Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 01-01-2014 , and ending 12-31-2014
BCheck if applicable:
CName of organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
20103 LAKE CHABOT ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CASTRO VALLEY, CA94546
D Employer identification number

77-0146047
E Telephone number

G Gross receipts $ 302,580,050
F Name and address of principal officer:
DAVID BRADLEY
20103 LAKE CHABOT ROAD
CASTRO VALLEY,CA94546
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SUTTERHEALTH.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1986
M State of legal domicile: CA
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 1,344
6 Total number of volunteers (estimate if necessary) ............. 6 71
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  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 573,338 1,058,693
9 Program service revenue (Part VIII, line 2g) ......... 267,225,336 300,010,046
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 652,514 139,055
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 691,388 979,852
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 269,142,576 302,187,646
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 9,538 80,237
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) 137,333,562 132,928,750
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet54,436    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 143,173,630 149,923,283
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 280,516,730 282,932,270
19 Revenue less expenses. Subtract line 18 from line 12....... -11,374,154 19,255,376
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 453,043,945 440,008,840
21 Total liabilities (Part X, line 26)............. 333,172,107 349,771,207
22 Net assets or fund balances. Subtract line 21 from line 20..... 119,871,838 90,237,633
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 247,551,033 including grants of $ 17,100 ) (Revenue $ 300,010,046 )
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 expensesMediumBullet247,551,033
Form 990 (2014)
Form 990 (2014)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV
.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
1,344
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
18
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletCHRIS BOUDREAUX
91OO FOOTHILLS BOULEVARD
Roseville,CA95747 (916) 297-8007
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) CHRISTOPHER BECNEL........................................................................
TRUSTEE, CHAIR
1.0
.......................0.0
X   X       0 0 0
(2) DIANA BELL........................................................................
TRUSTEE
1.0
.......................  
X           0 0 0
(3) DAVID BLACK MD........................................................................
TRUSTEE, VICE CHAIR
1.0
.......................  
X   X       0 0 0
(4) DAVID BRADLEY........................................................................
REGIONAL PRES, East Bay
1.0
.......................40.0
X   X       0 1,158,898 245,821
(5) MICHAEL DAVIES........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(6) MICHAEL DIGIACOMO DPM........................................................................
TRUSTEE, CHAIR F&P
1.0
.......................0.0
X   X       0 0 0
(7) ERIC DOVICHI MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(8) ERIC FLOWERS........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(9) VINCENT FORTE........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(10) DAVID FREY........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(11) PAT FRY........................................................................
PRESIDENT & CEO, SUTTER HEALTH
1.0
.......................40.0
X           0 3,626,367 2,728,330
(12) OWEN GARRICK MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(13) DAVID HOWARD MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(14) SARAH KREVANS........................................................................
COO, SUTTER HEALTH
1.0
.......................40.0
X           0 1,762,486 424,237
(15) DONALD NELSON........................................................................
TRUSTEE
1.0
.......................0.0
X             0 0
(16) JEFFREY RANDALL MD........................................................................
TRUSTEE
1.0
.......................0.0
X                
(17) TED SAENGER........................................................................
TRUSTEE
1.0
.......................0.0
X                
Form 990 (2014)
Form 990 (2014)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (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)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) ANNETTE SHAIEB MD........................................................................
TRUSTEE
1.0
.......................0.0
X                
(19) GREGORY BROWN........................................................................
VP & REG COUNSEL, EAST BAY
1.0
.......................40.0
    X       0 346,455 83,184
(20) JOHN GATES........................................................................
REGIONAL VP FINANCE EAST/WEST
1.0
.......................40.0
    X       0 1,058,493 146,579
(21) TERRY GLUBKA........................................................................
CEO
40.0
.......................0.0
    X       0 599,097 106,345
(22) ROSE CORCORAN RN........................................................................
VP PATIENT CARE SERVICES
40.0
.......................0.0
      X     0 313,843 46,198
(23) BRYAN DAYLOR........................................................................
VP ANCILLARY SUPPORT SVCS
40.0
.......................0.0
      X     0 339,814 48,368
(24) CATHERINE MESSMAN........................................................................
ADMINISTRATIVE DIRECTOR FIN
40.0
.......................0.0
      X     0 308,112 41,327
(25) CHERYL HARLESS........................................................................
CNE
40.0
.......................0.0
      X     0 313,359 51,379
(26) DEBORA HENDRICKSON........................................................................
REGIONAL ADMIN DIR. QUALITY
40.0
.......................0.0
      X     211,539 0 21,173
(27) SIDNEY WANETICK........................................................................
VP MEDICAL AFFAIRS
40.0
.......................0.0
      X     0 502,903 59,910
(28) KAREN MANNERING........................................................................
CHARGE NURSE
40.0
.......................0.0
        X   308,846 0 14,855
(29) KATHERINE NAAS........................................................................
NURSE STAFF II
40.0
.......................0.0
        X   222,958 0 25,733
(30) EDGAR REVELO........................................................................
TECH, OPERATING ROOM
40.0
.......................0.0
        X   251,282 0 26,682
(31) LISA ROBINSON........................................................................
NURSE STAFF II
40.0
.......................0.0
        X   240,437 0 26,291
(32) JEFFREY SILVERS........................................................................
PHYSICIAN
40.0
.......................0.0
        X   251,384 0 11,558
(33) ED BERDICK........................................................................
SVP SUTTER SHARED SVCS
0.0
.......................40.0
          X 0 1,638,864 269,901
(34) BRIAN HUNTER........................................................................
SH VP, REVENUE CYCLE
0.0
.......................40.0
          X 0 739,122 127,712
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,486,446 12,707,813 4,505,583
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet473
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
ALAMEDA ANESTHESIA ASSOC INC,
PO BOX 5641
PORTLAND,OR972285641
Medical Services 3,275,368
PACIFIC BRAIN SPINE MEDICAL GROUP,
20055 LAKE CHABOT RD STE 110
CASTRO VALLEY,CA94546
Medical Services 1,444,071
TOWERS WATSON DELAWARE INC,
28025 NETWORK PL
CHICAGO,IL606731280
Consulting Services 1,241,824
HEALTHCARE SECURITY SERVICE OF CA,
3589 NEVADA STREET
DENVER,CO80217
Medical Services 1,175,620
BAY CHILDRENS PHYSICIANS,
6425 CHRISTIE AVE STE 100
EMERYVILLE,CA94608
Medical Services 879,942
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 MediumBullet64
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,058,693
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above
1f
 
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 1,058,693
 Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 622110 300,094,683 300,094,683    
b EAST BAY RADIATION 622310 -84,637 -84,637    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 300,010,046
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 123,783     123,783
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,351,576  
b Less: rental expenses 371,724  
c Rental income or (loss) 979,852 0
d Net rental income or (loss).......MediumBullet 979,852     979,852
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   35,952
b Less: cost or other basis and sales expenses   20,680
c Gain or (loss)   15,272
d Net gain or (loss)..........MediumBullet 15,272     15,272
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 302,187,646 300,010,046   1,118,907
Form 990 (2014)
Form 990 (2014)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 79,562 79,562
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 675 675
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............ 0  
4 Benefits paid to or for members .... 0  
5 Compensation of current officers, directors, trustees, and key employees .... 2,963,367   2,963,367  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages .... 89,114,671 86,553,356 2,561,315  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,843,264 2,672,668 170,596  
9 Other employee benefits ....... 30,467,865 28,639,793 1,828,072  
10 Payroll taxes ........... 7,539,583 7,087,208 452,375  
11 Fees for services (non-employees):        
a Management ...... 1,235,386   1,235,386  
b Legal ......... 0      
c Accounting ........... 25,099   25,099  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 54,317   54,317  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 17,945,542 17,460,691 484,851  
12 Advertising and promotion .... 0      
13 Office expenses ....... 2,253,891 1,637,722 616,169  
14 Information technology ...... 7,660,601 7,638,598 22,003  
15 Royalties .. 0      
16 Occupancy ........... 3,585,592 3,585,592    
17 Travel ............ 43,773 41,147 2,626  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 35,475 30,215 5,260  
20 Interest ........... 10,340,130 10,340,130    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 26,681,727 26,681,727    
23 Insurance .............. 2,168,580 2,168,580    
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 24,757,563 24,397,007 360,556  
b SYSTEM ALLOCATIONS 20,973,188   20,973,188  
c HOSPITAL PROVIDER FEE 16,966,330 16,966,330    
d PURCHASED SERVICES 11,952,222 9,184,764 2,767,458  
e All other expenses 3,243,867 2,385,268 804,163 54,436
25 Total functional expenses. Add lines 1 through 24e 282,932,270 247,551,033 35,326,801 54,436
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 7,709,072 2 9,815,987
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 53,698,431 4 42,977,875
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 .............. 4,292,774 8 4,939,134
9 Prepaid expenses and deferred charges .......... 674,324 9 990,878
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 404,433,131
b Less: accumulated depreciation ..... 10b 53,008,160 365,077,640 10c 351,424,971
11 Investments—publicly traded securities .......... 0 11 133,146
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 7,940,651 13 465,602
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 13,651,053 15 29,261,247
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 453,043,945 16 440,008,840
Liabilities 17 Accounts payable and accrued expenses ......... 44,567,168 17 60,781,803
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 287,967,368 20 288,253,210
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.................... 637,571 25 736,194
26 Total liabilities. Add lines 17 through 25......... 333,172,107 26 349,771,207
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 116,093,531 27 90,237,633
28 Temporarily restricted net assets ........... 3,778,307 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 119,871,838 33 90,237,633
34 Total liabilities and net assets/fund balances ........ 453,043,945 34 440,008,840
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
302,187,646
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
282,932,270
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
19,255,376
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
119,871,838
5
Net unrealized gains (losses) on investments ...............
5
216,733
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
-2,552,715
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-46,553,599
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
90,237,633
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? .................
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.)..            
11 Total support Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2014
(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2015. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
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


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
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 value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
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.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   17,407,749 17,407,749
b Buildings ................   290,803,574 27,905,938 262,897,636
c Leasehold improvements ............   371,500 100,615 270,885
d Equipment ................   56,362,531 22,504,931 33,857,600
e Other .................   39,487,777 2,496,676 36,991,101
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 351,424,971
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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.)Small Bullet  
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) UNAMORTIZED FINANCING COSTS 1,969,373
(2) INTERCOMPANY RECEIVABLES 10,650
(3) OTHER RECEIVABLES 25,530,689
(4) OTHER ASSETS 1,750,535





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 29,261,247
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
SELF INSURANCE 663,794
OTHER LIABILITIES 72,400







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 736,194
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) 2014

Schedule D (Form 990) 2014
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 (losses) 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
PART X, LINE 2 ASC 740 (FIN48) FOOTNOTE FROM AUDIT: THIS ORGANIZATION WAS PART OF A CONSOLIDATED FINANCIAL SYSTEM AUDIT. THE ASC 740 AUDIT FOOTNOTE DISCLOSURE FOR THE SUTTER SYSTEM IS AS FOLLOWS: SUTTER HEALTH, THE LEGAL ENTITY, AND MOST AFFILIATES HAVE BEEN DETERMINED TO BE EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE, (PURSUANT TO INTERNAL REVENUE CODE SECTION 501(C)(3)), AND THE CALIFORNIA FRANCHISE TAX BOARD (PURSUANT TO CALIFORNIA REVENUE AND TAXATION CODE 23701(D)) AND, GENERALLY, ARE NOT SUBJECT TO TAXES ON INCOME. CERTAIN ACTIVITIES OF SUTTER ARE SUBJECT TO INCOME TAXES; HOWEVER, SUCH ACTIVITIES ARE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS. WITH RESPECT TO ITS TAXABLE ACTIVITIES, SUTTER RECORDS INCOME TAXES USING THE LIABILITY METHOD, UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASIS OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR SETTLED. SUTTER RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. SUTTER RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT DECEMBER 31, 2014 AND 2013, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS.
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) 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:
3a
Yes
 
%
b
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: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    7,061,715   7,061,715 2.500 %
b Medicaid (from Worksheet 3,
column a) ....
    89,977,062 63,344,340 23,632,722 8.350 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
    39,763 2,125 37,638 0.010 %
d Total Financial Assistance
and Means-Tested
Government Programs .
    97,078,540 63,346,465 30,732,075 10.860 %
Other Benefits
16 20,150 341,914 17,065 324,849 0.110 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
1 150 389,784   389,784 0.140 %
g Subsidized health services
(from Worksheet 6) ..
1 100 395,096 65,466 329,630 0.120 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
6 7,830 223,347   223,347 0.080 %
j Total. Other Benefits .. 24 28,230 1,350,141 82,531 1,267,610 0.450 %
k Total. Add lines 7d and 7j . 24 28,230 98,428,681 63,428,996 31,999,685 11.310 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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 1 13 56,167   56,167 0.020 %
6 Coalition building            
7 Community health improvement advocacy 1 1,400 333   333  
8 Workforce development            
9 Other            
10 Total 2 1,413 56,500   56,500 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,821,808
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
59,443,885
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
72,761,356
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-13,317,471
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(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) 2014
Schedule H (Form 990) 2014
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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 SUTTER MEDICAL CENTER CASTRO VALLEY
20130 LAKE CHABOT ROAD
CASTRO VALLEY,CA945465305
www.edenmedicalcenter.org
LICENSE #140000030
X X         X   OUTPATIENT SERVICES  
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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)
SUTTER MEDICAL CENTER CASTRO VALLEY
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 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 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, 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) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

SUTTER MEDICAL CENTER CASTRO VALLEY
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 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
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

SUTTER MEDICAL CENTER CASTRO VALLEY
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other 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?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ................................ 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
SCHEDULE H, PART V, SECTION B, LINE 5 CHNA INPUT FROM KEY ADVISORS REPRESENTING BROAD COMMUNITY INTERESTS: IN CONDUCTING ITS MOST RECENT CHNA, SUTTER MEDICAL CENTER CASTRO VALLEY (SMCCV) DID TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY IN THE HOSPITAL'S SERVICE AREA (KEY INFORMANTS). KEY INFORMANTS ARE HEALTH AND COMMUNITY EXPERTS FAMILIAR WITH THE POPULATIONS AND GEOGRAPHIC AREAS WITHIN THE SERVICE AREA. TO GAIN A DEEPER UNDERSTANDING OF THE HEALTH ISSUES PERTAINING TO CHRONIC DISEASE AND THE POPULATIONS LIVING IN THESE VULNERABLE COMMUNITIES, INPUT FROM 35 KEY INFORMANT INTERVIEWS WERE CONDUCTED USING A THEORETICALLY GROUNDED INTERVIEW GUIDE. EACH INTERVIEW WAS RECORDED AND CONTENT ANALYSIS WAS CONDUCTED TO IDENTIFY KEY THEMES AND IMPORTANT POINTS PERTAINING TO EACH GEOGRAPHIC AREA. FINDINGS FROM THESE INTERVIEWS WERE USED TO HELP IDENTIFY COMMUNITIES IN WHICH FOCUS GROUPS WOULD MOST APTLY BE PERFORMED. A FULL LISTING OF ALL KEY INFORMANTS INTERVIEWED, INCLUDING NAME, PROFESSIONAL TITLE, DATE OF INTERVIEW, AND A DESCRIPTION OF KNOWLEDGE AND EXPERIENCE IN DETAIL: - LOUIS CHICOINE, EXECUTIVE DIRECTOR FOR ABODE SERVICES WITH EXPERTISE ON HOMELESS POPULATIONS. INTERVIEW DATE: MAR 13, 2013. - MARK FRIEDMAN, CEO AND CHRIS HWANG, EVALUATION & TECHNOLOGY ADMINISTRATOR OF FIRST 5-ALAMEDA WITH EXPERTISE ON CHILDREN AND FAMILIES. INTERVIEW DATE: JANUARY 28, 2013 - MARSHA VAUGHN, CLINICAL DIRECTOR OF COMMUNITY BASED SERVICES FOR BAY AREA YOUTH CENTER WITH EXPERTISE IN FOSTER CARE MENTAL HEALTH SERVICES AND YOUTH SERVICES. INTERVIEW DATE: MARCH 13, 2013 - JAIME JARAMILLO, EXECUTIVE DIRECTOR AND JOAQUIN ALMAGUER, BOARD MEMBER OF CENTRO DE SERVICIOS WITH EXPERTISE IN FAMILY SERVICES. INTERVIEW DATE: MARCH 27, 2013. - DARLENE FUJII, SENIOR MANAGER WITH THE ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT WITH EXPERTISE IN NUTRITION AND PHYSICAL ACTIVITY. INTERVIEW DATE: JANUARY 10, 2013 - ROSE PADILLA-JOHNSON, EXECUTIVE DIRECTOR FOR DAVIS STREET FAMILY RESOURCE CENTER WITH EXPERTISE IN FAMILY SERVICES, COMMUNITY HEALTH, DENTAL, AND MENTAL HEALTH SERVICES. INTERVIEW DATE: JANUARY 10, 2013. - DR. ZETTIE PAGE, INTERIM CEO, BETHSHEBA ORERO, HIV AND WOMEN'S HEALTH PLANNER, AND AMY O'CALLAGHAN, COMMUNITY HEALTH PROGRAMS PLANNER FOR TRI CITY HEALTH CENTER WITH EXPERTISE IN COMMUNITY HEALTH AND HEALTH EDUCATION. INTERVIEW DATE: MARCH 26, 2013 - CARLOS LONDONO, DIRECTOR OF PROGRAMS FOR TIBURCIO VASQUEZ HEALTH CENTER WITH EXPERTISE IN COMMUNITY HEALTH AND HEALTH EDUCATION. INTERVIEW DATE: FEBRUARY 1, 2013 - SHIRLEY SISK, EXECUTIVE DIRECTOR FOR LOV NEWARK WITH EXPERTISE IN VOLUNTEER COORDINATION AND RECREATION PROGRAMING. INTERVIEW DATE: MARCH 13, 2013 - PAUL MILLER, EXECUTIVE DIRECTOR FOR KIDANGO WITH EXPERTISE IN EARLY EDUCATION, CHILD DEVELOPMENT SERVICES AND FAMILY SERVICES. INTERVIEW DATE: MARCH 26, 2013 - JUDY JONES, HOSPITAL OUTREACH MANAGER WITH FIRST 5 - ALAMEDA WITH EXPERTISE IN PRE- AND POST-NATAL EDUCATION IN AREAS OF NUTRITION, LITERACY AND EARLY LANGUAGE, AND SMOKING CESSATION. INTERVIEW DATE: MARCH 29, 2013 - RODNEY CLARK, EXECUTIVE DIRECTOR FOR SAVE WITH EXPERTISE IN DOMESTIC VIOLENCE. INTERVIEW DATE: APRIL 23, 2013. - SUZAN BATESON, EXECUTIVE DIRECTOR, ALLISON PRATT, DIRECTOR OF POLICY & SERVICES, AND JUSTINE KAPLAN, DIRECTOR OF FOOD AGENCY & NUTRITION FOR ALAMEDA COUNTY COMMUNITY FOOD BANK WITH EXPERTISE ON FOOD ACCESS AND NUTRITION. INTERVIEW DATE: MAY 2, 2013. - DAVID KORTH, NEIGHBORHOOD SERVICES MANAGER FOR HAYWARD NEIGHBORHOOD SERVICES WITH EXPERTISE IN COMMUNITY ORGANIZING. INTERVIEW DATE: MAY 1, 2013. - JANE GARCIA, CEO AND PATRICIA ZAYAS, CHIEF MEDICAL OFFICER FOR LA CLINICA WITH EXPERTISE IN COMMUNITY HEALTH AND MEDICAL CARE. INTERVIEW DATE: APRIL 29, 2013. - MARIELLEN FARIA, CHIEF NURSING OFFICER FOR SAN LEANDRO HOSPITAL WITH EXPERTISE IN COMMUNITY HEALTH, PRIMARY CARE, AND MEDICAL CARE. INTERVIEW DATE: MARCH 13, 2013 - SAFIA ALOCOZY, HEALTH MANAGER FOR CHILD, FAMILY & COMMUNITY SERVICES, INC WITH EXPERTISE IN CHILDREN AND FAMILIES, NUTRITION, AND PERSIAN COMMUNITIES. INTERVIEW DATE: APRIL 24, 2013. - DR. DAMON FRANCIS OF THE ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT WITH EXPERTISE ON HOMELESS POPULATIONS. INTERVIEW DATE: APRIL 24, 2013.
SCHEDULE H, PART V, SECTION B, LINE 6 CHNA HOSPITAL COLLABORATORS: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS A COLLABORATIVE REPORT COMMISSIONED BY FIVE LOCAL NON-PROFIT HOSPITALS IN THE EAST BAY - SUTTER MEDICAL CENTER CASTRO VALLEY, ALTA BATES SUMMIT MEDICAL CENTER, ST. ROSE HOSPITAL, WASHINGTON HOSPITAL HEALTHCARE SYSTEM AND CHILDREN'S HOSPITAL & RESEARCH CENTER. The CHNA Core Group, a group representing the collaborating hospitals, members from Alameda County Public Health and the Hospital Council of Northern and Central California worked in partnership to define specific demographic and health status measures for review and analysis and jointly reviewed and discussed the results. The hospitals retained Valley Vision, Inc. to conduct the ten-month assessment process. Valley Vision, Inc. is a non-profit 501(c)(3) consulting firm with over seven years experience in conducting CHNAs.
SCHEDULE H, PART V, SECTION B, LINE 7A, 7B AND 10A HOSPITAL FACILITY'S WEBSITE: HTTP://WWW.EDENMEDICALCENTER.ORG/CHNA/SUTTERMEDCENTERCASTROVALLEY_FINAL_CH NA.PDF OTHER WEBSITE: HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML
SCHEDULE H, PART V, SECTION B, LINE 11 The following significant health needs were identified in the 2013 Community Health Needs Assessment and are needs that Eden Medical Center intends to address through its implementation strategy: Access to health resources - Inability to address basic health care needs to due to a lack of access to resources to maintain and/or improve one's health, including primary, specialty and preventative care. Health literacy - Inability to improve one's health due to limited health literacy and education, including how to maintain and improve one's health through healthy behaviors such as diet and physical activity. Nutrition - Poor dieting habits resulting from living in an unhealthy food environment with limited access to fresh and healthier foods. Mental health - Issues arising from living in a state of stress; living in a stressful environment due to limited economic resources; safety concerns for self and family. Descriptions of the community benefit programs that address these significant health needs can be found in Part VI.
SCHEDULE H, PART V, SECTION B, LINE 13H ELIGIBILITY CRITERIA - OTHER: ADDITIONAL FACTORS USED IN DETERMING AMOUNTS CHARGED TO PATIENTS INCLUDES HOUSEHOLD SIZE, WHICH IS PART OF THE FEDERAL PROVERTY GUIDELINES.
SCHEDULE H, PART V, SECTION B, LINE 16I MEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED ON THE HOSPITAL'S FACILITY'S WEBSITE, WAS ATTACHED TO BILLING INVOICES, WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY/WAITING ROOM, WAS POSTED IN THE HOSPITAL'S ADMISSIONS OFFICE, WAS PROVIDED IN WRITING ON ADMISSION TO THE HOSPITAL, AND WAS AVAILABLE ON REQUEST. PATIENTS ELIGIBLE FOR CHARITY CARE ARE TRACKED IN THE HOSPITAL'S LEGACY SYSTEM AND ARE REMINDED 30 DAYS AFTER CHARITY CARE PACKET IS RECEIVED IF PAPERWORK HAS NOT BEEN SUBMITTED. ORGANIZATION USES AN INCOME VALIDATION TOOL TO ALERT PATIENTS THAT THEY MAY BE ELIGIBLE FOR CHARITY CARE.
SCHEDULE H, PART V, SECTION B, LINE 22D AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR DIFFERENT LEVELS OF ASSISTANCE FOR PATIENTS BASED ON VARIOUS ELIGIBILITY REQUIREMENTS INCLUDING, BUT NOT LIMITED TO (1) FULL CHARITY CARE, (2) PARTIAL CHARITY CARE, (3) SPECIAL CIRCUMSTANCES CHARITY CARE, (4) CATASTROPHIC CHARITY CARE, (5) HIGH COST MEDICAL CHARITY CARE, (6) UNINSURED PATIENT DISCOUNT, AND (7) PROMPT PAYMENT DISCOUNT. THE MAXIMUM AMOUNT BILLED TO THE PATIENT IS CALCULATED DIFFERENTLY DEPENDING ON THE CATEGORY OF FINANCIAL ASSISTANCE FOR WHICH THEY ARE ELIGIBLE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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?1
Name and address Type of Facility (describe)
1 REHABILITATION SERVICES
14207 E 14TH STREET
SAN LEANDRO,CA94578
OUTPATIENT REHABILITATION SVCS
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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 I, LINE 3C FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA: TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 200% OF FPG. PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES APPLIES TO UNINSURED PATIENTS THAT WHOSE FAMILY INCOMES ARE BETWEEN 201% AND 400%. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: - SPECIAL CIRCUMSTANCES CHARITY CARE: FOR UNINSURED PATIENTS WHO DO NOT MEET THE FINANCIAL ASSISTANCE CRITERIA SET FORTH BY THE ORGANIZATION, A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, ELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE ORGANIZATION'S CHARITY CARE ELIGIBILITY CRITERIA. - CATASTROPHIC CHARITY CARE: PARTIAL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 30% OF THE PATIENT'S FAMILY INCOME. PATIENTS THAT MEET THE CRITERIA WILL RECEIVE A FULL WRITE-OFF OF UNDISCOUNTED CHARGES THAT EXCEED 30% OF THEIR FAMILY INCOME. - HIGH MEDICAL COST CHARITY CARE (FOR INSURED PATIENTS): PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES FOR PATIENTS WHOSE FAMILY INCOME IS LESS THAN 350% OF FPG, MEDICAL EXPENSES EXCEED 10% OF THE PATIENT'S FAMILY INCOME, AND THE PATIENT'S INSURER HAS NOT PROVIDED A DISCOUNT. - UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAT THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. - PROMPT PAYMENT DISCOUNT: PARTIAL WRITE-OFF AVAILABLE TO UNINSURED PATIENTS WHO PAY PROMPTLY, CONSISTING OF AT LEAST A 10% DISCOUNT FOR THOSE WHO PAY WITHIN 30 DAYS OF FINAL BILLING, OR A 20% DISCOUNT IF 50% OF THE ESTIMATED BILL IS PAID PRIOR TO DISCHARGE.
SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY USED: COST TO CHARGE RATIO UTILIZING WORKSHEET 2 METHODOLOGY.
SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: SUTTER MEDICAL CENTER CASTRO VALLEY (SMCCV) FUNDS THE FOLLOWING PROGRAMS THAT HELP ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS AND IMPACT THE HEALTH AND WELL-BEING IN THE COMMUNITIES WE SERVE (ALSO KNOWN AS COMMUNITY-BUILDING ACTIVITIES). THESE PROGRAMS HELP SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF SUTTER HEALTH. THE YOUTH BRIDGE CAREER AND INTERNSHIP PROGRAM IS A COMPREHENSIVE, YEAR-ROUND YOUTH DEVELOPMENT PROGRAM DESIGNED TO ASSIST EAST BAY HIGH SCHOOL STUDENTS BY ENCOURAGING THEM TO COMPLETE THEIR SCHOOLING AND TO PURSUE HIGHER ACADEMIC AND/OR VOCATIONAL GOALS. THE MAJORITY OF STUDENTS INVOLVED IN YOUTH BRIDGE ARE CONSIDERED "HIGH-RISK" STUDENTS. ONE OF THE GOALS OF YOUTH BRIDGE IS TO ENCOURAGE STUDENTS TO "DREAM BEYOND THEIR CIRCUMSTANCE." THE PROGRAM IS DESIGNED TO HELP PARTICIPANTS LEARN TO SET GOALS, MAKE DECISIONS, COMPLETE TASKS, AND BENEFIT FROM OPPORTUNITIES THAT MAY ARISE. A REPRESENTATIVE OF SMCCV PROVIDED ASSISTANCE AND RECOMMENDATIONS ON CURRICULUM OFFERINGS FOR THE CASTRO VALLEY ADULT SCHOOL IN 2014.
SCHEDULE H, PART III, LINE 2 METHODOLOGY FOR CALCULATING BAD DEBT (AT COST): THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.
SCHEDULE H, PART III, LINE 3 METHODOLOGY FOR DETERMINING THE AMOUNT OF BAD DEBT LIKELY ATTRIBUTABLE TO CHARITY CARE: AMOUNTS MAY BE INCLUDED IN BAD DEBT PENDING A CHARITY CARE DETERMINATION. UPON ELIGIBILITY THESE AMOUNTS WOULD BE RECLASSIFIED AS CHARITY CARE.
SCHEDULE H, PART III, LINE 4 BAD DEBT AUDIT FOOTNOTE: THE ORGANIZATION MAKES EVERY EFFORT TO QUALIFY THOSE ELIGIBLE FOR CHARITY CARE. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS. AUDIT FOOTNOTE: THE ORGANIZATION IS AN AFFILIATE OF SUTTER HEALTH WHICH UNDERWENT A SYSTEM-WIDE AUDIT. THE AUDIT REPORT DOES NOT INCLUDE A BAD DEBT EXPENSE FOOTNOTE. PROVISION FOR BAD DEBTS IS LISTED ON A SEPARATE LINE ITEM IN THE FINANCIAL STATEMENTS. THE AUDIT DOES INCLUDE FOOTNOTES FOR PATIENT ACCOUNTS RECEIVABLE AND PATIENT SERVICE REVENUES LISTED BELOW. PATIENT ACCOUNTS RECEIVABLE AUDIT FOOTNOTE: SUTTER'S PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. SUTTER MANAGES THE RECEIVABLES BY REGULARLY REVIEWING ITS PATIENT ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE ESTIMATED BASED UPON AN EVALUATION OF HISTORICAL PAYMENTS, NEGOTIATED CONTRACTS AND GOVERNMENTAL REIMBURSEMENTS. SUTTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 90% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2014 AND 2013. ADJUSTMENTS AND CHANGES IN ESTIMATES ARE RECORDED IN THE PERIOD IN WHICH THEY ARE DETERMINED. SIGNIFICANT CONCENTRATIONS OF GROSS PATIENT ACCOUNTS RECEIVABLE ARE AS FOLLOWS: MEDICARE 29% AS OF 12/31/14 33% AS OF 12/31/13 MEDI-CAL 27% AS OF 12/31/14 21% AS OF 12/31/13 DURING 2014 AND 2013, CERTAIN AFFILIATES COLLECTED ON ACCOUNTS THAT WERE PREVIOUSLY DEEMED UNCOLLECTIBLE AND RESERVED. SUCH RECOVERIES ARE RECOGNIZED IN THE PERIOD THAT CASH IS RECEIVED AND WERE NOT MATERIAL. DUE TO THE INHERENT VARIABILITY IN THIS AREA OF PATIENT RECEIVABLE COLLECTIONS, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT THE ESTIMATION MAY CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. PATIENT SERVICE REVENUES FOOTNOTE: PATIENT SERVICE REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT PROGRAMS WITH THIRD-PARTY PAYERS. ESTIMATED SETTLEMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, PRIMARILY AS A RESULT OF FINAL COST REPORT SETTLEMENTS WITH GOVERNMENTAL AGENCIES. PATIENT SERVICE REVENUES LESS PROVISION FOR BAD DEBTS ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. SUTTER'S SELF-PAY WRITE-OFFS WERE $287 MILLION AND $375 MILLION FOR 2014 AND 2013, RESPECTIVELY.
SCHEDULE H, PART III, LINE 7 MEDICARE COST REPORTS THAT THE ORGANIZATION FILES DO NOT INCLUDE ALL OF THE COSTS REQUIRED TO TREAT MEDICARE PATIENTS.
SCHEDULE H, PART III, LINE 8 MEDICARE SHORTFALL COMMUNITY BENEFIT AND COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. COMMUNITY BENEFIT MEDICARE SHORTFALL: THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE DEFICIT.
SCHEDULE H, PART III, LINE 9B COLLECTION POLICY FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE: COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS WILL BE GIVEN AN APPLICATION WHICH WILL DOCUMENT THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 30 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS A COLLABORATIVE REPORT COMMISSIONED BY FIVE LOCAL NON-PROFIT HOSPITALS IN THE EAST BAY-SUTTER MEDICAL CENTER CASTRO VALLEY, ALTA BATES SUMMIT MEDICAL CENTER, ST. ROSE HOSPITAL, WASHINGTON HOSPITAL HEALTHCARE SYSTEM AND CHILDREN'S HOSPITAL & RESEARCH CENTER. THE CHNA CORE GROUP, A GROUP REPRESENTING THE COLLABORATING HOSPITALS, MEMBERS FROM ALAMEDA COUNTY PUBLIC HEALTH AND THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA WORKED IN PARTNERSHIP TO DEFINE SPECIFIC DEMOGRAPHIC AND HEALTH STATUS MEASURES FOR REVIEW AND ANALYSIS AND JOINTLY REVIEWED AND DISCUSSED THE RESULTS. THE HOSPITALS RETAINED VALLEY VISION, INC. TO CONDUCT THE TEN-MONTH ASSESSMENT PROCESS. VALLEY VISION, INC. IS A NON-PROFIT 501(C)(3) CONSULTING FIRM WITH OVER SEVEN YEARS EXPERIENCE IN CONDUCTING CHNAS. THE ASSESSMENT USED A MIXED METHOD DATA COLLECTION APPROACH THAT INCLUDED PRIMARY DATA SUCH AS KEY INFORMANT INTERVIEWS, COMMUNITY FOCUS GROUPS, AND A COMMUNITY ASSETS ASSESSMENT. SECONDARY DATA INCLUDED HEALTH OUTCOMES, DEMOGRAPHIC DATA, BEHAVIORAL DATA, AND ENVIRONMENTAL DATA. THE HEALTH NEEDS IDENTIFIED THROUGH ANALYSIS OF BOTH QUANTITATIVE AND QUALITATIVE DATA ARE AS FOLLOWS: - MENTAL HEALTH: ISSUES ARISING FROM LIVING IN A STATE OF STRESS, LIVING IN A STRESSFUL ENVIRONMENT DUE TO LIMITED ECONOMIC RESOURCES, SAFETY CONCERNS FOR SELF AND FAMILY - ACCESS TO HEALTH RESOURCES: INABILITY TO ADDRESS BASIC HEALTHCARE NEEDS DUE TO A LACK OF ACCESS TO RESOURCES TO MAINTAIN AND/OR IMPROVE ONE'S HEALTH, INCLUDING PRIMARY, SPECIALTY, AND PREVENTATIVE CARE - NUTRITION: POOR DIETING HABITS RESULTING FROM LIVING IN AN UNHEALTHY FOOD ENVIRONMENT WITH LIMITED ACCESS TO FRESH AND HEALTHIER FOODS - DENTAL CARE: ISSUES RESULTING FROM A LACK OF ACCESS TO DENTAL SERVICES - HEALTH LITERACY: INABILITY TO IMPROVE ONE'S HEALTH DUE TO LIMITED HEALTH LITERACY AND EDUCATION, INCLUDING HOW TO MAINTAIN AND IMPROVE ONE'S HEALTH THROUGH HEALTHY BEHAVIORS SUCH AS DIET AND PHYSICAL ACTIVITY - POLLUTION: RESPIRATORY AND RELATED ISSUES RESULTING FROM LIVING IN COMMUNITIES WITH POOR AIR QUALITY DUE TO HOUSING CONDITIONS AND ADJACENCY TO HIGH POLLUTION AREAS SUCH AS MAJOR INTERSTATE HIGHWAYS THE ENTIRE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT FOR SUTTER MEDICAL CENTER CASTRO VALLEY IS AVAILABLE AT: HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS-ASSESSMENT.HT ML
SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SUTTER MEDICAL CENTER CASTRO VALLEY FOLLOWS A SUTTER HEALTH SYSTEM-WIDE CHARITY CARE POLICY, WHICH INCLUDES THE FOLLOWING DETAILS OF HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. FOR A MORE DETAILED LOOK AT OUR CHARITY CARE POLICIES BY REGION, PLEASE VISIT THE OFFICE OF STATEWIDE AND HEALTH PLANNING'S WEBSITE AT HTTP://SYFPHR.OSHPD.CA.GOV. COMMUNICATIONS OF FINANCIAL ASSISTANCE AVAILABILITY A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL AFFILIATES SHALL PROVIDE: A. ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS). B. PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, "STATEMENT OF FINANCIAL CONDITION". 2. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL AFFILIATES SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION FORM, "STATEMENT OF FINANCIAL CONDITION". B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS: 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE SUTTER HEALTH WEBSITE AND EACH HOSPITAL AFFILIATE WEBSITE, IF ANY. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE, COLLECTION PRACTICES, HOSPITAL AFFILIATE THIRD-PARTY LIENS, AND AFFILIATE DISPUTE INITIATION POLICY (FINANCE POLICY 14-227). C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL AFFILIATES SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGE(S) OF THE AFFILIATE'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATIONS TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL PROVIDE THE PATIENT WITH AN ESTIMATE OF THE AMOUNT THE HOSPITAL AFFILIATE WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS.
SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SUTTER MEDICAL CENTER CASTRO VALLEY'S PRIMARY HOSPITAL SERVICE AREA, OR HSA, IS BASED UPON COMMUNITIES WHERE A SIGNIFICANT PERCENTAGE OF DISCHARGES ORIGINATE, BASED UPON THE PATIENT'S HOME ZIP CODE. THESE ZIP CODES INCLUDED 94541, 94542, 94544, 94545, 94546, 94552, 94577, 94578, 94579, AND 94580. THE HSA INCLUDES A RICHLY DIVERSE POPULATION OF JUST OVER 362,000 RESIDENTS. WHITES, HISPANICS, ASIANS AND BLACKS MAKE UP THE LARGEST MAJORITY OF RESIDENTS WITH WHITES PREDOMINATELY RESIDING IN 94542, 94546, 94552, AND 94577 ZIP CODES; HISPANICS PREDOMINATELY RESIDING IN THE 94541, 94544, 94578 AND 94580 ZIP CODES; AND ASIANS PREDOMINATELY RESIDE IN 94545 AND 94579 ZIP CODES. THE ECONOMIC DIVERSITY OF THE HSA ALSO VARIES FROM ZIP CODE TO ZIP CODE. FOR EXAMPLE, THE MEDIAN INCOME OF RESIDENTS OF 94552 IS $134,256 WHILE THE MEDIAN INCOME OF RESIDENTS IN 94578 IS $52,512. TO IDENTIFY COMMUNITIES OF CONCERN, INPUT FROM THE CHNA TEAM, PRIMARY DATA FROM KEY INFORMANT INTERVIEWS AND FOCUS GROUPS, ALONG WITH DETAILED ANALYSIS OF SECONDARY DATA, HEALTH OUTCOME INDICATORS, AND SOCIO-DEMOGRAPHICS WERE EXAMINED. ZIP CODES WITH RATES THAT CONSISTENTLY EXCEEDED COUNTY, STATE, AND/OR HEALTHY PEOPLE 2020 BENCHMARKS FOR ED UTILIZATION, HOSPITALIZATION, AND MORTALITY WERE CONSIDERED. ZIP CODES WITH RATES THAT CONSISTENTLY FELL IN THE TOP 20% WERE NOTED AND TRIANGULATED WITH PRIMARY AND SOCIO-DEMOGRAPHIC DATA TO IDENTIFY PRELIMINARY COMMUNITIES OF CONCERN. THESE ZIP CODES WERE THEN CONFIRMED WITH EACH CORRESPONDING HOSPITAL CHNA WORKGROUP FOR MODIFICATION, AND IN SOME INSTANCES ADDITIONAL ZIP CODES WERE ADDED. THE COMMUNITIES OF CONCERN ARE HOME TO MORE THAN 250,000 COMMUNITY RESIDENTS. THE AREAS CONSIST OF SIX ZIP CODES, ALL LOCATED IN ALAMEDA COUNTY. ZIP CODE 94541 IS HOME TO THE ALL OR PORTIONS OF HAYWARD, FAIRVIEW, CHERRYLAND, AND ASHLAND, AND IS HOME TO OVER 60,000 RESIDENTS. ZIP CODE 94544 IS THE MOST HEAVILY POPULATED OF ALL THE COMMUNITIES OF CONCERN, AND IS HOME TO PORTIONS OF THE CITIES OF HAYWARD AND UNION CITY. ZIP CODE 94545 SITS TO THE WEST OF 94544, AND IS HOME TO PORTIONS OF THE CITY OF HAYWARD. NORTH OF THE CENTRAL HAYWARD AREA IS SAN LEANDRO ZIP CODE 94578, HOME TO OVER 38,000 RESIDENTS. ADJACENT AND TO THE WEST OF THIS ZIP CODE IS 94579, THE LEAST POPULATED AMONG ALL COMMUNITIES OF CONCERN WITH JUST OVER 20,000 RESIDENTS. TO THE SOUTH OF THIS ZIP CODE IS 94580, THE SAN LORENZO AREA, HOME TO OVER 27,000 RESIDENTS. THERE ARE FIVE HOSPITALS SERVING THE COMMUNITY. THE COMMUNITIES OF CONCERN SIT ADJACENT THE SAN FRANCISCO BAY AND ARE SITUATED ALONG THE INTERSTATE 880, 580, AND HIGHWAY 238 CORRIDORS, WHICH RUN NORTH AND SOUTH THROUGH THE EAST BAY AREA. HIGHWAY 92 AND THE SAN MATEO BRIDGE RUNS EAST AND WEST THROUGH THE AREA, AND CONNECT THE EAST BAY WITH SOUTH BAY AREA. FROM AN ECONOMIC PERSPECTIVE, ZIP CODES 94541 AND 94578 EXCEEDED BENCHMARKS FOR THE PERCENT OF FAMILIES WITH CHILDREN LIVING IN POVERTY. IN 94578, 22.4% OF ALL FAMILIES WITH CHILDREN, OR JUST OVER ONE IN FIVE, LIVED IN POVERTY. FURTHER, WELL OVER ONE-THIRD OF ALL SINGLE-FEMALE HEADED HOUSEHOLDS LIVED IN POVERTY IN THE ZIP CODE COMMUNITIES OF 94544, 94578, AND 94587. ALSO, EACH OF THE SIX COMMUNITIES OF CONCERN EXCEEDED BENCHMARKS FOR HIGH UNEMPLOYMENT RATES. LAST, NEARLY SIX IN TEN RESIDENTS OF 94578 RENTED THEIR RESIDENCE, AN INDICATOR OF ECONOMIC MEANS. ALL COMMUNITIES OF CONCERN WERE HOME TO DIVERSE POPULATIONS, WITH PEOPLES OF COLOR ACCOUNTING FOR THE MAJORITY OF COMMUNITY RESIDENTS. FOR EXAMPLE, NEARLY 9 OF 10 RESIDENTS OF ZIP CODES 94545 AND 94587 WERE NON-WHITE. FURTHER, EACH ZIP CODE EXCEEDED BENCHMARKS FOR THE PERCENT OF THE POPULATION OVER THE AGE OF FIVE THAT SPOKE LIMITED ENGLISH AT HOME, WITH 16.1% OF ALL RESIDENTS OVER THE AGE OF FIVE IN 94544 SPEAKING LIMITED ENGLISH AT HOME. FROM AN EDUCATIONAL PERSPECTIVE, ALL ZIP CODES EXCEEDED BENCHMARKS FOR THE PERCENT OF THE TOTAL POPULATION OVER THE AGE OF 25 WITHOUT A HIGH SCHOOL DIPLOMA. LAST, TWO OF THE ZIP CODE COMMUNITIES OF CONCERN EXCEEDED BENCHMARKS FOR THE PERCENT OF POPULATION THAT HAD NO HEALTH INSURANCE. ZIP CODES 94541 AND 94578 HAD 18.6% AND 18.8%, RESPECTIVELY, OF RESIDENTS WITHOUT HEALTH INSURANCE. AN IN-DEPTH VIEW OF THE DEMOGRAPHICS AND GEOGRAPHY OF THE SERVICE AREA IS AVAILABLE IN THE SUTTER MEDICAL CENTER CASTRO VALLEY CHNA AT HTTP://WWW.SUTTERHEALTH.ORG/COMMUNITYBENEFIT/COMMUNITY-NEEDS- ASSESSMENT.HTML
SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: SUTTER HEALTH'S MISSION IS TO "ENHANCE THE WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE, THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES." SUTTER HEALTH'S MISSION REACHES BEYOND THE WALLS OF OUR HOSPITALS AND FACILITIES. OUR AFFILIATES FURTHER THEIR TAX-EXEMPT PURPOSE BY: - BUILDING RELATIONSHIPS OF TRUST BY WORKING COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS; - SUPPORTING NONPROFIT ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICES AND EMPLOYEE VOLUNTEERISM; AND - PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS. ALL SUTTER MEDICAL CENTER CASTRO VALLEY COMMUNITY BENEFIT INITIATIVES ALIGN WITH THE FOLLOWING PILLARS: 1. CONNECT PATIENTS TO THE RIGHT CARE, PLACE AND TIME THROUGH ACCESS TO PRIMARY CARE AND MENTAL HEALTH SERVICES. 2. INVEST IN VULNERABLE AREAS TO ENSURE CAPACITY OF CARE MEETS DEMANDS OF VULNERABLE POPULATIONS. 3. COLLABORATE TO INFLUENCE BEHAVIOR TO UTILIZE PREVENTIVE CARE, CHRONIC DISEASE MANAGEMENT AND COMMUNITY SERVICES. 4. BUILD COMMUNITY CAPACITY AND IMPROVE HEALTH. THE 2013-2015 IMPLEMENTATION STRATEGY FOR SUTTER MEDICAL CENTER CASTRO VALLEY DEFINES A VARIETY OF PROGRAMS AND PARTNERSHIPS THAT ADDRESS IDENTIFIED PRIORITY HEALTH NEEDS AND IMPROVE THE OVERALL HEALTH OF THE COMMUNITY IT SERVES. A FEW OF THOSE PROGRAMS AND PARTNERSHIPS ARE DESCRIBED BELOW: THE LACK OF ACCESS TO HEALTH RESOURCES IS A PRIORITY HEALTH NEED FOR SUTTER MEDICAL CENTER CASTRO VALLEY. THE EMERGENCY DEPARTMENT UTILIZATION AND CARE INITIATIVE WILL FUNCTION TO ESTABLISH STRONGER WORKING RELATIONSHIPS WITH WINTON WELLNESS CENTER AND TIBURCIO HEALTH CENTER. THE GOALS OF THE INITIATIVE ARE TO IMPROVE CARE TRANSITIONS OF TARGETED PATIENTS BETWEEN SMCCV AND THESE HEALTH CENTERS, DECREASE LEVEL 1 AND LEVEL 2 EMERGENCY DEPARTMENT VISITS, DECREASE READMISSION OF PATIENTS FROM THESE CLINICS AND PROVIDE ACCESS FOR UNINSURED AND UNDERINSURED PATIENTS. IN JUNE OF 2014, SMCCV ENTERED INTO A CARE TRANSITIONS COLLABORATION WITH TIBURCIO VASQUEZ HEALTH CENTER. COMMUNITY BENEFIT DOLLARS FUNDED THE PLACEMENT OF A NURSE PRACTITIONER TO EXPAND CAPACITY FOR PATIENTS REFERRED FROM SMCCV. IN ADDITION, A NEW CARE TRANSITIONS NURSE AND MEDICAL ASSISTANT WERE PLACED AT TIBURCIO FOR THE PURPOSE OF ENSURING CONNECTION TO A MEDICAL HOME AND A PRIMARY CARE FOLLOW UP APPOINTMENT FOR BOTH INPATIENTS AND THOSE VISITING THE EMERGENCY DEPARTMENT. DUE TO ISSUES WITH EPIC ACCESS AND OTHER LOGISTICS, THERE WERE CHALLENGES WITH START UP. SINCE PROGRAM INCEPTION, 515 PATIENTS HAVE BEEN IDENTIFIED AND APPOINTMENTS REQUESTED. HOWEVER, ONLY 50% OF PATIENTS ACTUALLY KEPT THE APPOINTMENTS. LOOKING TO THE FUTURE, WE ARE WORKING TO INCREASE BOTH PATIENTS CONTACTED AND APPOINTMENT ATTENDANCE RATES. TRANSPORTATION CAN BE A CHALLENGE FOR THOSE WHO ARE DISCHARGED FROM THE HOSPITAL AND HAVE NO MEANS OF RETURNING HOME. SMCCV PLANS TO ALLOCATE FUNDING TO SUPPORT THE TAXI VOUCHER PROGRAM. THIS PROGRAM BRIDGES THE TRANSPORTATION GAP FOR THE INDIGENT AND ALLOWS PATIENTS THE ABILITY TO RETURN HOME SAFELY. ACCESS TO MEDICAL TREATMENT FOR UNDERSERVED POPULATIONS CAN BE A CHALLENGE. EVEN MORE CHALLENGING IS THE COST OF MEDICATIONS TO ENSURE THEIR RECOVERY. WITHOUT PRESCRIBED MEDICATIONS, PATIENTS MAY EXPERIENCE SLOW RECOVERY TIME, RELAPSE, COMPLICATIONS, AND POSSIBLE READMISSION. IMPROVING ACCESS TO NEEDED MEDICATIONS IMPROVES PATIENT OUTCOMES. THROUGH AN AGREEMENT WITH WALGREENS AND SAFEWAY, SMCCV PROVIDES FUNDING FOR PRESCRIPTION DRUGS FOR UP TO THE FIRST THREE DAYS OF A PATIENT'S DISCHARGE FOR PEOPLE WHO WOULD OTHERWISE BE UNABLE TO PAY FOR THEIR PRESCRIPTIONS. A TOTAL OF 71 COMMUNITY MEMBERS BENEFITTED FROM THIS PROGRAM IN 2014. SMCCV CONTINUES TO SUPPORT PROFESSIONAL EDUCATION TO ENSURE HEALTH CARE WORKERS RECEIVE THE SKILLS, TRAINING AND EXPERIENCE THEY NEED TO BUILD A SUSTAINABLE WORKFORCE AND IMPROVE ACCESS TO HEALTH CARE. WORKING WITH PROFESSIONAL EDUCATION INSTITUTIONS SUCH AS SAMUEL MERRITT NURSING SCHOOL AND TOURO UNIVERSITY, THE PRECEPTORSHIP AND INTERNSHIP PROGRAMS ALLOW STUDENTS THE ABILITY TO WORK ALONGSIDE STAFF AND GAIN VALUABLE CLINIC EXPERIENCE IN A MULTI-DISCIPLINARY ENVIRONMENT. EDUCATION AND TRAINING MANAGED THROUGH SMCCV LED TO JOB PLACEMENT IN THE COMMUNITY FOR APPROXIMATELY 60% OF THE TRANSITION TO PRACTICE STUDENTS. IN ADDITION, SMCCV EXPANDED ITS EFFORTS IN COLLABORATION WITH ALTA BATES SUMMIT'S YOUTH BRIDGE PROGRAM AND PROVIDED MENTORING AND PAID SUMMER INTERNSHIP PLACEMENTS FOR NINE HIGH SCHOOL STUDENTS FROM SOME OF THE MOST VULNERABLE ZIP CODES IN OUR COMMUNITIES. SMCCV CONTINUES TO WORK TO IMPROVE HEALTH DRIVERS THAT IMPACT MENTAL HEALTH (SAFETY). THE VIOLENCE/INJURY PREVENTION EDUCATION AND REDUCTION PROGRAMS AT SUTTER MEDICAL CENTER CASTRO VALLEY IS COORDINATED BY THE TRAUMA DEPARTMENT STAFF IN COLLABORATION WITH LOCAL FIRST RESPONDERS, SMCCV STAFF, CITY AND GOVERNMENT AGENCIES TO REDUCE UNINTENTIONAL INJURY, REDUCE INJURY FROM MOTOR VEHICLE ACCIDENTS AND REDUCE VIOLENCE IN YOUTH TO IMPROVE SAFETY IN THE COMMUNITY. THESE THREE PROGRAMS INCLUDE INJURY PREVENTION EDUCATION, "EVERY 15 MINUTES" PROGRAM FOR JUNIOR AND SENIOR HIGH SCHOOL STUDENTS, AND CAUGHT IN THE CROSSFIRE PROGRAM, A GANG DIVERSION PROGRAM. THROUGH CONTINUED EDUCATION AND AWARENESS ACTIVITIES, FAMILY MEMBERS AND SENIORS WILL BEGIN TO HAVE A GREATER SENSE OF AWARENESS ON HOW TO REDUCE FALLS, STUDENTS WILL HAVE A BETTER UNDERSTANDING OF THE RAMIFICATIONS OF DRUNK DRIVING AND POOR DECISIONS, AND YOUTH INVOLVED IN VIOLENCE WILL HAVE THE OPPORTUNITY TO TURN AWAY FROM VIOLENCE. THESE ACTIONS INCREASE SAFETY AND REDUCE STRESS NOT ONLY WITHIN FAMILIES, BUT IN THE COMMUNITIES WHERE WE LIVE. THE 2014 EVERY 15 MINUTES PROGRAM VIDEO, WHICH HIGHLIGHTS THE DANGERS OF DRINKING AND DRIVING, HAS REACHED OVER 600,000 PEOPLE ON YOUTUBE. THE MOCK CRASH AND ASSEMBLY WERE CARRIED OUT IN FRONT OF 1,500 HIGH SCHOOL JUNIORS AND SENIORS. AN EDUCATIONAL FALL PREVENTION FAIR WAS OFFERED FREE TO COMMUNITY SENIORS AND OFFERED INFORMATION ON HOW TO PREVENT A FALL INCLUDING MEDICATION MANAGEMENT AND EXERCISE.
SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: SUTTER MEDICAL CENTER CASTRO VALLEY IS AFFILIATED WITH SUTTER HEALTH, A NOT-FOR-PROFIT NETWORK OF HOSPITALS, PHYSICIANS, EMPLOYEES AND VOLUNTEERS WHO CARE FOR PEOPLE WHO LIVE IN MORE THAN 100 NORTHERN CALIFORNIA TOWNS AND CITIES. TOGETHER, WE'RE CREATING A MORE INTEGRATED, SEAMLESS AND AFFORDABLE APPROACH TO CARING FOR PATIENTS. THE HOSPITAL'S MISSION IS TO ENHANCE THE WELL-BEING OF THE PEOPLE IN OUR COMMUNITIES THROUGH COMPASSION, EXCELLENCE AND INNOVATION IN HEALTH CARE SERVICES, RESEARCH AND EDUCATION. OVER THE PAST FIVE YEARS, SUTTER HEALTH HAS COMMITTED NEARLY $4 BILLION TO CARE FOR PATIENTS WHO COULDN'T AFFORD TO PAY, AND TO SUPPORT PROGRAMS THAT IMPROVE COMMUNITY HEALTH. OUR 2014 COMMITMENT OF $767 MILLION INCLUDES UNREIMBURSED COSTS OF PROVIDING CARE TO MEDI-CAL PATIENTS, TRADITIONAL CHARITY CARE AND INVESTMENTS IN HEALTH EDUCATION AND PUBLIC BENEFIT PROGRAMS. FOR EXAMPLE: - TO PROVIDE CARE TO MEDI-CAL PATIENTS IN 2014, SUTTER HEALTH INVESTED $535 MILLION MORE THAN THE STATE PAID. SUTTER HEALTH HOSPITALS PROUDLY SERVE MORE MEDI-CAL PATIENTS IN OUR NORTHERN CALIFORNIA SERVICE AREA THAN ANY OTHER HEALTH CARE PROVIDER. - IN 2014, SUTTER HEALTH'S COMMITMENT TO DELIVERING CHARITY CARE TO PATIENTS WAS $91 MILLION. OUR CHARITY CARE INVESTMENT REPRESENTED AN AVERAGE OF NEARLY $1.8 MILLION PER WEEK. - THROUGHOUT OUR HEALTH CARE SYSTEM, WE PARTNER WITH AND SUPPORT COMMUNITY HEALTH CENTERS TO ENSURE THAT THOSE IN NEED HAVE ACCESS TO PRIMARY AND SPECIALTY CARE. WE ALSO SUPPORT CHILDREN'S HEALTH CENTERS, FOOD BANKS, YOUTH EDUCATION, JOB TRAINING PROGRAMS AND SERVICES THAT PROVIDE COUNSELING TO DOMESTIC VIOLENCE VICTIMS. EVERY THREE YEARS, SUTTER HEALTH HOSPITALS PARTICIPATE IN A COMPREHENSIVE AND COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IDENTIFIES LOCAL HEALTH CARE PRIORITIES AND GUIDES OUR COMMUNITY BENEFIT STRATEGIES. THE ASSESSMENTS HELP ENSURE THAT WE INVEST OUR COMMUNITY BENEFIT DOLLARS IN A WAY THAT TARGETS AND ADDRESSES REAL COMMUNITY NEEDS.
SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: CALIFORNIA
Schedule H (Form 990) 2014
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number
77-0146047
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. 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 section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) MARCH OF DIMES FULFILLMENT CENTER
PO BOX 1657
WILKESBARRES,PA187021657
13-1846366 501(C)(3) 14,213       GENERAL SUPPORT
(2) FIRST CAMERA
2472 3RD STREET
SAN FRANCISCO,CA94107
94-3151948   7,500       GENERAL SUPPORT
(3) AVIA PARTNERS INC
PO BOX 742962
LOS ANGELES,CA900742962
94-3022728   6,432       GENERAL SUPPORT


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
2
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. 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 (Form 990) 2014


Additional Data


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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 Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
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.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1DAVID BRADLEYREGIONAL PRES, East Bay (i)
(ii)
0
...............................
679,664
0
...............................
379,812
0
...............................
99,422
0
...............................
226,653
0
...............................
19,168
0
...............................
1,404,719
0
...............................
84,475
2GREGORY BROWNVP & REG COUNSEL, EAST BAY (i)
(ii)
0
...............................
311,501
0
...............................
29,190
0
...............................
5,764
0
...............................
68,121
0
...............................
15,063
0
...............................
429,639
0
...............................
0
3PAT FRYPRESIDENT & CEO, SUTTER HEALTH (i)
(ii)
0
...............................
1,523,132
0
...............................
1,687,050
0
...............................
416,185
0
...............................
2,693,377
0
...............................
34,953
0
...............................
6,354,697
0
...............................
396,136
4JOHN GATESREGIONAL VP FINANCE EAST/WEST (i)
(ii)
0
...............................
604,705
0
...............................
303,767
0
...............................
150,021
0
...............................
128,539
0
...............................
18,040
0
...............................
1,205,072
0
...............................
51,581
5KAREN MANNERINGCHARGE NURSE (i)
(ii)
204,722
...............................
0
8,367
...............................
0
95,757
...............................
0
5,199
...............................
0
9,656
...............................
0
323,701
...............................
0
0
...............................
0
6KATHERINE NAASNURSE STAFF II (i)
(ii)
158,169
...............................
0
4,736
...............................
0
60,053
...............................
0
4,459
...............................
0
21,274
...............................
0
248,691
...............................
0
0
...............................
0
7EDGAR REVELOTECH, OPERATING ROOM (i)
(ii)
135,763
...............................
0
0
...............................
0
115,519
...............................
0
5,026
...............................
0
21,656
...............................
0
277,964
...............................
0
0
...............................
0
8LISA ROBINSONNURSE STAFF II (i)
(ii)
160,006
...............................
0
 
...............................
0
80,431
...............................
0
4,809
...............................
0
21,482
...............................
0
266,728
...............................
0
0
...............................
0
9JEFFREY SILVERSPHYSICIAN (i)
(ii)
251,190
...............................
0
 
...............................
0
194
...............................
0
5,028
...............................
0
6,530
...............................
0
262,942
...............................
0
0
...............................
0
10TERRY GLUBKACEO (i)
(ii)
0
...............................
358,148
0
...............................
208,009
0
...............................
32,940
0
...............................
89,865
0
...............................
16,480
0
...............................
705,442
0
...............................
29,000
11ROSE CORCORAN RNVP PATIENT CARE SERVICES (i)
(ii)
0
...............................
209,382
0
...............................
89,893
0
...............................
14,568
0
...............................
30,499
0
...............................
15,699
0
...............................
360,041
0
...............................
9,913
12BRYAN DAYLORVP ANCILLARY SUPPORT SVCS (i)
(ii)
0
...............................
240,540
0
...............................
80,072
0
...............................
19,202
0
...............................
33,461
0
...............................
14,907
0
...............................
388,182
0
...............................
14,331
13CATHERINE MESSMANADMINISTRATIVE DIRECTOR FIN (i)
(ii)
0
...............................
219,816
0
...............................
75,931
0
...............................
12,365
0
...............................
30,176
0
...............................
11,151
0
...............................
349,439
0
...............................
11,590
14CHERYL HARLESSCNE (i)
(ii)
0
...............................
229,743
0
...............................
82,970
0
...............................
646
0
...............................
30,472
0
...............................
20,907
0
...............................
364,738
0
...............................
0
15DEBORA HENDRICKSONREGIONAL ADMIN DIR. QUALITY (i)
(ii)
194,900
...............................
0
15,847
...............................
0
792
...............................
0
4,231
...............................
0
16,942
...............................
0
232,712
...............................
0
0
...............................
0
16SIDNEY WANETICKVP MEDICAL AFFAIRS (i)
(ii)
0
...............................
338,500
0
...............................
108,548
0
...............................
55,855
0
...............................
52,810
0
...............................
7,100
0
...............................
562,813
0
...............................
54,500
17ED BERDICKSVP SUTTER SHARED SVCS (i)
(ii)
0
...............................
793,820
0
...............................
593,527
0
...............................
251,517
0
...............................
248,054
0
...............................
21,847
0
...............................
1,908,765
0
...............................
0
18BRIAN HUNTERSH VP, REVENUE CYCLE (i)
(ii)
0
...............................
444,061
0
...............................
260,859
0
...............................
34,202
0
...............................
113,451
0
...............................
14,261
0
...............................
866,834
0
...............................
32,973
19SARAH KREVANSCOO, SUTTER HEALTH (i)
(ii)
0
...............................
916,159
0
...............................
689,878
0
...............................
156,449
0
...............................
399,554
0
...............................
24,683
0
...............................
2,186,723
0
...............................
142,787
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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
PART I, LINE 1A RELEVANT INFORMATION REGARDING COMPENSATION ITEMS: TAX INDEMNIFICATION: STANDARD POLICY FOR ALL SUTTER HEALTH EMPLOYEES IS THAT NON-CASH GIFTS AND AWARDS ARE GROSSED-UP FOR TAX PURPOSES. THE AMOUNT OF THE GROSS-UP IS ADDED TO THE EMPLOYEE'S WAGES AND TAXED ACCORDINGLY.
PART I, LINE 3 SUPPLEMENTAL COMPENSATION INFORMATION: THE CEO OF THE ORGANIZATION IS AN EMPLOYEE OF SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION. THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ENSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. PLEASE SEE SCHEDULE O'S PART VI, LINE 15 DISCLOSURE FOR FURTHER DETAILS ON COMPENSATION PROCEDURES.
PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN: THE PURPOSE OF THE NONQUALIFIED RETIREMENT PLAN IS TO PROVIDE SUTTER HEALTH EXECUTIVES WITH A COMPETITIVE RETIREMENT BENEFIT CONSISTENT WITH SUTTER HEALTH'S OVERALL COMPENSATION PHILOSOPHY FOR ALL EMPLOYEES. CONTRIBUTIONS ARE DESIGNED TAKING INTO CONSIDERATION LOST RETIREMENT BENEFITS THAT WOULD OTHERWISE BE OBTAINED THROUGH THE QUALIFIED PENSION PLAN. SUTTER'S PLANS ARE DESIGNED CONSISTENT WITH COMPETITIVE INDUSTRY PRACTICES. THE RETIREMENT PLAN FOR SUTTER HEALTH EMPLOYEES IS A COMBINATION OF SOCIAL SECURITY, 403B EMPLOYER MATCH CONTRIBUTIONS AND QUALIFIED PLAN BENEFITS. SUTTER HEALTH EXECUTIVES ARE GENERALLY INELIGIBLE FOR EMPLOYER MATCH CONTRIBUTIONS. ADDITIONALLY, QUALIFIED PLAN BENEFITS CAPS HAVE THE EFFECT OF SUBSTANTIALLY REDUCING RETIREMENT BENEFITS THAT ARE OTHERWISE PROVIDED TO ALL EMPLOYEES. THE EFFECT IS THAT EXECUTIVES OFTEN DO NOT RECEIVE THE SAME LEVEL OF RETIREMENT BENEFIT ON AN INCOME REPLACEMENT BASIS AS OTHER EMPLOYEES. TO ENSURE A COMPETITIVE RETIREMENT BENEFIT AND TO ADDRESS THE SHORTFALLS DESCRIBED ABOVE, SUTTER HEALTH MAKES AN ANNUAL CONTRIBUTION TO A NON-QUALIFIED 457(F) PLAN FOR ITS EXECUTIVES. THE FORMULA HAS TWO PARTS: (1) 4% TO 7% OF BASE SALARY (COMMENSURATE WITH MANAGEMENT LEVEL), PLUS (2) A CONTRIBUTION STARTING AT 5% (BASED UPON TENURE) FOR EARNINGS BEYOND THE PENSION PAY CAP. THE LATTER OF WHICH IS DESIGNED TO HELP RESTORE LOST PENSION BENEFITS FORFEITED UNDER THE QUALIFIED PLAN FOR EARNINGS OVER THE PENSION PAY CAP LIMIT. CONTRIBUTIONS ARE ALSO MADE FOR A SMALL GROUP OF SENIOR LEVEL EXECUTIVES WHOSE ESTIMATED RETIREMENT BENEFIT (SOCIAL SECURITY PLUS QUALIFIED PLAN BENEFITS PLUS 457F) FALLS BELOW 50% - 65% OF FINAL 4-YEAR AVERAGE BASE SALARY WHEN RETIRING AT AGE 65. TARGET BENEFIT LEVELS VARY BY YEARS OF SERVICE. UNLIKE SUTTER HEALTH'S QUALIFIED PLAN WHERE EMPLOYEE BENEFITS ARE GUARANTEED (I.E., A DEFINED BENEFIT), SUTTER'S NON-QUALIFIED PLAN BENEFITS ARE NOT GUARANTEED BY SUTTER HEALTH. INVESTMENT RISK IS BORNE BY PARTICIPANTS AND BENEFITS ARE NOT PROTECTED SHOULD SUTTER HEALTH BECOME INSOLVENT.
PART I, LINE 7 NON-FIXED PAYMENTS: SPOT AWARDS ARE INFREQUENTLY USED TO REWARD EMPLOYEES. THERE ARE NO SPECIFIC GUIDELINES FOR THE AMOUNT OF THE SPOT AWARD BUT THE AMOUNT TENDS TO NOT EXCEED 5% OF GROSS PAY. ANNUAL INCENTIVE PLAN (AIP): THE PURPOSE OF THE PLAN IS TO FOCUS EXECUTIVES ON SPECIFIC, SHORTER-TERM GOALS THAT ARE CRITICAL TO THE ACHIEVEMENT OF AFFILIATE, REGION, AND SYSTEM-WIDE OBJECTIVES THAT DRIVE OVERALL ORGANIZATION PERFORMANCE. A PORTION OF THE PLAN AWARD IS DISCRETIONARY IN THAT THE SUPERVISOR MAY ADD +/- 5% TO THE AWARD PROVIDED THE TOTAL AWARD (FORMULA PORTION PLUS DISCRETIONARY) DOES NOT EXCEED THE MAXIMUM ESTABLISHED FOR ANY GIVEN EXECUTIVE. LONG TERM PERFORMANCE PLANS: SUTTER HEALTH ALSO EMPLOYS LONG TERM PERFORMANCE PLANS WHICH ARE DESIGNED TO FOCUS ON LONGER TERM STRATEGIC OBJECTIVES OF THE ORGANIZATION. SUTTER'S LONG TERM PERFORMANCE PLAN APPROACH IS A COMBINATION OF BOTH LONGER TERM MEASURES OF ORGANIZATION SUCCESS AND KEY ORGANIZATION STRATEGIES WHICH REQUIRE THE COMBINED EFFORT OF ALL LEADERSHIP TO ACHIEVE SUCCESS. SUTTER USES A COMMON FATE APPROACH IN THAT ALL PLAN PARTICIPANTS ARE MEASURED AGAINST THE SAME, ORGANIZATION-WIDE CRITERIA VS. INDIVIDUAL EFFORTS. THIS FOSTERS A COMMON PURPOSE ACROSS LEADERSHIP AND A SHARED SENSE OF ACCOUNTABILITY FOR THE OVERALL SUCCESS OF SUTTER HEALTH. TO ENSURE THAT EXTRAORDINARY EFFORTS BY INDIVIDUALS CAN BE RECOGNIZED AND THAT ACTIONS OF LEADERSHIP ARE CONSISTENT WITH SUPPORTING SUTTER HEALTH'S OVERALL MISSION, VISION, AND VALUES, SUTTER'S LONG TERM INCENTIVE PLAN APPROACH ALSO INCORPORATES A COMBINATION OF CEO AND SUTTER HEALTH COMPENSATION COMMITTEE DISCRETION. IN SOME CASES, THE SUTTER HEALTH COMPENSATION COMMITTEE HAS DELEGATED AUTHORITY TO THE PRESIDENT & CEO TO MODIFY INDIVIDUAL AWARDS WITHIN LIMITS THAT HAVE BEEN PRE-APPROVED BY THE SUTTER HEALTH COMPENSATION COMMITTEE. THIS INCLUDES BOTH THE REDUCTION AND INCREASE OF AWARD AMOUNTS. SUCH MODIFICATIONS GENERALLY DO NOT EXCEED +/- 20% AND ARE EMPLOYED JUDICIOUSLY. IN ALL CASES, THE COMPENSATION COMMITTEE OF THE BOARD DETERMINES ACHIEVEMENT OF ORGANIZATION GOALS AND MAKES FINAL AWARD DETERMINATION WHICH MAY RESULT IN A REDUCTION OF AWARD IF APPROPRIATE. ALL SENIOR EXECUTIVE AWARDS ARE REVIEWED FOR COMPENSATION REASONABLENESS AND APPROVED PRIOR TO PAYMENT BY THE COMPENSATION COMMITTEE.
Schedule J (Form 990) 2014

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number
77-0146047
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A CHFFA 2011B
 
52-1643828 13033LKW6 02-10-2011 470,318,145 Construction.   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 472,888,501      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 0      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 472,888,501      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2012
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? X              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . . X              
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? X              
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.370 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.040 %      
6 Total of lines 4 and 5 . . . . . . . . . . . . . 0.410 %      
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. 0 %      
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . .
X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . .   X            
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
 
 
 
 
 
 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . . 0
 
 
 
 
 
 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K REPORTING THE ORGANIZATION'S SOLE CORPORATE MEMBER IS A CONDUIT BORROWER OF TAX-EXEMPT BOND ISSUES THAT ALLOCATES PORTIONS OF EACH ISSUE TO CERTAIN SUBSIDIARY ORGANIZATIONS, INCLUDING THE ORGANIZATION. THE OUTSTANDING BOND LIABILITY ALLOCATED TO THIS ORGANIZATION IS REPORTED ON FORM 990, PART X, BALANCE SHEET, AND PART VI HEREIN. WITH THE EXCEPTION OF THIS PORTION OF PART VI, THE SCHEDULE K FOR THIS ORGANIZATION IS REPORTING INFORMATION FOR THE ENTIRE BOND ISSUE.
SCHEDULE K, PART I, COLUMN E THE FILING ORGANIZATION RECEIVED BOND PROCEEDS IN THE AMOUNT OF: $287,141,586.
SCHEDULE K, PART II, LINE 7 ISSUANCE COSTS FROM PROCEEDS ISSUANCE COSTS WERE FUNDED THROUGH EQUITY CONTRIBUTIONS.
Schedule K (Form 990) 2014

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ 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
2014
Open to Public
Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
Return Reference Explanation
FORM 990, PART I, LINE 1 AND PART III, LINE 1 MISSION STATEMENT: WE ENHANCE THE WELL-BEING OF PEOPLE IN THE COMMUNITIES WE SERVE THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES.
FORM 990, PART III, LINE 4A EXEMPT PURPOSE ACHIEVEMENTS: SUTTER MEDICAL CENTER, CASTRO VALLEY IS A STATE-OF-THE-ART FACILITY THAT REPLACED THE OLD EDEN MEDICAL CENTER IN DECEMBER 2012. SUTTER MEDICAL CENTER, CASTRO VALLEY BRINGS TOGETHER PATIENT-CENTERED CARE, TECHNOLOGY AND SOPHISTICATED DESIGN IN A LEED-CERTIFIED SUSTAINABLE AND SEISMICALLY-SAFE BUILDING. THE FACILITY HAS 130 PRIVATE PATIENT ROOMS, WITH AN ADDITIONAL 34-BED UNIVERSAL CARE UNIT AND IS HOME TO THE SUTTER EAST BAY NEUROSCIENCE INSTITUTE, A PRIMARY STROKE CENTER, THE REGIONAL LEVEL II TRAUMA CENTER FOR SOUTHERN ALAMEDA COUNTY, AND A WIDE RANGE OF CENTERS OF EXCELLENCE INCLUDING CANCER CARE, ADVANCED IMAGING SERVICES, REHABILITATION AND COMPLETE SURGICAL AND ACUTE-CARE SERVICES. OUR AWARD-WINNING HOSPITAL WAS RECENTLY NAMED A TOP PERFORMER IN KEY QUALITY MEASURES BY THE JOINT COMMISSION. SUTTER MEDICAL CENTER, CASTRO VALLEY IS PART OF THE SUTTER HEALTH NETWORK OF CARE, A FAMILY OF DOCTORS, NOT-FOR-PROFIT HOSPITALS AND OTHER HEALTH CARE SERVICE PROVIDERS THAT JOIN RESOURCES AND SHARE EXPERTISE TO ADVANCE HEALTH CARE QUALITY AND ACCESS FOR PATIENTS IN MORE THAN 100 NORTHERN CALIFORNIA CITIES AND TOWNS. THERE WERE 216,111 PATIENT DAYS IN 2014.
FORM 990, PART VI, LINE 1A THE AFFAIRS AND MANAGEMENT OF SUTTER MEDICAL CENTER CASTRO VALLEY (SMCCV) ARE SUPERVISED BY THE EXECUTIVE COMMITTEE WHICH HAS POWER TO TRANSACT ALL REGULAR BUSINESS OF SMCCV DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE CONSISTS OF AT LEAST FIVE (5) BOARD MEMBERS INCLUDING THE CORPORATION'S CHAIR WHO SERVES AS CHAIR OF THE COMMITTEE, THE VICE CHAIR, THE CHAIR OF THE FINANCE AND PLANNING COMMITTEE, AN ADDITIONAL DIRECTOR AND THE PRESIDENT OF THE CORPORATION. AT LEAST ONE COMMITTEE MEMBER IS A PHYSICIAN DIRECTOR.
FORM 990, PART VI, LINE 6 & 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS: THIS CORPORATION IS AN AFFILIATE OF SUTTER HEALTH, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. SUTTER HEALTH IS THE SOLE MEMBER WITH THE RIGHT TO ELECT AT LEAST A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS: SUTTER HEALTH AS THE SOLE MEMBER OF THE ORGANIZATION IS ENTITLED TO EXERCISE FULLY ALL RIGHTS AND PRIVILEGES OF MEMBERS OF NONPROFIT CORPORATIONS UNDER THE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION LAW, AND ALL OTHER APPLICABLE LAWS. THE MEMBER HAS THE RIGHTS AND POWERS TO APPOINT (AND REMOVE) MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE PROVISIONS OF THE BYLAWS. IN ADDITION, THE MEMBER HAS THE RIGHT TO APPROVE THE FOLLOWING ACTIONS OF THE CORPORATION'S BOARD OF DIRECTORS: A. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; C. ADOPTION OF OPERATING BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THE CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; D. ADOPTION OF CAPITAL BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; E. AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED APPROVED OPERATING OR CAPITAL BUDGETS BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE GENERAL MEMBER; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE DIRECTORS OF THE GENERAL MEMBER, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THE CORPORATION; G. APPOINTMENT OF AN INDEPENDENT AUDITOR AND HIRING OF INDEPENDENT COUNSEL EXCEPT IN CONFLICT SITUATIONS BETWEEN THE GENERAL MEMBER AND THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; H. THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE ENTITY; I. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; J. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. THE GENERAL MEMBER SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; K. APPROVAL OF STRATEGIC PLANS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; L. ADOPTION OF QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE GENERAL MEMBER; M. ANY TRANSACTION BETWEEN THE CORPORATION, A SUBSIDIARY OR AFFILIATE AND A DIRECTOR OF THE CORPORATION OR AN AFFILIATE OF SUCH DIRECTOR. IN ADDITION, THE GENERAL MEMBER SHALL HAVE THE AUTHORITY (BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF ITS BOARD), TO DECLARE A MAJOR ACTIVITY REQUIRING APPROVAL.
FORM 990, PART VI, LINE 11B DESCRIBE THE PROCESS USED BY MGMT &/OR GOVERNING BODY TO REVIEW FORM 990: SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION, HAS A CENTRALIZED TAX DEPARTMENT RESPONSIBLE FOR THE PREPARATION OF THE FORM 990. ANNUALLY THE TAX DEPARTMENT PROVIDES TRAINING AND EDUCATION TO AFFILIATE PERSONNEL WHO ASSIST THE TAX DEPARTMENT IN COLLECTING AND REVIEWING DATA TO BE REPORTED ON THE FORM 990. THE PREPARATION MATERIAL IS REVIEWED BY VARIOUS DEPARTMENTS INCLUDING TAX, FINANCE, LEGAL, AND HUMAN RESOURCES. A NATIONAL ACCOUNTING FIRM PREPARES AND/OR REVIEWS THE RETURN. A COMPLETED RETURN IS THEN REVIEWED BY THE TAX DEPARTMENT, THE AFFILIATE, AND THE CFO BEFORE THE RETURN IS FILED.
FORM 990, PART VI, LINE 12 DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST: EMPLOYEES ARE EDUCATED ON THE CONFLICT OF INTEREST POLICY AND THE NEED TO MAKE DISCLOSURE AS PART OF ANNUAL COMPLIANCE EDUCATION. IN ADDITION, ANNUALLY A DISCLOSURE STATEMENT IS COMPLETED BY ALL DIRECTORS AND OFFICERS THAT INCLUDES AN ACKNOWLEDGEMENT THAT THEY HAVE READ THE CONFLICT OF INTEREST POLICY. ON THIS STATEMENT THE INDIVIDUAL WILL LIST A WIDE RANGE OF INFORMATION WHICH INCLUDES BUSINESS RELATIONSHIPS, EMPLOYMENT RELATIONSHIPS, PROPERTY INTERESTS, AND THOSE OF RELATED PARTIES. THE CEO AND BOARD CHAIR WILL REVIEW THE STATEMENTS AND MONITOR SITUATIONS THAT MAY POSE A POTENTIAL CONFLICT OF INTEREST. THE CEO AND BOARD CHAIR MAY CONSULT WITH THE OFFICE OF THE GENERAL COUNSEL AS NECESSARY. IF THERE IS A POTENTIAL CONFLICT OF INTEREST RELATED TO A PARTICULAR TRANSACTION, THE INTERESTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE AND NATURE OF THE RELATIONSHIP. THE BOARD CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE CONFLICT. UNTIL THE POTENTIAL CONFLICT IS RESOLVED, THE BOARD CHAIR MAY REQUEST THE INDIVIDUAL TO NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE INTERESTED INDIVIDUAL SHALL REFRAIN FROM VOTING ON ANY MATTER RELATED TO THE TRANSACTION.
FORM 990, PART VI, LINE 15 PROCESS FOR DETERMINING COMPENSATION: THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ENSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. IN ORDER TO ENSURE EXTERNAL COMPETITIVENESS, NATIONAL, CALIFORNIA AND LOCAL MARKET AREA COMPENSATION DATA COMPARISONS ARE REVIEWED. COMPETITIVE ANALYSIS INCLUDES: (A) BASE SALARY, (B) TOTAL CASH (BASE SALARY + ANNUAL INCENTIVE) AND (C) TOTAL REMUNERATION (BASE SALARY + ANNUAL INCENTIVE + BENEFITS AND LONG TERM INCENTIVE). THIS ANALYSIS INCLUDES COMPARABLE ORGANIZATIONS AND GEOGRAPHIC CONSIDERATIONS. FOR THE MOST SENIOR EXECUTIVE POSITIONS, NATIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS SUTTER HEALTH ARE MOST APPROPRIATE SINCE IT IS A NATIONAL MARKETPLACE IN WHICH SUTTER COMPETES FOR EXECUTIVE TALENT. ON THE OTHER HAND, BECAUSE CALIFORNIA'S UNDERLYING COMPENSATION STRUCTURE IS HIGHER THAN NATIONAL DATA (ESPECIALLY IN THE BAY AREA), REGIONAL PAY COMPARISONS AND ADJUSTMENTS ARE MADE. OFFICERS AND KEY EMPLOYEES OF THIS ORGANIZATION WHO ARE SUTTER HEALTH EMPLOYEES UNDERGO A REVIEW AND COMPENSATION COMMITTEE APPROVAL, AND SUCH APPROVAL IS RECORDED IN THE MINUTES. THE COMPENSATION REVIEW PROCESS WAS LAST COMPLETED IN DECEMBER OF 2014.
FORM 990, PART VI, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC: THE SUTTER HEALTH SYSTEM POSTS ITS CURRENT AND PAST AUDITED FINANCIAL STATEMENTS AT SUTTERHEALTH.ORG. OTHER DOCUMENTS ARE ALSO LOCATED AT THIS WEBSITE INCLUDING THE ANNUAL REPORT, MISSION STATEMENT, HISTORY, AND LINKS TO AFFILIATE WEBSITES. THE GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
FORM 990, PART XI, LINE 9 OTHER CHANGES IN FUND BALANCE: EQUITY TRANSFERS (NET) (41,960,680) PARTNERSHIP INCOME ON BOOKS (10,208) CHANGE IN INTEREST/AUDIT ADJUSTMENT (4,667,125) K-1 INTEREST INCOME (223) K-1 ORDINARY INCOME 84,637 ----------- TOTAL (46,553,599) ===========
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
SUTTER MEDICAL CENTER CASTRO VALLEY
 
Employer identification number

77-0146047
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?
Yes No
(1) ADOLESCENT TREATMENT CENTERS INC
390 40TH STREET

OAKLAND,CA94609
68-0088443
HEALTHCARE CA 501(C)(3) 3 SUTTER EBH
 
Yes
 
(2) Better Health East Bay Foundation
3012 SUMMIT STREET 3RD FLOOR

OAKLAND,CA94609
51-0160184
FUNDRAISING CA 501(C)(3) 7 SUTTER EBH
 
Yes
 
(3) CALIFORNIA PACIFIC MEDICAL CTR FOUND
2015 STEINER STREET 2ND FLOOR

SAN FRANCISCO,CA94115
94-2728423
FUNDRAISING CA 501(C)(3) 7 SUTTER WBH
 
Yes
 
(4) EAST BAY PERINATAL CENTER
3012 SUMMIT STREET 3RD FLOOR

OAKLAND,CA94609
51-0172285
HEALTHCARE CA 501(C)(3) 3 SUTTER EBH
 
Yes
 
(5) EDEN MEDICAL CENTER
20103 LAKE CHABOT ROAD

CASTRO VALLEY,CA94546
94-2948100
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(6) MEMORIAL HOSPITAL FOUNDATION
1800 COFFEE ROAD SUITE 76

MODESTO,CA95355
94-2290244
FUNDRAISING CA 501(C)(3) 11a - I SUTTER CVH
 
Yes
 
(7) MILLS-PENINSULA HEALTH SERVICES
1501 TROUSDALE DRIVE

BURLINGAME,CA94010
94-1156265
HOSPITAL CA 501(C)(3) 3 PAMF
 
Yes
 
(8) MILLS-PENINSULA HOSPITAL FOUNDATION
1501 TROUSDALE DRIVE

BURLINGAME,CA94010
23-7288765
FUNDRAISING CA 501(C)(3) 7 MPHS
 
Yes
 
(9) PALO ALTO MEDICAL FOUNDATION
2350 EL CAMINO REAL

MOUNTAIN VIEW,CA94040
94-1156581
HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(10) SAMUEL MERRITT UNIVERSITY
450 30TH STREET 2840

OAKLAND,CA94609
94-2992642
UNIVERSITY CA 501(C)(3) 2 SUTTER EBH
 
Yes
 
(11) SUTTER AUBURN FAITH HOSPITAL FOUNDATION
11815 EDUCATION ST

AUBURN,CA95602
94-2594966
FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(12) SUTTER CENTRAL VALLEY HOSPITALS
1800 COFFEE ROAD SUITE 76

MODESTO,CA95355
94-1080917
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(13) SUTTER COAST HOSPITAL
800 E WASHINGTON BLVD

CRESCENT CITY,CA95531
94-2988520
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(14) SUTTER DAVIS HOSPITAL FOUNDATION
PO BOX 1617

DAVIS,CA95617
68-0217870
FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(15) SUTTER EAST BAY HOSPITALS
3012 SUMMIT STREET 3RD FLOOR

OAKLAND,CA94609
94-1196176
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(16) SUTTER EAST BAY MEDICAL FOUNDATION
3687 MT DIABLO BLVD 200

LAFAYETTE,CA94549
94-2690415
HEALTHCARE CA 501(C)(3) 11B - II SUTTER HLTH
 
Yes
 
(17) SUTTER GOULD MEDICAL FOUNDATION
600 COFFEE ROAD

MODESTO,CA95355
94-1682256
HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(18) SUTTER HEALTH
2200 RIVER PLAZA DRIVE

SACRAMENTO,CA95833
94-2788907
SUPPORTING OR CA 501(C)(3) 11c III-FI NA
 
 
No
(19) SUTTER HEALTH PACIFIC
91-2301 FT WEAVER RD

EWA BEACH,HI96706
99-0298651
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(20) SUTTER HEALTH PLAN
2200 RIVER PLAZA DRIVE

SACRAMENTO,CA95833
46-1183948
HEALTH PLAN CA PENDING PENDING SUTTER HLTH
 
Yes
 
(21) SUTTER HEALTH SACRAMENTO SIERRA REGION
PO BOX 160727

SACRAMENTO,CA95816
94-1156621
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(22) SUTTER INSURANCE SERVICES CORPORATION
745 FORT STREET SUITE 800

HONOLULU,HI96813
99-0289310
INSURANCE SER HI 501(C)(3) 11C III-FI SUTTER HLTH
 
Yes
 
(23) SUTTER MEDICAL CENTER FOUNDATION
PO BOX 160727

SACRAMENTO,CA95816
94-2788906
FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(24) SUTTER MEDICAL FOUNDATION
2800 L STREET 7TH FLOOR

SACRAMENTO,CA95816
68-0273974
HEALTHCARE CA 501(C)(3) 11b - II SUTTER HLTH
 
Yes
 
(25) SUTTER ROSEVILLE MEDICAL CTR FOUNDATION
ONE MEDICAL PLAZA

ROSEVILLE,CA95661
68-0040113
FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(26) SUTTER SOLANO CHARITABLE FOUNDATION
300 HOSPITAL DRIVE

VALLEJO,CA94589
94-2668262
FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(27) SUTTER VISITING NURSE ASSOC AND HOSPICE
1900 POWELL ST 300

EMERYVILLE,CA94608
94-6068843
HEALTHCARE CA 501(C)(3) 9 SUTTER HLTH
 
Yes
 
(28) SUTTER WEST BAY HOSPITALS
2333 BUCHANAN STREET

SAN FRANCISCO,CA94115
94-0562680
HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(29) SUTTER WEST BAY MEDICAL FOUNDATION
2015 STEINER STREET 1ST FLOOR

SAN FRANCISCO,CA94115
94-2948131
HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
Yes
 
(30) TRACY HOSPITAL FOUNDATION
1420 N TRACY BLVD

TRACY,CA95376
68-0318845
FUNDRAISING CA 501(C)(3) 11a - I SUTTER CVH
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



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

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




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



(k)
Percentage
ownership


Yes No Yes No
(1) MAGNETIC IMAGING AF

175 LENNON
WLN CK,CA94598
94-2953833
PATIENT CARE CA NA
 
                 
(2) SURG CTR OF ABSMC

3875 TELEGRAPH
OAKLAND,CA94609
47-0946086
OUTPATIENT SURG CA NA
 
                 
(3) ALTA CT SERVICES LP

175 LENNON
WLN CK,CA94598
94-3083464
PATIENT CARE CA NA
 
                 
(4) CALIFORNIA PACIFIC ADV IMAGING LLC

PO BOX 6102
NOVATO,CA94948
56-2311840
MRI JOINT VENTURE CA NA
 
                 
(5) SAN FRANCISCO ENDOSCOPY CENTER LLC

3000 RIVERCHASE
BIRMINGHAM,AL35244
91-2165231
ENDOSCOPY JV CA NA
 
                 
(6) PRESIDIO SURGERY CENTER LLC

1635 DIVISADERO
SF,CA94115
32-0144060
AMBULATORY SURG CA NA
 
                 
(7) SUTTER FAIRFIELD SURGERY CTR

2700 LOW CT
FAIRFIELD,CA94533
30-0233892
SURGERY CA NA
 
                 
(8) TWIN CITIES SURGICAL HOSPITAL LLC

250 S WACKER
CHICAGO,IL60606
35-2182617
SURGERY CA NA
 
                 
(9) SUTTER AMADOR SURGERY CENTER LLC

2200 RIVER PLAZA
SACRAMENTO,CA95833
46-1398093
SURGERY CA NA
 
                 
(10) ROSEVILLE ENDOSCOPY CENTER LLC

4 MEDICAL PLAZA SUITE 210
ROSEVILLE,CA95661
87-0710513
ENDOSCOPY JV CA NA
 
                 
(11) MEMORIAL MEDICAL OFFICE BUILDING PRTNR I

1800 COFFEE RD SUITE 76
MODESTO,CA95355
77-0234236
OFFICE RENTAL CA NA
 
                 
(12) MEMORIAL MEDICAL OFFICE BUILDING PRTNR I

1800 COFFEE RD SUITE 76
MODESTO,CA95355
77-0287288
OFFICE RENTAL CA NA
 
                 
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTH VENTURES INC

350 HAWTHORNE ST
OAKLAND,CA94609
94-2918780
HEALTH SERVICES CA NA
 
C CORP       Yes  












Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) SUTTER MEDICAL FOUNDATION

l 151,025 FMV
(2) SUTTER WEST BAY HOSPITALS

l 993,351 FMV
(3) BETTER HEALTH EAST BAY FOUNDATION

c 1,043,898 FMV
(4) SUTTER EAST BAY MEDICAL FOUNDATION

m 2,600,606 FMV


Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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