TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) PAUL KIRINCIC...................................................................... CHAIRMAN	2.00 .................	X	X		0	0
(2) STEVEN A SCHROEDER MD...................................................................... Vice Chairman	2.00 .................	X	X		0	0
(3) Mara Perez Phd...................................................................... MGH Board member/SECRETARY	2.00 .................	X	X		0	0
(4) JEREMY FAIR...................................................................... Treasurer	2.00 .................	X	X		0	0
(5) David Hill...................................................................... MGH Board member	2.00 .................	X			0	0
(6) ANN KAO MD...................................................................... MGH Board member	2.00 .................	X			0	0
(7) Gene Marie O'Connell...................................................................... MGH Board member	2.00 .................	X			0	0
(8) Robert Peirce...................................................................... MGH Board member	2.00 .................	X			0	0
(9) Timothy Sowerby MD...................................................................... MGH Board member	2.00 .................	X			0	0
(10) WALTER ROSE...................................................................... MGH Board member	2.00 .................	X			0	0
(11) ANDREA SCHULTZ...................................................................... MGH Board member	2.00 ................. 0.50	X			0	0
(12) CHING-HUA WANG PHD MD...................................................................... MGH Board member	2.00 .................	X			0	0
(13) LEE DOMANICO...................................................................... CEO/MGH Board Ex-Officio	36.00 ................. 4.00		X		1,568,309	17,885
(14) James P Mcmanus...................................................................... CHF Financial Officer	38.00 ................. 2.00		X		442,590	35,112
(15) JON D FRIEDENBERG...................................................................... Chf Administrative Officer	32.00 ................. 8.00			X	625,180	47,642
(16) MARK A ZIELAZINSKI...................................................................... CHIEF INFO & TECH OFFICER	40.00 .................			X	445,481	35,285
(17) JOEL SKLAR MD...................................................................... Chief Medical Officer	40.00 .................			X	436,133	36,100

(A) Name and business address	(B) Description of services	(C) Compensation
PRIMA MEDICAL FOUNDATION 9 Commercial Blvd Suite 200 Novato,CA94949	PHYSICIAN SERVICES	3,587,464
MARIN HOSPITALIST MEDICAL GROUP PO BOX 708 Novato,CA94948	PHYSICIAN SERVICES	2,297,169
ANESTHESIOLOGY CONSULTANTS OF 540 San Pedro Cove San Rafael,CA94901	PHYSICIAN SERVICES	1,548,188
QUEST DIAGNOSTICS INC 3924 COLLECTION CTR DR Chicago,IL60693	Laboratory/Testing Services	1,219,836
DMS HEALTH TECHNOLOGIES 26273 NETWORK PLACE Chicago,IL60673	Radiology Services	1,024,676
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 53

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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

2015

Open to Public
Inspection

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

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

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

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.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) 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.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

Section B. Type I Supporting Organizations

Yes

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2015

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Marin General Hospital

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Marin General Hospital		Employer identification number 94-2823538

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Marin General Hospital			Employer identification number 94-2823538
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2015

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

23,014

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

23,014

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
Part II-B, Line 1:	THE ORGANIZATION PAYS MEMBERSHIP DUES TO HOSPITAL COUNCIL NORTHERN CENTRAL CALIFORNIA (HCNCC) AND DISTRICT HOSPITAL LEADERSHIP FORUM. A PORTION OF THE DUES PAID WERE USED FOR LOBBYING PURPOSES.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

2015

Open to Public Inspection

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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 ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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

Part V

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

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on 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 ...
b	Buildings	26,512,684	26,271,985	240,699
c	Leasehold improvements	66,667,122	54,192,284	12,474,838
d	Equipment ...	127,269,053	92,327,519	34,941,534
e	Other ...	21,955,018	286,669	21,668,349
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				69,325,420

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) OTHER RECEIVABLES				5,127,188
(2) Assets Limited to Use				10,280,863
(3) Deposits				385,000
(4) INTERCOMPANY RECEIVABLES				2,003,571
(5) Third party settlements				6,617,142
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				24,413,764

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INSURANCE LIABILITIES	4,726,000
POST-RETIREMENT HEALTH OBLIGATION	8,811,226
INTERCOMPANY PAYABLES	3,175,540
Accrued Pension Liabilities	20,085,934
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	36,798,700
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	382,035,000
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-487,562
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-4,806,863
e	Add lines 2a through 2d .....................			2e	-5,294,425
3	Subtract line 2e from line 1..................			3	387,329,425
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	9,428
b	Other (Describe in Part XIII.) ...........	4b	-2,715,318
c	Add lines 4a and 4b....................			4c	-2,705,890
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	384,623,535

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	347,844,000
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	2,715,564
e	Add lines 2a through 2d....................			2e	2,715,564
3	Subtract line 2e from line 1...................			3	345,128,436
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	9,428
b	Other (Describe in Part XIII.) ............	4b	16,594,253
c	Add lines 4a and 4b.....................			4c	16,603,681
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	361,732,117

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 V, Line 4:	ENDOWMENT FUNDS ARE NOW ADMINISTERED BY FOUNDATION OF WHICH THE ORGANIZATION IS THE SOLE CORPORATE PARENT. EARNINGS FROM GENERAL ENDOWMENT FUND ARE AVAILABLE TO BE DESIGNATED BY FOUNDATION BOARD. THE EARNINGS FROM THE OTHER ENDOWMENT FUNDS ARE TRANSFERRED TO RELATED TEMPORARILY RESTRICTED FUNDS.
Part X, Line 2:	MGH is organized as a not-for-profit entity under the general nonprofit corporation laws of the State of California. Exemptions from federal income taxation under Internal Revenue Code Section 501(c)(3) and California franchise taxation have been obtained. Certain activities and subsidiaries may be subject to income taxes; however, such activities are not significant to the consolidated financial statements. Accordingly, no provision for income taxes has been provided in the accompanying consolidated financial statements.
Part XI, Line 2d - Other Adjustments:	Change in Beneficial Interest in Prima Medical Foundation -9,581,059. CHANGE IN BENEFIT PLAN 354,486. Equity transfer to foundation reclassified to grant expense -540,000. Equity transfer to prima reclassified to grant expense -570,589. RECLASSification OF support to related organizations -5,902,605. Change in the INVESTMENT IN MGHF 11,432,480. AUDITED FINANCIAL STATEMENT ROUNDING 424.
Part XI, Line 4b - Other Adjustments:	RECLASSification OF RENTAL EXPENSES FROM EXPENSES -2,715,015. RECLASSification loss on disposal of asset to revenue -303.
Part XII, Line 2d - Other Adjustments:	Audited financial statement rounding 246. RECLASSIFICATION OF RENTAL EXPENSES TO REVENUE 2,715,015. RECLASSification loss on disposal of asset to revenue 303.
Part XII, Line 4b - Other Adjustments:	Equity transfer to foundation reclassified from revenues 540,000. RECLASSIFICATION OF SUPPORT TO RELATED ORGANIZATIONS 5,902,605. EQUITY TRANSFER TO PRIMA RECLASSIFIED TO GRANT EXPENSE 570,589. Change in Beneficial Interest in Prima Medical Foundation 9,581,059.
PARTS XI, XII, & XIII - RECONCILIATIONS:	The organization's audited financial statements are prepared on a consolidated basis; however, separate financial information is maintained for each organization. The separate financial information for this organization is the basis for the reconciliations at Schedule D, Parts XI, XII, & XIII.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

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

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

Yes

100% 150% 200% Other 40000.0000000000 %

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

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

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .		1,907,992		1,907,992	0.530 %
b	Medicaid (from Worksheet 3, column a) . . . . .		54,994,509	28,907,512	26,086,997	7.210 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .		32,935		32,935	0.010 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		56,935,436	28,907,512	28,027,924	7.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	3,626	184,243	10,800	173,443	0.050 %
f	Health professions education (from Worksheet 5) . . .	1,284	937,929	5,070	932,859	0.260 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .		15,907,877	944	15,906,933	4.400 %
j	Total. Other Benefits . .	4,910	17,030,049	16,814	17,013,235	4.710 %
k	Total. Add lines 7d and 7j .	4,910	73,965,485	28,924,326	45,041,159	12.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

8,480,090

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. ......

1,754,196

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

Section B. Medicare

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

83,480,996

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

140,783,667

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

-57,302,671

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 MGHSCA LLC	outpatient surgery center	51.000 %	0 %	0 %
22 MARIN MAGNETIC RESONANCE IMAGING CENTER	OUTPATIENT IMAGING/MRI CENTER	51.000 %	0 %	0 %
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

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)
1	MARIN GENERAL HOSPITAL 250 BON AIR ROAD GREENBRAE,CA94904 110000361	X	X	X

Schedule H (Form 990) 2015

Page 4

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)

	MARIN GENERAL HOSPITAL
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):

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): WWW.MARINGENERAL.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.maringeneral.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	MARIN GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 400.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.maringeneral.ORG

The FAP application form was widely available on a website (list url):

WWW.maringeneral.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.maringeneral.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	MARIN GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

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

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

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

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

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
MARIN GENERAL HOSPITAL	Part V, Section B, Line 5: Community Input:Individuals with special knowledge of, or expertise in, public health that provided input included:- Marin County Health and Human Services Department- Community Epidemiology Chief, Marin County Health and Human Services Department- Faculty, Family Health Outcomes Project, University of California, San Francisco- Former Director, Marin County Health and Human Services Department, previously served 17 years with San Francisco Public Health Department, currently President, Marin Community Foundation- Marin County Health and Human Services Department, Public Health Officer- Marin County Health and Human Services Department, Chief of Division of Alcohol, Tobacco & Other DrugsThese public health experts participated in key informant interviews and three also participated in the Healthy Marin Partnership(HMP)-coordinated community convening. The Community Epidemiology Chief was also a consultant to the CHNA work group and process. From April 23, 2012 to June 11, 2012 the Abinader Group conducted 25 phone interviews of stakeholders selected by HMP leadership. Stakeholders interviewed were HMP leadership and representatives from hospital and health organizations, public health experts, funding institutions, government, business, education, and community based agencies. Key informants, community physicians and those participating in the HMP-coordinated community convening included 44 Marin County residents and leaders representing key populations as follows. Most of the key informants also participated in the community convening.Focus groups, led by Marin Health and Human Services, were held in Marin City, Novato, Canal, San Geronimo, West Marin, Whistlestop and at the Youth Leadership Institute between April 16 and May 9, 2012. The survey asked focus group participants about: important health issues they face, their families, and their communities faced; what they saw as healthy and unhealthy about their communities; and what they'd change in their communities to make them healthier. A total of 103 English and 50 Spanish responses were obtained. Focus groups included 144 community residents representing low income, medically underserved, minority residents as well as those with chronic diseases.
MARIN GENERAL HOSPITAL	Part V, Section B, Line 6a: Other hospitals that participated with Marin General Hospital included Novato Community Hospital and Kaiser Permanente Medical Center - San Rafael.
MARIN GENERAL HOSPITAL	Part V, Section B, Line 6b: MARIN GENERAL HOSPITAL CONDUCTS ITS CHNA IN COOPERATION WITH THE HEALTHY MARIN PARTNERSHIP, WHICH INCLUDES NOVATO COMMUNITY HOSPITAL, KAISER PERMANENTE MEDICAL CENTER-SAN RAFAEL, THE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, COUNTY OFFICE OF EDUCATION, NORTH BAY LEADERSHIP COUNCIL, MARIN COMMUNITY FOUNDATION, HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA, UNITED WAY OF THE BAY AREA AND THE SAN RAFAEL CHAMBER OF COMMERCE.
MARIN GENERAL HOSPITAL	Part V, Section B, Line 11: In order to select the hospital priorities, the Community Benefit Committee reviewed the CHNA data and community-identified priorities, updated its prioritization criteria from previous CHNA periods and reviewed the available community resources for the community-identified priorities. Criteria included magnitude and severity of the health need, opportunity for Marin General Hospital to make a meaningful contribution, health disparities, ability to collaborate with existing community partnerships, community priority, opportunity to prevent more serious health issues and availability of effective strategies to address health issues.Marin General Hospital selected Access to Health Care as its community health need priority for 2014-2016. In conjunction with the CHNA report, Marin General Hospital developed an implementation strategy work plan. Listed below is a description of the selected health priority, including the need statement, the long-term goal and the anticipated impact of the strategies.Health Need PriorityAccess to health care/medical homes/insurance coverage is a health need because of its impact on obtaining timely and effective treatment for all health outcome needs such as cancer, heart disease, asthma, mental health, substance abuse and diabetes.Goal: Increase number of individuals who have access to and receive appropriate health care services in Marin County.Anticipated Impact:a. Increased access to care.b. Increase the number of patients seen and/or the range of services offered at community health centers and clinics.Ongoing programs to address significant health needs in the community:Care For Low Income And Uninsured Residents: The hospital will continue to provide Charity Care to the indigent and care for Medi-Cal beneficiaries for whom MGH is reimbursed less than the cost of providing care.Health Education Events: Marin General Hospital will continue to provide health education programs, patient support groups and community consultation through phone support for residents with breastfeeding and nutrition questions as well as low-cost mammogram screenings.Center for Integrative Health & Wellness: Marin General Hospital will offer integrative health therapies and educational classes to the broader community.Financial Support for Key Community Health Programs: Marin General Hospital will continue financial and inkind support to a variety of organizations, with priority given to those who are directly health related and support the vulnerable communities in Marin County.Professional and Student Education: Marin General Hospital, in cooperation with local colleges and universities, will continue to provide preceptorships and clinical rotations for health professionals in departments such as nursing, pharmacy, radiology, respiratory therapy and rehabilitation services as well as education for current physicians, nurses and staff. Marin General Hospital also offers job-shadowing opportunities for those interested in health careers.Marin General Hospital does not intend to specifically address the following community health needs except through its access programs and community collaborations:1. Mental health2. Substance abuse3. Socioeconomic status (income, employment, education level)4. Healthy eating and active living (nutrition/healthy food/food access/physical activity5. Social supports (family and community support systems and services; connectedness)6. Cancer7. Heart diseaseThe reasons for not addressing these needs as a community benefit priority include: resource constraints and limited ability to have a meaningful impact.

Schedule H (Form 990) 2015

Page 8

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?10
Name and address		Type of Facility (describe)
1	1 - IMAGING CENTER 1350 s Eliseo drive 105 205 greenbrae,CA94904	Outpatient Imaging
2	2 - oncology services 1350 s Eliseo drive 100 140 greenbrae,CA94904	Outpatient Oncology
3	3 - outpatient lab 655 redwood hwy 100 mill valley,CA94941	outpatient lab
4	4 - outpatient lab 5 bon Air road 119 Larkspur,CA94939	outpatient lab
5	5 - outpatient lab 900 s Eliseo drive 104 greenbrae,CA94904	outpatient lab
6	6 - physical therapy 1350 s Eliseo drive 250 greenbrae,CA94904	physical therapy
7	7 - OUTPATIENT SURGERY CENTER 505 Sir Francis Drake Blvd GREenbrae,CA94904	Outpatient Surgery
8	8 - PRIMA Medical Foundation 100 A Drakes Landing GREENbrae,CA94904	Physician's Medical Group
9	9 - OUTPATIENT LAB 100 A Drakes Landing greenbrae,CA94904	OUTPATIENT LAB
10	10 - Marin Magnetic Imaging 1260 S Eliseo GREENBRAE,CA94904	OUTPATIENT IMAGING

Schedule H (Form 990) 2015

Page 9

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
Part I, Line 3c:	TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINE (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: 1) SPECIAL CIRCUMSTANCES CHARITY CARE: A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, INELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING MGH'S CHARITY CARE ELIGIBILITY CRITERIA. 2) CATASTROPHIC CHARITY CARE: PARTIAL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 10% OF PATIENT'S FAMILY INCOME. PATIENTS THAT MEET THE CRITERIA WILL RECEIVE A FULL WRITE-OFF OF UNDISCOUNTED CHARGES THAT EXCEED 30% OF THEIR INCOME. 3) UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN 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. 4) PROMPT PAYMENT DISCOUNT: ADDITIONAL DISCOUNT FOR PATIENTS RECEIVING THE UNINSURED DISCOUNT OF AT LEAST 10% WHO PAYS ESTIMATED BILL PRIOR TO DISCHARGE.
Part III, Line 4:	1. 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 2.2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.3. ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS - MGH'S NET PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, MGH ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCES FOR BOTH CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THESE ALLOWANCES. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, MGH ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PAYMENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), MGH RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST ALLOWANCE FOR DOUBTFUL ACCOUNTS.MGH'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 21.9% AND 21.1% OF NET PATIENT ACCOUNTS RECEIVABLE AT DECEMBER 31, 2015 AND 2014, RESPECTIVELY. MGH HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2015 OR 2014.SIGNIFICANT CONCENTRATIONS OF NET PATIENT ACCOUNTS RECEIVABLE ARE AS FOLLOWS:COMMERCIAL - 64%MEDICARE - 18%MEDI-CAL - 14%PRIVATE PAY AND OTHER - 4%MGH PROVIDES FOR ESTIMATED LOSSES ON PATIENT ACCOUNTS RECEIVABLE BASED ON PRIOR BAD DEBT EXPERIENCE AND GENERALLY DOES NOT CHARGE INTEREST ON PAST DUE BALANCES. PAST DUE STATUS IS BASED UPON THE DATE OF SERVICES PROVIDED. UNCOLLECTIBLE RECEIVABLES ARE CHARGED OFF WHEN DEEMED UNCOLLECTIBLE. DUE TO THE INHERENT VARIABILITY IN THIS AREA OF PATIENT RECEIVABLE COLLECTIONS, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM.
Part III, Line 8:	The organization did not count the Medicare shortfall as a community benefit. All Medicare revenue and cost was included in the organization's Medicare cost report. Medicare allowable costs were calculated using a cost to charge ratio.
Part III, Line 9b:	COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS ARE GIVEN AN APPLICATION WHICH DOCUMENTS 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 AND HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
Part VI, Line 2:	NEEDS ASSESSMENT: IN ADDITION TO THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, HEALTH NEEDS ARE MONITORED AS FOLLOWS:- MARIN GENERAL HOSPITAL PARTICIPATION IN THE HEALTHY MARIN PARTNERSHIP DESCRIBED IN SCHEDULE H, PART II;- MARIN HEALTHCARE DISTRICT BOARD MEETINGS, WHICH INCLUDE PUBLIC COMMENTS AND WHICH THE MARIN GENERAL HOSPITAL CEO ATTENDS AND SHARES COMMUNITY INPUT WITH HOSPITAL STAFF AS APPROPRIATE;- MARIN GENERAL HOSPITAL BOARD MEMBERS ARE ALL COMMUNITY RESIDENTS AND SHARE COMMUNITY HEALTH CONCERNS WHEN APPROPRIATE;- COMMUNITY COMMENTS ON THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE COLLECTED ON THE MARIN GENERAL HOSPITAL WEBSITE AND ARE MONITORED BY THE COMMUNITY RELATIONS DEPARTMENT.
Part VI, Line 3:	PATIENT EDUCATION of ELIGIBILITY FOR ASSISTANCE: MGH's Charity Care Policy includes the following details related to patient education for eligibiity assistance. Communication of financial assistance availability A. Information provided to patients: 1. Preadmission or registration: During preadmission or registration (or as soon thereafter as practicable) hospital shall provide: A. All patients with information regarding the availability of financial assistance and their right to request an estimate of their financial responsibilty for services (important billing information for uninsured patients). B. Patients who the hospital identify may be uninsured with a financial assistance application substantially similar to the Marin General Hospital standarized financial assistance application, "Statement of Financial Condition". 2. Emergency Services: In the case of emergency services, hospital 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 shall provide patients with information about their right to request an estimate of their financial responsibility for services, MGH 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 MGH website. 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 third-party liens, and dispute initiation policy. C. Applications provided at discharge: If not previously provided, hospital shall provide uninsured patients with applications for Medi-cal, Healthy Families, California Children's Services, or any other potentially applicable govenrment program at the time of discharge. D. Languages: All notices/communications provided in this section shall be available in the primary languages of MGH's service area and in a manner consistent with all applicable federal and state laws and regulations. E. Notification 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 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 represent the amount the hospital 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.
Part VI, Line 4:	COMMUNITY INFORMATION: MARIN GENERAL HOSPITAL DEFINES THE COMMUNITY SERVED BY THE HOSPITAL AS THOSE INDIVIDUALS RESIDING WITHIN ITS HOSPITAL SERVICE AREA. A HOSPITAL SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW-INCOME OR UNDERSERVED POPULATIONS. THE MARIN GENERAL HOSPITAL SERVICE AREA INCLUDES ALL OF MARIN COUNTY. THE CITIES INCLUDED ARE: BELVEDERE, CORTE MADERA, FAIRFAX, LARKSPUR, MILL VALLEY, NOVATO, ROSS, SAN ANSELMO, SAN RAFAEL, SAUSALITO, TIBURON, AND THE COASTAL TOWNS OF STINSON BEACH, BOLINAS, POINT REYES, INVERNESS, MARSHALL, AND TOMALES. CERTAIN SPECIALTY PROGRAMS, INCLUDING ITS TRAUMA SERVICE, SERVE A BROADER POPULATION, INCLUDING PATIENTS FROM SONOMA COUNTY, THE BROADER SAN FRANCISCO BAY AREA AND BEYOND.THE KEY DRIVERS OF HEALTH STATUS ARE INCOME, EDUCATION AND HEALTH INSURANCE. WHILE MARIN COUNTY COMPARES WELL WITH THE STATE, THERE ARE CLEAR VULNERABLE POPULATIONS WHOSE HEALTH STATUS IS MOST AT RISK; 19.14% OF RESIDENTS LIVING BELOW 200% FEDERAL POVERTY LEVEL (FPL); 17.8% OF CHILDREN LIVING BELOW 200% FPL; 8.9% OF RESIDENTS WHO ARE UNINSURED; 7.6% OF RESIDENTS WITHOUT A HIGH SCHOOL DIPLOMA; 15.5% OF RESIDENTS ARE HISPANIC/LATINO; 2.9% OF RESIDENTS ARE BLACK AND 5.6% OF RESIDENTS ARE ASIAN.
Part VI, Line 5:	PROMOTION OF COMMUNITY HEALTH: In addition to the services listed in Part I, line 7, Marin General Hospital is the only full service acute care hospital in the County, the only hospital with an obstetrical service or in patient behavioral health service. It serves as the Trauma Center for Marin County and surrounding areas. The Board of directors is composed of community residents. All funds are used to improve health care services, maintain uptodate facilities and support training programs for health professionals in areas such as nursing, pharmacy, radiology, respiratory therapy, rehabilitation services and behavioral health. The medical staff is open to all qualified physicians.
Part VI, Line 7, Reports Filed With States	CA

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

Complete if the organization answered "Yes," on 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

2015

Open to Public
Inspection

Name of the organization
Marin General Hospital

Employer identification number
94-2823538

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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) Marin General Hospital Volunteers 250 Bon Air Rd Greenbrae,CA94904	94-2823538	501(c)(3)	63,355	General Support
(2) Marin Economic Forum 3501 Civic Center Drive San Rafael,CA94903	68-0101012	501(c)(3)	10,000	General Support
(3) San Rafael Chamber of Commerce 817 Mission Ave San Rafael,CA94901	94-0839470	501(c)(6)	6,000	General Support
(4) Marin General Hospital Foundation 100B Drakes Landing 255 Greenbrae,CA94904	94-6127213	501(c)(3)	540,000	General Support
(5) PRIMA MEDICAL FOUNDATION 9 Commercial Blvd 200 NOVATO,CA94949	27-1376321	501(c)(3)	10,151,649	General Support
(6) Marin Healthcare District 100B DRAKES LANDING 200 Greenbrae,CA94904	91-1886269	HC dist. entity	5,848,370	Support 1206b Clinics
(7) Mt Tam Orhopedics 18 Bon Air Road Larkspur,CA94925	68-0237096	N/A	35,400	General Support
(8) Colin Hamblin a Professional Medical Corp PO Box 246 11150 State Route One Point Reyes Station,CA94956	46-1119089	HC dist. entity	5,250	Support 1206b Clinics

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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

(1) PATIENT ASSISTANCE	110	28,202
(1)
(2)
(3)
(4)
(5)
(6)
(7)

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
Part I, Line 2:	ORGANIZATION PRE-SCREENS INDIVIDUALS FOR ELIGIBILITY. GRANTS ARE PAID DIRECTLY TO PROVIDER OF SERVICES TO PATIENTS. THE HOSPITAL DOES NOT REQUIRE ACCOUNTING OF THE USE OF GRANT FUNDS PROVIDED. IN THE CASES OF GENERAL PURPOSE GRANTS, THE GRANTEE'S CHARITABLE PURPOSE IS REVIEWED PRIOR TO THE ISSUANCE OF THE GRANT.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

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? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

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

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

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

Any related organization?

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1LEE DOMANICOCEO/MGH Board Ex-Officio	(i) (ii)	774,366 ------------- 0	576,254 ------------- 0	217,689 ------------- 0	17,885 ------------- 0	0 ------------- 0	1,586,194 ------------- 0	0 ------------- 0
2James P McmanusCHF Financial Officer	(i) (ii)	383,283 ------------- 0	0 ------------- 0	59,307 ------------- 0	13,250 ------------- 0	21,862 ------------- 0	477,702 ------------- 0	0 ------------- 0
3JON D FRIEDENBERGChf Administrative Officer	(i) (ii)	402,126 ------------- 0	163,747 ------------- 0	59,307 ------------- 0	17,726 ------------- 0	29,916 ------------- 0	672,822 ------------- 0	0 ------------- 0
4MARK A ZIELAZINSKICHIEF INFO & TECH OFFICER	(i) (ii)	330,281 ------------- 0	70,116 ------------- 0	45,084 ------------- 0	14,047 ------------- 0	21,238 ------------- 0	480,766 ------------- 0	0 ------------- 0
5JOEL SKLAR MDChief Medical Officer	(i) (ii)	298,197 ------------- 0	113,916 ------------- 0	24,020 ------------- 0	14,862 ------------- 0	21,238 ------------- 0	472,233 ------------- 0	0 ------------- 0
6LINDA LANGChf HR Officer	(i) (ii)	274,108 ------------- 0	69,617 ------------- 0	42,368 ------------- 0	13,642 ------------- 0	10,094 ------------- 0	409,829 ------------- 0	0 ------------- 0
7Karin ReeseVP Nursing	(i) (ii)	266,833 ------------- 0	8,424 ------------- 0	0 ------------- 0	13,250 ------------- 0	7,376 ------------- 0	295,883 ------------- 0	0 ------------- 0
8GREGORY LEECard Cath Tech IV	(i) (ii)	490,975 ------------- 0	0 ------------- 0	0 ------------- 0	32,607 ------------- 0	10,094 ------------- 0	533,676 ------------- 0	0 ------------- 0
9SANDY D AUGUSTUSClinical RN III	(i) (ii)	374,260 ------------- 0	0 ------------- 0	0 ------------- 0	24,367 ------------- 0	29,916 ------------- 0	428,543 ------------- 0	0 ------------- 0
10MARGARET M ROBERTSClinical RN III	(i) (ii)	346,226 ------------- 0	0 ------------- 0	0 ------------- 0	57,161 ------------- 0	21,238 ------------- 0	424,625 ------------- 0	0 ------------- 0
11CHUN LIChief Clin Physicist	(i) (ii)	296,808 ------------- 0	35,594 ------------- 0	0 ------------- 0	62,490 ------------- 0	19,952 ------------- 0	414,844 ------------- 0	0 ------------- 0
12Paula ScariatiCHF Med Info Officer (thru 12/24/15)	(i) (ii)	306,122 ------------- 0	33,002 ------------- 0	0 ------------- 0	0 ------------- 0	18,788 ------------- 0	357,912 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

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 3, Other reportable Compensation:

THE TAXABLE COMPENSATION RECEIVED BY THE EXECUTIVE TEAM WAS FOR HEALTH AND WELFARE BENEFITS, DEFINED BENEFIT RETIREMENT PENSION PLAN, DISBILITY, LONG-TERM CARE INSURANCE, LIFE INSURANCE AND ACCIDENTIAL DEATH AND DISMEMBERMENT INSURANCE. THE TAXABLE COMPENSATION RECEIVED BY THE KEY EMPLOYEES AND FIVE HIGHEST COMPENSATED EMPLOYEES WAS FOR GROUP TERM LIFE INSURANCE. THE OTHER REPORTABLE COMPENSATION WAS INCLUDED IN THEIR FORM W-2.

Part I, Line 7:

The calculation of bonuses is dependent on many factors that are assigned various weightings. Those factors are: - Patient satisfaction survey scores - Employee satisfaction survey scores - Physician satisfaction survey scores - Excess of revenue over expenses - Revenue growth - Community benefit programs - Quality and safety results

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 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

2015

Open to Public
Inspection

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Return Reference	Explanation
FORM 990, PART III, LINE 4A : EXEMPT PURPOSE ACHIEVEMENTS	MARIN GENERAL HOSPITAL (MGH) IS A NOT-FOR-PROFIT HOSPITAL LOCATED IN GREENBRAE, CALIFORNIA, WITH 235 LICENSED ACUTE CARE BEDS, IT IS THE LARGEST ACUTE CARE HOSPITAL IN MARIN COUNTY AND PROVIDES BOTH PRIMARY AND SECONDARY CARE AND GENERAL SERVICES SUCH AS THE CANCER INSTITUTE AND THE HAYNES CARDIOVASCULAR INSTITUTE. OTHER SERVICES INCLUDE A LEVEL III TRAUMA CENTER AND FULL COMPLEMENT OF ACUTE CARE AND ANCILLARY SERVICES SUCH AS NEONATAL INTENSIVE CARE, PEDIATRICS, A FAMILY BIRTHING CENTER, ADULT BEHAVIORAL HEALTH SERVICES, AN ELECTROPHYSIOLOGY LABORATORY, STROKE PROGRAM AND CARDIAC CATHETERIZATION LABORATORY. MGH IS ACCREDITED BY THE JOINT COMMISSION AND HAS RECEIVED THE HEALTHGRADES DISTINGUISHED HOSPITAL AWARD FOR CLINICAL EXCELLENCE FOR THE PAST TWO YEARS. THIS AWARD IS GIVEN TO THE TOP 5% OF HOSPITALS IN THE NATION. MISSION AND VISION: MISSION OF MGH IS AS FOLLOWS: TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES IN A COMPASSIONATE AND HEALING ENVIRONMENT. VISION OF MGH IS AS FOLLOWS: TO EXCEED EACH COMMUNITY MEMBER'S HIGHEST EXPECTATIONS FOR QUALITY HEALTH CARE. GOVERNANCE: MGH IS AN INDEPENDENT 501(C)(3) NOT FOR PROFIT HOSPITAL. ITS SOLE CORPORATE MEMBER IS THE MARIN HEALTHCARE DISTRICT, A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA, WHICH RETAINS CERTAIN RESERVE POWERS OVER THE ORGANIZATION. MGH IS GOVERNED BY ITS OWN BOARD OF DIRECTORS.
Form 990, Part VI, Section A, line 6	Marin Healthcare District is the sole corporate member of Marin General Hospital.
Form 990, Part VI, Section A, line 7a	The Board of Directors of the General Member (a standing board-selected "nominating committee") may, by resolution, authorize a person or committee of persons to exercise its vote on any matter to come before the membership of this Corporation. In addition, the General Member may exercise its membership rights at any regular or special meeting of the Board of Directors of the General Member. The functions required by law or by the Bylaws to be performed at the annual membership meeting or any regular or special meeting of the members of this Corporation may be performed at any regular or special meeting of the General Member's own Board of Directors.
Form 990, Part VI, Section A, line 7b	OTHER RESERVED RIGHTS INCLUDE: A. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; B. DISPOSITION OF A SIGNIFICANT PORTION OF THE ASSETS OF THE ORGANIZATION; AND C. ISSUANCE OF LONG TERM DEBT EXCEEDING A CERTAIN PORTION OF THE ORGNIZATION'S ASSETS.
Form 990, Part VI, Section B, line 11	OUR TAX ADVISOR PROVIDES AND PREPARES THE RETURN IN CONSULTATION WITH OUR ACCOUNTING DEPARTMENT. THE INFORMATION IS THEN REVIEWED BY OUR CHIEF FINANCIAL OFFICER. A COPY OF THE FORM WAS PROVIDED TO ALL VOTING MEMBERS OF THE GOVERNING BOARD FOR THEIR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
Form 990, Part VI, Section B, line 12c	EACH INDIVIDUAL BOARD MEMBER AND OFFICER HAS TO SIGN AN ACKNOWLEDGEMENT FORM THAT THEY HAVE READ THE POLICY. A DISCLOSURE STATEMENT IS COMPLETED BY ALL OFFICERS AND BOARD MEMBERS ANNUALLY. 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 LEGAL COUNSEL AS NECESSARY. IF THERE IS A POTENTIAL CONFLICT OF INTEREST RELATED TO A PARTICULAR TRANSACTION, THE INTERESTED TRUSTEE 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 TRUSTEE TO LEAVE THE ROOM OR NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE INTERESTED TRUSTEE SHALL REFRAIN FROM VOTING ON ANY MATTER RELATED TO THE TRANSACTION.
Form 990, Part VI, Section B, line 15	THE EXECUTIVE COMMITTEE OF THE MGH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE EXECUTIVE COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF MGH'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 AND REGIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS MGH ARE MOST APPROPRIATE. ALL OFFICERS OF THE ORGANIZATION UNDERGO A REVIEW ANNUALLY.
Form 990, Part VI, Section C, line 19	MARIN GENERAL HOSPITAL WILL MAKE THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part XI, line 9:	Change in Benefit Plan 354,486. audited financial statement Rounding -511.
FORM 990, PART XII, LINE 2C : AUDIT COMMITTEE and Oversight	MARIN GENERAL HOSPITAL HAD AN AUDIT OF ITS BALANCE SHEET AND STATEMENT OF OPERATIONS PERFORMED BY INDEPENDENT AUDITORS. AN AUDIT COMMITTEE SELECTS THE AUDITORS AND REVIEWS RESULTS. There have been no changes to this process from prior year.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Marin General Hospital

Employer identification number

94-2823538

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Marin Healthcare District 100 B Drakes Landing Rd Ste 250 GREENBRAE,CA94904 91-1886269	Corporate Parent	CA	HC District entity		N/A		No
(2)Marin General Hospital Foundation 100 B Drakes Landing Rd Ste 250 GREENBRAE,CA94904 94-6127213	FundRaising Foundation	CA	501(C)(3)	11-i	MARIN GENERAL HOSPITAL	Yes
(3)PRIMA Medical Foundation 9 Commercial Blvd 200 Novato,CA94949 27-1376321	Physician Medical Foundation	CA	501(C)(3)	9			No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) mghsca llc 100B Drakes Landing Rd Ste 190 GREENBRAE,CA94904 38-3861395	outpatient surgery center	CA	Marin General Hospital	inVESTMENT	290,041	98,527		No		Yes		51.000 %
(2) MARIN MAGNETIC RESONANCE IMAGING CENTER 1260 south eliseo grEENBRAE,CA94904 68-0055977	outpatient imaging	CA		INVESTMENT	494,527	291,651		No			No	51.000 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) MARIN GENERAL HOSPITAL FOUNDATION	B	540,000	BOOK VALUE
(2) MARIN GENERAL HOSPITAL FOUNDATION	C	4,063,703	BOOK VALUE
(3) MARIN GENERAL HOSPITAL FOUNDATION	M	754,530	BOOK VALUE
(4) MARIN GENERAL HOSPITAL FOUNDATION	O	494,766	BOOK VALUE
(5) MARIN GENERAL HOSPITAL FOUNDATION	Q	578,591	BOOK VALUE
(6) PRIMA MEDICAL FOUNDATION	B	10,151,649	BOOK VALUE

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

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) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES IN A COMPASSIONATE AND HEALING ENVIRONMENT.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,870
6	Total number of volunteers (estimate if necessary) .............	6	230
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	24,050
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	1,634

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,264,934	4,063,703
9	Program service revenue (Part VIII, line 2g) .........	342,550,097	376,084,026
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	282,386	221,081
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,776,541	4,254,725
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	350,873,958	384,623,535
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	14,996,385	16,714,868
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)	186,875,779	198,861,599
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	130,332,785	146,155,650
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	332,204,949	361,732,117
19	Revenue less expenses. Subtract line 18 from line 12.......	18,669,009	22,891,418
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	220,313,642	244,811,264
21	Total liabilities (Part X, line 26).............	141,584,908	143,324,699
22	Net assets or fund balances. Subtract line 21 from line 20.....	78,728,734	101,486,565

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 331,018,116 including grants of $ 16,714,868 ) (Revenue $ 376,084,026 )
	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 expenses331,018,116

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) LINDA LANG........................................................................ Chf HR Officer	40.00 .......................	X		386,093	0	23,736
(19) Karin Reese........................................................................ VP Nursing	40.00 .......................	X		275,257	0	20,626
(20) GREGORY LEE........................................................................ Card Cath Tech IV	40.00 .......................		X	490,975	0	42,701
(21) SANDY D AUGUSTUS........................................................................ Clinical RN III	40.00 .......................		X	374,260	0	54,283
(22) MARGARET M ROBERTS........................................................................ Clinical RN III	40.00 .......................		X	346,226	0	78,399
(23) CHUN LI........................................................................ Chief Clin Physicist	40.00 .......................		X	332,402	0	82,442
(24) Paula Scariati........................................................................ CHF Med Info Officer (thru 12/24/15)	40.00 .......................		X	339,124	0	18,788

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,062,030	0	492,999

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	4,063,703
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.......		4,063,703

			Business Code
2a	PATIENT SERVICE REV.	621110	376,084,026	376,084,026
b
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			376,084,026

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			174,565			174,565
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,626,865
b	Less: rental expenses		2,715,015
c	Rental income or (loss)		-1,088,150
d	Net rental income or (loss)......			-1,088,150			-1,088,150
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	4,926	10,616,533
b	Less: cost or other basis and sales expenses	5,229	10,569,714
c	Gain or (loss)	-303	46,819
d	Net gain or (loss).....			46,516			46,516
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..
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..
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..
Business Code			Miscellaneous Revenue
11a	All Other Revenues		900099	3,661,724		24,050	3,637,674
b	EHR Revenue		541519	1,000,000			1,000,000
c	Investment in Partnership		900099	681,151			681,151
d	All other revenue ....
e	Total. Add lines 11a–11d ......			5,342,875
12	Total revenue. See Instructions......			384,623,535	376,084,026	24,050	4,451,756

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	16,686,666	16,686,666
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	28,202	28,202
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	4,395,431		4,395,431
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	146,636,968	135,978,647	10,658,321
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	10,233,987	9,448,407	785,580
9	Other employee benefits .......	27,160,133	24,620,420	2,539,713
10	Payroll taxes ...........	10,435,080	9,300,022	1,135,058
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	2,855,747	2,843,815	11,932
c	Accounting ...........	316,741		316,741
d	Lobbying ...........	23,014		23,014
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	13,522,384	13,522,384
12	Advertising and promotion ....	1,347,040	1,347,040
13	Office expenses .......	2,949,026	2,910,888	38,138
14	Information technology ......	1,404,401	1,259,045	145,356
15	Royalties ..
16	Occupancy ...........	19,257,777	17,817,769	1,440,008
17	Travel ............	184,489	184,489
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	909,372	909,372
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	14,087,301	14,087,301
23	Insurance ...	1,344,576	1,210,118	134,458
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	45,972,680	45,972,680
b	PURCHASED SERVICES	36,530,549	28,125,390	8,405,159
c
d
e	All other expenses	5,450,553	4,765,461	685,092
25	Total functional expenses. Add lines 1 through 24e	361,732,117	331,018,116	30,714,001	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			47,165,087	1	75,042,975
2	Savings and temporary cash investments .........			384,208	2	392,136
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			57,309,159	4	56,377,978
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
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
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			5,379,712	8	5,722,040
9	Prepaid expenses and deferred charges ......			4,369,756	9	3,911,211
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	242,403,877
b	Less: accumulated depreciation	10b	173,078,457	71,645,139	10c	69,325,420
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			8,503,260	12	9,625,740
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			25,557,321	15	24,413,764
16	Total assets. Add lines 1 through 15 (must equal line 34)...			220,313,642	16	244,811,264

17	Accounts payable and accrued expenses .....	53,813,846	17	51,278,565
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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..		22
23	Secured mortgages and notes payable to unrelated third parties ..	46,953,983	23	55,247,434
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	40,817,079	25	36,798,700
26	Total liabilities. Add lines 17 through 25..	141,584,908	26	143,324,699

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	78,728,734	27	101,486,565
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	78,728,734	33	101,486,565
34	Total liabilities and net assets/fund balances ........	220,313,642	34	244,811,264