TY 2013 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)
(1) JO SANDERSFELD........................................................................ BOARD SECRETARY (PART YEAR)	2.0 .......................52.0	X	X	0	302,545	35,840
(2) JOSEPHINE THORNTON........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(3) ANTHONY KOSINSKI........................................................................ CHIEF OF STAFF	2.0 .......................0.0	X		11,650	0	0
(4) MICHAEL TOMASINI........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(5) ROBERT CURRY........................................................................ BOARD MEMBER	2.0 .......................0.0	X		0	0	0
(6) ROBYNN VANPATTEN........................................................................ BOARD SECRETARY	2.0 .......................50.0	X	X	0	497,341	26,492
(7) SISTER MARY BERNADETTE MCNULTY........................................................................ BOARD MEMBER, TREASURER	2.0 .......................4.0	X	X	0	0	0
(8) NANCY PRATT........................................................................ BOARD MEMBER	2.0 .......................48.0	X		0	465,800	13,839
(9) SISTER MARIAN SCHUBERT........................................................................ BOARD MEMBER	2.0 .......................57.0	X		0	0	0
(10) TODD SALNAS........................................................................ BOARD MEMBER, PRESIDENT	7.0 .......................49.0	X	X	0	552,938	38,756
(11) JIM CARR........................................................................ VICE CHAIRPERSON	4.0 .......................0.0	X		0	0	0
(12) SISTER JUDITH DUGAN........................................................................ BOARD MEMBER (PART YEAR)	2.0 .......................4.0	X		0	0	0
(13) KATHRYN POWELL........................................................................ BOARD MEMBER (PART YEAR)	2.0 .......................0.0	X		0	0	0
(14) PAMELA TUFT........................................................................ BOARD MEMBER, CHAIRPERSON	5.0 .......................0.0	X	X	0	0	0
(15) MICHEL RICCIONI........................................................................ CHIEF FINANCIAL OFFICER	7.0 .......................43.0		X	0	555,423	46,007
(16) KEVIN KLOCKENGA........................................................................ REGIONAL EVP	7.0 .......................52.0		X	0	773,124	38,738
(17) DAVID ZIOLKOWSKI........................................................................ CHIEF OPERATING OFFICER	2.0 .......................50.0		X	0	291,676	17,056

(A) Name and business address	(B) Description of services	(C) Compensation
MEDICAL STAFFING NETWORK HEALTHCARE, PO BOX 840292DALLASTX75284	REGISTRY	861,292
PETALUMA CC INC, 1115 B STREETPETALUMACA94952	MEDICAL SERVICES	284,908
WINDSOR CARE CENTER OF PETALUMA, 523 HAYES LANEPETALUMACA94952	MEDICAL SERVICES	229,609
JACKSON COKER, PO BOX 277638ATLANTAGA30022	MEDICAL SERVICES	191,026
QUEST DIAGNOSTICS, FILE NO 51048LOS ANGELESCA90074	LABORATORY SERVICES	167,607
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 12

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	383,245	383,245
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	659,934	411,643	248,291	0
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	0	0	0
7	Other salaries and wages	28,694,811	27,189,192	1,321,064	184,555
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,908,015	1,794,078	101,012	12,925
9	Other employee benefits .......	9,584,514	9,031,845	460,157	92,512
10	Payroll taxes ...........	2,636,425	2,499,766	119,144	17,515
11	Fees for services (non-employees):
a	Management ......	4,424,922	4,289,739	135,183	0
b	Legal .........	328,211	0	328,211	0
c	Accounting ...........	56,903	0	56,903	0
d	Lobbying ...........	8,321	8,321	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	0	0	0	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	9,220,864	9,009,102	203,162	8,600
12	Advertising and promotion ....	67,755	67,414	0	341
13	Office expenses .......	1,913,235	1,759,093	74,569	79,573
14	Information technology ......	2,009,650	1,859,622	137,452	12,576
15	Royalties ..	0	0	0	0
16	Occupancy ...........	1,362,346	1,356,090	544	5,712
17	Travel ............	270,536	233,073	34,828	2,635
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0	0	0	0
19	Conferences, conventions, and meetings ....	6,198	6,198	0	0
20	Interest ...........	23,455	23,455	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization .....	1,642,857	1,635,112	7,745	0
23	Insurance ..............	661,501	661,501	0	0
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	MEDICAL SUPPLIES	5,694,566	5,694,566	0	0
b	CA HOSPITAL FEE PROGRAM	1,139,921	1,139,921	0	0
c	REPAIRS AND MAINTENANCE	310,873	296,560	1,069	13,244
d	LICENSES AND TAXES	151,482	55,131	47,766	48,585
e	All other expenses	3,320,431	2,447,119	873,176	136
25	Total functional expenses. Add lines 1 through 24e	76,480,971	71,851,786	4,150,276	478,909
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).	0

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	0	1	2,059
2	Savings and temporary cash investments .........	10,922,087	2	7,869,504
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	9,097,171	4	9,969,417
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 ..............	1,017,500	8	1,133,422
9	Prepaid expenses and deferred charges ..........	165,470	9	916,661
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	52,439,110
b	Less: accumulated depreciation .....	10b	36,000,188	17,984,696	10c	16,438,922
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 .....	131,163	12	232,974
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 ...........	3,037,073	15	3,412,123
16	Total assets. Add lines 1 through 15 (must equal line 34)......	42,355,160	16	39,975,082
	17	Accounts payable and accrued expenses .........	9,137,985	17	5,744,610
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....................	22,852,771	25	24,238,477
26	Total liabilities. Add lines 17 through 25.........	31,990,756	26	29,983,087
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	8,559,568	27	7,916,221
28	Temporarily restricted net assets ...........	1,804,836	28	2,075,774
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 ...........	10,364,404	33	9,991,995
34	Total liabilities and net assets/fund balances ........	42,355,160	34	39,975,082

- TIN:

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.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

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) 2013

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. 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—2012. 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—2013. 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—2012. 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) 2013

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. 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—2012. 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) 2013

Page 4

Part IV

Supplemental Information. 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) 2013

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.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

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 for 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 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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization SRM ALLIANCE HOSPITAL SERVICES

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, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization SRM ALLIANCE HOSPITAL SERVICES

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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

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) (2013)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2013

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2013

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

8,321

Total. Add lines 1c through 1i ...............................

8,321

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1I	PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS FOR LOBBYING DURING THE PAST YEAR, ST. JOSEPH HEALTH SYSTEM CONDUCTED ADVOCACY EFFORTS WHICH INCLUDED SOME LOBBYING ACTIVITIES. THESE INCLUDED MEETING WITH LOCAL, STATE AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS, AND COMMUNICATIONS TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION.

Schedule C (Form 990 or 990EZ) 2013

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. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

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) 2013

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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 ................	10,746,655	10,635,808	110,847
c	Leasehold improvements ............	5,844,443	3,038,451	2,805,992
d	Equipment ................	32,574,527	22,325,929	10,248,598
e	Other .................	3,273,485	0	3,273,485
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				16,438,922

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) HOSPITAL FEE				763,069
(2) HOSPICE RESTRICTED FUNDS				2,076,033
(3) OTHER RECEIVABLES				0
(4) REC FROM THIRD PARTY PAYORS				573,021





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				3,412,123

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
ACCRUED LIABILITIES		2,236,607
INTERCOMPANY BOND PAYABLES		337,471
DUE TO AFFILIATES		21,487,374
OTHER NON CURRENT LIABILITES		177,025





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		24,238,477
2. Liability for uncertain tax positions 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) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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.

Return Reference	Explanation
SCHEDULE D, PART X, LINE 2	FIN 48 (ASC 740) FOOTNOTE ACCOUNTING STANDARDS CODIFICATION (ASC 740), INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2014 OR 2013.

Return Reference

Explanation

SCHEDULE D, PART X, LINE 2

FIN 48 (ASC 740) FOOTNOTE ACCOUNTING STANDARDS CODIFICATION (ASC 740), INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2014 OR 2013.

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

See separate instructions.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization
SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total .................

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2013

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 BENEDETTI (event type)	(b) Event #2 GOLF TOURNAMNT (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	363,775	155,635	16,849	536,259
2	Less: Contributions . .	327,226	126,011	14,349	467,586
3	Gross income (line 1 minus line 2) . . .	36,549	29,624	2,500	68,673
4	Cash prizes . . .	0	0	0	0
5	Noncash prizes . .	0	16,432	758	17,190
6	Rent/facility costs . .	0	8,190	750	8,940
7	Food and beverages .	37,148	20,705	500	58,353
8	Entertainment . . .	6,000	0	922	6,922
9	Other direct expenses .	64,520	34,288	4,077	102,885
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				194,290
11	Net income summary. Subtract line 10 from line 3, column (d)...........				-125,617

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2013

Page 3

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2013

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.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

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 %

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 500 %

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		(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) ..	1,208,988		1,208,988	1.580 %
b	Medicaid (from Worksheet 3, column a) ....	15,724,142	9,604,056	6,120,086	8.000 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	1,975,029	734,808	1,240,221	1.620 %
d	Total Financial Assistance and Means-Tested Government Programs .	18,908,159	10,338,864	8,569,295	11.200 %
Other Benefits		332,704	140,111	192,593	0.250 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	332,704	140,111	192,593	0.250 %
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	27,000		27,000	0.040 %
j	Total. Other Benefits ..	359,704	140,111	219,593	0.290 %
k	Total. Add lines 7d and 7j .	19,267,863	10,478,975	8,788,888	11.490 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

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. ......

7,448,350

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).....

15,646,007

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

23,571,301

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

-7,925,294

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) 2013

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, primary website address, and state license number
1	SRM ALLIANCE HOSPITAL SERVICES 400 NORTH MCDOWELL BLVD PETALUMA,CA94954 WWW.STJHS.ORG 110000001	X	X	X

Schedule H (Form 990) 2013

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)

	SRM ALLIANCE HOSPITAL SERVICES
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility 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....................

Yes

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 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests 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 ....................

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): SEE SCHEDULE H, PART V, SECTION C

Other website (list url):

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 as of the end of the tax year):

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) 2013

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: 200.% 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: 500.% 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	Residency
i	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 individual’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 Section C)
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 individual’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 Section C)

Schedule H (Form 990) 2013

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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

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 individual 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 individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 3	COMMUNITY INPUT THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE (CHIC) SELECTED THREE TYPES OF COMMUNITY INPUT: KEY INFORMANT INTERVIEWS WITH LEADERS IN THE COMMUNITY, FROM THE COUNTY DEPARTMENT OF HEALTH SERVICES AND LOCAL HEALTH, EDUCATION AND BUSINESS LEADERS; FOCUS GROUPS IN DIFFERENT COMMUNITIES THROUGHOUT THE COUNTY, BALANCED IN TERMS OF GEOGRAPHY AND CULTURE; AND A TELEPHONE SURVEY OF 1,500 PEOPLE. THESE THREE METHODS ALLOWED THE CHIC TO HEAR FROM CONTENT EXPERTS, COMMUNITY LEADERS, AND A BROAD SPECTRUM OF COMMUNITY MEMBERS. KEY INFORMANT INTERVIEWS WITH LOCAL EXPERTS CHNA PROJECT PARTNERS IDENTIFIED A PANEL OF 18 KEY INFORMANTS. KEY INFORMANTS WERE SELECTED FOR THEIR EXPERTISE IN A BROAD VARIETY OF HEALTH AND HEALTH-RELATED DISCIPLINES INCLUDING HOSPITAL AND PRIMARY CARE, PUBLIC HEALTH, MATERNAL AND CHILD HEALTH, HUMAN SERVICES, BUSINESS AND EDUCATION. PROJECT CONSULTANTS INTERVIEWED KEY INFORMANTS INDIVIDUALLY USING A STANDARDIZED SET OF QUESTIONS DESIGNED TO ELICIT INFORMATION ON THE LOCAL HEALTH ISSUES OF GREATEST CONCERN AND PERSPECTIVES ON LOCAL OPPORTUNITIES TO IMPROVE POPULATION HEALTH AND/OR THE HEALTHCARE DELIVERY SYSTEM. COMMUNITY BASED FOCUS GROUPS ST. JOSEPH HEALTH, SONOMA COUNTY CONDUCTED A SERIES OF TARGETED, COMMUNITY-BASED FOCUS GROUPS ON BEHALF OF THE PROJECT PARTNERS. THE GOAL OF THE FOCUS GROUP PROCESS WAS TO GATHER INFORMATION FROM RESIDENTS OF LOW-INCOME NEIGHBORHOODS ON THEIR HEALTH CONCERNS, THE CHALLENGES THEY FACE IN MAINTAINING HEALTH AND THEIR IDEAS ON HOW TO IMPROVE THEIR COMMUNITY'S HEALTH AND WELLBEING. FOUR FOCUS GROUPS WERE HELD, AVERAGING 8 PARTICIPANTS PER GROUP. GROUPS WERE FACILITATED IN BOTH SPANISH AND ENGLISH, BASED ON GROUP MAKE-UP. THE GROUPS WERE CONDUCTED IN THE COMMUNITIES OF SONOMA VALLEY, ROHNERT PARK, SANTA ROSA, AND CLOVERDALE AND WERE FACILITATED BY ST. JOSEPH'S STAFF USING STANDARDIZED QUESTIONS APPROVED BY THE CHNA PARTNERSHIP. BRFSS - A TELEPHONE SURVEY OF SONOMA COUNTY RESIDENTS ST. JOSEPH HEALTH, SONOMA COUNTY CONTACTED 1500 PEOPLE (839 COMPLETED THE SURVEY) USING A SURVEY TOOL INCORPORATING QUESTIONS FROM THE NATIONAL BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) SURVEY. THE SURVEY PROVIDED VALUABLE INFORMATION ON LOCAL HEALTH STATUS, HEALTH BEHAVIORS, EXPERIENCE WITH THE LOCAL HEALTH SYSTEMS AND HIGHLIGHTED THE LINKS BETWEEN SOCIAL DETERMINANTS, PREDOMINANTLY INCOME AND EDUCATIONAL ATTAINMENT, AND DISPARITIES IN HEALTH AND HEALTH CARE ACCESS. ORGANIZATIONS, PUBLIC HEALTH OR OTHER DEPARTMENTS OR AGENCIES, COMMUNITY LEADERS AND REPRESENTATIVES, OTHERS WHICH REPRESENT THE BROAD INTERESTS OF THE COMMUNITY CONSULTED DURING THE CHNA PROCESS INCLUDED: SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES SONOMA COUNTY OFFICE OF EDUCATION ECONOMIC DEVELOPMENT BOARD DRUG ABUSE ALTERNATIVE CENTER SANTA ROSA COMMUNITY HEALTH CENTERS SONOMA INDIAN HEALTH PROJECT REDWOOD COMMUNITY HEALTH COALITION KAISER PERMANENTE PARTNERSHIP HEALTHPLAN OF CALIFORNIA SONOMA COUNTY ORAL HEALTH ACCESS COALITION IN AN EFFORT TO GATHER DIVERSE POINTS OF VIEW THOSE INTERVIEWED REPRESENTED THE FOLLOWING SECTORS, SERVICES, ORGANIZATIONS AND AGENCIES: HEALTH AND HUMAN SERVICES HOSPITALS SONOMA COUNTY SCHOOLS ORAL HEALTH SERVICES COMMUNITY HEALTH CENTERS COMMUNITY BASED ORGANIZATIONS HEALTH INSURANCE PLANS ECONOMIC DEVELOPMENT
SCHEDULE H, PART V, SECTION B, LINE 4	THE SONOMA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) 2013 IS A COLLABORATIVE EFFORT BY ST. JOSEPH HEALTH, SONOMA COUNTY (SANTA ROSA MEMORIAL AND PETALUMA VALLEY), SUTTER MEDICAL CENTER OF SANTA ROSA, KAISER PERMANENTE MEDICAL CENTER SANTA ROSA AND THE SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES TO ASSESS THE HEALTH STATUS OF SONOMA COUNTY RESIDENTS AND TO IDENTIFY CRITICAL AREAS FOR HEALTH IMPROVEMENT IN SONOMA COUNTY. THE 2013 ASSESSMENT CONTINUES A SUCCESSFUL COLLABORATION BETWEEN THE HOSPITAL PARTNERS AND LOCAL HEALTH DEPARTMENT, BEGUN IN 2000, TO IDENTIFY AND JOINTLY ADDRESS SIGNIFICANT COMMUNITY HEALTH ISSUES.
SCHEDULE H, PART V, SECTION B, LINE 5A	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-PVH-COMMUNITY- HEALTH-NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 7	THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE DIRECTLY ADDRESSED THROUGH PROGRAMMING OR FUNDING AND AN EXPLANATION IS PROVIDED BELOW. THESE HEALTH NEEDS, USING THE ESTABLISHED CRITERIA WERE NOT RANKED AS HIGHLY AS ACCESS TO CARE, HEALTHY EATING AND PHYSICAL FITNESS, MENTAL HEALTH AND SUBSTANCE USE, BARRIERS TO HEALTHY AGING AND ORAL HEALTH. SRM ALLIANCE HOSPITAL SERVICES HAS UNIQUE RESOURCES AND CAPACITY TO DEDICATE TO THE FIVE CHOSEN HEALTH NEEDS. IN ADDITION, THERE ARE OTHER STRONG COMMUNITY PARTNERS WHO ARE CURRENTLY ADDRESSING THE NEEDS BELOW. THE NEEDS THAT WILL NOT BE SPECIFICALLY ADDRESSED ARE: 1. DISPARITIES IN EDUCATIONAL ATTAINMENT. ST. JOSEPH HEALTH, SONOMA COUNTY (SJH, SC) DID NOT CHOOSE TO SPECIFICALLY ADDRESS THIS NEED DUE TO RESOURCE AND CAPACITY RESTRAINTS. HOWEVER, SJH, SC WILL SUPPORT THIS HEALTH PRIORITY THROUGH ITS PARTICIPATION WITH THE SONOMA COUNTY CRADLE TO CAREER INITIATIVE, AND THE UNITED WAY SCHOOLS OF HOPE. THE CRADLE TO CAREER INITIATIVE IS A COUNTY WIDE PARTNERSHIP THAT CONNECTS ALL SEGMENTS OF THE EDUCATIONAL CONTINUUM OF EARLY EDUCATION, K-12, COLLEGE/TECHNICAL TRAINING WITH BROAD COMMUNITY SUPPORT TO IMPROVE THE EDUCATIONAL, ECONOMIC AND HEALTH OUTCOMES OF ALL SONOMA COUNTY YOUTH. IN ADDITION, THE HOSPITAL LEADERSHIP TEAM SUPPORTS VOLUNTEER SERVICE AND PARTICIPATION ON COMMUNITY BOARDS, SUCH AS UNITED WAY WITH ITS SCHOOLS OF HOPE INITIATIVE, AN EARLY READING INITIATIVE THAT HELPS CHILDREN BUILD THE CRITICAL SKILLS TO SUCCEED IN SCHOOLS AND LIFE. 2. CARDIOVASCULAR DISEASE. THOUGH SJH, SC WILL NOT SUPPORT EFFORTS TO REDUCE CARDIOVASCULAR DISEASE AS PART OF THE COMMUNITY BENEFIT IMPLEMENTATION PLAN, AS WE PLAN TO FOCUS ON HEALTH PROMOTION AND DISEASE PREVENTION EFFORTS. THE HOSPITAL WILL SUPPORT ADDRESSING CARDIOVASCULAR DISEASE THROUGH QUALITY, CULTURALLY COMPETENT CARE, WHICH WILL ENABLE EARLY DETECTION, INTERVENTION AND TREATMENT. THE HEART & VASCULAR INSTITUTE AT SJH, SC OFFERS STATE-OF-THE-ART DIAGNOSTIC PROCEDURES TO AID IN THE EVALUATION, DIAGNOSIS AND TREATMENT OF POSSIBLE HEART DISEASE. SJH, SC HAS IDENTIFIED HEALTHY EATING AND ACTIVE LIVING AS ONE OF ITS HEALTH PRIORITIES AND COMMUNITY BENEFITS TEAM MEMBERS ARE ACTIVE PARTICIPANTS IN THE COUNTY WIDE WORK OF COMMUNITY ACTIVITY AND NUTRITION COALITION OF SONOMA COUNTY (CAN-C) WHICH FOCUSES ON HEALTHY EATING AND PHYSICAL FITNESS, AND THIS INVOLVEMENT ADDRESSES THE PREVENTION AND ROOT CAUSES OF CARDIOVASCULAR DISEASE. 3. ADVERSE CHILDHOOD EXPOSURE TO STRESS (ACES). THIS HEALTH NEED WILL NOT BE ADDRESSED SEPARATELY, AS THE RESEARCH IN THIS AREA IS RELATIVELY NEW, AND WE CONTINUE TO INVESTIGATE OPPORTUNITIES TO BETTER ADDRESS THIS ISSUE. CIRCLE OF SISTERS, A PROGRAM OF THE SJH COMMUNITY BENEFIT DEPARTMENT, DOES INCLUDE CURRICULA AND PROGRAMMING THAT WORKS TO BUILD THE CONFIDENCE, SELF-ESTEEM, AND SELF-EFFICACY OF UNDERPRIVILEGED GIRLS IN PUBLIC SCHOOLS IN SONOMA COUNTY. 4. LUNG, BREAST, AND COLORECTAL CANCER. SJH, SC WILL ADDRESS CANCER THROUGH ITS SUPPORT FOR ACCESS TO PRIMARY CARE, COVERAGE AND MEDICAL HOMES, WHICH WILL ENABLE EARLY DETECTION, INTERVENTION AND TREATMENT FOR RESIDENTS WHO DEVELOP CANCER. WE DID NOT ADDRESS THIS HEALTH NEED IN OUR COMMUNITY BENEFIT IMPLEMENTATION PLAN, AS THERE ARE INSUFFICIENT RESOURCES IN COMMUNITY BENEFIT TO SUPPLEMENT THE EXISTING WORK THAT SJH, SC DOES IN THIS AREA. 5. TOBACCO USE. THE COMMUNITY BENEFIT PLAN DOES NOT FOCUS ON TOBACCO CESSATION, AS WE HAVE A LACK OF CAPACITY IN THIS SPECIFIC AREA. SJH, SC ADDRESSES TOBACCO USE THROUGH ITS FOCUS ON ACCESS TO CARE, EDUCATION AND PREVENTION EFFORTS. IN PARTICULAR, SJH,SC COLLABORATES WITH THE SONOMA COUNTY HEALTH DEPARTMENT AND THE EFFORTS OF ST. JOSEPH'S NEIGHBORHOOD CARE STAFF YOUTH LEADERS, WHO WORK TO CREATE HEALTHY RETAIL OUTLET ENVIRONMENTS. ALTHOUGH NO HEALTH CARE FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY, WE ARE COMMITTED TO CONTINUE OUR MISSION THROUGH COMMUNITY BENEFIT EFFORTS AND BY FUNDING OTHER NON-PROFITS THROUGH THE ST. JOSEPH COMMUNITY PARTNERSHIP FUND. IN ADDITION, SJH, SC WILL CONTINUE ITS COLLABORATIVE WORK AS A MEMBER OF THE SONOMA COUNTY HEALTH ALLIANCE, COMMUNITY HEALTH IMPROVEMENT COMMITTEE AND THE SONOMA COUNTY HEALTH ACTION COMMITTEE FOCUSED ON IDENTIFYING AND JOINTLY ADDRESSING SIGNIFICANT COMMUNITY HEALTH ISSUES. FOR FURTHER INFORMATION, PLEASE SEE THE IMPLEMENTATION STRATEGY FOUND AT: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/FY15-FY17-PVH-CB-AN D-IS-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 12I	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 14G	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDED THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH PATIENT BILLS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY MORE THAN 5% OR MORE OF THE HOSPITAL'S PATIENT POPULATION.
SCHEDULE H, PART V, SECTION B, LINE 18E	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDED THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH PATIENT BILLS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY MORE THAN 5% OR MORE OF THE HOSPITAL'S PATIENT POPULATION.
SCHEDULE H, PART V, SECTION B, LINE 20D	FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE ORGANIZATION USES MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES IS USED TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. 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?6
Name and address		Type of Facility (describe)
1	HOSPICE OF PETALUMA 416 PAYRAN STREET PETALUMA,CA95954	HOSPICE
2	HOSPICE OF SANTA ROSA 439 COLLEGE AVE SANTA ROSA,CA95401	HOSPICE
3	HOSPICE OF SANTA ROSA 447 COLLEGE AVE SANTA ROSA,CA95401	HOSPICE
4	LYNCH CREEK LABORATORY 151 LYNCH CREEK PETALUMA,CA95954	LAB OUTREACH
5	LYNCH CREEK IMAGING 151 LYNCH CREEK PETALUMA,CA95954	IMAGING/RADIOLOGY
6	HOSPICE OF NORTH COUNTY 205 EAST STREET HEALDSBURG,CA95448	HOSPICE
7
8
9
10

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
SCHEDULE H, PART V, SECTION B, LINE 3	COMMUNITY INPUT THE COMMUNITY HEALTH IMPROVEMENT COMMITTEE (CHIC) SELECTED THREE TYPES OF COMMUNITY INPUT: KEY INFORMANT INTERVIEWS WITH LEADERS IN THE COMMUNITY, FROM THE COUNTY DEPARTMENT OF HEALTH SERVICES AND LOCAL HEALTH, EDUCATION AND BUSINESS LEADERS; FOCUS GROUPS IN DIFFERENT COMMUNITIES THROUGHOUT THE COUNTY, BALANCED IN TERMS OF GEOGRAPHY AND CULTURE; AND A TELEPHONE SURVEY OF 1,500 PEOPLE. THESE THREE METHODS ALLOWED THE CHIC TO HEAR FROM CONTENT EXPERTS, COMMUNITY LEADERS, AND A BROAD SPECTRUM OF COMMUNITY MEMBERS. KEY INFORMANT INTERVIEWS WITH LOCAL EXPERTS CHNA PROJECT PARTNERS IDENTIFIED A PANEL OF 18 KEY INFORMANTS. KEY INFORMANTS WERE SELECTED FOR THEIR EXPERTISE IN A BROAD VARIETY OF HEALTH AND HEALTH-RELATED DISCIPLINES INCLUDING HOSPITAL AND PRIMARY CARE, PUBLIC HEALTH, MATERNAL AND CHILD HEALTH, HUMAN SERVICES, BUSINESS AND EDUCATION. PROJECT CONSULTANTS INTERVIEWED KEY INFORMANTS INDIVIDUALLY USING A STANDARDIZED SET OF QUESTIONS DESIGNED TO ELICIT INFORMATION ON THE LOCAL HEALTH ISSUES OF GREATEST CONCERN AND PERSPECTIVES ON LOCAL OPPORTUNITIES TO IMPROVE POPULATION HEALTH AND/OR THE HEALTHCARE DELIVERY SYSTEM. COMMUNITY BASED FOCUS GROUPS ST. JOSEPH HEALTH, SONOMA COUNTY CONDUCTED A SERIES OF TARGETED, COMMUNITY-BASED FOCUS GROUPS ON BEHALF OF THE PROJECT PARTNERS. THE GOAL OF THE FOCUS GROUP PROCESS WAS TO GATHER INFORMATION FROM RESIDENTS OF LOW-INCOME NEIGHBORHOODS ON THEIR HEALTH CONCERNS, THE CHALLENGES THEY FACE IN MAINTAINING HEALTH AND THEIR IDEAS ON HOW TO IMPROVE THEIR COMMUNITY'S HEALTH AND WELLBEING. FOUR FOCUS GROUPS WERE HELD, AVERAGING 8 PARTICIPANTS PER GROUP. GROUPS WERE FACILITATED IN BOTH SPANISH AND ENGLISH, BASED ON GROUP MAKE-UP. THE GROUPS WERE CONDUCTED IN THE COMMUNITIES OF SONOMA VALLEY, ROHNERT PARK, SANTA ROSA, AND CLOVERDALE AND WERE FACILITATED BY ST. JOSEPH'S STAFF USING STANDARDIZED QUESTIONS APPROVED BY THE CHNA PARTNERSHIP. BRFSS - A TELEPHONE SURVEY OF SONOMA COUNTY RESIDENTS ST. JOSEPH HEALTH, SONOMA COUNTY CONTACTED 1500 PEOPLE (839 COMPLETED THE SURVEY) USING A SURVEY TOOL INCORPORATING QUESTIONS FROM THE NATIONAL BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) SURVEY. THE SURVEY PROVIDED VALUABLE INFORMATION ON LOCAL HEALTH STATUS, HEALTH BEHAVIORS, EXPERIENCE WITH THE LOCAL HEALTH SYSTEMS AND HIGHLIGHTED THE LINKS BETWEEN SOCIAL DETERMINANTS, PREDOMINANTLY INCOME AND EDUCATIONAL ATTAINMENT, AND DISPARITIES IN HEALTH AND HEALTH CARE ACCESS. ORGANIZATIONS, PUBLIC HEALTH OR OTHER DEPARTMENTS OR AGENCIES, COMMUNITY LEADERS AND REPRESENTATIVES, OTHERS WHICH REPRESENT THE BROAD INTERESTS OF THE COMMUNITY CONSULTED DURING THE CHNA PROCESS INCLUDED: SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES SONOMA COUNTY OFFICE OF EDUCATION ECONOMIC DEVELOPMENT BOARD DRUG ABUSE ALTERNATIVE CENTER SANTA ROSA COMMUNITY HEALTH CENTERS SONOMA INDIAN HEALTH PROJECT REDWOOD COMMUNITY HEALTH COALITION KAISER PERMANENTE PARTNERSHIP HEALTHPLAN OF CALIFORNIA SONOMA COUNTY ORAL HEALTH ACCESS COALITION IN AN EFFORT TO GATHER DIVERSE POINTS OF VIEW THOSE INTERVIEWED REPRESENTED THE FOLLOWING SECTORS, SERVICES, ORGANIZATIONS AND AGENCIES: HEALTH AND HUMAN SERVICES HOSPITALS SONOMA COUNTY SCHOOLS ORAL HEALTH SERVICES COMMUNITY HEALTH CENTERS COMMUNITY BASED ORGANIZATIONS HEALTH INSURANCE PLANS ECONOMIC DEVELOPMENT
SCHEDULE H, PART V, SECTION B, LINE 4	THE SONOMA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) 2013 IS A COLLABORATIVE EFFORT BY ST. JOSEPH HEALTH, SONOMA COUNTY (SANTA ROSA MEMORIAL AND PETALUMA VALLEY), SUTTER MEDICAL CENTER OF SANTA ROSA, KAISER PERMANENTE MEDICAL CENTER SANTA ROSA AND THE SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES TO ASSESS THE HEALTH STATUS OF SONOMA COUNTY RESIDENTS AND TO IDENTIFY CRITICAL AREAS FOR HEALTH IMPROVEMENT IN SONOMA COUNTY. THE 2013 ASSESSMENT CONTINUES A SUCCESSFUL COLLABORATION BETWEEN THE HOSPITAL PARTNERS AND LOCAL HEALTH DEPARTMENT, BEGUN IN 2000, TO IDENTIFY AND JOINTLY ADDRESS SIGNIFICANT COMMUNITY HEALTH ISSUES.
SCHEDULE H, PART V, SECTION B, LINE 5A	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-PVH-COMMUNITY- HEALTH-NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 7	THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE DIRECTLY ADDRESSED THROUGH PROGRAMMING OR FUNDING AND AN EXPLANATION IS PROVIDED BELOW. THESE HEALTH NEEDS, USING THE ESTABLISHED CRITERIA WERE NOT RANKED AS HIGHLY AS ACCESS TO CARE, HEALTHY EATING AND PHYSICAL FITNESS, MENTAL HEALTH AND SUBSTANCE USE, BARRIERS TO HEALTHY AGING AND ORAL HEALTH. SRM ALLIANCE HOSPITAL SERVICES HAS UNIQUE RESOURCES AND CAPACITY TO DEDICATE TO THE FIVE CHOSEN HEALTH NEEDS. IN ADDITION, THERE ARE OTHER STRONG COMMUNITY PARTNERS WHO ARE CURRENTLY ADDRESSING THE NEEDS BELOW. THE NEEDS THAT WILL NOT BE SPECIFICALLY ADDRESSED ARE: 1. DISPARITIES IN EDUCATIONAL ATTAINMENT. ST. JOSEPH HEALTH, SONOMA COUNTY (SJH, SC) DID NOT CHOOSE TO SPECIFICALLY ADDRESS THIS NEED DUE TO RESOURCE AND CAPACITY RESTRAINTS. HOWEVER, SJH, SC WILL SUPPORT THIS HEALTH PRIORITY THROUGH ITS PARTICIPATION WITH THE SONOMA COUNTY CRADLE TO CAREER INITIATIVE, AND THE UNITED WAY SCHOOLS OF HOPE. THE CRADLE TO CAREER INITIATIVE IS A COUNTY WIDE PARTNERSHIP THAT CONNECTS ALL SEGMENTS OF THE EDUCATIONAL CONTINUUM OF EARLY EDUCATION, K-12, COLLEGE/TECHNICAL TRAINING WITH BROAD COMMUNITY SUPPORT TO IMPROVE THE EDUCATIONAL, ECONOMIC AND HEALTH OUTCOMES OF ALL SONOMA COUNTY YOUTH. IN ADDITION, THE HOSPITAL LEADERSHIP TEAM SUPPORTS VOLUNTEER SERVICE AND PARTICIPATION ON COMMUNITY BOARDS, SUCH AS UNITED WAY WITH ITS SCHOOLS OF HOPE INITIATIVE, AN EARLY READING INITIATIVE THAT HELPS CHILDREN BUILD THE CRITICAL SKILLS TO SUCCEED IN SCHOOLS AND LIFE. 2. CARDIOVASCULAR DISEASE. THOUGH SJH, SC WILL NOT SUPPORT EFFORTS TO REDUCE CARDIOVASCULAR DISEASE AS PART OF THE COMMUNITY BENEFIT IMPLEMENTATION PLAN, AS WE PLAN TO FOCUS ON HEALTH PROMOTION AND DISEASE PREVENTION EFFORTS. THE HOSPITAL WILL SUPPORT ADDRESSING CARDIOVASCULAR DISEASE THROUGH QUALITY, CULTURALLY COMPETENT CARE, WHICH WILL ENABLE EARLY DETECTION, INTERVENTION AND TREATMENT. THE HEART & VASCULAR INSTITUTE AT SJH, SC OFFERS STATE-OF-THE-ART DIAGNOSTIC PROCEDURES TO AID IN THE EVALUATION, DIAGNOSIS AND TREATMENT OF POSSIBLE HEART DISEASE. SJH, SC HAS IDENTIFIED HEALTHY EATING AND ACTIVE LIVING AS ONE OF ITS HEALTH PRIORITIES AND COMMUNITY BENEFITS TEAM MEMBERS ARE ACTIVE PARTICIPANTS IN THE COUNTY WIDE WORK OF COMMUNITY ACTIVITY AND NUTRITION COALITION OF SONOMA COUNTY (CAN-C) WHICH FOCUSES ON HEALTHY EATING AND PHYSICAL FITNESS, AND THIS INVOLVEMENT ADDRESSES THE PREVENTION AND ROOT CAUSES OF CARDIOVASCULAR DISEASE. 3. ADVERSE CHILDHOOD EXPOSURE TO STRESS (ACES). THIS HEALTH NEED WILL NOT BE ADDRESSED SEPARATELY, AS THE RESEARCH IN THIS AREA IS RELATIVELY NEW, AND WE CONTINUE TO INVESTIGATE OPPORTUNITIES TO BETTER ADDRESS THIS ISSUE. CIRCLE OF SISTERS, A PROGRAM OF THE SJH COMMUNITY BENEFIT DEPARTMENT, DOES INCLUDE CURRICULA AND PROGRAMMING THAT WORKS TO BUILD THE CONFIDENCE, SELF-ESTEEM, AND SELF-EFFICACY OF UNDERPRIVILEGED GIRLS IN PUBLIC SCHOOLS IN SONOMA COUNTY. 4. LUNG, BREAST, AND COLORECTAL CANCER. SJH, SC WILL ADDRESS CANCER THROUGH ITS SUPPORT FOR ACCESS TO PRIMARY CARE, COVERAGE AND MEDICAL HOMES, WHICH WILL ENABLE EARLY DETECTION, INTERVENTION AND TREATMENT FOR RESIDENTS WHO DEVELOP CANCER. WE DID NOT ADDRESS THIS HEALTH NEED IN OUR COMMUNITY BENEFIT IMPLEMENTATION PLAN, AS THERE ARE INSUFFICIENT RESOURCES IN COMMUNITY BENEFIT TO SUPPLEMENT THE EXISTING WORK THAT SJH, SC DOES IN THIS AREA. 5. TOBACCO USE. THE COMMUNITY BENEFIT PLAN DOES NOT FOCUS ON TOBACCO CESSATION, AS WE HAVE A LACK OF CAPACITY IN THIS SPECIFIC AREA. SJH, SC ADDRESSES TOBACCO USE THROUGH ITS FOCUS ON ACCESS TO CARE, EDUCATION AND PREVENTION EFFORTS. IN PARTICULAR, SJH,SC COLLABORATES WITH THE SONOMA COUNTY HEALTH DEPARTMENT AND THE EFFORTS OF ST. JOSEPH'S NEIGHBORHOOD CARE STAFF YOUTH LEADERS, WHO WORK TO CREATE HEALTHY RETAIL OUTLET ENVIRONMENTS. ALTHOUGH NO HEALTH CARE FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY, WE ARE COMMITTED TO CONTINUE OUR MISSION THROUGH COMMUNITY BENEFIT EFFORTS AND BY FUNDING OTHER NON-PROFITS THROUGH THE ST. JOSEPH COMMUNITY PARTNERSHIP FUND. IN ADDITION, SJH, SC WILL CONTINUE ITS COLLABORATIVE WORK AS A MEMBER OF THE SONOMA COUNTY HEALTH ALLIANCE, COMMUNITY HEALTH IMPROVEMENT COMMITTEE AND THE SONOMA COUNTY HEALTH ACTION COMMITTEE FOCUSED ON IDENTIFYING AND JOINTLY ADDRESSING SIGNIFICANT COMMUNITY HEALTH ISSUES. FOR FURTHER INFORMATION, PLEASE SEE THE IMPLEMENTATION STRATEGY FOUND AT: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/FY15-FY17-PVH-CB-AN D-IS-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 12I	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 14G	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDED THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH PATIENT BILLS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY MORE THAN 5% OR MORE OF THE HOSPITAL'S PATIENT POPULATION.
SCHEDULE H, PART V, SECTION B, LINE 18E	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDED THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH PATIENT BILLS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY MORE THAN 5% OR MORE OF THE HOSPITAL'S PATIENT POPULATION.
SCHEDULE H, PART V, SECTION B, LINE 20D	FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE ORGANIZATION USES MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES IS USED TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
SRM ALLIANCE HOSPITAL SERVICES

Employer identification number
68-0395200

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) NORTHERN CALIFORNIA CENTER FOR WELL BEING 365-B TESCONI CIRCLE SANTA ROSA,CA95401	93-1144835	501(c)(3)	15,345	PROGRAM SUPPORT
(2) ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DR STE 100 IRVINE,CA92612	33-0143024	501(c)(3)	350,900	CARE FOR THE POOR
(3) PETALUMA PEOPLE SERVICES 1500 A PETALUMA BLVD S PETALUMA,CA94952	94-2271299	501(c)(3)	17,000	PROGRAM SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2013

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	DESCRIPTION OF ORG'S PROCEDURES FOR MONITORING THE USE OF GRANTS DONATIONS TO OTHER ORGANIZATIONS ARE APPROVED BY MANAGEMENT TO ENSURE THEY SUPPORT THE MISSION OF SRM ALLIANCE HOSPITAL SERVICES. WE DO NOT MONITOR DONATIONS MADE.

Schedule I (Form 990) 2013

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, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

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
directors, trustees, officers, including 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) 2013

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)JO SANDERSFELDBOARD SECRETARY (PART YEAR)	(i) (ii)	0 202,999	0 63,415	0 36,131	0 18,250	0 17,590	0 338,385	0 0
(2)MICHEL RICCIONICHIEF FINANCIAL OFFICER	(i) (ii)	0 334,981	0 161,077	0 59,365	0 17,606	0 28,401	0 601,430	0 0
(3)GARY MAHANMANAGER - PHARMACY	(i) (ii)	174,646 0	8,863 0	50 0	16,621 0	22,361 0	222,541 0	0 0
(4)KEVIN KLOCKENGAREGIONAL EVP	(i) (ii)	0 505,252	0 207,110	0 60,762	0 10,200	0 28,538	0 811,862	0 0
(5)JANETTE MARLOWSTAFF NURSE III - CNA	(i) (ii)	187,933 0	0 0	25 0	19,100 0	30,795 0	237,853 0	0 0
(6)JANE READVP-OPERATIONS	(i) (ii)	203,382 0	63,629 0	14,159 0	9,302 0	12,544 0	303,016 0	0 0
(7)JAYNIE BORENN. CA REG VP - STRATEGIC SVCS	(i) (ii)	0 262,619	0 89,261	0 27,698	0 7,729	0 22,672	0 409,979	0 0
(8)DAVID ZIOLKOWSKICHIEF OPERATING OFFICER	(i) (ii)	0 188,631	0 46,287	0 56,758	0 0	0 17,056	0 308,732	0 0
(9)ROBYNN VANPATTENBOARD SECRETARY	(i) (ii)	0 339,611	0 120,996	0 36,734	0 0	0 26,492	0 523,833	0 0
(10)PAULA GRIFFITHSTAFF NURSE IV-CNA	(i) (ii)	167,499 0	0 0	2,289 0	17,263 0	22,925 0	209,976 0	0 0
(11)MICHELE GEILSSTAFF NURSE IV-CNA	(i) (ii)	164,258 0	0 0	50 0	14,641 0	29,129 0	208,078 0	0 0
(12)WENDI THOMASDIRECTOR-NURSING SVCS	(i) (ii)	170,734 0	5,345 0	5,320 0	12,049 0	29,277 0	222,725 0	0 0
(13)NANCY PRATTBOARD MEMBER	(i) (ii)	0 349,244	0 81,974	0 34,582	0 0	0 13,839	0 479,639	0 0
(14)TODD SALNASBOARD MEMBER, PRESIDENT	(i) (ii)	0 346,507	0 163,867	0 42,564	0 10,200	0 28,556	0 591,694	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 1A	SUPPLEMENTAL COMPENSATION IFNORMATION COMPANION TRAVEL ST. JOSEPH HEALTH SYSTEM ALLOWS FOR COMPANION TRAVEL TO CERTAIN PRE-APPROVED, MINISTRY SPONSORED EVENTS. COMPANION TRAVEL IS TREATED AS TAXABLE COMPENSATION IN MOST CASES. IN THE CASE THAT COMPANION TRAVEL IS NOT TAXABLE COMPENSATION, THE INDIVIDUAL IS PROVIDING A SERVICE TO THE HEALTH SYSTEM AS A REPRESENTATIVE WITH KNOWLEDGE OF THE COMMUNITIES AND MINISTRIES WE SERVE. MEMBERS OF THE BOARD AND EXECUTIVE MANAGEMENT TEAM ARE SELECTED TO PARTICIPATE IN AN ANNUAL PILGRIMAGE TO LE PUY, FRANCE, WHERE THE SISTERS' FIRST CONGREGATION WAS FORMED. THE PURPOSE OF THE PILGRIMAGE IS FOR THE ORGANIZATION'S LEADERS TO DEVELOP A DEEPER UNDERSTANDING OF THE ROOTS AND HERITAGE OF THE ORGANIZATION IN ORDER TO CARRY OUT THE MISSION. COMPANION TRAVEL IS CONSIDERED TO BE AN ESSENTIAL PART OF THIS EXPERIENCE AND THE COMPANION ACTS AS A REPRESENTATIVE WITH KNOWLEDGE OF THE COMMUNITIES AND MINISTRIES WE SERVE. THE FOLLOWING INDIVIDUALS RECEIVED A BENEFIT FOR COMPANION TRAVEL THAT WAS INTENDED TO BE COMPENSATION: TODD SALNAS - $2,235 DISCRETIONARY SPENDING ACCOUNT EXECUTIVES RECEIVE A PERCENTAGE OF BASE COMPENSATION FOR DISCRETIONARY SPENDING. THESE AMOUNTS ARE INCLUDED IN OTHER REPORTABLE COMPENSATION.
SCHEDULE J, PART I, LINE 3	THE ORGANIZATION'S PRESIDENT IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATIONS. SEE SCHEDULE O FORM 990, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4B	EXECUTIVES COULD PARTICIPATE IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER INTERNAL REVENUE CODE 457 (F). THE PLAN WAS FROZEN EFFECTIVE DECEMBER 31, 2007 AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED TO THE PLAN. THIS PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISION OF THE PLAN.
SCHEDULE J, PART I, LINE 7	A PORTION OF EXECUTIVE SALARIES ARE PLACED 'AT RISK' AND ARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE AT ST. JOSEPSH HEALTH SYSTEM. AT RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES, AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENT OF AT RISK PAY.

Schedule J (Form 990) 2013

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.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Return Reference	Explanation
FORM 990, PART I, LINE 1	ORGANIZATION'S MISSION STATEMENT SRM ALLIANCE HOSPITAL IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES WE SERVE.
FORM 990, PART III, LINE 4A	PROGRAM SERVICE ACCOMPLISHMENTS SRM ALLIANCE HOSPITAL HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 30 YEARS, SERVING THE COMMUNITIES OF SOUTHERN SONOMA COUNTY AND MARIN COUNTY REGIONS. SRM ALLIANCE HOSPITAL, APPROXIMATELY 40 MILES NORTH OF SAN FRANCISCO JUST OFF THE HIGHWAY 101 CORRIDOR IN SOUTHERN SONOMA COUNTY IN THE TOWN OF PETALUMA, IS AN 80-BED ACUTE CARE HOSPITAL. ITS SERVICES INCLUDE A 24-HOUR EMERGENCY DEPARTMENT, INTENSIVE/CORONARY CARE UNIT, FAMILY BIRTH CENTER, INPATIENT MEDICAL/SURGICAL UNIT, DAY SURGERY, IMAGING, LABORATORY, AND RESPIRATORY, PHYSICAL AND OCCUPATIONAL THERAPIES. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, SRM ALLIANCE HOSPITAL IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORS" AND MINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBILITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH MINISTRY. SRM ALLIANCE HOSPITAL IS COMMITTED TO THREE SYSTEMWIDE MISSION OUTCOMES: 1) EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTER HAS A DIRECT CONNECTION TO THE OVERALL MISSION. OUR VALUE OF DIGNITY CALLS FOR US TO RESPECT EACH PERSON AS AN INHERENTLY VALUABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. WE STRIVE TO DO THIS BY KEEPING AT THE FOREFRONT OF OUR MINDS THE UNDERSTANDING OF THE IMPACT WE CAN HAVE ON ONE ANOTHER WITH EVERY ACTION WE TAKE. THE MAIN GOAL SURROUNDING SACRED ENCOUNTERS IS TO PROVIDE CARE TO PATIENTS DISTINGUISHED BY EASE OF USE, TIMELY ACCESS, SAFETY, AND HIGH RELIABILITY WITH AN EMPHASIS ON PATIENT SAFETY AND PATIENT SATISFACTION. SRM ALLIANCE HOSPITAL HAS IMPLEMENTED EVIDENCED BASED BEST PRACTICE STANDARD WORK TO ADDRESS WHAT WE DO & HOW WE DO WHAT WE DO TO ADDRESS ALL EIGHT KEY HCAHPS COMPOSITE MEASURES OF PATIENT EXPERIENCE. ANY LOCATION PERFORMING BELOW MINISTRY HCAHPS PERFORMANCE GOALS MUST PROVIDE COUNTERMEASURE FOR IMPROVEMENT TO EXECUTIVE LEADERSHIP. ALL STANDARD WORK INCLUDES EDUCATION, MONITORING & COACHING, IS AUDITED DAILY FOR REAL TIME PROGRESS REPORT TO ALL LEVELS OF THE ORGANIZATION, AND RELIES ON THE INFRASTRUCTURE PROVIDED BY SONOMA WAY AND OUR PERFORMANCE IMPROVEMENT AND IMPLEMENTATION TEAM OF EDUCATORS TO SUPPORT SUSTAINMENT. STANDARD WORK IS CONSIDERED HARD WIRED WHEN IT IS PERFORMED CONSISTENTLY AT 90% ON AUDIT OUTCOME DATA. FALLOUTS FROM 90% PERFORMANCE LASTING TWO WEEKS REQUIRE IMMEDIATE ACTION PLANS FOR RESTORATION OF PERFORMANCE. ALL OF THESE INITIATIVES HAVE EDUCATION, STANDARD WORK AND COACHING/MENTORING OF STAFF. AUDITS WITH VISUAL MANAGEMENT BOARDS TRACK PROJECTS AND UNITS ARE CONSIDERED HARDWIRED IF ALL AUDITS ARE AT 90% FOR 2 SIMULTANEOUS WEEKS. IN ADDITION SRM ALLIANCE HOSPITAL IMPLEMENTED A "SPOTLIGHTING PROGRAM," WHICH IS AN INITIATIVE THAT GIVES CAREGIVERS NEW TOOLS TO SHOW THEIR COMPASSION, HONOR PATIENT DIGNITY AND FOSTER AN ENVIRONMENT IN WHICH PATIENTS FEEL SAFE AND NURTURED. SPECIFICALLY, THE FOCUS WAS ON THREE MOMENTS: ADMISSION, BED TIME AND DISCHARGE. DEPARTMENTS LOOKED CLOSELY AT EVERY ASPECT OF THESE EXPERIENCES, DETERMINED THE TONE THEY WANTED TO ESTABLISH AND THEN EXPLORED WHAT CAREGIVERS COULD DO AND SAY TO FOSTER A SACRED ENCOUNTER. THE IDEA WAS TO CREATE TOOLS THAT ALLOW THE CAREGIVERS TO REACH OUT AND HAVE AUTHENTIC ENCOUNTERS WITH THE PATIENTS. 2) ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. OUR MISSION IS TO CONTINUALLY IMPROVE THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. OUR VISION IS THAT EVERY PATIENT WE CARE FOR RECEIVES PERFECT CARE. PERFECT CARE MEANS THAT EVERY PATIENT GETS THE HIGHEST STANDARD OF CARE, EVERY TIME. TO ACHIEVE THOSE GOALS, WE PARTICIPATE IN THE FOLLOWING QUALITY PROGRAM: - CENTER FOR MEDICARE & MEDICAID SERVICES PARTICIPANT IN THE PARTNERSHIP FOR PATIENTS; HOSPITAL ENGAGEMENT NETWORK-A VOLUNTARY PROGRAM TO REDUCE HARM AND IMPROVE CARE IN THE U.S. 3) THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. IN PURSUIT OF THIS OUTCOME, SRM ALLIANCE HOSPITAL ENGAGED LOW-INCOME COMMUNITY MEMBERS IN PREVENTION ACTIVITIES THAT SUPPORT HEALTHY NUTRITION AND PHYSICAL ACTIVITY. IN FY14, THE PROMOTORES DE SALUD SERVED 36 LOW-INCOME INDIVIDUALS IN PETALUMA THROUGH 348 SERVICE ENCOUNTERS. SENIOR CARE MANAGEMENT AS PART OF A COORDINATED CONTINUUM OF CARE WITHIN THE HOSPITAL THAT INCLUDES CASE MANAGEMENT, HOSPICE AND OTHER DEPARTMENTS, AS WELL AS COMMUNITY PARTNERS, THE COMMUNITY BENEFIT HOUSE CALLS PROGRAM PROVIDED 236 SERVICE ENCOUNTERS IN PETALUMA DURING FY14, HELPING TO PREVENT INFECTIOUS AND MANAGE CHRONIC DISEASES AMONG LOW-INCOME SENIORS WITH COMPLEX MEDICAL AND SOCIO-ECONOMIC CONDITIONS. FOR MORE INFORMATION ABOUT SRM ALLIANCE HOSPITAL, PLEASE VISIT WWW.STJOSEPHHEALTH.ORG. FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG
FORM 990, PART VI, LINE 6	DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS SANTA ROSA MEMORIAL HOSPITAL IS THE SOLE CORPORATE MEMBER OF SRM ALLIANCE HOSPITAL SERVICES.
FORM 990, PART VI, LINE 7A	DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS SRM ALLIANCE HOSPITAL SERVICES HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE SRM ALLIANCE HOSPITAL SERVICES BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE SRM ALLIANCE HOSPITAL SERVICES BOARD AS NOMINATIONS MUST BE APPROVED BY SANTA ROSA MEMORIAL HOSPITAL.
FORM 990, PART VI, LINE 7B	DESCR CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS THE RESERVED RIGHTS IN OUR TIER GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY SANTA ROSA MEMORIAL HOSPITAL, ITS SOLE CORPORATE MEMBER, FOR THE FOLLOWING: A. ESTABLISHING THE PHILOSOPHY, OBJECTIVES AND PURPOSES OF THE ORGANIZATION; B. LONG-TERM AND SHORT-TERM FINANCING; C. SALE, LEASE, DISPOSITION OR HYPOTHECATION OF REAL PROPERTY; D. ANNUAL BUDGETS; E. CAPITAL EXPENDITURES; F. ORGANIZATION'S STRATEGIC PLANS; G. MERGER OR DISSOLUTION; H. APPOINTMENT OR REMOVAL OF FISCAL AUDITORS; I. APPOINTMENT OR REMOVAL OF TRUSTEES, OFFICERS OF THE BOARD AND CHIEF EXECUTIVE OFFICER; J. AMENDMENT OR RESCISSION OF THE BYLAWS; K. EXERCISE THE POWERS WHICH ARE RESERVED TO THE ORGANIZATION IN ITS CAPACITY AS A CORPORATE MEMBER OF ANY SUBSIDIARY; AND L. EXERCISE SUCH OTHER POWERS AS MAY BE REQUIRED OR PERMITTED BY LAW AND BY THE ARTICLES OF INCORPORATION AND THE BYLAWS.
FORM 990, PART VI, LINE 11B	DESCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 WAS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE MARCH 2015 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING.
FORM 990, PART VI, LINE 12C	CONFLICT OF INTEREST POLICY OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE.
FORM 990, PART VI, LINE 15A & 15B	PROCESS USED TO DETERMINE COMPENSATION THE ORGANIZATION'S PRESIDENT IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS APPROVED BY THE SRM ALLIANCE HOSPITAL SERVICES EXECUTIVE MANAGEMENT COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEATLH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF FOR PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2013. DURING THE YEAR, THE SRM ALLIANCE HOSPITAL SERVICES EXECUTIVE MANAGEMENT COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTNG FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING.
FORM 990, PART VI, LINE 19	AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
FORM 990, PART IX, LINE 11G	OTHER FEES EXCEEDING 10% PHYSICIAN FEES AND MEDICAL SERVICES $ 5,195,974 CONTRACT SERVICES $ 2,027,937 OTHER PURCHASED SERVICES $ 1,996,953 ------------ TOTAL $ 9,220,864
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS EQUITY TRANSFERS ($ 3,668,361) OTHER $ 25,351 ------------ TOTAL ($ 3,643,010)

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.
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Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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) COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 46-1259908	HEALTHCARE	CA	501(C)(3)	11, III	SJHS	Yes
(2) COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK,TX79410 61-1573313	HEALTHCARE	TX	501(C)(3)	11,I	CHS	Yes
(3) COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK,TX79410 75-2765566	HEALTHCARE	TX	501(C)(3)	3	SJHS	Yes
(4) COVENANT HEALTH SYSTEM FOUNDATION 4000 24TH STREET LUBBOCK,TX79410 75-2897026	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(5) COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK,TX79410 75-2743883	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(6) COVENANT PHYSICIAN PARTNERS 3615 19TH STREET LUBBOCK,TX79410 46-3516417	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(7) HOAG CHARITY SPORTS 3920 BIRCH STREET SUITE 105 NEWPORT BEACH,CA92660 45-2982422	SUPPORT	CA	501(C)(3)	7	HHF	Yes
(8) HOAG HOSPITAL FOUNDATION 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92663 95-3222343	FUNDRAISING	CA	501(C)(3)	7	HMHP	Yes
(9) HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92663 95-1643327	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(10) HOME CARE PARTNERS 1165 MONTGOMERY DR SANTA ROSA,CA95405 68-0318656	INACTIVE	CA	501(C)(3)	3	SRMH	Yes
(11) HOSPICE OF LUBBOCK 1102 SLIDE ROAD LUBBOCK,TX79414 75-2133781	HEALTHCARE	TX	501(C)(3)	9	CHS	Yes
(12) LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK,TX79410 75-2220963	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(13) METHODIST CHILDREN'S HOSPITAL 3610 21ST STREET LUBBOCK,TX79410 75-2428911	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(14) METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND,TX79336 75-2246348	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(15) METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW,TX79072 75-2426010	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(16) MISSION HOSPITAL REGIONAL MEDICAL CTR 27700 MEDICAL CENTER ROAD MISSION VIEJO,CA92691 95-1643360	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(17) QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA,CA94558 94-1243669	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(18) REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA,CA95540 94-2779313	HEALTHCARE	CA	501(C)(3)	7	RMH	Yes
(19) REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA,CA95540 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(20) SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DR SANTA ROSA,CA95405 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(21) SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE,CA92868 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	NA		No
(22) ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(23) ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 95-3589356	HEALTHCARE	CA	501(C)(3)	11, I	SJHM		No
(24) ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 33-0143024	HEALTHCARE	CA	501(C)(3)	7	SJHS	Yes
(25) ST JOSEPH HOME CARE NETWORK 170 PROFESSIONAL CENTER DR B ROHNERT PARK,CA94928 68-0331084	HEALTHCARE	CA	501(C)(3)	9	SJHS	Yes
(26) ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA,CA95501 94-1156596	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(27) ST JOSEPH HOSPITAL OF ORANGE 1100 WEST STEWART DRIVE ORANGE,CA92868 95-1643359	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(28) ST JUDE HOSPITAL YORBA LINDA 500 S MAIN STREET STE 1000 ORANGE,CA92868 33-0185031	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(29) ST JUDE HOSPITAL INC 101 EAST VALENCIA MESA DRIVE FULLERTON,CA92635 95-1643324	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(30) ST MARY MEDICAL CENTER 18300 HIGHWAY 18 APPLE VALLEY,CA92307 95-1914489	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(31) ST MARY OF THE PLAINS HOSPITAL FDN 4000 24TH STREET LUBBOCK,TX79410 75-1653181	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(32) TALLER SAN JOSE 801 NORTH BROADWAY SANTA ANA,CA92701 59-3816355	WORKFORCE DEV	CA	501(C)(3)	2	SSJO	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ST JOSEPH HLTH SYS HOME HLTH SEE PART VII ORANGE,CA92868 33-0282945	HOME HEALTH	CA	NA	N/A
(2) ST JOSEPH HLTH SYS HOME CARE 33-0307672	HOME HEALTH	CA	NA	N/A
(3) METHODIST DIAGNOSTIC IMAGING 75-2343261	HEALTHCARE SVCS	TX	NA	N/A
(4) SHA LLC 75-2569094	INSURANCE	TX	NA	N/A
(5) LUBBOCK SURGERY CENTER LTD 75-2177401	HEALTHCARE SVCS	TX	NA	N/A
(6) COVENANT LONG-TERM CARE LP 20-5033419	HEALTHCARE SVCS	TX	NA	N/A
(7) HERITAGE INVESTMENT GROUP 27-1000061	INVESTMENTS	CA	NA	N/A					0
(8) MISSION AMBULATORY SURGICENTER 33-0355575	HEALTHCARE SVCS	CA	NA	N/A
(9) COMPREHENSIVE IMAGING PARTNERS 26-4591502	HEALTHCARE SVCS	CA	NA	N/A
(10) ST JOSEPH PHYSICIAN VENTURES	REAL ESTATE	CA	NA	N/A
(11) ADVANCED SURGERY INSTITUTE LLC	HEALTHCARE SVCS	CA	NA	N/A
(12) HOAG OUTPATIENT CENTERS	HEALTHCARE SVCS	CA	NA	N/A
(13) NEWPORT IMAGING CENTER	HEALTHCARE SVCS	CA	NA	N/A
(14) HOAG ORTHOPEDIC INSTITUTE	HEALTHCARE SVCS	CA	NA	N/A
(15) MAIN ST SPECIALTY SURGERY CNTR	HEALTHCARE SVCS	CA	NA	N/A
(16) ORTHOPEDIC SURGERY CNTR OF OC	HEALTHCARE SVCS	CA	NA	N/A
(17) THE INSTITUTE FOR INNOVATION	HEALTHCARE SVCS	DE	NA	N/A
(18) HEALTHCARE DESIGN & CONSTRUCT	REAL ESTATE	DE	NA	N/A
(19) NORTH BAY ENDOSCOPY CENTER	HEALTHCARE SVCS	CA	NA	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(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) ST JOSEPH PROF SVCS ENTERPRISES INC 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 33-0155323	HEALTHCARE SVCS	CA	NA	C-CORP
(2) AMERICAN UNITY GROUP LTD 58 PAR-LA-VILLE ROAD HAMILTON HM HX BD	CAPTIVE INSURANCE	AL	NA	C-CORP
(3) ALLIANCE PHYSICIAN SERVICES	INACTIVE	CA	NA	C-CORP
(4) MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD 354 MISSION VIEJO,CA92691 33-0212905	HEALTHCARE SVCS	CA	NA	C-CORP
(5) ST JOSEPH YORBA PARK	INACTIVE	CA	NA	C-CORP
(6) LUBBOCK METHODIST HOSPITAL SVCS PO BOX 1201 LUBBOCK,TX79410 75-2118585	HEALTHCARE SVCS	TX	NA	C-CORP
(7) LUBBOCK METHODIST HOSP PRACTICE MGMT 2107 OXFORD STREET STE 300 LUBBOCK,TX79410 75-2578995	INACTIVE	TX	NA	C-CORP
(8) HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0731587	HEALTHCARE SVCS	CA	NA	C-CORP
(9) COASTAL MANAGEMENT SERVICES ORGANIZATION 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0676831	HEALTHCARE SVCS	CA	NA	C-CORP
(10) HMTS INC FKA HOAG MEDICAL FOUNDATION 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 45-3583707	HEALTHCARE SVCS	CA	NA	C-CORP
(11) ST JOSEPH HEALTH SOURCE INC 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 46-1900168	HEALTHCARE SVCS	CA	NA	C-CORP
(12) DATU HEALTH INC 16150 MAIN CIRCLE DR SUITE 250 CHESTERFIELD,MO63017 46-3070062	IT SVCS	MO	NA	C-CORP
(13) ST JOSEPH HEALTH 3345 MICHELSON DR SUITE 100 IRVINE,CA92612 46-2340232	HOLDING COMPANY	CA	NA	C-CORP

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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

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

Yes

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

Yes

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

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

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION	b	350,900	ACCRUAL
(2) ST JOSEPH HEALTH SYSTEM FOUNDATION	c	180,000	ACCRUAL
(3) SANTA ROSA MEMORIAL HOSPITAL	p	23,130,000	CASH
(4) SANTA ROSA MEMORIAL HOSPITAL	o	577,302	ACCRUAL

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(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 V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

SCHEDULE R, PART III

IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 200 ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 100, ORANGE, CA 92868-2012 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 2301 QUAKER, LUBBOCK, TX 79410 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 3345 MICHELSON DRIVE, STE. 100, IRVINE, CA 92612 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE. 362, MISSION VIEJO, CA 92691 COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY, LLC EIN: 26-4591502 ADDRESS: ONE CITY BOULEVARD WEST, SUITE 1100, ORANGE, CA 92868 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 ADVANCED SURGERY INSTITUTE, LLC EIN: 26-2299255 ADDRESS: 17349 4TH STREET, SANTA ROSA, CA 95404 HOAG OUTPATIENT CENTERS EIN: 45-3587572 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 MAIN ST SPECIALTY SURGERY CENTER EIN: 95-4813223 ADDRESS: 280 MAIN STREET, STE 100, ORANGE, CA 92868 ORTHOPEDIC SURGERY CENTER OF OC, LLC EIN: 33-0841806 ADDRESS: 22 CORPORATE PLAZA, NEWPORT BEACH, CA 92660 THE INSTITUTE FOR INNOVATION, LLC EIN: 90-0745066 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 HEALTHCARE DESIGN AND CONSTRUCTION EIN: 46-2611662 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 NORTH BAY ENDOSCOPY CENTER, LLC EIN: 61-1559876 ADDRESS: 1383 N. MCDOWELL BLVD SUITE 110, PETALUMA, CA 94954

Schedule R (Form 990) 2013

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	7
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	573
6	Total number of volunteers (estimate if necessary) .............	6	179
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) .........	1,491,474	1,240,396
9	Program service revenue (Part VIII, line 2g) .........	80,881,013	78,537,609
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	54,580	59,685
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-84,820	-86,118
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	82,342,247	79,751,572
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	35,235	383,245
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)	47,836,532	43,483,699
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 478,909
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	35,674,017	32,614,027
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	83,545,784	76,480,971
19	Revenue less expenses. Subtract line 18 from line 12.......	-1,203,537	3,270,601
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	42,355,160	39,975,082
21	Total liabilities (Part X, line 26).............	31,990,756	29,983,087
22	Net assets or fund balances. Subtract line 21 from line 20.....	10,364,404	9,991,995

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 71,851,786 including grants of $ 383,245 ) (Revenue $ 78,577,108 )
	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 expenses71,851,786

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) RICHARD CARVOLTH........................................................................ CHIEF MEDICAL OFCR (PART YEAR)	7.0 .......................50.0	X			0	23,146	0
(19) JANE READ........................................................................ VP-OPERATIONS	43.0 .......................0.0		X		281,170	0	21,846
(20) JAYNIE BOREN........................................................................ N. CA REG VP - STRATEGIC SVCS	5.0 .......................54.0		X		0	379,578	30,401
(21) GARY MAHAN........................................................................ MANAGER - PHARMACY	40.0 .......................0.0			X	183,559	0	38,982
(22) JANETTE MARLOW........................................................................ STAFF NURSE III - CNA	32.0 .......................0.0			X	187,958	0	49,895
(23) PAULA GRIFFITH........................................................................ STAFF NURSE IV-CNA	32.0 .......................0.0			X	169,788	0	40,188
(24) MICHELE GEILS........................................................................ STAFF NURSE IV-CNA	32.0 .......................0.0			X	164,308	0	43,770
(25) WENDI THOMAS........................................................................ DIRECTOR-NURSING SVCS	40.0 .......................0.0			X	181,399	0	41,326

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,179,832	3,841,571	483,136

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c		467,586
d	Related organizations...1d		180,000
e	Government grants (contributions)1e		6,250

f	All other contributions, gifts, grants, and similar amounts not included above1f		586,560

g	Noncash contributions included in lines 1a-1f:$		2,458
h	Total. Add lines 1a-1f.......			1,240,396
			Business Code
2a	NET PATIENT REVENUE		622110	77,373,068	77,373,068	0	0
b	ELECTRONIC HEALTH RECORDS		622110	867,763	867,763	0	0
c	CAFETERIA		722514	80,875	80,875	0	0
d	OTHER OPERATING REVENUE		900099	215,903	215,903	0	0
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			78,537,609
3	Investment income (including dividends, interest, and other similar amounts).......			59,685			59,685
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 $ 467,586 of contributions reported on line 1c). See Part IV, line 18 ..
	a		68,673
b	Less: direct expenses ...b		194,290
c	Net income or (loss) from fundraising events..			-125,617			-125,617
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	CASH PURCHASES AND DISCOUNTS		900099	20,616	20,616	0	0
b	REBATES AND REFUNDS		900099	18,883	18,883	0	0
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			39,499
12	Total revenue. See Instructions......			79,751,572	78,577,108	0	-65,932


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			0	1	2,059
2	Savings and temporary cash investments .........			10,922,087	2	7,869,504
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			9,097,171	4	9,969,417
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 ..............			1,017,500	8	1,133,422
9	Prepaid expenses and deferred charges ..........			165,470	9	916,661
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	52,439,110
b	Less: accumulated depreciation .....	10b	36,000,188	17,984,696	10c	16,438,922
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			131,163	12	232,974
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 ...........			3,037,073	15	3,412,123
16	Total assets. Add lines 1 through 15 (must equal line 34)......			42,355,160	16	39,975,082
17	Accounts payable and accrued expenses .........			9,137,985	17	5,744,610
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....................			22,852,771	25	24,238,477
26	Total liabilities. Add lines 17 through 25.........			31,990,756	26	29,983,087
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			8,559,568	27	7,916,221
28	Temporarily restricted net assets ...........			1,804,836	28	2,075,774
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 ...........			10,364,404	33	9,991,995
34	Total liabilities and net assets/fund balances ........			42,355,160	34	39,975,082