAN IS TO PROVIDE SUTTER HEALTH EXECUTIVES WITH A COMPETITIVE RETIREMENT BENEFIT CONSISTENT WITH SUTTER HEALTH'S OVERALL COMPENSATION PHILOSOPHY FOR ALL EMPLOYEES. CONTRIBUTIONS ARE DESIGNED TAKING INTO CONSIDERATION LOST RETIREMENT BENEFITS THAT WOULD OTHERWISE BE OBTAINED THROUGH THE QUALIFIED PENSION PLAN. SUTTER'S PLANS ARE DESIGNED CONSISTENT WITH COMPETITIVE INDUSTRY PRACTICES. THE RETIREMENT PLAN FOR SUTTER HEALTH EMPLOYEES IS A COMBINATION OF SOCIAL SECURITY, 403B EMPLOYER MATCH CONTRIBUTIONS AND QUALIFIED PLAN BENEFITS. SUTTER HEALTH EXECUTIVES ARE GENERALLY INELIGIBLE FOR EMPLOYER MATCH CONTRIBUTIONS. ADDITIONALLY, QUALIFIED PLAN BENEFITS CAPS HAVE THE EFFECT OF SUBSTANTIALLY REDUCING RETIREMENT BENEFITS THAT ARE OTHERWISE PROVIDED TO ALL EMPLOYEES. THE EFFECT IS THAT EXECUTIVES OFTEN DO NOT RECEIVE THE SAME LEVEL OF RETIREMENT BENEFIT ON AN INCOME REPLACEMENT BASIS AS OTHER EMPLOYEES. TO ENSURE A COMPETITIVE RETIREMENT BENEFIT AND TO ADDRESS THE SHORTFALLS DESCRIBED ABOVE, SUTTER HEALTH MAKES AN ANNUAL CONTRIBUTION TO A NON-QUALIFIED 457(F) PLAN FOR ITS EXECUTIVES. THE FORMULA HAS TWO PARTS: (1) 4% TO 7% OF BASE SALARY (COMMENSURATE WITH MANAGEMENT LEVEL), PLUS (2) A CONTRIBUTION STARTING AT 5% (BASED UPON TENURE) FOR EARNINGS BEYOND THE PENSION PAY CAP. THE LATTER OF WHICH IS DESIGNED TO HELP RESTORE LOST PENSION BENEFITS FORFEITED UNDER THE QUALIFIED PLAN FOR EARNINGS OVER THE PENSION PAY CAP LIMIT. CONTRIBUTIONS ARE ALSO MADE FOR A SMALL GROUP OF SENIOR LEVEL EXECUTIVES WHOSE ESTIMATED RETIREMENT BENEFIT (SOCIAL SECURITY PLUS QUALIFIED PLAN BENEFITS PLUS 457F) FALLS BELOW 50% - 65% OF FINAL 4-YEAR AVERAGE BASE SALARY WHEN RETIRING AT AGE 65. TARGET BENEFIT LEVELS VARY BY YEARS OF SERVICE. UNLIKE SUTTER HEALTH'S QUALIFIED PLAN WHERE EMPLOYEE BENEFITS ARE GUARANTEED (I.E., A DEFINED BENEFIT), SUTTER'S NON-QUALIFIED PLAN BENEFITS ARE NOT GUARANTEED BY SUTTER HEALTH. INVESTMENT RISK IS BORNE BY PARTICIPANTS AND BENEFITS ARE NOT PROTECTED SHOULD SUTTER HEALTH BECOME INSOLVENT. THE FOLLOWING INDIVIDUAL RECEIVED A TAXABLE DISTRIBUTION FROM THE PLAN: ROBERT PETRINA: $173,833
NON-FIXED PAYMENTS	PART I, QUESTION 7	SPOT AWARDS ARE INFREQUENTLY USED TO REWARD EMPLOYEES. THERE ARE NO SPECIFIC GUIDELINES FOR THE AMOUNT OF THE SPOT AWARD BUT THE AMOUNT TENDS TO NOT EXCEED 5% OF GROSS PAY. ANNUAL INCENTIVE PLAN (AIP) THE PURPOSE OF THE PLAN IS TO FOCUS EXECUTIVES ON SPECIFIC, SHORTER-TERM GOALS THAT ARE CRITICAL TO THE ACHIEVEMENT OF AFFILIATE, REGION, AND SYSTEM-WIDE OBJECTIVES THAT DRIVE OVERALL ORGANIZATION PERFORMANCE. A PORTION OF THE PLAN AWARD IS DISCRETIONARY IN THAT THE SUPERVISOR MAY ADD +/- 5% TO THE AWARD PROVIDED THE TOTAL AWARD (FORMULA PORTION PLUS DISCRETIONARY) DOES NOT EXCEED THE MAXIMUM ESTABLISHED FOR ANY GIVEN EXECUTIVE. LONG TERM PERFORMANCE PLANS SUTTER HEALTH ALSO EMPLOYS LONG TERM PERFORMANCE PLANS WHICH ARE DESIGNED TO FOCUS ON LONGER TERM STRATEGIC OBJECTIVES OF THE ORGANIZATION. SUTTER'S LONG TERM PERFORMANCE PLAN APPROACH IS A COMBINATION OF BOTH LONGER TERM MEASURES OF ORGANIZATION SUCCESS AND KEY ORGANIZATION STRATEGIES WHICH REQUIRE THE COMBINED EFFORT OF ALL LEADERSHIP TO ACHIEVE SUCCESS. SUTTER USES A COMMON FATE APPROACH IN THAT ALL PLAN PARTICIPANTS ARE MEASURED AGAINST THE SAME, ORGANIZATION-WIDE CRITERIA VS. INDIVIDUAL EFFORTS. THIS FOSTERS A COMMON PURPOSE ACROSS LEADERSHIP AND A SHARED SENSE OF ACCOUNTABILITY FOR THE OVERALL SUCCESS OF SUTTER HEALTH. TO ENSURE THAT EXTRAORDINARY EFFORTS BY INDIVIDUALS CAN BE RECOGNIZED AND THAT ACTIONS OF LEADERSHIP ARE CONSISTENT WITH SUPPORTING SUTTER HEALTH'S OVERALL MISSION, VISION, AND VALUES, SUTTER'S LONG TERM INCENTIVE PLAN APPROACH ALSO INCORPORATES A COMBINATION OF CEO AND SUTTER HEALTH COMPENSATION COMMITTEE DISCRETION. IN SOME CASES, THE SUTTER HEALTH COMPENSATION COMMITTEE HAS DELEGATED AUTHORITY TO THE PRESIDENT & CEO TO MODIFY INDIVIDUAL AWARDS WITHIN LIMITS THAT HAVE BEEN PRE-APPROVED BY THE SUTTER HEALTH COMPENSATION COMMITTEE. THIS INCLUDES BOTH THE REDUCTION AND INCREASE OF AWARD AMOUNTS. SUCH MODIFICATIONS GENERALLY DO NOT EXCEED +/- 20% AND ARE EMPLOYED JUDICIOUSLY. IN ALL CASES, THE COMPENSATION COMMITTEE OF THE BOARD DETERMINES ACHIEVEMENT OF ORGANIZATION GOALS AND MAKES FINAL AWARD DETERMINATION WHICH MAY RESULT IN A REDUCTION OF AWARD IF APPROPRIATE. ALL SENIOR EXECUTIVE AWARDS ARE REVIEWED FOR COMPENSATION REASONABLENESS AND APPROVED PRIOR TO PAYMENT BY THE COMPENSATION COMMITTEE.

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

2012

Open to Public
Inspection

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

Identifier	Return Reference	Explanation
MISSION STATEMENT	FORM 990, PART I, LINE 1 AND PART III, LINE 1	ADOLESCENT TREATMENT CENTERS, INC., DOING BUSINESS AS THUNDER ROAD, THEIR MISSION IS TO ASSIST YOUTH AND THEIR FAMILIES IN THE CHALLENGES TO RECOVER FROM THE ABUSE OF ALCOHOL, DRUGS AND NICOTINE, AND TO SUPPORT THEIR GROWTH AS HEALTHY, CONNECTED, AND HONORABLE MEMBERS WITHIN OUR NEIGHBORHOODS AND COMMUNITIES. IN ACHIEVING OUR MISSION, THUNDER ROAD IS GUIDED BY OPERATING PRINCIPLES THAT INCLUDE: - LEADERSHIP IN TREATMENT TECHNIQUES - INNOVATION AND CHANGE - DEDICATION TO EMPLOYEES - ACCESSIBILITY OF TREATMENT SERVICES - FAIR COST OF TREATMENT SERVICES - BALANCING THE INTERESTS OF CONSTITUENTS - ETHICAL RESPONSIBILITIES - DIVERSITY AND CULTURAL COMPETENCY - RECOVERING COMMUNITY WE STRIVE TO MAKE THUNDER ROAD THE CENTER OF A RECOVERING COMMUNITY WHICH WILL PROVIDE YOUTH AND FAMILIES WITH A PERMANENT SOURCE OF SUPPORT IN THEIR SOBRIETY.
EXEMPT PURPOSE ACHIEVEMENTS	FORM 990, PART III, LINE 4A	ADOLESCENT TREATMENT CENTERS, INC. (ATC), IS A CALIFORNIA NONPROFIT, PUBLIC BENEFIT CORPORATION DOING BUSINESS UNDER THE REGISTERED FEDERAL SERVICE MARK, "THUNDER ROAD." ATC OPERATES INTEGRATED ALCOHOL, OTHER DRUG, AND MENTAL HEALTH PROGRAMS FOR TEENAGERS AND THEIR FAMILIES, PROVIDING A BROAD RANGE OF EDUCATION, PREVENTION, ASSESSMENT, REFERRAL, AND TREATMENT SERVICES. THUNDER ROAD IS DUALLY LICENSED AS BOTH A CHEMICAL DEPENDENCY RECOVERY HOSPITAL (CDRH) BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES AND AS A GROUP HOME (GH) BY THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. WE SERVE AN AVERAGE OF 35 PATIENTS PER DAY. THE LARGEST COMPONENT OF THE THUNDER ROAD PROGRAM IS A RESIDENTIAL/ INPATIENT TREATMENT CENTER LOCATED ON 40TH STREET IN OAKLAND, CALIFORNIA. THE PROGRAM WORKS EXCLUSIVELY WITH YOUTH AGED 13 TO 19 WITH A HISTORY OF BEHAVIORAL HEALTH PROBLEMS WITH AN EMPHASIS ON DRUG AND ALCOHOL ABUSE OR DEPENDENCY. THE AVERAGE CLIENT IS NOT A "HARDENED ADDICT." MOST ARE TROUBLED YOUTH SUFFERING FROM VARIOUS BEHAVIOR DISORDERS, WHICH ARE MANIFESTED IN THE CHRONIC USE OF DRUGS, ALCOHOL, OR BOTH. NO APPLICANTS ARE ACCEPTED WHO ARE CONSIDERED TO POSE AN IMMEDIATE THREAT TO THEMSELVES OR OTHERS. SOME CLIENTS, INCLUDING MOST CLIENTS IN THE LONG-TERM GH COMPONENT, HAVE HAD SOME ENCOUNTER WITH THE JUVENILE JUSTICE SYSTEM AS A RESULT OF THEIR SUBSTANCE ABUSE.
DESCRIPTION OF CHANGES TO GOVERNING DOCUMENTS SINCE PRIOR FORM 990	FORM 990, PART VI, QUESTION 4	THE GENERAL MEMBER MAY NOT TRANSFER ITS MEMBERSHIP OR ANY RIGHTS ARISING THERE FROM EXCEPT AS PROVIDED IN THE CALIFORNIA CORPORATIONS CODE SECTION 5920. THE GENERAL MEMBER OF THE CORPORATION SHALL EXERCISE ITS MEMBERSHIP RIGHTS THROUGH ITS OWN BOARD OF DIRECTORS. SUBJECT TO THE PROVISIONS OF THE GENERAL MEMBER'S BYLAWS, THE BOARD OF DIRECTORS OF THE GENERAL MEMBER MAY, BY RESOLUTION, AUTHORIZE A PERSON OR COMMITTEE OF PERSONS TO EXERCISE ITS VOTE ON ANY MATTER TO COME BEFORE THE MEMBERSHIP OF THE CORPORATION. IN ADDITION, THE GENERAL MEMBER MAY EXERCISE ITS MEMBERSHIP RIGHTS AT ANY REGULAR OR SPECIAL MEETING OF THE BOARD OF DIRECTORS OF THE GENERAL MEMBER. SUTTER HEALTH AND THE CORPORATION'S GENERAL MEMBER HAVE THE POWER TO DIRECT OR CAUSE THE DIRECTION OF THE MANAGEMENT AND POLICIES OF THE CORPORATION. DIRECTORS: NUMBER, QUALIFICATION, SELECTION. THE BOARD OF DIRECTORS OF THE CORPORATION (HEREAFTER SOMETIMES REFERRED TO AS THE "BOARD") SHALL CONSIST OF BETWEEN FIVE (5) AND FIFTEEN (15) DIRECTORS. THE EXACT NUMBER OF DIRECTORS SHALL BE SET BY THE GENERAL MEMBER. ANY NUMBER OUTSIDE OF THESE LIMITS MAY BE REQUESTED BY THE CORPORATION AND APPROVED OR NOT APPROVED BY THE GENERAL MEMBER. SUCH APPROVAL SHALL BE DOCUMENTED AS AN EXHIBIT TO THESE BYLAWS. ALL DIRECTORS SHALL BE ELIGIBLE TO VOTE AND PARTICIPATE IN ALL DISCUSSIONS OF THE BOARD EXCEPT WHEN THE BOARD IS CONSIDERING A MATTER INVOLVING A DIRECTOR WHO IS CONSIDERED TO HAVE A CONFLICT FOR THE PARTICULAR MATTER UNDER CONSIDERATION. A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE BROADLY REPRESENTATIVE OF THE GEOGRAPHIC AREA SERVED BY THE CORPORATION. NOT MORE THAN FORTY-NINE PERCENT (49%) OF THE PERSONS SERVING AS MEMBERS OF THE BOARD OF DIRECTORS AT ANY TIME MAY BE INTERESTED PERSONS. THE PRESIDENT OF THE GENERAL MEMBER MAY DESIGNATE, BY WRITTEN NOTICE TO THE SECRETARY OF THE CORPORATION, TWO (2) VOTING MEMBERS OF THE BOARD ("DESIGNATED DIRECTORS"). ANY RESIDENCY REQUIREMENT APPLICABLE TO DIRECTORS SHALL NOT APPLY TO THE DESIGNATED DIRECTORS. THE PRESIDENT OF THE GENERAL MEMBER MAY REVOKE ANY SUCH DESIGNATION EFFECTIVE UPON DELIVERY OF WRITTEN NOTICE THEREOF TO THE SECRETARY OF THE CORPORATION. IN ANY INSTANCE WHERE HE/SHE HAS NOT BEEN DESIGNATED A "DESIGNATED DIRECTOR," THE PRESIDENT OF THE GENERAL MEMBER SHALL BE INVITED TO AND MAY ATTEND ANY BOARD OR COMMITTEE MEETING. THE PRESIDENT OF THE CORPORATION AND THE CHIEF FINANCIAL OFFICER SHALL BE EX OFFICIO MEMBERS OF THE BOARD OF DIRECTORS WITH FULL VOTING RIGHTS. FOR PURPOSES OF THESE BYLAWS "EX OFFICIO" MEANS "BY VIRTUE OF THE OFFICE HELD" AND, UNLESS OTHERWISE EXPRESSLY STATED IN THESE BYLAWS, A PERSON WHO IS A MEMBER OF THE BOARD EX OFFICIO WILL HAVE THE SAME RIGHTS AND PRIVILEGES OF (INCLUDING VOTING RIGHTS), AND WILL SERVE UNDER THE SAME LIMITATIONS AS, ALL OTHER MEMBERS OF THE BOARD. THE RESIGNATION OR REMOVAL OF ANY SUCH PERSON FROM OFFICE SHALL AUTOMATICALLY TERMINATE SUCH PERSON'S MEMBERSHIP ON THE BOARD. DIRECTORS SHALL BE APPOINTED BY THE GENERAL MEMBER FROM A SLATE OF NOMINEES SELECTED AS DESCRIBED AT SECTION 5-5 OF THE BYLAWS. THE STANDARD TERMS OF ALL APPOINTED DIRECTORS SHALL BE THREE (3) YEARS, OR UNTIL HIS/HER SUCCESSOR HAS BEEN APPOINTED BY THE GENERAL MEMBER, AND THE TERMS SHALL BE STAGGERED. NO APPOINTED DIRECTOR MAY SERVE FOR MORE THAN NINE (9) CONSECUTIVE YEARS. THE POWERS AND RESPONSIBILITIES OF THE BOARD OF DIRECTORS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: - TO ACT AS FIDUCIARIES TO FULFILL THE PURPOSES OF THE CORPORATION AS SET FORTH IN ITS ARTICLES OF INCORPORATION; - TO SUPERVISE THE CORPORATION'S QUALITY IMPROVEMENT ACTIVITIES, INCLUDING ALL ASPECTS OF PATIENT CARE EVALUATION, CONSISTENT WITH GUIDELINES ESTABLISHED BY SUTTER HEALTH; - TO MONITOR AND ASSURE THAT THE CORPORATION HAS AN EFFECTIVE ETHICS AND COMPLIANCE PROGRAM WHICH IS CONSISTENT WITH THE SUTTER HEALTH'S ETHICS AND COMPLIANCE PROGRAM; - TO ASSURE THAT THE CORPORATION'S COMMUNITY BENEFIT AND CHARITY CARE PROGRAMS ARE MEETING THE NEEDS OF THE COMMUNITIES SERVED BY THE CORPORATION WITHIN THE RESOURCES AVAILABLE TO DO SO; - TO REVIEW OPERATIONS WITH MANAGEMENT AND ENSURE THAT SERVICES ARE NECESSARY TO THE CORPORATION'S MISSION, ARE AFFORDABLE WHEN COMPARED TO LIKE SERVICES IN THE COMMUNITIES SERVED, AND ARE COST EFFECTIVELY PROVIDED; - TO OVERSEE THE DEVELOPMENT AND IMPLEMENTATION OF ANNUAL OPERATING AND CAPITAL BUDGETS, IN ACCORDANCE WITH GUIDELINES ESTABLISHED BY THE GENERAL MEMBER AND SUTTER HEALTH WITH DUE CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD; - TO OVERSEE THE DEVELOPMENT AND IMPLEMENTATION OF STRATEGIC PLANS WHICH ARE CONSISTENT WITH AND FULLY SUPPORT PROGRESS TOWARD ACHIEVING STRATEGIC OBJECTIVES AS DEFINED BY THE GENERAL MEMBER, SUTTER HEALTH AND THE CORPORATION; - TO SELECT AND APPOINT A QUALIFIED MEDICAL STAFF AND MAINTAIN A LIAISON THEREWITH. - TO PROVIDE INPUT TO THE PRESIDENT OF THE GENERAL MEMBER, OR HIS/HER DESIGNEE, REGARDING THE PERFORMANCE OF THE PRESIDENT OF THE CORPORATION AND OTHER KEY EXECUTIVES; - TO RECOMMEND INDIVIDUALS FOR APPOINTMENT BY THE GENERAL MEMBER TO THE BOARD; - TO ARRANGE AND CONDUCT PERIODIC REVIEW OF ITS OWN PERFORMANCE AS PRESCRIBED BY THE GENERAL MEMBER; - TO OVERSEE AND SUPPORT THE PHILANTHROPIC ACTIVITIES OF THE CORPORATION AND ANY AFFILIATE PHILANTHROPIC FOUNDATION; - TO BE LOYAL TO THE CORPORATION, ITS GENERAL MEMBER AND SUTTER HEALTH, ALWAYS FURTHERING THE INTERESTS OF THE CORPORATION, ITS GENERAL MEMBER AND SUTTER HEALTH IN THEIR PURSUIT OF THEIR MISSIONS AND COMPLYING WITH ALL LAWS, REGULATIONS AND BOARD POLICIES REGARDING CONFLICTS OF INTEREST; - TO BE DILIGENT IN THE FULFILLMENT OF BOARD RESPONSIBILITIES. THIS INCLUDES BEING PREPARED FOR QUESTIONS ADDRESSED BY THE BOARD, ATTENDANCE AT AND ACTIVE PARTICIPATION IN BOARD MEETINGS, AND PARTICIPATION IN CONTINUING EDUCATION OPPORTUNITIES; - TO BE PRUDENT IN ALL DECISIONS MADE ON BEHALF OF THE CORPORATION, INCLUDING ALWAYS ACTING IN GOOD FAITH AND IN A MANNER BELIEVED TO BE IN THE BEST INTERESTS OF THE CORPORATION, ITS GENERAL MEMBER AND SUTTER HEALTH, EMPLOYING JUDGMENT CONSISTENT WITH GENERALLY ACCEPTED COMMUNITY STANDARDS AND/OR PRACTICES FOR THE ISSUE AT HAND, INCLUDING MAKING REASONABLE INQUIRY AS AN ORDINARILY PRUDENT PERSON WOULD UNDER THE CIRCUMSTANCES; - TO RESPECT THE CONFIDENTIALITY OF THE BOARDROOM; AND - TO SUPPORT THE DECISIONS AND POLICIES OF THE BOARD, UNTIL SUCH TIME AS THOSE DECISIONS OR POLICIES ARE CHANGED BY AN OFFICIAL ACTION OF THE BOARD AND PLANNING RESPONSIBILITIES. NOTICE SHALL BE PROVIDED CONSISTENT WITH THE PROVISIONS OF CALIFORNIA CORPORATIONS CODE SECTION 5211. SPECIAL MEETINGS OF THE BOARD OF DIRECTORS SHALL BE HELD UPON FOUR (4) DAYS' NOTICE TO EACH DIRECTOR BY FIRST-CLASS MAIL OR FORTY-EIGHT (48) HOURS' NOTICE TO EACH DIRECTOR DELIVERED PERSONALLY OR BY ELECTRONIC OR TELEPHONIC TRANSMISSION. THE ATTENDANCE OF A DIRECTOR AT ANY MEETING SHALL CONSTITUTE A WAIVER OF NOTICE OF THE MEETING, EXCEPT WHERE A DIRECTOR ATTENDS A MEETING ONLY FOR THE EXPRESS PURPOSE OF OBJECTING TO THE TRANSACTION OF ANY BUSINESS. HOWEVER, A MAJORITY OF THOSE PRESENT AT THE TIME AND PLACE OF ANY MEETING, ALTHOUGH LESS THAN A QUORUM, MAY ADJOURN THE SAME FROM TIME TO TIME OR FROM DAY TO DAY, WITHOUT FURTHER NOTICE, UNTIL A QUORUM IS IN ATTENDANCE, AND WHEN A QUORUM IS PRESENT, ANY BUSINESS MAY BE TRANSACTED WHICH MIGHT HAVE BEEN TRANSACTED AT THE MEETING HAD THE SAME BEEN HELD ON THE DAY THE MEETING WAS ORIGINALLY CALLED. THE FOLLOWING PERSONS SHALL BE AUTHORIZED TO EXECUTE ANY DEEDS, MORTGAGES, BONDS, CONTRACTS, OR OTHER INSTRUMENTS WHICH THE BOARD HAS AUTHORIZED TO BE EXECUTED AND FOR WHICH THE CORPORATION HAS AUTHORITY TO ACT: A. ANY OFFICER OR OTHER PERSON DULY AUTHORIZED BY RESOLUTION OF THE BOARD TO EXECUTE DOCUMENTS; OR B. IN THE ABSENCE OF EXPRESS AUTHORIZATION BY BOARD RESOLUTION, THE PRESIDENT OF THE CORPORATION, THE SECRETARY, ANY ASSISTANT SECRETARY, OR THE CHIEF FINANCIAL OFFICER (ALL SUBJECT TO SUCH LIMITATIONS AS MAY BE IMPOSED BY RESOLUTION OF THE BOARD).
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS	FORM 990, PART VI, QUESTIONS 6 & 7A	THIS CORPORATION IS AN AFFILIATE OF SUTTER HEALTH, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. SUTTER HEALTH IS THE SOLE MEMBER WITH THE RIGHT TO ELECT AT LEAST A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS	FORM 990, PART VI, QUESTION 7B	SUTTER HEALTH AS THE SOLE MEMBER OF THE ORGANIZATION IS ENTITLED TO EXERCISE FULLY ALL RIGHTS AND PRIVILEGES OF MEMBERS OF NONPROFIT CORPORATIONS UNDER THE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION LAW, AND ALL OTHER APPLICABLE LAWS. THE MEMBER HAS THE RIGHTS AND POWERS TO APPOINT (AND REMOVE) MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE PROVISIONS OF THE BYLAWS. IN ADDITION, THE MEMBER HAS THE RIGHT TO APPROVE THE FOLLOWING ACTIONS OF THE CORPORATION'S BOARD OF DIRECTORS: A. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; C. ADOPTION OF OPERATING BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THE CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; D. ADOPTION OF CAPITAL BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; E. AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED APPROVED OPERATING OR CAPITAL BUDGETS BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE GENERAL MEMBER; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE DIRECTORS OF THE GENERAL MEMBER, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THE CORPORATION; G. APPOINTMENT OF AN INDEPENDENT AUDITOR AND HIRING OF INDEPENDENT COUNSEL EXCEPT IN CONFLICT SITUATIONS BETWEEN THE GENERAL MEMBER AND THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; H. THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE ENTITY; I. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; J. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. THE GENERAL MEMBER SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; K. APPROVAL OF STRATEGIC PLANS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; L. ADOPTION OF QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE GENERAL MEMBER; M. ANY TRANSACTION BETWEEN THE CORPORATION, A SUBSIDIARY OR AFFILIATE AND A DIRECTOR OF THE CORPORATION OR AN AFFILIATE OF SUCH DIRECTOR. IN ADDITION, THE GENERAL MEMBER SHALL HAVE THE AUTHORITY (BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF ITS BOARD), TO DECLARE A MAJOR ACTIVITY REQUIRING APPROVAL.
DESCRIBE THE PROCESS USED BY MGMT &/OR GOVERNING BODY TO REVIEW FORM 990	FORM 990, PART VI, QUESTION 11B	SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION, HAS A CENTRALIZED TAX DEPARTMENT RESPONSIBLE FOR THE PREPARATION OF THE FORM 990. ANNUALLY THE TAX DEPARTMENT PROVIDES TRAINING AND EDUCATION TO AFFILIATE PERSONNEL WHO ASSIST THE TAX DEPARTMENT IN COLLECTING AND REVIEWING DATA TO BE REPORTED ON THE FORM 990. THE PREPARATION MATERIAL IS REVIEWED BY VARIOUS DEPARTMENTS INCLUDING TAX, FINANCE, LEGAL, AND HUMAN RESOURCES. A NATIONAL ACCOUNTING FIRM PREPARES AND/OR REVIEWS THE RETURN. A COMPLETED RETURN IS THEN REVIEWED BY THE TAX DEPARTMENT, THE AFFILIATE, AND THE CFO BEFORE THE RETURN IS FILED.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST	FORM 990, PART VI, QUESTION 12	EMPLOYEES ARE EDUCATED ON THE CONFLICT OF INTEREST POLICY AND THE NEED TO MAKE DISCLOSURE AS PART OF ANNUAL COMPLIANCE EDUCATION. IN ADDITION, ANNUALLY A DISCLOSURE STATEMENT IS COMPLETED BY ALL DIRECTORS AND OFFICERS THAT INCLUDES AN ACKNOWLEDGEMENT THAT THEY HAVE READ THE CONFLICT OF INTEREST POLICY. ON THIS STATEMENT THE INDIVIDUAL WILL LIST A WIDE RANGE OF INFORMATION WHICH INCLUDES BUSINESS RELATIONSHIPS, EMPLOYMENT RELATIONSHIPS, PROPERTY INTERESTS, AND THOSE OF RELATED PARTIES. THE CEO AND BOARD CHAIR WILL REVIEW THE STATEMENTS AND MONITOR SITUATIONS THAT MAY POSE A POTENTIAL CONFLICT OF INTEREST. THE CEO AND BOARD CHAIR MAY CONSULT WITH THE OFFICE OF THE GENERAL COUNSEL AS NECESSARY. IF THERE IS A POTENTIAL CONFLICT OF INTEREST RELATED TO A PARTICULAR TRANSACTION, THE INTERESTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE AND NATURE OF THE RELATIONSHIP. THE BOARD CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE CONFLICT. UNTIL THE POTENTIAL CONFLICT IS RESOLVED, THE BOARD CHAIR MAY REQUEST THE INDIVIDUAL TO NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE INTERESTED INDIVIDUAL SHALL REFRAIN FROM VOTING ON ANY MATTER RELATED TO THE TRANSACTION.
PROCESS FOR DETERMINING COMPENSATION	FORM 990, PART VI, QUESTION 15	THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ENSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. IN ORDER TO ENSURE EXTERNAL COMPETITIVENESS, NATIONAL, CALIFORNIA AND LOCAL MARKET AREA COMPENSATION DATA COMPARISONS ARE REVIEWED. COMPETITIVE ANALYSIS INCLUDES: (A) BASE SALARY, (B) TOTAL CASH (BASE SALARY + ANNUAL INCENTIVE) AND (C) TOTAL REMUNERATION (BASE SALARY + ANNUAL INCENTIVE + BENEFITS AND LONG TERM INCENTIVE). THIS ANALYSIS INCLUDES COMPARABLE ORGANIZATIONS AND GEOGRAPHIC CONSIDERATIONS. FOR THE MOST SENIOR EXECUTIVE POSITIONS, NATIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS SUTTER HEALTH ARE MOST APPROPRIATE SINCE IT IS A NATIONAL MARKETPLACE IN WHICH SUTTER COMPETES FOR EXECUTIVE TALENT. ON THE OTHER HAND, BECAUSE CALIFORNIA'S UNDERLYING COMPENSATION STRUCTURE IS HIGHER THAN NATIONAL DATA (ESPECIALLY IN THE BAY AREA), REGIONAL PAY COMPARISONS AND ADJUSTMENTS ARE MADE. OFFICERS AND KEY EMPLOYEES OF THIS ORGANIZATION WHO ARE SUTTER HEALTH EMPLOYEES UNDERGO A REVIEW AND COMPENSATION COMMITTEE APPROVAL, AND SUCH APPROVAL IS RECORDED IN THE MINUTES.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC	FORM 990, PART VI, QUESTION 19	THE SUTTER HEALTH SYSTEM POSTS ITS CURRENT AND PAST AUDITED FINANCIAL STATEMENTS AT SUTTERHEALTH.ORG. OTHER DOCUMENTS ARE ALSO LOCATED AT THIS WEBSITE INCLUDING THE ANNUAL REPORT, MISSION STATEMENT, HISTORY, AND LINKS TO AFFILIATE WEBSITES. THE GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
OTHER FEES FOR SERVICES	FORM 990, PART IX, LINE 11G	HEALTHCARE PROVIDER PAYMENTS $765,496
OTHER CHANGES IN FUND BALANCES	FORM 990, PART XI, LINE 9	EQUITY TRANSFERS (NET) $450,000

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

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- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

ADOLESCENT TREATMENT CENTERS INC

Employer identification number

68-0088443

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) 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

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
(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	Yes	No
(1) ALTA BATES SUMMIT FOUNDATION 3012 SUMMIT STREET 3RD FLOOR OAKLAND,CA94609 51-0160184	FUNDRAISING	CA	501(C)(3)	7	SUTTER EBH	Yes
(2) CALIFORNIA PACIFIC MEDICAL CTR FOUND 2015 STEINER STREET 2ND FLOOR SAN FRANCISCO,CA94115 94-2728423	FUNDRAISING	CA	501(C)(3)	7	SUTTER WBH	Yes
(3) DELTA MEMORIAL HOSPITAL FOUNDATION 3901 LONE TREE WAY ANTIOCH,CA94509 94-2417022	FUNDRAISING	CA	501(C)(3)	11a - I	SUTTER EBH	Yes
(4) EAST BAY PERINATAL CENTER 3012 SUMMIT STREET 3RD FLOOR OAKLAND,CA94609 51-0172285	HEALTHCARE	CA	501(C)(3)	3	SUTTER EBH	Yes
(5) EDEN MEDICAL CENTER 20103 LAKE CHABOT ROAD CASTRO VALLEY,CA94546 94-2948100	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(6) MARIN COMMUNITY HEALTH 250 BON AIRE ROAD GREENBRAE,CA94904 94-2994751	SUPPORTING OR	CA	501(C)(3)	11b - II	SUTTER HLTH	Yes
(7) MEMORIAL HOSPITAL FOUNDATION 1800 COFFEE ROAD SUITE 76 MODESTO,CA95355 94-2290244	FUNDRAISING	CA	501(C)(3)	11a - I	SUTTER CVH	Yes
(8) MILLS-PENINSULA HEALTH SERVICES 1501 TROUSDALE DRIVE BURLINGAME,CA94010 94-1156265	HOSPITAL	CA	501(C)(3)	3	PAMF	Yes
(9) MILLS-PENINSULA HOSPITAL FOUNDATION 1501 TROUSDALE DRIVE BURLINGAME,CA94010 23-7288765	FUNDRAISING	CA	501(C)(3)	7	MPHS	Yes
(10) PALO ALTO MEDICAL FOUNDATION 2350 EL CAMINO REAL MOUNTAIN VIEW,CA94040 94-1156581	HEALTHCARE	CA	501(C)(3)	3	SUTTER HLTH	Yes
(11) SAMUEL MERRITT UNIVERSITY 450 30TH STREET 2840 OAKLAND,CA94609 94-2992642	UNIVERSITY	CA	501(C)(3)	2	SUTTER EBH	Yes
(12) SUTTER AUBURN FAITH HOSPITAL FOUNDATION 11815 EDUCATION ST AUBURN,CA95602 94-2594966	FUNDRAISING	CA	501(C)(3)	7	SUTTER SSR	Yes
(13) SUTTER CENTRAL VALLEY HOSPITALS 1800 COFFEE ROAD SUITE 76 MODESTO,CA95355 94-1080917	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(14) SUTTER COAST HOSPITAL 800 E WASHINGTON BLVD CRESCENT CITY,CA95531 94-2988520	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(15) SUTTER DAVIS HOSPITAL FOUNDATION PO BOX 1617 DAVIS,CA95617 68-0217870	FUNDRAISING	CA	501(C)(3)	7	SUTTER SSR	Yes
(16) SUTTER EAST BAY HOSPITALS 3012 SUMMIT STREET 3RD FLOOR OAKLAND,CA94609 94-1196176	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(17) SUTTER EAST BAY MEDICAL FOUNDATION 3687 MT DIABLO BLVD 200 LAFAYETTE,CA94549 94-2690415	HEALTHCARE	CA	501(C)(3)	3	SUTTER HLTH	Yes
(18) SUTTER GOULD MEDICAL FOUNDATION 600 COFFEE ROAD MODESTO,CA95355 94-1682256	HEALTHCARE	CA	501(C)(3)	3	SUTTER HLTH	Yes
(19) SUTTER HEALTH 2200 RIVER PLAZA DRIVE SACRAMENTO,CA95833 94-2788907	SUPPORTING OR	CA	501(C)(3)	11c III-FI	NA		No
(20) SUTTER HEALTH PACIFIC 91-2301 FT WEAVER RD EWA BEACH,HI96706 99-0298651	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(21) SUTTER HEALTH PLAN 2200 RIVER PLAZA DRIVE SACRAMENTO,CA95833 46-1183948	HEALTH PLAN	CA	PENDING	PENDING	SUTTER HLTH	Yes
(22) SUTTER HEALTH SACRAMENTO SIERRA REGION PO BOX 160727 SACRAMENTO,CA95816 94-1156621	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(23) SUTTER INSURANCE SERVICES CORPORATION 745 FORT STREET SUITE 800 HONOLULU,HI96813 99-0289310	INSURANCE SER	HI	501(C)(3)	11b - II	SUTTER HLTH	Yes
(24) SUTTER MEDICAL CENTER FOUNDATION PO BOX 160727 SACRAMENTO,CA95816 94-2788906	FUNDRAISING	CA	501(C)(3)	7	SUTTER SSR	Yes
(25) SUTTER MEDICAL CENTER CASTRO VALLEY 2200 RIVER PLAZA DRIVE SACRAMENTO,CA95833 77-0146047	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(26) SUTTER MEDICAL FOUNDATION 2800 L STREET 7TH FLOOR SACRAMENTO,CA95816 68-0273974	HEALTHCARE	CA	501(C)(3)	11b - II	SUTTER HLTH	Yes
(27) SUTTER ROSEVILLE MEDICAL CTR FOUNDATION ONE MEDICAL PLAZA ROSEVILLE,CA95661 68-0040113	FUNDRAISING	CA	501(C)(3)	7	SUTTER SSR	Yes
(28) SUTTER SOLANO CHARITABLE FOUNDATION 300 HOSPITAL DRIVE VALLEJO,CA94589 94-2668262	FUNDRAISING	CA	501(C)(3)	7	SUTTER SSR	Yes
(29) SUTTER VISITING NURSE ASSOC AND HOSPICE 1900 POWELL ST 300 EMERYVILLE,CA94608 94-6068843	HEALTHCARE	CA	501(C)(3)	9	SUTTER HLTH	Yes
(30) SUTTER WEST BAY HOSPITALS 2333 BUCHANAN STREET SAN FRANCISCO,CA94115 94-0562680	HOSPITAL	CA	501(C)(3)	3	SUTTER HLTH	Yes
(31) SUTTER WEST BAY MEDICAL FOUNDATION 2015 STEINER STREET 1ST FLOOR SAN FRANCISCO,CA94115 94-2948131	HEALTHCARE	CA	501(C)(3)	3	SUTTER HLTH	Yes
(32) TRACY HOSPITAL FOUNDATION 1420 N TRACY BLVD TRACY,CA95376 68-0318845	FUNDRAISING	CA	501(C)(3)	11a - I	SUTTER CVH	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) MAGNETIC IMAGING AF 175 LENNON WLN CK,CA94598 94-2953833	PATIENT CARE	CA	NA	N/A
(2) SURG CTR OF ABSMC 3875 TELEGRAPH OAKLAND,CA94609 47-0946086	OUTPATIENT SURG	CA	NA	N/A
(3) ALTA CT SERVICES LP 175 LENNON WLN CK,CA94598 94-3083464	PATIENT CARE	CA	NA	N/A
(4) CALIFORNIA PACIFIC ADV IMAGING LLC PO BOX 6102 NOVATO,CA94948 56-2311840	MRI JOINT VENTURE	CA	NA	N/A
(5) SAN FRANCISCO ENDOSCOPY CENTER LLC 3000 RIVERCHASE BIRMINGHAM,AL35244 91-2160588	ENDOSCOPY JV	CA	NA	N/A
(6) PRESIDIO SURGERY CENTER LLC 1635 DIVISADERO SF,CA94115 32-0144060	AMBULATORY SURG	CA	NA	N/A
(7) SUTTER FAIRFIELD SURGERY CTR 2700 LOW CT FAIRFIELD,CA94533 30-0233892	SURGERY	CA	NA	N/A
(8) TWIN CITIES SURGICAL HOSPITAL LLC 250 S WACKER CHICAGO,IL60606 35-2182617	SURGERY	CA	NA	N/A
(9) SUTTER AMADOR SURGERY CENTER LLC 2200 RIVER PLAZA DRIVE SACRAMENTO,CA95833 46-1398093	SURGERY	CA	NA	N/A
(10) ROSEVILLE ENDOPSCOPY CENTER LLC 4 MEDICAL PLAZA SUITE 210 ROSEVILLE,CA95661 87-0710513	ENDOSCOPY JV	CA	NA	N/A
(11) MEMORIAL MEDICAL OFFICE BUILDING PRTNR I 1800 COFFEE RD SUITE 76 MODESTO,CA95355 77-0287288	OFFICE RENTAL	CA	NA	N/A
(12) MEMORIAL MEDICAL OFFICE BUILDING PRTNR I 1800 COFFEE RD SUITE 76 MODESTO,CA95355 77-0287288	OFFICE RENTAL	CA	NA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) HEALTH VENTURES INC 350 HAWTHORNE ST OAKLAND,CA94609 94-2918780	HEALTH SERVICE	CA	NA	C CORP			Yes

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ALTA BATES SUMMIT FOUNDATION	C	527,331	FMV
(2) SUTTER EAST BAY HOSPITALS	S	450,000	FMV

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

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

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	112
6	Total number of volunteers (estimate if necessary) .............	6	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	480,060	527,331
9	Program service revenue (Part VIII, line 2g) .........	4,440,819	5,385,286
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,996	9,902
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	4,923,875	5,922,519
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	3,907,043	4,131,173
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 25,463
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,925,544	2,089,290
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	5,832,587	6,220,463
19	Revenue less expenses. Subtract line 18 from line 12.......	-908,712	-297,944
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,928,261	2,284,491
21	Total liabilities (Part X, line 26).............	782,077	988,156
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,146,184	1,296,335

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 5,428,855 including grants of $ 0 ) (Revenue $ 5,385,286 )
	SEE SCHEDULE O

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 expenses5,428,855

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	135,038	2,450,293	1,151,184

(A) Name and business address	(B) Description of services	(C) Compensation
GARY D NELSON ASSOCIATES INC, PO BOX 49195SAN JOSECA951619195	STAFFING SERVICES	341,131
DAVID CHERRY MD, 2424 DWIGHT WAY 9BERKELEYCA94704	PSYCHIATRIC SERVICES	126,898



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 2

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		527,331
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$		11,000
h	Total. Add lines 1a-1f.......			527,331
			Business Code
2a	PATIENT SERVICE REVENUE		622110	5,385,286	5,385,286
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			5,385,286
3	Investment income (including dividends, interest, and other similar amounts).......			9,902			9,902
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........			0
8a	Gross income from fundraising events (not including $ 0 of contributions reported on line 1c). See Part IV, line 18 ..
	a		8,926
b	Less: direct expenses ...b		8,926
c	Net income or (loss) from fundraising events..			0			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...			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..			0
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions......			5,922,519	5,385,286		9,902


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			0	1	0
2	Savings and temporary cash investments .........			461,173	2	628,544
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			1,117,859	4	1,404,528
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			6,490	8	6,552
9	Prepaid expenses and deferred charges ..........			9,715	9	22,648
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,032,602
b	Less: accumulated depreciation .....	10b	810,383	333,024	10c	222,219
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)......			1,928,261	16	2,284,491
17	Accounts payable and accrued expenses .........			748,149	17	957,419
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other 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 ..			0	23	0
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....................			33,928	25	30,737
26	Total liabilities. Add lines 17 through 25.........			782,077	26	988,156
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			1,146,184	27	1,296,335
28	Temporarily restricted net assets ...........			0	28	0
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			1,146,184	33	1,296,335
34	Total liabilities and net assets/fund balances ........			1,928,261	34	2,284,491