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) ROBERT CURRY...................................................................... BOARD MEMBER, VICE CHAIRPERSON	4.0 ................. 0.0	X			0	0	0
(2) RICHARD IGRAM...................................................................... BOARD MEMBER	2.0 ................. 48.0	X			0	550,744	39,085
(3) ANTHONY KOSINSKI...................................................................... CHIEF OF STAFF	2.0 ................. 0.0	X			0	0	0
(4) SISTER MARY BERNADETTE MCNULTY...................................................................... BOARD MEMBER, TREASURER	2.0 ................. 48.0	X	X		0	0	0
(5) SCOTT PRITCHARD...................................................................... BOARD MEMBER	2.0 ................. 0.0	X			0	0	0
(6) TODD SALNAS...................................................................... BOARD MEMBER/PRESIDENT, SJH-SC	2.0 ................. 48.0	X	X		0	650,942	50,791
(7) SISTER MARIAN SCHUBERT...................................................................... BOARD MEMBER	2.0 ................. 48.0	X			0	0	0
(8) JOSEPHINE THORNTON...................................................................... BOARD MEMBER	2.0 ................. 0.0	X			0	0	0
(9) MICHAEL TOMASINI...................................................................... BOARD MEMBER	2.0 ................. 0.0	X			0	0	0
(10) PAMELA TUFT...................................................................... BOARD MEMBER, CHAIRPERSON	5.0 ................. 0.0	X			0	0	0
(11) JAMES WATSON...................................................................... BOARD SECRETARY (PART YEAR)	2.0 ................. 48.0	X	X		0	720,505	55,849
(12) OLUYEMI ADEYANJU...................................................................... BOARD SECRETARY	2.0 ................. 48.0		X		0	166,281	2,087
(13) MICHEL RICCIONI...................................................................... CHIEF FINANCIAL OFFICER	7.0 ................. 43.0		X		0	752,852	46,110
(14) JANE READ...................................................................... VP-OPERATIONS	50.0 ................. 0.0			X	335,762	0	22,868
(15) KEVIN KLOCKENGA...................................................................... REGIONAL EVP - NCA	7.0 ................. 43.0			X	0	1,021,111	33,602
(16) DAVID ZIOLKOWSKI...................................................................... CHIEF OPERATING OFFICER	7.0 ................. 43.0			X	0	376,494	38,082
(17) JAYNIE BOREN...................................................................... N.CA REG VP-STRATEGIC SVCS	7.0 ................. 43.0			X	0	427,709	32,872

(A) Name and business address	(B) Description of services	(C) Compensation
MEDICAL STAFFNG NETWORK, PO BOX 840292 DALLAS,TX75284	MEDICAL STAFFING	857,231
INTERIM PHYSICIANS LLC, PO BOX 678004 DALLAS,TX75267	MEDICAL STAFFING	544,026
CARDINAL HEALTH INC, 3238 DWIGHT ROAD ELK GROVE,CA95758	MEDICAL SUPPLIES	515,582
M ATCHISON CRNA INC, 107 MACINNES COURT NAPA,CA94558	MEDICAL STAFFING	501,875
PETALUMA SURGICAL ASSOCIATES, 1496 PROFESSIONAL DRIVE STE 601 PETALUMA,CA94954	MEDICAL STAFFING	496,377
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 21

- 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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

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

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

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

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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, 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 SRM ALLIANCE HOSPITAL SERVICES

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	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 SRM ALLIANCE HOSPITAL SERVICES		Employer identification number 68-0395200

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 SRM ALLIANCE HOSPITAL SERVICES			Employer identification number 68-0395200
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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

9,314

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

9,314

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
SCHEDULE C, PART II-B, LINE 1I	PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS FOR LOBBYING DURING THE YEAR, ST. JOSEPH HEALTH SYSTEM CONDUCTED ADVOCACY EFFORTS WHICH INCLUDED SOME LOBBYING ACTIVITIES. THESE ACTIVITIES INCLUDED MEETING WITH LOCAL, STATE AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS, AS WELL AS COMMUNICATION TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION. THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO PETALUMA VALLEY HOSPITAL.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1I

PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS FOR LOBBYING DURING THE YEAR, ST. JOSEPH HEALTH SYSTEM CONDUCTED ADVOCACY EFFORTS WHICH INCLUDED SOME LOBBYING ACTIVITIES. THESE ACTIVITIES INCLUDED MEETING WITH LOCAL, STATE AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS, AS WELL AS COMMUNICATION TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION. THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO PETALUMA VALLEY HOSPITAL.

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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" 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 ...			0
b	Buildings	10,715,959	10,715,959
c	Leasehold improvements	6,250,793	5,310,069	940,724
d	Equipment ...	31,717,185	23,326,453	8,390,732
e	Other ...	2,936,129		2,936,129
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				12,267,585

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) HOSPITAL FEE				840,499
(2) HOSPICE RESTRICTED FUNDS				2,297,274
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				3,137,773

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	0
ACCRUED LIABILITIES	2,379,847
INTERCOMPANY BOND PAYABLES	114,015
DUE TO AFFILIATES	13,137,650
PAYABLE TO THIRD PARTY PAYORS	875,420
OTHER NON-CURRENT LIABILITIES	154,951
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	16,661,883
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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

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

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

SCHEDULE D, PART X, LINE 2

FIN 48(ASC 740) Footnote ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2016 OR 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

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

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

Information about Schedule G (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
SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

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

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

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

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

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

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

YesNo

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

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










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

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

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

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

		(a) Event #1 BENEDETTI (event type)	(b) Event #2 HOSPICE GOLF (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	340,200	106,591	446,791
2	Less: Contributions . . . .	310,450	80,095	390,545
3	Gross income (line 1 minus line 2) . . . . . .	29,750	26,496	56,246

4	Cash prizes . . . . .
5	Noncash prizes . . . .		12,197	12,197
6	Rent/facility costs . . . .		10,199	10,199
7	Food and beverages . . .	31,680	17,805	49,485
8	Entertainment . . . .	375		375
9	Other direct expenses . . .	67,794	17,915	85,709
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			157,965
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			-101,719

Part III

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

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	67,794	17,915	85,709

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

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

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

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

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

YesNo

If "No," explain:

10a

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

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

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

YesNo

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

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

YesNo

Indicate the percentage of gaming activity conducted in:

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

13a

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

13b

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

Name

Address

15a

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

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

YesNo

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

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

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

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

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

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

YesNo

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

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

Part IV

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

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

200% 250% 300% 350% 400% Other 500 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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		(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) . . .	900,164		900,164	0.980 %
b	Medicaid (from Worksheet 3, column a) . . . . .	22,226,144	13,257,456	8,968,688	9.780 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	392	115	277
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	23,126,700	13,257,571	9,869,129	10.760 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	153,176	26,187	126,989	0.140 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	25,000		25,000	0.030 %
j	Total. Other Benefits . .	178,176	26,187	151,989	0.170 %
k	Total. Add lines 7d and 7j .	23,304,876	13,283,758	10,021,118	10.930 %

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.

		(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	25,574	8,245	17,329	0.010 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	25,574	8,245	17,329	0.010 %

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. ......

4,871,549

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

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

Section B. Medicare

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

19,322,626

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

27,052,826

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

-7,730,200

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 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	SRM ALLIANCE HOSPITAL SERVICES 400 NORTH MCDOWELL BLVD PETALUMA,CA94954 WWW.STJOESONOMA.ORG 110000001	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)

	SRM ALLIANCE HOSPITAL SERVICES
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): SEE SCHEDULE H, PART V, SECTION C

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): SEE SCHEDULE H, PART V, SECTION C

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)

	SRM ALLIANCE HOSPITAL SERVICES
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 200.% and FPG family income limit for eligibility for discounted care of 500.%

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

Yes

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):

SEE PART V, SECTION C

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

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C

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)

	SRM ALLIANCE HOSPITAL SERVICES
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
SCHEDULE H, PART V, SECTION B, LINE 5	THE SANTA ROSA MEMORIAL HOSPITAL AND PETALUMA VALLEY HOSPITAL (SRMH AND PVH) COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED AS A COMMUNITY COLLABORATIVE AND TOOK INTO ACCOUNT COMMUNITY INPUT THROUGH THREE METHODS: KEY INFORMANT INTERVIEWS WITH LEADERS IN THE COMMUNITY INCLUDING FROM THE COUNTY DEPARTMENT OF HEALTH SERVICES AND LOCAL HEALTH, EDUCATION AND BUSINESS LEADERS, FOCUS GROUPS IN DIFFERENT COMMUNITIES THROUGHOUT THE COUNTY, BALANCED IN TERMS OF GEOGRAPHY AND CULTURE, AND A TELEPHONE SURVEY OF 1,500 PEOPLE. THESE THREE METHODS ALLOWED THE CHIC TO HEAR FROM CONTENT EXPERTS, COMMUNITY LEADERS, AND A BROAD SPECTRUM OF COMMUNITY MEMBERS. KEY INFORMANT INTERVIEWS WITH LOCAL EXPERTS CHNA PROJECT PARTNERS IDENTIFIED A PANEL OF 18 KEY INFORMANTS. KEY INFORMANTS WERE SELECTED FOR THEIR EXPERTISE IN A BROAD VARIETY OF HEALTH AND HEALTH-RELATED DISCIPLINES INCLUDING HOSPITAL AND PRIMARY CARE, PUBLIC HEALTH, MATERNAL AND CHILD HEALTH, HUMAN SERVICES, BUSINESS AND EDUCATION. PROJECT CONSULTANTS INTERVIEWED KEY INFORMANTS INDIVIDUALLY USING A STANDARDIZED SET OF QUESTIONS DESIGNED TO ELICIT INFORMATION ON THE LOCAL HEALTH ISSUES OF GREATEST CONCERN AND PERSPECTIVES ON LOCAL OPPORTUNITIES TO IMPROVE POPULATION HEALTH AND/OR THE HEALTHCARE DELIVERY SYSTEM. COMMUNITY-BASED FOCUS GROUPS SANTA ROSA MEMORIAL HOSPITAL, IN PARTNERSHIP WITH OTHER COMMUNITY HOSPITALS INCLUDING PETALUMA VALLEY HOSPITAL, CONDUCTED A SERIES OF TARGETED, COMMUNITY-BASED FOCUS GROUPS ON BEHALF OF THE PROJECT PARTNERS. THE GOAL OF THE FOCUS GROUP PROCESS WAS TO GATHER INFORMATION FROM RESIDENTS OF LOW-INCOME NEIGHBORHOODS ON THEIR HEALTH CONCERNS, THE CHALLENGES THEY FACE IN MAINTAINING HEALTH AND THEIR IDEAS ON HOW TO IMPROVE THEIR COMMUNITY'S HEALTH AND WELLBEING. FOUR FOCUS GROUPS WERE HELD, AVERAGING 8 PARTICIPANTS PER GROUP. GROUPS WERE FACILITATED IN BOTH SPANISH AND ENGLISH, BASED ON GROUP MAKE-UP. THE GROUPS WERE CONDUCTED IN THE COMMUNITIES OF SONOMA VALLEY, ROHNERT PARK, SANTA ROSA, AND CLOVERDALE AND WERE FACILITATED BY ST. JOSEPH HEALTH STAFF USING STANDARDIZED QUESTIONS APPROVED BY THE CHNA PARTNERSHIP. TELEPHONE SURVEY OF SONOMA COUNTY RESIDENTS THE COLLABORATIVE CONTACTED 1,500 PEOPLE (839 COMPLETED THE SURVEY) USING A SURVEY TOOL INCORPORATING QUESTIONS FROM THE NATIONAL BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) SURVEY. THE SURVEY PROVIDED VALUABLE INFORMATION ON LOCAL HEALTH STATUS, HEALTH BEHAVIORS, EXPERIENCE WITH THE LOCAL HEALTH SYSTEMS AND HIGHLIGHTED THE LINKS BETWEEN SOCIAL DETERMINANTS, PREDOMINANTLY INCOME AND EDUCATIONAL ATTAINMENT, AND DISPARITIES IN HEALTH AND HEALTH CARE ACCESS. ORGANIZATIONS, PUBLIC HEALTH OR OTHER DEPARTMENTS OR AGENCIES, COMMUNITY LEADERS AND REPRESENTATIVES, OTHERS WHICH REPRESENT THE BROAD INTERESTS OF THE COMMUNITY CONSULTED DURING THE CHNA PROCESS INCLUDED SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES, SONOMA COUNTY OFFICE OF EDUCATION, ECONOMIC DEVELOPMENT BOARD, DRUG ABUSE ALTERNATIVE CENTER, SANTA ROSA COMMUNITY HEALTH CENTERS, SONOMA INDIAN HEALTH PROJECT, REDWOOD COMMUNITY HEALTH COALITION, KAISER PERMANENTE PARTNERSHIP HEALTH PLAN OF CALIFORNIA, SONOMA COUNTY ORAL HEALTH ACCESS COALITION. IN AN EFFORT TO GATHER DIVERSE POINTS OF VIEW THOSE INTERVIEWED REPRESENTED THE FOLLOWING SECTORS, SERVICES, ORGANIZATIONS AND AGENCIES: HEALTH AND HUMAN SERVICES, NONPROFIT HOSPITALS, SONOMA COUNTY SCHOOLS, ORAL HEALTH SERVICES, COMMUNITY HEALTH CENTERS, COMMUNITY-BASED ORGANIZATIONS, HEALTH INSURANCE PLANS, ECONOMIC DEVELOPMENT. OVER THE COURSE OF 5 MONTHS (APRIL SEPTEMBER 2012), PVH ALONG WITH CHNA PARTNERS CONDUCTED THE FOLLOWING ACTIVITIES TO CREATE THE 2013 CHNA: - DEVELOPED A DEMOGRAPHIC SUMMARY OF SONOMA COUNTYS CURRENT POPULATION ALONG WITH POPULATION GROWTH PROJECTIONS WHEN AVAILABLE. INFORMATION IS PROVIDED ON A VARIETY OF DEMOGRAPHIC INDICATORS INCLUDING POPULATION DISTRIBUTION, AGE, ETHNICITY, INCOME, HEALTHCARE COVERAGE, EDUCATION AND EMPLOYMENT. - ASSEMBLED SUMMARY DATA FROM A VARIETY OF SECONDARY SOURCES IDENTIFYING HEALTH BEHAVIORS AND CONDITIONS THAT COMPROMISE THE HEALTH AND HEALTHY DEVELOPMENT OF CHILDREN AND CONTRIBUTE MOST PROMINENTLY TO ILLNESS AND INJURY, DISABILITY AND DEATH FOR SONOMA COUNTY ADULTS AND CHILDREN. WHERE KNOWN, INFORMATION ON CONTRIBUTING FACTORS IS PRESENTED ALONG WITH EACH HEALTH INDICATOR. HEALTH DISPARITIES ARE HIGHLIGHTED. - CONDUCTED KEY INFORMANT INTERVIEWS, COMMUNITY-BASED FOCUS GROUPS AND A COUNTYWIDE RANDOM TELEPHONE SURVEY TO GATHER DATA ON HEALTH STATUS AND ELICIT INFORMATION ON COMMUNITY HEALTH ISSUES OF GREATEST CONCERN AND PERSPECTIVES ON LOCAL OPPORTUNITIES TO IMPROVE POPULATION HEALTH AND/OR THE HEALTHCARE DELIVERY SYSTEM.
SCHEDULE H, PART V, SECTION B, LINE 6A	THE 2013 SONOMA COUNTY COMMUNITY NEEDS ASSESSMENT (CHNA) IS A COLLABORATIVE EFFORT BY ST. JOSEPH HEALTH-SONOMA COUNTY (SRMH AND PVH), SUTTER MEDICAL CENTER OF SANTA ROSA, KAISER PERMANENTE MEDICAL CENTER SANTA ROSA AND THE SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES TO ASSESS THE HEALTH STATUS OF SONOMA COUNTY RESIDENTS AND TO IDENTIFY CRITICAL AREAS FOR HEALTH IMPROVEMENT IN SONOMA COUNTY. THE 2013 CHNA CONTINUES A SUCCESSFUL COLLABORATION BETWEEN THE HOSPITAL PARTNERS AND LOCAL HEALTH DEPARTMENT, BEGUN IN 2000, TO IDENTIFY AND JOINTLY ADDRESS SIGNIFICANT COMMUNITY HEALTH ISSUES.
SCHEDULE H, PART V, SECTION B, LINE 6B	THE SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES
SCHEDULE H, PART V, SECTION B, LINE 7A	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/2014-PVH-COMMUNITY- HEALTH-NEEDS-ASSESSMENT-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 10A	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/FY15-FY17-PVH-CB-AN D-IS-REPORT.PDF
SCHEDULE H, PART V, SECTION B, LINE 11	THE FOLLOWING HEALTH PROMOTION ACTIVITIES WERE PERFORMED IN FY16 IN RESPONSE TO NEEDS IDENTIFIED IN THE CHNA. ACCESS TO HEALTH CARE SERVICES: SRMH AND PVH'S MOBILE MEDICAL CLINIC SERVES SECTION PATIENTS IN THEIR COMMUNITIES AT NO COST. THE PROGRAM SEEKS TO PROVIDE CARE TO THOSE WHO FALL THROUGH THE TRADITIONAL PRIMARY CARE SAFETY NET, AND FOR REASONS RELATED TO TRANSPORTATION, POVERTY, OR OTHER FACTORS, FACE INSURMOUNTABLE BARRIERS TO ACCESSING CARE AT COMMUNITY HEALTH CENTERS OR OTHER MEDICAL HOMES. THE CLINIC OFFERS HEALTH SCREENINGS, TREATMENT OF MINOR MEDICAL PROBLEMS, HEALTH AND NUTRITIONAL EDUCATION, AND INFORMATION AND REFERRALS. IN FY16, THE CLINIC SAW 838 PATIENTS OVER 2,372 ENCOUNTERS AT SEVERAL LOCATIONS COUNTYWIDE, INCLUDING THE CITIES OF SONOMA/BOYES HOT SPRINGS, SANTA ROSA, AND WINDSOR. HEALTHY EATING AND PHYSICAL FITNESS: THE PROMOTORES DE SALUD (HEALTH PROMOTERS) BRIDGE LANGUAGE AND CULTURE, PROVIDING HEALTH INFORMATION AND REFERRALS, CONDUCTING COOKING AND NUTRITION CLASSES, AND TRAINING COMMUNITY VOLUNTEER HEALTH PROMOTERS IN HEART HEALTH. IN FY16, THE PROMOTORES DE SALUD SERVED 580 LOW-INCOME INDIVIDUALS THROUGH 2,090 SERVICE ENCOUNTERS ACROSS SONOMA COUNTY. THE PROGRAM ENCOURAGED PARTICIPANTS TO BE MORE PHYSICALLY ACTIVE, PARTICIPATED IN HEALTH FAIRS, AND TAUGHT HEALTH EDUCATION AND HEALTHY COOKING CLASSES. HEALTHY FOR LIFE IS A SCHOOL-BASED PHYSICAL ACTIVITY AND NUTRITION PROGRAM THAT WORKS TO TEACH HEALTHY BEHAVIORS AT AN EARLY AGE AND ENSURE GOOD HEALTH FOR YEARS TO COME. THIS YEAR, 16 PARTNER SCHOOLS, 24 CHAMPION TEACHERS AND OVER 2,178 STUDENTS AND PARENTS PARTICIPATED IN FITNESS AND NUTRITION COURSES ACROSS 19,540 ENCOUNTERS. GAPS IN ACCESS TO PRIMARY CARE: STRONG PRIMARY CARE SYSTEMS ARE ASSOCIATED WITH IMPROVED HEALTH OUTCOMES AND REDUCED HEALTH CARE COSTS. WHILE MOST SONOMA COUNTY RESIDENTS HAVE A REGULAR SOURCE OF CARE AND CAN ACCESS HEALTH CARE WHEN THEY NEED IT, TOO MANY DO NOT. THOSE WHO ARE UNINSURED, LOW-INCOME, OR ARE MEMBERS OF RACIAL AND ETHNIC MINORITIES ARE LESS LIKELY TO HAVE AN ONGOING SOURCE OF CARE AND MORE LIKELY TO DEFER NEEDED CARE, MEDICINES AND DIAGNOSTICS, OFTEN AT THE COST OF UNNECESSARY SUFFERING AND POOR HEALTH OUTCOMES. INCREASING ACCESS TO AFFORDABLE, PREVENTION-FOCUSED PRIMARY CARE CAN HELP TO ELIMINATE HEALTH DISPARITIES AND PROMOTE HEALTH AND WELLBEING. ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES: CIRCLE OF SISTERS (COS) IS A POSITIVE YOUTH DEVELOPMENT AFTER-SCHOOL PROGRAM FOR GIRLS AGES 9 TO 14 OFFERED AT NO COST. PROGRAM PARTICIPANTS ATTEND SCHOOLS WITH HIGH RATES OF ELIGIBILITY FOR THE FREE AND REDUCED LUNCH PROGRAM. IN FY16, COS SERVED 213 YOUNG WOMEN IN 6,123 ENCOUNTERS COUNTYWIDE. THE PROGRAM HELPS WITH SELF-ESTEEM AND MAKING GOOD CHOICES ABOUT THE FUTURE, AND ADDRESSES MENTAL HEALTH ISSUES SUCH AS SELF-HARM, THE RISKS OF SUBSTANCE USE, AND THE VALUE OF BUILDING STRONG AND RESILIENT RELATIONSHIPS. BARRIERS TO HEALTHY AGING: SRMH AND PVH'S HOUSE CALLS PROGRAM TENDS TO THE PHYSICAL, SPIRITUAL AND EMOTIONAL NEEDS OF FRAIL ELDERLY SENIORS AND ADULTS WITH CHRONIC DISEASES BY PROVIDING PRIMARY MEDICAL CARE AT HOME. ELIGIBLE SENIORS HAVE LIMITED ACCESS TO CARE DUE TO IMPAIRED MOBILITY, UNDER-INSURANCE, AND LACK OF FUNDS. THE HOUSE CALLS TEAM, WHICH INCLUDES NURSE PRACTITIONERS, NURSES, CASE MANAGEMENT, AND HOME HEALTH ASSISTANCE, PROVIDED 6,674 PATIENT ENCOUNTERS DURING FY16, WHICH HELP PREVENT UNNECESSARY EMERGENCY DEPARTMENT VISITS AND TO MORE EFFECTIVELY MANAGE CHRONIC DISEASE FOR 142 INDIVIDUALS. DISPARITIES IN ORAL HEALTH: SRMH AND PVH'S CONTINUUM OF ORAL HEALTH SERVICES INCLUDE A FIXED SITE DENTAL CLINIC LOCATED IN SANTA ROSA THAT SERVES CHILDREN FROM ALL OVER THE COUNTY, THE MOBILE DENTAL CLINIC, THE MIGHTY MOUTH SCHOOL-BASED DENTAL DISEASE PREVENTION PROGRAM, AND MOMMY AND ME, WHICH TEACHES GOOD DENTAL HEALTH PRACTICES TO CHILDREN ZERO TO FIVE YEARS OLD AND THEIR MOTHERS. THE CLINICS PRIORITIZE SERVICE TO CHILDREN AGES 0-16 YEARS, BUT ALSO SERVE ADULTS WITH URGENT NEEDS. THEY PROVIDE BASIC, PREVENTIVE, EMERGENCY AND COMPREHENSIVE DENTAL CARE WITH A STRONG FOCUS ON PREVENTION AND EDUCATION DURING. FY16 5,434 INDIVIDUALS RECEIVED 8,535 SERVICE ENCOUNTERS AT THE SJH DENTAL CLINIC. SRMH AND PVH'S MOBILE DENTAL CLINIC AND MIGHTY MOUTH SCHOOL-BASED PROGRAM SAW 11,702 MOSTLY EDUCATION AND PREVENTION VISITS WITH A TOTAL OF 5,729 PATIENTS. NO HOSPITAL FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WE ARE COMMITTED TO CONTINUE SRMH AND PVH'S MISSION THROUGH COMMUNITY BENEFIT PROGRAMS AND BY FUNDING OTHER NON-PROFITS THROUGH SRMH AND PVH'S CARE FOR THE POOR PROGRAM MANAGED BY SRMH AND PVH. FURTHERMORE, SRMH AND PVH ENDORSE LOCAL NON-PROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH THE SJH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES OR RESOURCES TO MEET THE IDENTIFIED NEEDS OF UNDERSERVED COMMUNITIES THROUGH SJH COMMUNITIES. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE DIRECTLY ADDRESSED BY PVH'S COMMUNITY BENEFIT STRATEGIC PRIORITIES, THOUGH WE ARE PERFORMING THE FOLLOWING RELATED ACTIVITIES. 1) DISPARITIES IN EDUCATIONAL ATTAINMENT: SRMH AND PVH PARTICIPATE IN A NUMBER OF COUNTYWIDE EFFORTS THAT ARE WORKING TO ADDRESS THIS IMPORTANT NEED, INCLUDING SONOMA HEALTH ACTION, WHICH IS A COLLECTIVE ACTION INITIATIVE IN THE COUNTY. TODD SALNAS, PRESIDENT OF SANTA ROSA MEMORIAL HOSPITAL AND PETALUMA VALLEY HOSPITAL, SITS ON THE HEALTH ACTION COUNCIL, AND CRADLE TO CAREER IS ONE KEY INITIATIVE OF HEALTH ACTION AND IS FOCUSED ON EDUCATIONAL ATTAINMENT AND WORKFORCE DEVELOPMENT. 2) CARDIOVASCULAR DISEASE: SRMH AND PVH'S PROMOTORES DE SALUD PROGRAM FOLLOWS A PROVEN MODEL OF PEER EDUCATION, CONNECTING WITH UNDERSERVED COMMUNITIES IN A CULTURALLY APPROPRIATE MANNER. THE YOUR HEART, YOUR LIFE COURSE WE TEACH AT NO COST TO ANYONE WHO CHOOSES TO ENROLL TAKES PLACE OVER 10 WEEKS AND ALLOWS STAFF TO BUILD RELATIONSHIPS WITH PARTICIPANTS, AND LEVERAGE THOSE RELATIONSHIPS TO DRIVE REAL AND SUSTAINED BEHAVIORAL CHANGES. SRMH AND PVH'S PROGRAM IS SUPPORTED BY VOLUNTEERS, MANY OF WHOM ARE COURSE GRADUATES THEMSELVES AND WHOSE LIVES HAVE BEEN DEEPLY AFFECTED BY THE PROGRAM. THEY ARE INSPIRED TO SHARE THAT EXPERIENCE WITH OTHERS AND SHARE THE BENEFITS OF HEALTHY LIVING. 3) ADVERSE CHILDHOOD EXPERIENCES OR EXPOSURE TO STRESS (ACES): THIS IS A POSITIVE PARENTING PROGRAM AND AN INTERNATIONAL EVIDENCE-BASED MODEL THAT IS WIDELY UNDERSTOOD AS AN EFFECTIVE PROGRAM TO HELP PREVENT THE OCCURRENCES OF ACES AND SPREAD POSITIVE AND SUPPORTIVE PARENTING PRACTICES. BY BECOMING CERTIFIED, PVH'S STAFF MEMBERS WHO WORK DIRECTLY WITH PARENTS CAN OFFER INFORMATION AND BRIEF INTERVENTIONS, EDUCATING ABOUT AND SUPPORTING PARENTS IN MAKING GOOD DECISIONS. 4) TOBACCO USE: WE COLLABORATE WITH AND SUPPORT THROUGH SPONSORSHIPS SEVERAL ORGANIZATIONS THAT PERFORM SCREENING FOR TOBACCO USE AND SMOKING CESSATION, INCLUDING THE PETALUMA HEALTH CENTER, WEST COUNTY HEALTH CENTERS, AND SANTA ROSA COMMUNITY HEALTH CENTERS. SRMH AND PVH ALSO HAVE A COMMUNITY BENEFIT STAFF LIAISON ON THE BOARD, AND PROVIDES CORE FUNDING TO THE HEALTHY COMMUNITIES CONSORTIUM, WHICH IS ACTIVE IN VARIOUS TOBACCO CONTROL INITIATIVES. 5) COORDINATION AND INTEGRATION OF LOCAL HEALTH CARE SYSTEM: SRMH AND PVH PARTICIPATES IN THE HEALTH SYSTEM IMPROVEMENT INITIATIVE OF SONOMA HEALTH ACTION, AND HAVE BEEN ACTIVE IN BOTH THE MY CARE, MY PLAN SPEAK UP SONOMA COUNTY INITIATIVE AS WELL AS THE HEARTS OF SONOMA COUNTY INITIATIVE, BOTH OF WHICH SEEK TO LEVERAGE INTEGRATION AND COORDINATION OF EFFORT. THE FORMER INITIATIVE IS FOCUSED ON ADVANCE CARE PLANNING AND THE LATTER ON CARDIOVASCULAR HEALTH. SRMH AND PVH ALSO SUPPORTED THE SANTA ROSA COMMUNITY HEALTH CENTERS WITH AN $80,600 GRANT TO SUPPORT THE COORDINATION OF CARE FOR UNDERSERVED PATIENTS, CO-LOCATING A STAFF MEMBER OF THEIRS WITHIN SRMH'S FACILITY TO ASSIST WITH TRANSITIONS AND DISCHARGE PLANNING. 6) LUNG, BREAST, AND COLORECTAL CANCER: WE OFFER CHARITY CARE SUPPORT FOR MOBILE MEDICAL PATIENTS WHO REQUIRE CANCER DIAGNOSTICS AND MAKE SIGNIFICANT EFFORTS TO CONNECT PATIENTS TO SPECIALTY CANCER CARE, COORDINATING CARE AND REFERRALS WHEN APPROPRIATE.
SCHEDULE H, PART V, SECTION B, LINE 13H	THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.
SCHEDULE H, PART V, SECTION B, LINE 16A	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/FINANCIAL-ASSISTANCE-POLICY.PDF
SCHEDULE H, PART V, SECTION B, LINE 16B	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/SONOMA-FAA-ENGLISH.PDF
SCHEDULE H, PART V, SECTION B, LINE 16C	THE WEB ADDRESS IS: HTTP://WWW.STJOESONOMA.ORG/DOCUMENTS/PATIENT-FINANCIAL-ASSISTANCE/SONOMA_F ABROCHURE_2016.PDF
SCHEDULE H, PART V, SECTION B, LINE 16I	THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA.
SCHEDULE H, PART V, SECTION B, LINE 22D	FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USED MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE HOSPITAL FACILITY USED THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED.

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?6
Name and address		Type of Facility (describe)
1	HOSPICE OF PETALUMA 416 PAYRAN STREET PETALUMA,CA94954	HOSPICE
2	HOSPICE OF SANTA ROSA 439 COLLEGE AVE SANTA ROSA,CA95401	HOSPICE
3	HOSPICE OF SANTA ROSA 447 COLLEGE AVE SANTA ROSA,CA95401	HOSPICE
4	LYNCH CREEK LABORATORY 151 LYNCH CREEK PETALUMA,CA95954	LAB OUTREACH
5	LYNCH CREEK IMAGING 151 LYNCH CREEK PETALUMA,CA95954	IMAGING/RADIOLOGY
6	HOSPICE OF NORTH COUNTY 205 EAST STREET HEALDSBURG,CA95448	HOSPICE
7
8
9
10

Schedule H (Form 990) 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
SCHEDULE H, PART I, LINE 3C	IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES WERE ALSO CONSIDERED WHEN DETERMINING ELIGIBILITY, INCLUDING BUT NOT LIMITED TO, DISABILITY AND HOMELESSNESS.
SCHEDULE H, PART I, LINE 6A	PETALUMA VALLEY HOSPITAL PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT WWW.STJOESONOMA.ORG.
SCHEDULE H, PART I, LINES 7A-7I	COST-TO-CHARGE RATIO USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGE WAS USED TO DETERMINE AMOUNTS ON LINE 7.
SCHEDULE H, PART II	SRMH AND PVH'S COMMUNITY BENEFIT DEPARTMENT INTEGRATES ACTIONS THAT ADDRESS THE POLITICAL, SOCIAL, BEHAVIORAL AND PHYSIOLOGICAL DETERMINANTS OF HEALTH. THE PRIMARY STRATEGIES EMPLOYED TO ADDRESS COMMUNITY NEEDS ARE COMMUNITY CAPACITY BUILDING AND IMPROVING HEALTH OUTCOMES FOR VULNERABLE POPULATIONS. SRMH'S PROGRAMS FOCUS ON BUILDING COMMUNITY CAPACITY AND EMPOWERMENT TO ADDRESS QUALITY OF LIFE CONCERNS IN ADDITION TO COUNTYWIDE COLLABORATION AND PARTNERSHIP DEVELOPMENT. TO SUPPORT THESE ACTIONS, THE NEIGHBORHOOD CARE STAFF (NCS) PROGRAM IS ESPECIALLY FOCUSED ON COMMUNITY BUILDING. THIS PROGRAM IS AN INTEGRAL PART OF THE HOSPITAL'S INITIATIVE TO IMPROVE COMMUNITY AND ADDRESS SOCIAL DETERMINANTS OF HEALTH. NCS MENTOR GRASSROOTS RESIDENTS TO ADDRESS LOCAL COMMUNITY HEALTH AND QUALITY OF LIFE ISSUES. NCS MODELS AND MENTORS COMMUNITY REPRESENTATIVES IN THESE KEY FUNCTIONS: THE IDENTIFICATION OF LOCAL ASSETS, PROVIDING FORUMS FOR DIALOGUE, SURFACING AND SUPPORTING LOCAL LEADERS, FACILITATING THE DEVELOPMENT OF SELF-SUSTAINING COMMUNITY GROUPS, FACILITATING COMMUNITY-BASED STRATEGIC PLANNING, HELPING TO BUILD LINKAGES TO AND BETWEEN COMMUNITY RESOURCES, AND ADVOCATING FOR COMMUNITY PARTICIPATION IN THE ISSUES THAT MOST AFFECT IT. IN FY16, NCS WORKED WITH 401 RESIDENTS COUNTYWIDE FROM LOW-INCOME NEIGHBORHOODS WITH DISPROPORTIONATE UNMET HEALTH NEEDS AND ENGAGED IN 7,201 SERVICE ENCOUNTERS WITH THESE INDIVIDUALS. ADDITIONALLY, SRMH AND PVH COLLABORATED WITH OR SUPPORTED THE FOLLOWING COMMUNITY BUILDING INITIATIVES: - A PORTRAIT OF SONOMA COUNTY IS AN IN-DEPTH LOOK AT HOW RESIDENTS OF SONOMA COUNTY ARE FARING IN THREE FUNDAMENTAL AREAS OF LIFE HEALTH, ACCESS TO KNOWLEDGE, AND LIVING STANDARDS. ST. JOSEPH HEALTH STAFF SERVED ON THE PORTRAIT LEADERSHIP TEAM, INTEGRATED THE REPORT INTO THE NEW EMPLOYEE ORIENTATION FOR ALL ST. JOSEPH HEALTH INCOMING EMPLOYEES, FAMILIARIZING STAFF WITH ISSUES RELATED TO DISPARITIES, SOCIAL DETERMINANTS OF HEALTH, AND PLACE-BASED INTERVENTIONS TO IMPROVE OUTCOMES. - SONOMA HEALTH ACTION IS THE FRAMEWORK FOR A COMMUNITY ENGAGEMENT EFFORT TO GET PEOPLE INVOLVED IN CREATING A HEALTHIER SONOMA COUNTY. IT STARTS AT HOME WITH A PERSONAL COMMITMENT. IT CONTINUES AT WORK AND SCHOOL WITH WELLNESS-FOCUS POLICIES AND OPPORTUNITIES THAT ENCOURAGE HEALTHY LIVING. IT CULMINATES IN THE COMMUNITY WITH A SHARED VISION FOR OVERALL GOOD HEALTH. SRMH AND PVH'S PRESIDENT SERVED ON THE HEALTH ACTION COUNCIL, COMMUNITY BENEFIT STAFF PARTICIPATED IN THE ECONOMIC WELLNESS INITIATIVE AND THE HEARTS OF SONOMA COUNTY. CARDIOVASCULAR DISEASE RISK REDUCTION INITIATIVE SUPPORTED COLLECTIVE ACTION PRINCIPLES AND PROVIDED INPUT AND LEADERSHIP IN A VARIETY OF OTHER AREAS. - THE SONOMA COUNTY FUNDERS' CIRCLE HELPS CREATE HEALTHY COMMUNITIES WITH WIDESPREAD EQUITY THROUGH COLLECTIVE INVESTING. ALL MEMBERS ARE COMMITTED TO SOCIAL INVESTMENT FOR SYSTEMIC CHANGE THAT INCLUDES LEADERSHIP IN ADVOCACY, RESEARCH, COLLABORATIVE LEARNING, CAPACITY BUILDING, AND APPLIED PRACTICE. COMMUNITY BENEFIT STAFF CHAIRED THE GOVERNANCE COMMITTEE, PARTICIPATED IN THE FORMULATION OF GOVERNANCE GUIDELINES AND HELPED TO BUILD THE CAPACITY OF THIS COLLABORATIVE WORKGROUP. - THE COMMUNITY ACTIVITY AND NUTRITION COALITION (CAN-C) OF SONOMA COUNTY IS A GROUP OF INDIVIDUALS, PROFESSIONALS AND COMMUNITY BASED ORGANIZATIONS CONCERNED ABOUT THE NUTRITIONAL HEALTH, ACTIVITY LEVEL AND WELL-BEING OF THE RESIDENTS OF SRMH AND PVH'S COMMUNITY. COMMUNITY BENEFIT STAFF SERVED ON THE STEERING COMMITTEE, MADE SEVERAL PRESENTATIONS ON RELATED PROGRAMS AND UPDATES TO CAN-C MEMBERSHIP, ATTENDED REGULAR MEETINGS AND SUBCOMMITTEE MEETINGS FOR HEALTHY STUDENTS INITIATIVE, PHYSICAL ACTIVITY SUBCOMMITTEES. - LOS CIEN LATINO LEADERS DEDICATED TO BUILDING A BETTER FUTURE FOR SONOMA COUNTY. COMMUNITY BENEFIT STAFF PARTICIPATED IN REGULAR MONTHLY MEETINGS OF LOS CIEN AND COMMITTED ONE STAFF MEMBER AS A FORMAL LIAISON TO LOS CIEN, PROVIDING SUPPORT AND ASSISTANCE TO THE GROUP.
SCHEDULE H, PART III, SECTION A, LINE 2	COSTING METHODOLOGY THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 3 THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS WERE GRANTED 100 PERCENT FINANCIAL ASSISTANCE (FREE CARE). AFTER THE RECLASSIFICATION THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART III, SECTION A, LINE 4 THE HEALTH SYSTEM RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE HEALTH SYSTEM BELIEVES THERE ARE NO SIGNIFICANT CREDIT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED PAYORS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE HEALTH SYSTEM. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM REGULARLY ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
SCHEDULE H, PART III, SECTION B, LINE 8	THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING CMS STANDARD COSTING METHODS. THIS INCLUDES STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS.
SCHEDULE H, PART III, SECTION C, LINE 9B	PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT IN ADDITION TO CONDUCTING A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT, ST. JOSEPH HEALTH STAFF SERVED ON THE DEVELOPMENT OF THE PORTRAIT OF SONOMA COUNTY LEADERSHIP TEAM. A PORTRAIT OF SONOMA COUNTY IS AN IN-DEPTH LOOK AT HOW RESIDENTS OF SONOMA COUNTY ARE FARING IN THREE FUNDAMENTAL AREAS OF LIFE: HEALTH, ACCESS TO KNOWLEDGE, AND LIVING STANDARDS. ST. JOSEPH HEALTH STAFF INTEGRATED THE PORTRAIT OF SONOMA COUNTY REPORT INTO SRMH AND PVHS NEW EMPLOYEE ORIENTATION FOR ALL INCOMING EMPLOYEES, FAMILIARIZING STAFF WITH ISSUES RELATED TO DISPARITIES, SOCIAL DETERMINANTS OF HEALTH, AND PLACE-BASED INTERVENTIONS TO IMPROVE OUTCOMES.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION THE COLLABORATIVE CHNA PROCESS AND DATA GATHERING ADDRESSES SONOMA COUNTY. SONOMA COUNTY IS A LARGE, URBAN-RURAL COUNTY ENCOMPASSING 1,575 SQUARE MILES. THE COUNTY'S TOTAL POPULATION IS CURRENTLY ESTIMATED AT 487,011 ACCORDING TO PROJECTIONS FROM THE CALIFORNIA DEPARTMENT OF FINANCE. COUNTY POPULATION IS PROJECTED TO GROW BY 8.3% TO 546,204 IN 2020. THIS RATE OF GROWTH IS LESS THAN THAT PROJECTED FOR CALIFORNIA AS A WHOLE (10.1%). SONOMA COUNTY RESIDENTS INHABIT NINE CITIES AND A LARGE UNINCORPORATED AREA, INCLUDING MANY GEOGRAPHICALLY ISOLATED COMMUNITIES. THE MAJORITY OF THE COUNTY'S POPULATION RESIDES WITHIN ITS CITIES, THE LARGEST OF WHICH ARE CLUSTERED ALONG THE HIGHWAY 101 CORRIDOR. SANTA ROSA IS THE LARGEST CITY WITH A POPULATION OF 168,841 AND IS THE SERVICE HUB FOR THE ENTIRE COUNTY AND THE LOCATION OF THE COUNTY'S THREE MAJOR HOSPITALS. SINCE 2006, THE COUNTY POPULATION HAS GROWN AT AN OVERALL RATE OF 1.8% WITH THE CITIES OF SONOMA, SANTA ROSA AND WINDSOR EXPERIENCING THE FASTEST GROWTH RATES. SONOMA COUNTY'S UNINCORPORATED AREAS ARE HOME TO 146,739 RESIDENTS, 30.1% OF THE TOTAL POPULATION. A SIGNIFICANT NUMBER OF THESE INDIVIDUALS LIVE IN LOCATIONS THAT ARE VERY RURAL AND GEOGRAPHICALLY REMOTE. RESIDENTS OF THESE AREAS MAY EXPERIENCE SOCIAL ISOLATION AND SIGNIFICANT BARRIERS IN ACCESSING BASIC SERVICES AND SUPPORTS SUCH AS TRANSPORTATION, HEALTH CARE, NUTRITIOUS FOOD AND OPPORTUNITIES TO SOCIALIZE. LOW-INCOME AND SENIOR POPULATIONS LIVING IN REMOTE AREAS MAY FACE SPECIAL CHALLENGES IN MAINTAINING HEALTH AND QUALITY OF LIFE. OF THE COUNTY'S TOTAL SENIOR POPULATION, AGE 60 AND OLDER, 12,144 (12%) ARE CONSIDERED "GEOGRAPHICALLY ISOLATED" AS DEFINED BY THE OLDER AMERICANS ACT (SOURCE: CALIFORNIA DEPT. OF AGING, CALIFORNIA AGING POPULATION DEMOGRAPHIC PROJECTIONS FOR INTRASTATE FUNDING FORMULA (2011)). RACE AND ETHNICITY: WHITE, NON-HISPANICS CURRENTLY REPRESENT 64.2% OF THE COUNTY'S POPULATION WHILE HISPANICS ACCOUNT FOR 25.6%. OTHER ETHNIC GROUPS INCLUDE ASIAN/PACIFIC ISLANDER (5.2%), AFRICAN AMERICANS (1.7%), AMERICAN INDIANS (1.0%), AND PERSONS REPORTING TWO OR MORE RACES (2.3%). WHILE THE COUNTY'S POPULATION IS LESS DIVERSE THAN THAT OF CALIFORNIA AS A WHOLE, THIS IS CHANGING BY 2020. SONOMA'S HISPANIC POPULATION, CURRENTLY ESTIMATED AT 129,057, IS EXPECTED TO GROW TO 168,290 AND ACCOUNT FOR 31% OF THE TOTAL POPULATION. OTHER ETHNIC GROUPS ARE PROJECTED TO EXPERIENCE LESS DRAMATIC GROWTH (SOURCE: CALIFORNIA DEPT. OF FINANCE, E-5 POPULATION AND HOUSING ESTIMATES FOR CITIES, COUNTIES, AND THE STATE (2011-2012)). WHILE THE MAJORITY OF THE COUNTY'S ETHNIC POPULATIONS ARE ENGLISH-PROFICIENT, THE 2010 CENSUS ESTIMATES THAT 50,236 RESIDENTS, AGE 5 AND OLDER, OR 11.26% OF TOTAL POPULATION, ARE "LINGUISTICALLY ISOLATED" IE: SPEAKING A LANGUAGE OTHER THAN ENGLISH AT HOME AND SPEAKING ENGLISH LESS THAN "VERY WELL." AGE AND GENDER: SONOMA COUNTY IS SLIGHTLY OLDER THAN CALIFORNIA AS A WHOLE, WITH A MEDIAN AGE OF 39.5 YEARS, AS COMPARED WITH 34.9 YEARS. SONOMA COUNTY SENIORS, AGE 60 AND OVER, REPRESENT 20.4% OF THE TOTAL POPULATION AS COMPARED WITH A STATEWIDE FIGURE OF 16.9%. OF NOTE IS THE DISPARITY IN AGE BETWEEN THE COUNTY'S OLDER WHITE POPULATION AND ITS MORE YOUTHFUL HISPANIC POPULATION. OVER 30% OF SONOMA COUNTY HISPANICS ARE AGE 12 AND UNDER, AS COMPARED TO 12% FOR WHITES. AT THE OTHER END OF THE SPECTRUM, 26.6% OF WHITES ARE SENIORS (AGE 60 AND ABOVE) AS COMPARED WITH 7.1% OF HISPANICS. SENIORS ARE THE COUNTY'S FASTEST GROWING POPULATION AGE GROUP. THIS POPULATION IS PROJECTED TO GROW FROM 102,639 IN 2012 TO 128,589 IN 2020, WITH THE GREATEST GROWTH IN THE 70-74 AGE GROUP THE BABY BOOM "AGE WAVE". THIS AGE WAVE, COMBINED WITH INCREASED LONGEVITY, WILL CONTINUE TO DRIVE GROWTH IN SENIOR POPULATIONS, ESPECIALLY IN THE 75 AND OVER AGE GROUP. SENIORS AGE 75 OVER CURRENTLY REPRESENT ABOUT 9% OF THE TOTAL POPULATION AT 44,813. FEMALES SIGNIFICANTLY OUTNUMBER MALES IN THIS AGE GROUP (62%/38%). INCOME AND WEALTH FROM 2006-2010: THE MEDIAN INCOME OF SONOMA COUNTY'S 184,000 HOUSEHOLDS WAS $63,274, SLIGHTLY HIGHER THAN THE CALIFORNIA AVERAGE. DURING THIS PERIOD, 17.7% OF SONOMA COUNTY HOUSEHOLDS HAD INCOMES OF LESS THAN $25,000. AT THE UPPER END OF THE SCALE, 28% OF HOUSEHOLDS EARNED OVER $100,000 ANNUALLY. THE IMPACT OF THE RECESSION ON INCOME AND WEALTH HAS BEEN SIGNIFICANT. WHILE LOCAL DATA ARE NOT AVAILABLE, A NATIONAL SURVEY OF CONSUMER FINANCE SHOWED THAT, BETWEEN 2007 AND 2010, THE MEDIAN NET WORTH OF AMERICAN FAMILIES PLUNGED MORE THAN 38% (SOURCE: BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM, SURVEY OF CONSUMER FINANCES 2010). INCOME STATUS VARIES SIGNIFICANTLY BY GENDER. DURING 2006-2010, MEDIAN INCOME FOR SONOMA COUNTY MALES WAS $ 44,973 AS COMPARED WITH $31,960 FOR FEMALES. THIS DIFFERENTIAL EXPANDS WITH EDUCATIONAL ATTAINMENT, MEDIAN INCOME FOR MALES WITH GRADUATE DEGREES ($85,470) WAS SIGNIFICANTLY HIGHER THAN FOR FEMALES AT THE SAME EDUCATIONAL LEVEL ($55,272) (SOURCE: US CENSUS BUREAU, 2006-2010 ACS (REPORTED IN 2010 INFLATION ADJUSTED DOLLARS)). SONOMA COUNTY HOUSEHOLD INCOMES ALSO VARY SIGNIFICANTLY BY BOTH EDUCATIONAL ATTAINMENT AND ETHNICITY. 80% OF SONOMA COUNTY HOUSEHOLDS WITH GRADUATE EDUCATION EARNED ABOVE $66,150 ANNUALLY AS COMPARED WITH ONLY 42.9% OF HOUSEHOLDS WITH HIGH SCHOOL OR LESS EDUCATION AND, WHILE 68.6% OF WHITE, NON-HISPANICS HAD ANNUAL HOUSEHOLD INCOME IN EXCESS OF $66,150 ONLY 34.5% OF HISPANICS DID (SOURCE US CENSUS BUREAU, 2010 ACS 1-YEAR ESTIMATE). WHILE MANY SONOMA COUNTY RESIDENTS ENJOY FINANCIAL SECURITY, 10.27% OF COUNTY RESIDENTS REPORTED ANNUAL INCOMES BELOW FEDERAL POVERTY LEVEL. IN 2010 THE 2010 FEDERAL POVERTY LEVEL (FPL) WAS $10,830 IN ANNUAL INCOME FOR AN INDIVIDUAL OR $22,050 FOR A FAMILY OF FOUR. THE FEDERAL POVERTY GUIDELINES ARE NOT SCALED TO REFLECT SIGNIFICANT REGIONAL VARIATIONS IN THE COST OF LIVING. GIVEN THE HIGH COST OF LIVING IN SONOMA COUNTY, IT IS GENERALLY ACCEPTED THAT AN ANNUAL INCOME UNDER 200% OF FPL ($21,660 FOR AN INDIVIDUAL) IS INADEQUATE TO MEET BASIC NEEDS FOR FOOD, CLOTHING, SHELTER, TRANSPORTATION, HEALTH CARE AND OTHER NECESSITIES. POVERTY RATES VARY SIGNIFICANTLY BY ETHNICITY. SIGNIFICANT DISPARITIES EXIST, ESPECIALLY FOR SONOMA COUNTY HISPANICS, WHO EXPERIENCE A MUCH HIGHER RATE OF POVERTY (21.8%) THAN WHITES OR ASIANS. THE COUNTY'S YOUNGEST RESIDENTS ARE MOST SIGNIFICANTLY IMPACTED BY POVERTY, WITH NEARLY 17% OF CHILDREN UNDER AGE 6 LIVING BELOW 100% FEDERAL POVERTY LEVEL. AMONG SONOMA COUNTY SENIORS AGE 75 AND OVER, OVER 2,000 LIVE IN HOUSEHOLDS WITH HOUSEHOLD INCOME BELOW 100% FPL AND AN ADDITIONAL 6,000 HAVE INCOME UNDER 200% OF FPL. POVERTY STATUS IS ALSO LINKED TO FAMILY CONFIGURATION. AMONG AN ESTIMATED 116,699 SONOMA COUNTY FAMILIES, THOSE OF MARRIED COUPLES EXPERIENCE THE LOWEST POVERTY RATES (3.8%) THE FAMILIES OF SINGLE, FEMALE HOUSEHOLDERS EXPERIENCE THE HIGHEST RATES, WITH SIGNIFICANT DISPARITY BY ETHNICITY. AMONG HISPANIC FAMILIES WITH A FEMALE SINGLE HEAD-OF-HOUSEHOLD, 29.2% ARE LIVING BELOW FPL AS COMPARED WITH 12.5% FOR WHITES IN THIS CATEGORY. AMONG SENIORS, THOSE WHO ARE MARRIED HAVE A LOWER POVERTY RATE (1.9%) THAN DO FEMALE SENIORS LIVING AS SINGLE, HEADS-OF-HOUSEHOLD (2.4%). IN SOME PARTS OF SOUTHWEST SANTA ROSA, THE RUSSIAN RIVER CORRIDOR, SONOMA VALLEY AND UNINCORPORATED AREAS IN THE NORTHWEST AND NORTHEAST, POVERTY RATES FOR CHILDREN UNDER AGE 18 EXCEED 40%. BASED ON NEIGHBORHOOD CONDITIONS, RESIDENTS IN THESE COMMUNITIES MAY HAVE LIMITED ACCESS TO SAFE PLACES TO PLAY, SAFE ROUTES TO WALK AND BIKE TO SCHOOL, GROCERY STORES THAT OFFER AFFORDABLE, FRESH FRUITS AND VEGETABLES OR PREVENTION-FOCUSED HEALTH AND DENTAL SERVICES. THE COUNTY'S LOWEST INCOME SENIOR POPULATIONS ARE CLUSTERED AROUND SANTA ROSA, THE SONOMA VALLEY AND THE RUSSIAN RIVER. SIMILARLY, LOW-INCOME SENIORS MAY FACE BARRIERS IN ACCESSING AFFORDABLE TRANSPORTATION, NUTRITIOUS FOOD, SAFE PLACES TO EXERCISE AND OPPORTUNITIES TO SOCIALIZE WITH OTHERS. PETALUMA VALLEY HOSPITAL IS APPROXIMATELY 40 MILES NORTH OF SAN FRANCISCO JUST OFF THE HIGHWAY 101 CORRIDOR IN SOUTHERN SONOMA COUNTY IN THE TOWN OF PETALUMA. THIS 80-BED ACUTE AND CRITICAL CARE HOSPITAL OFFERS 24 HOUR EMERGENCY AND OUTPATIENT SERVICES. THE CITIES AND TOWNS IN THE PETALUMA VALLEY PRIMARY SERVICE AREA (PSA) INCLUDE PETALUMA IN SONOMA COUNTY AND VALLEY FORD, TOMALES, DILLON BEACH AND MARSHALL, IN MARIN COUNTY. THE SECONDARY SERVICE AREA (SSA) INCLUDES COTATI, PENNGROVE AND ROHNERT PARK IN SONOMA COUNTY. THE POPULATION OF THE SERVICE AREA IS 127,095 OF WHICH 71,488 ARE IN THE PRIMARY SERVICE AREA AND 55,607 RESIDE IN THE SECONDARY SERVICE AREA. THE POVERTY RATE IS LOW IN THE PRIMARY SERVICE AND HIGHER IN THE SECONDARY SERVICE AREA.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH SANTA ROSA MEMORIAL HOSPITAL AND PETALUMA VALLEY HOSPITAL HAVE BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 60 YEARS. SERVING THE COMMUNITIES OF SONOMA COUNTY, THE MINISTRY'S CORE FACILITIES ARE PVH, AN 80-BED ACUTE CARE HOSPITAL, AND SRMH, A FULL-SERVICE 278-BED ACUTE CARE HOSPITAL THAT INCLUDES A LEVEL II TRAUMA CENTER FOR THE COASTAL REGION FROM SAN FRANCISCO TO THE OREGON BORDER. MAJOR PROGRAMS AND SERVICES INCLUDE CARDIAC CARE, CRITICAL CARE, DIAGNOSTIC IMAGING, AND A WIDE RANGE OF SPECIALTY SERVICES, EMERGENCY MEDICINE AND OBSTETRICS. SRMH AND PVH ARE COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE OF ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: THERE IS A COMMUNITY BENEFIT COMMITTEE THAT HAS COMMUNITY REPRESENTATION, AN OPEN MEDICAL STAFF, AND THROUGH SRMH AND PVH'S COMMUNITY BENEFIT PROGRAMS WHICH ARE PARTLY FUNDED BY CARE FOR THE POOR DOLLARS. SRMH AND PVH ARE HEALING MINISTRIES OF ST. JOSEPH HEALTH SYSTEM. AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPITAL CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IN THE COMMUNITIES WE SERVE. LOCAL COMMUNITY BENEFIT COMMITTEE: THE ROLE OF THE SRMH AND PVH'S COMMUNITY BENEFIT COMMITTEE IS TO SUPPORT THE BOARD OF TRUSTEES IN OVERSEEING COMMUNITY BENEFIT EFFORTS. THE COMMITTEE ACTS IN ACCORDANCE WITH A BOARD-APPROVED CHARTER. THE COMMUNITY BENEFIT COMMITTEE IS CHARGED WITH DEVELOPING POLICIES AND PROGRAMS THAT ADDRESS IDENTIFIED NEEDS IN THE SERVICE AREA PARTICULARLY FOR UNDERSERVED POPULATIONS, OVERSEEING DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORTS, AND PROVIDING DIRECTION OF COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY BENEFIT COMMITTEE HAS A MINIMUM OF EIGHT MEMBERS INCLUDING THREE MEMBERS OF THE BOARD OF TRUSTEES. CURRENT MEMBERSHIP INCLUDES THREE MEMBERS OF THE BOARD OF TRUSTEES AND EIGHT COMMUNITY MEMBERS. A MAJORITY OF MEMBERS HAVE KNOWLEDGE AND EXPERIENCE WITH THE POPULATIONS MOST LIKELY TO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE COMMUNITY BENEFIT COMMITTEE GENERALLY MEETS BI-MONTHLY. COMMUNITY BENEFIT INVESTMENT: THIS IS DEMONSTRATED THROUGH THE FOLLOWING KEY PROGRAMS: - PVHS CONTINUUM OF ORAL HEALTH SERVICES INCLUDE A FIXED SITE DENTAL CLINIC LOCATED IN SANTA ROSA THAT SERVES CHILDREN FORM THROUGHOUT THE COUNTY, THE MOBILE DENTAL CLINIC, THE MIGHTY MOUTH SCHOOL-BASED DENTAL DISEASE PREVENTION PROGRAM, AND MOMMY AND ME, WHICH TEACHES GOOD DENTAL HEALTH PRACTICES TO VERY YOUNG CHILDREN ZERO TO FIVE YEARS OLD AND THEIR MOTHERS. THE CLINICS PRIORITIZE SERVICE TO CHILDREN AGES 0-16 YEARS, BUT ALSO SERVE ADULTS WITH URGENT NEEDS. THEY PROVIDE BASIC, PREVENTIVE, EMERGENCY AND COMPREHENSIVE DENTAL CARE WITH A STRONG FOCUS ON PREVENTION AND EDUCATION. DURING FY16, 5,202 PATIENTS WERE SERVED OVER 8,090 ENCOUNTERS AT THE SJH DENTAL CLINIC. OUR MOBILE DENTAL CLINIC AND MIGHTY MOUTH SCHOOL-BASED PREVENTION PROGRAM SERVED 5,546 PATIENTS AND COMPLETED 11,359 ENCOUNTERS COUNTYWIDE. OF THE MOMMY AND ME PARTICIPANTS THROUGHOUT THE COUNTY, THERE WAS A 1% DECAY RATE AMONG ONE-YEAR OLDS, COMPARED TO 5% DECAY RATE AMONG PATIENTS IN THE CLINIC WHO DID NOT PARTICIPATE IN THE PROGRAM. WE SAW A 13% DECAY RATE AMONG RETURNING 2-5 YEAR-OLDS IN MOMMY AND ME PROGRAM, COMPARED TO NON-PARTICIPATING CHILDREN IN THE SAME AGE GROUP WITH 22% DECAY RATE. -PVHS MOBILE MEDICAL CLINIC SERVES PATIENTS IN THEIR COMMUNITIES AT NO COST. THE PROGRAM SEEKS TO PROVIDE CARE TO THOSE WHO FALL THROUGH THE TRADITIONAL PRIMARY CARE SAFETY NET, AND FOR REASONS RELATED TO TRANSPORTATION, POVERTY, OR OTHER FACTORS, FACE INSURMOUNTABLE BARRIERS TO ACCESSING CARE AT COMMUNITY HEALTH CENTERS OR OTHER MEDICAL HOMES. THE CLINIC OFFERS HEALTH SCREENINGS, TREATMENT OF MINOR MEDICAL PROBLEMS, HEALTH AND NUTRITIONAL EDUCATION, AND INFORMATION AND REFERRALS. IN FY 16, IN THE PVH SERVICE AREA, THE CLINIC SERVED 834 PATIENTS OVER 2,367 ENCOUNTERS AT SEVERAL LOCATIONS, INCLUDING THE CITIES OF SONOMA/BOYES HOT SPRINGS, SANTA ROSA, AND WINDSOR. - PVHS HOUSE CALLS PROGRAM TENDS TO THE PHYSICAL, SPIRITUAL AND EMOTIONAL NEEDS OF FRAIL ELDERLY SENIORS AND ADULTS WITH CHRONIC DISEASES BY PROVIDING PRIMARY MEDICAL CARE AT HOME. ELIGIBLE SENIORS HAVE LIMITED ACCESS TO CARE DUE TO IMPAIRED MOBILITY, UNDER-INSURANCE, AND LACK OF FUNDS. THE PROGRAM TEAM, WHICH INCLUDES NURSE PRACTITIONERS, NURSES, CASE MANAGEMENT, AND HOME HEALTH ASSISTANCE, PROVIDED SERVICE TO 135 PATIENTS AND COMPLETED OVER 6,340 ENCOUNTERS COUNTYWIDE, HELPING TO PREVENT UNNECESSARY EMERGENCY DEPARTMENT VISITS AND TO MORE EFFECTIVELY MANAGE CHRONIC DISEASE.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM SANTA ROSA MEMORIAL HOSPITAL AND PETALUMA VALLEY HOSPITAL ARE HEALING MINISTRIES OF ST. JOSEPH HEALTH, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. ST. JOSEPH HEALTH IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPITAL CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IN THE COMMUNITIES WE SERVE. IN 1986, ST. JOSEPH HEALTH (SJH) CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FREE CARE. FOR THOSE IN NEED OF ACUTE SERVICES, SJH CREATED THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND (FORMERLY THE ST. JOSEPH HEALTH SYSTEM FOUNDATION) TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. EVERY YEAR, EACH ST. JOSEPH HEALTH HOSPITAL MINISTRY CONTRIBUTES 10 PERCENT OF ITS NET INCOME TO THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. IN FY16, SANTA ROSA MEMORIAL CONTRIBUTED $6.6 MILLION TO THE SJH COMMUNITY PARTNERSHIP FUND (SJH CPF). PETALUMA VALLEY HOSPITAL DID NOT CONTRIBUTE DUE TO NET LOSS. 75% OF THE CONTRIBUTIONS ARE USED TO SUPPORT CARE FOR THE POOR PROGRAMS THAT ARE SELECTED LOCALLY BY EACH HOSPITAL. 17.5% IS USED TO SUPPORT COMMUNITY PARTNERSHIP FUND INITIATIVES, SUCH AS THE WELLNESS AND PREVENTION INITIATIVE, AND THE COMMUNITY BUILDING INITIATIVE. THE REMAINING 7.5% IS DESIGNATED TOWARD THE ENDOWMENT, WHICH HELPS ENSURE THE FUND'S ABILITY TO SUSTAIN PROGRAMS INTO THE FUTURE THAT ASSIST LOW-INCOME AND UNDERSERVED POPULATIONS. COMMUNITY INVESTMENT FUND ST. JOSEPH HEALTH FURTHER RECOGNIZES THAT THE HEALTH OF ANY COMMUNITY DEPENDS ON THE MAINTENANCE AND CREATION OF STRONG STRUCTURES-BOTH PHYSICAL AND SOCIAL-THAT CONTRIBUTE TO THE LONG-TERM WELL-BEING OF PEOPLE. THAT PHILOSOPHY INSPIRED THE INITIATION OF THE COMMUNITY INVESTMENT FUND-AN EFFORT TO ENABLE NONPROFIT 501(C)(3) ORGANIZATIONS TO ACHIEVE THEIR FULL POTENTIAL AND PLAY A MAJOR ROLE IN THE GROWTH OF THEIR COMMUNITIES. THE COMMUNITY INVESTMENT FUND PROVIDES CAPITAL IN THE FORM OF LOANS, DEPOSITS OR OTHER SUPPORT TO NONPROFITS TO PROMOTE SOCIAL GOOD AND THE DEVELOPMENT OF HEALTHIER COMMUNITIES. IN FY16, A TOTAL OF $11.2 MILLION WAS INVESTED INTO THE COMMUNITY THROUGH LOANS AND LINES OF CREDIT. FUNDED NON-PROFITS INCLUDE THOSE THAT SERVE THE HOMELESS, PROVIDE AFFORDABLE HOUSING, PROVIDE ACCESS TO PRIMARY MEDICAL CARE, AND ADDRESS YOUTH DEVELOPMENT. TO LEARN MORE ABOUT ST. JOSEPH HEALTH GO TO STJHS.ORG.
SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA

Schedule H (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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed 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? .........

Yes

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

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

Only 501(c)(3), 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)
1RICHARD IGRAMBOARD MEMBER	(i) (ii)	0 ------------- 351,139	0 ------------- 151,730	0 ------------- 47,875	0 ------------- 23,235	0 ------------- 15,850	0 ------------- 589,829	0 ------------- 0
2TODD SALNASBOARD MEMBER/PRESIDENT, SJH-SC	(i) (ii)	0 ------------- 403,846	0 ------------- 199,653	0 ------------- 47,443	0 ------------- 13,250	0 ------------- 37,541	0 ------------- 701,733	0 ------------- 0
3OLUYEMI ADEYANJUBOARD SECRETARY	(i) (ii)	0 ------------- 124,704	0 ------------- 30,000	0 ------------- 11,577	0 ------------- 0	0 ------------- 2,087	0 ------------- 168,368	0 ------------- 0
4JAMES WATSONBOARD SECRETARY (PART YEAR)	(i) (ii)	0 ------------- 446,722	0 ------------- 206,201	0 ------------- 67,582	0 ------------- 21,200	0 ------------- 34,649	0 ------------- 776,354	0 ------------- 0
5JANE READVP-OPERATIONS	(i) (ii)	222,569 ------------- 0	88,018 ------------- 0	25,175 ------------- 0	11,183 ------------- 0	11,685 ------------- 0	358,630 ------------- 0	0 ------------- 0
6GAY CORDERO-JOLAVARSTAFF NURSE II-CNA	(i) (ii)	193,678 ------------- 0	0 ------------- 0	4,655 ------------- 0	9,771 ------------- 0	3,061 ------------- 0	211,165 ------------- 0	0 ------------- 0
7THELMA COLLINSHOUSE SUPERVISOR	(i) (ii)	190,445 ------------- 0	0 ------------- 0	37 ------------- 0	9,666 ------------- 0	25,167 ------------- 0	225,315 ------------- 0	0 ------------- 0
8CHRIS FALLEYDIRECTOR HOSPICE SERVICES	(i) (ii)	146,239 ------------- 0	21,576 ------------- 0	16,839 ------------- 0	5,959 ------------- 0	28,218 ------------- 0	218,831 ------------- 0	0 ------------- 0
9HAI GAOSTAFF NURSE III	(i) (ii)	182,147 ------------- 0	0 ------------- 0	112 ------------- 0	9,222 ------------- 0	30,009 ------------- 0	221,490 ------------- 0	0 ------------- 0
10WENDI THOMASDIRECTOR, NURSING	(i) (ii)	150,933 ------------- 0	22,689 ------------- 0	2,124 ------------- 0	12,233 ------------- 0	27,469 ------------- 0	215,448 ------------- 0	0 ------------- 0
11MICHEL RICCIONICHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 374,936	0 ------------- 141,096	0 ------------- 236,820	0 ------------- 18,347	0 ------------- 27,763	0 ------------- 798,962	0 ------------- 181,755
12KEVIN KLOCKENGAREGIONAL EVP - NCA	(i) (ii)	0 ------------- 626,686	0 ------------- 314,627	0 ------------- 79,798	0 ------------- 13,250	0 ------------- 20,352	0 ------------- 1,054,713	0 ------------- 0
13DAVID ZIOLKOWSKICHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 259,049	0 ------------- 95,835	0 ------------- 21,610	0 ------------- 10,407	0 ------------- 27,675	0 ------------- 414,576	0 ------------- 0
14JAYNIE BORENN.CA REG VP-STRATEGIC SVCS	(i) (ii)	0 ------------- 289,266	0 ------------- 110,871	0 ------------- 27,572	0 ------------- 10,600	0 ------------- 22,272	0 ------------- 460,581	0 ------------- 0
15RICHARD CARVOLTHCHIEF MEDICAL OFFICER	(i) (ii)	0 ------------- 366,309	0 ------------- 143,116	0 ------------- 38,367	0 ------------- 10,210	0 ------------- 19,394	0 ------------- 577,396	0 ------------- 0
16ROBERT EISENREGIONAL VP HR	(i) (ii)	0 ------------- 233,095	0 ------------- 85,863	0 ------------- 19,403	0 ------------- 8,793	0 ------------- 29,290	0 ------------- 376,444	0 ------------- 0
17ROBERT JUST IIINCAL REGION, COO	(i) (ii)	0 ------------- 272,669	0 ------------- 105,558	0 ------------- 34,829	0 ------------- 18,550	0 ------------- 29,201	0 ------------- 460,807	0 ------------- 0
18MAUREEN DISBOTREG VP, QUALITY &SAFETY-N.CA	(i) (ii)	0 ------------- 296,147	0 ------------- 109,625	0 ------------- 29,626	0 ------------- 4,396	0 ------------- 19,345	0 ------------- 459,139	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
SCHEDULE J, PART I, LINE 3	THE ORGANIZATION'S PRESIDENT IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY ST. JOSEPH HEALTH SYSTEM.
SCHEDULE J, PART I, LINE 4B	BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE YEAR OR AGE 65 VESTING SCHEDULE. EXECUTIVES PREVIOUSLY PARTICIPATED IN ANOTHER NON-QUALIFIED DEFERRED COMPENSATION PLAN THAT WAS FROZEN EFFECTIVE DECEMBER 2007, AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED. THIS FROZEN PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN. THE FOLLOWING INDIVIDUAL RECEIVED 457(F) PAYMENTS DURING THE YEAR: MICHEL RICCIONI: $181,755
SCHEDULE J, PART I, LINE 7	A PORTION OF EXECUTIVE SALARIES ARE PLACED 'AT-RISKARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE STRATEGIC OBJECTIVES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY.

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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Return Reference	Explanation
FORM 990, PART I, LINE 1	ORGANIZATIONS MISSION STATEMENT SRM ALLIANCE HOSPITAL IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE.
FORM 990, PART III, LINE 4A	REALIZING OUR MISSION PETALUMA VALLEY HOSPITAL HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 18 YEARS. SERVING THE COMMUNITIES OF SONOMA COUNTY, PVH IS AN 80-BED ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF CARDIAC CARE, DIAGNOSTIC IMAGING, AND A WIDE RANGE OF SPECIALTY SERVICES, EMERGENCY MEDICINE AND OBSTETRICS. WITH OVER 574 EMPLOYEES COMMITTED TO REALIZING THE MISSION, PVH IS ONE OF THE LARGEST EMPLOYERS IN SONOMA COUNTY. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, PVH IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORSMINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBILITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. PATIENT FINANCIAL ASSISTANCE PROGRAM PETALUMA VALLEY HOSPITAL BELIEVES THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY PVH HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM (FAP) THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. IN FY16, PVH PROVIDED $900,164 IN FREE AND DISCOUNTED CARE. MEDICAID PROGRAM PETALUMA VALLEY HOSPITAL PROVIDED ACCESS TO UNINSURED AND UNDERINSURED PERSONS BY PARTICIPATING IN THE FEDERAL AND STATE SPONSORED MEDICAID PROGRAM. IN FY16, PVH PROVIDED $8.9M IN MEDICAID SHORTFALL. PROGRAM SERVICE ACCOMPLISHMENTS COMMUNITY BENEFIT INVESTMENT IS DEMONSTRATED THROUGH THE FOLLOWING KEY PROGRAMS: - PVHS CONTINUUM OF ORAL HEALTH SERVICES INCLUDE A FIXED SITE DENTAL CLINIC LOCATED IN SANTA ROSA THAT SERVES CHILDREN FORM THROUGHOUT THE COUNTY, THE MOBILE DENTAL CLINIC, THE MIGHTY MOUTH SCHOOL-BASED DENTAL DISEASE PREVENTION PROGRAM, AND MOMMY AND ME, WHICH TEACHES GOOD DENTAL HEALTH PRACTICES TO VERY YOUNG CHILDREN ZERO TO FIVE YEARS OLD AND THEIR MOTHERS. THE CLINICS PRIORITIZE SERVICE TO CHILDREN AGES 0-16 YEARS, BUT ALSO SERVE ADULTS WITH URGENT NEEDS. THEY PROVIDE BASIC, PREVENTIVE, EMERGENCY AND COMPREHENSIVE DENTAL CARE WITH A STRONG FOCUS ON PREVENTION AND EDUCATION. DURING FY16, 5,434 PATIENTS WERE SERVED OVER 8,535 ENCOUNTERS AT THE SJH DENTAL CLINIC. OUR MOBILE DENTAL CLINIC AND MIGHTY MOUTH SCHOOL-BASED PREVENTION PROGRAM SERVED 5,729 PATIENTS AND COMPLETED 11,702 ENCOUNTERS COUNTYWIDE. OF THE MOMMY AND ME PARTICIPANTS THROUGHOUT THE COUNTY, THERE WAS A 1% DECAY RATE AMONG ONE-YEAR OLDS, COMPARED TO 5% DECAY RATE AMONG PATIENTS IN THE CLINIC WHO DID NOT PARTICIPATE IN THE PROGRAM. WE SAW A 13% DECAY RATE AMONG RETURNING 2-5 YEAR-OLDS IN MOMMY AND ME PROGRAM, COMPARED TO NON-PARTICIPATING CHILDREN IN THE SAME AGE GROUP WITH 22% DECAY RATE. - PVHS MOBILE MEDICAL CLINIC SERVES PATIENTS IN THEIR COMMUNITIES AT NO COST. THE PROGRAM SEEKS TO PROVIDE CARE TO THOSE WHO FALL THROUGH THE TRADITIONAL PRIMARY CARE SAFETY NET, AND FOR REASONS RELATED TO TRANSPORTATION, POVERTY, OR OTHER FACTORS, FACE INSURMOUNTABLE BARRIERS TO ACCESSING CARE AT COMMUNITY HEALTH CENTERS OR OTHER MEDICAL HOMES. THE CLINIC OFFERS HEALTH SCREENINGS, TREATMENT OF MINOR MEDICAL PROBLEMS, HEALTH AND NUTRITIONAL EDUCATION, AND INFORMATION AND REFERRALS. IN FY 16, IN THE PVH SERVICE AREA, THE CLINIC SERVED 838 PATIENTS OVER 2,372 ENCOUNTERS AT SEVERAL LOCATIONS, INCLUDING THE CITIES OF SONOMA/BOYES HOT SPRINGS, SANTA ROSA, AND WINDSOR. - PVHS HOUSE CALLS PROGRAM TENDS TO THE PHYSICAL, SPIRITUAL AND EMOTIONAL NEEDS OF FRAIL ELDERLY SENIORS AND ADULTS WITH CHRONIC DISEASES BY PROVIDING PRIMARY MEDICAL CARE AT HOME. ELIGIBLE SENIORS HAVE LIMITED ACCESS TO CARE DUE TO IMPAIRED MOBILITY, UNDER-INSURANCE, AND LACK OF FUNDS. THE PROGRAM TEAM, WHICH INCLUDES NURSE PRACTITIONERS, NURSES, CASE MANAGEMENT, AND HOME HEALTH ASSISTANCE, PROVIDED SERVICE TO 142 PATIENTS AND COMPLETED OVER 6,674 ENCOUNTERS COUNTYWIDE, HELPING TO PREVENT UNNECESSARY EMERGENCY DEPARTMENT VISITS AND TO MORE EFFECTIVELY MANAGE CHRONIC DISEASE. FOR MORE INFORMATION ABOUT PETALUMA VALLEY HOSPITAL, PLEASE VISIT WWW.STJOESONOMA.ORG. FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG.
FORM 990, PART V, LINE 1A	ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR SJH ENTITIES UNDER SJH AP SHARED SERVICES. THEREFORE, SJHS ISSUES FORM 1099-MISC UNDER ITS TAX ID. SJHS COMPLIES WITH BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS.
FORM 990, PART VI, LINE 6	DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS SANTA ROSA MEMORIAL HOSPITAL IS THE SOLE CORPORATE MEMBER OF SRM ALLIANCE HOSPITAL SERVICES.
FORM 990, PART VI, LINE 7A	DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS SRM ALLIANCE HOSPITAL SERVICES HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE SRM ALLIANCE HOSPITAL SERVICES BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE SRM ALLIANCE HOSPITAL SERVICES BOARD AS NOMINATIONS MUST BE APPROVED BY SANTA ROSA MEMORIAL HOSPITAL.
FORM 990, PART VI, LINE 7B	DESCR OF CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY SANTA ROSA MEMORIAL HOSPITAL, ITS SOLE CORPORATE MEMBER, FOR THE FOLLOWING: A. ESTABLISHING THE PHILOSOPHY, OBJECTIVES AND PURPOSES OF THE ORGANIZATION; B. LONG-TERM AND SHORT-TERM FINANCING; C. SALE, LEASE, DISPOSITION OR HYPOTHECATION OF REAL PROPERTY; D. ANNUAL BUDGETS; E. CAPITAL EXPENDITURES; F. ORGANIZATION'S STRATEGIC PLANS; G. MERGER OR DISSOLUTION; H. APPOINTMENT OR REMOVAL OF FISCAL AUDITORS; I. APPOINTMENT OR REMOVAL OF TRUSTEES, OFFICERS OF THE BOARD AND CHIEF EXECUTIVE OFFICER; J. AMENDMENT OR RESCISSION OF THE BYLAWS; K. EXERCISE THE POWERS WHICH ARE RESERVED TO THE ORGANIZATION IN ITS CAPACITY AS A CORPORATE MEMBER OF ANY SUBSIDIARY; AND L. EXERCISE SUCH OTHER POWERS AS MAY BE REQUIRED OR PERMITTED BY LAW AND BY THE ARTICLES OF INCORPORATION AND THE BYLAWS.
FORM 990, PART VI, LINE 11B	DESCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AND WAS REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD AT THE APRIL 2017 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING.
FORM 990, PART VI, LINE 12C	MONITORING & ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
FORM 990, PART VI, LINES 15A & 15B	PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION'S PRESIDENT IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS APPROVED BY THE SRM ALLIANCE HOSPITAL SERVICES EXECUTIVE MANAGEMENT COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF THE PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2016. DURING THE YEAR, THE SRM ALLIANCE HOSPITAL SERVICES EXECUTIVE MANAGEMENT COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTING FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING.
FORM 990, PART VI, LINE 19	PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS EQUITY TRANSFERS (2,612,996)
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:3891560
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACT SERVIVCES TOTAL FEES:3379557
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:3954476

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

SRM ALLIANCE HOSPITAL SERVICES

Employer identification number

68-0395200

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 46-1259908	HEALTHCARE	CA	501(C)(3)	11,III	SJHS	Yes
(2)COVENANT ACO 3615 19TH STREET LUBBOCK,TX79410 61-1573313	HEALTHCARE	TX	501(C)(3)	11,I	CHS	Yes
(3)COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK,TX79410 75-2765566	HEALTHCARE	TX	501(C)(3)	3	SJHS	Yes
(4)COVENANT HEALTH SYSTEM FOUNDATION 3623 22ND PLACE LUBBOCK,TX79410 75-2897026	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(5)COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK,TX79410 75-2743883	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(6)COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK,TX79410 46-3516417	HEALTHCARE	TX	501(C)(3)	11,I	CHS	Yes
(7)HMTS INC 1 HOAG DRIVE NEWPORT BEACH,CA92658 45-3583707	HEALTHCARE	CA	501(C)(3)	11,I	HMHP	Yes
(8)HOAG CHARITY SPORTS 330 PLACENTIA AVE NEWPORT BEACH,CA92663 45-2982422	SUPPORT	CA	501(C)(3)	7	HHF	Yes
(9)HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH,CA92663 95-3222343	FUNDRAISING	CA	501(C)(3)	7	HMHP	Yes
(10)HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH,CA92663 95-1643327	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(11)HOME CARE PARTNERS 1165 MONTGOMERY DR SANTA ROSA,CA95405 68-0318656	INACTIVE	CA	501(C)(3)	3	SRMH	Yes
(12)HOSPICE OF LUBBOCK 3702 21ST STREET LUBBOCK,TX79410 75-2133781	HEALTHCARE	TX	501(C)(3)	9	CHS	Yes
(13)LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK,TX79410 75-2220963	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(14)METHODIST CHILDREN'S HOSPITAL 4015 22ND PLACE LUBBOCK,TX79410 75-2428911	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(15)METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND,TX79336 75-2246348	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(16)METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW,TX79072 75-2426010	HEALTHCARE	TX	501(C)(3)	3	CHS	Yes
(17)MISSION HOSPITAL REGIONAL MEDICAL CTR 27700 MEDICAL CENTER ROAD MISSION VIEJO,CA92691 95-1643360	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(18)QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA,CA94558 94-1243669	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(19)REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA,CA95540 94-2779313	HEALTHCARE	CA	501(C)(3)	7	RMH	Yes
(20)REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA,CA95540 94-1384665	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(21)SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DR SANTA ROSA,CA95405 94-1231005	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(22)SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE,CA92868 95-1643383	RELIGIOUS ORG	CA	501(C)(3)	1	NA		No
(23)ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 27-1666576	RELIGIOUS ORG	CA	501(C)(3)	1	SSJO		No
(24)ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 95-3589356	HEALTHCARE	CA	501(C)(3)	11, I	SJHM		No
(25)ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DRIVE STE 100 IRVINE,CA92612 33-0143024	HEALTHCARE	CA	501(C)(3)	7	SJHS	Yes
(26)ST JOSEPH HOME CARE NETWORK 1111 SONOMA STE 308 SANTA ROSA,CA95405 68-0331084	HEALTHCARE	CA	501(C)(3)	9	SJHS	Yes
(27)ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA,CA95501 94-1156596	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(28)ST JOSEPH HOSPITAL OF ORANGE 1100 WEST STEWART DRIVE ORANGE,CA92868 95-1643359	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(29)ST JUDE HOSPITAL YORBA LINDA 200 WEST CENTER ST PROMENADE ANAHEIM,CA92805 33-0185031	HEALTHCARE	CA	501(C)(3)	3	SJHS	Yes
(30)ST JUDE HOSPITAL INC 101 EAST VALENCIA MESA DRIVE FULLERTON,CA92835 95-1643324	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(31)ST MARY MEDICAL CENTER 18300 HIGHWAY 18 APPLE VALLEY,CA92307 95-1914489	HEALTHCARE	CA	501(C)(3)	3	CHN	Yes
(32)ST MARY OF THE PLAINS HOSPITAL FDN 4000 24TH STREET LUBBOCK,TX79410 75-1653181	HEALTHCARE	TX	501(C)(3)	7	CHS	Yes
(33)TALLER SAN JOSE 801 NORTH BROADWAY SANTA ANA,CA92701 59-3816355	WORK DEVELOPM	CA	501(C)(3)	2	SSJO	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 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?
(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) COVENANT LONG-TERM CARE LP 75-2569094	HEALTHCARE	TX	NA	N/A
(2) HERITAGE INVESTMENT GROUP 75-2177401	INVESTMENTS	CA	NA	N/A
(3) HOAG ORTHOPEDIC INSTITUTE SEE PART VII LUBBOCK,TX79410 20-5033419	HEALTHCARE	CA	NA	N/A
(4) LUBBOCK SURGERY CENTER LTD 27-1000061	HEALTHCARE	TX	NA	N/A
(5) METHODIST DIAGNOSTIC IMAGING 33-0355575	HEALTHCARE	TX	NA	N/A
(6) MISSION AMBULATORY SURGICENTER SEE PART VII ORANGE,CA92868 26-4591502	HEALTHCARE	CA	NA	N/A
(7) NEWPORT IMAGING CENTER	HEALTHCARE	CA	NA	N/A
(8) SHA LLC	HEALTHCARE	TX	NA	N/A
(9) ST JOSEPH PHYSICIAN VENTURES	REAL ESTATE	CA	NA	N/A
(10) ST JOSEPH HLTH SYS HOME CARE	HOME HEALTH	CA	NA	N/A
(11) ST JOSEPH HLTH SYS HOME HLTH	HOME HEALTH	CA	NA	N/A
(12) THE INNOVATION INSTITUTE	HEALTHCARE	DE	NA	N/A
(13) NORTH BAY ENDOSCOPY CENTER	HEALTHCARE	CA	NA	N/A
(14) MISSN VIEJO PHSCN PRTNRS I LLC	HEALTHCARE	CA	NA	N/A
(15) ADVANCED SURGERY INSTITUTE LLC	HEALTHCARE	CA	NA	N/A

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) AMERICAN UNITY GROUP LTD 90 PITTS BAY ROAD PEMBROKE HM08 BD	CAPTIVE INSURANCE	BD	NA	C-CORP
(2) COASTAL MANAGEMENT SERVICES ORGANIZATION 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0676831	HEALTHCARE	CA	NA	C-CORP
(3) DATU HEALTH INC 16150 MAIN CIRCLE DR SUITE 250 CHESTERFIELD,MO63017 46-3070062	IT SVCS	DE	NA	C-CORP
(4) HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH,CA92658 33-0731587	HEALTHCARE	CA	NA	C-CORP
(5) LUBBOCK METHODIST HOSP PRACTICE MGMT 2107 OXFORD STREET STE 300 LUBBOCK,TX79410 75-2578995	INACTIVE	TX	NA	C-CORP
(6) LUBBOCK METHODIST HOSPITAL SVCS PO BOX 1201 LUBBOCK,TX79410 75-2118585	HEALTHCARE	TX	NA	C-CORP
(7) MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD 354 MISSION VIEJO,CA92691 33-0212905	HEALTHCARE	CA	NA	C-CORP
(8) ST JOSEPH HEALTH 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 46-2340232	HOLDING COMPANY	CA	NA	C-CORP
(9) ST JOSEPH HEALTH SOURCE INC 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 46-1900168	HEALTHCARE	CA	NA	C-CORP
(10) ST JOSEPH PROF SVCS ENTERPRISES INC 3345 MICHELSON DRIVE SUITE 100 IRVINE,CA92612 33-0155323	HEALTHCARE	CA	NA	C-CORP

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

Yes

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH HEALTH SYSTEM FOUNDATION	c	296,000	ACCRUAL
(2) SANTA ROSA MEMORIAL HOSPITAL	P	8,700,000	CASH

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, PART III

IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 500 S. MAIN STREET, STE 1000, ORANGE, CA 92868 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE 362, MISSION VIEJO, CA 92691 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 100, ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 200 ORANGE, CA 92868-2012 THE INNOVATION INSTITUTE EIN: 90-0745066 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 NORTH BAY ENDOSCOPY CENTER, LLC EIN: 61-1559876 ADDRESS: 1383 N. MCDOWELL BLVD SUITE 110, PETALUMA, CA 94954 MISSION VIEJO PHYSICIAN PARTNERS I LLC EIN: 47-1559873 ADDRESS: 27700 MEDICAL CENTER ROAD, MISSION VIEJO, CA 92691 ADVANCED SURGERY INSTITUTE LLC EIN: 26-2299255 ADDRESS: 1739 4TH STREET, SANTA ROSA, CA 95404

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,025,191	1,066,498
9	Program service revenue (Part VIII, line 2g) .........	87,120,719	90,119,971
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	47,714	54,676
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-89,431	-66,678
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	88,104,193	91,174,467
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	499,600	9,750
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)	44,221,164	46,526,325
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 498,994
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	39,971,343	45,156,963
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	84,692,107	91,693,038
19	Revenue less expenses. Subtract line 18 from line 12.......	3,412,086	-518,571
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	34,364,472	32,106,690
21	Total liabilities (Part X, line 26).............	24,821,015	25,694,800
22	Net assets or fund balances. Subtract line 21 from line 20.....	9,543,457	6,411,890

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 83,868,734 including grants of $ 9,750 ) (Revenue $ 90,155,012 )
	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 expenses83,868,734

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) RICHARD CARVOLTH........................................................................ CHIEF MEDICAL OFFICER	7.0 .......................43.0	X		0	547,792	29,604
(19) ROBERT EISEN........................................................................ REGIONAL VP HR	7.0 .......................43.0	X		0	338,361	38,083
(20) ROBERT JUST III........................................................................ NCAL REGION, COO	7.0 .......................43.0	X		0	413,056	47,751
(21) MAUREEN DISBOT........................................................................ REG VP, QUALITY &SAFETY-N.CA	7.0 .......................43.0	X		0	435,398	23,741
(22) GAY CORDERO-JOLAVAR........................................................................ STAFF NURSE II-CNA	40.0 .......................0.0		X	198,333	0	12,832
(23) THELMA COLLINS........................................................................ HOUSE SUPERVISOR	40.0 .......................0.0		X	190,482	0	34,833
(24) CHRIS FALLEY........................................................................ DIRECTOR HOSPICE SERVICES	40.0 .......................0.0		X	184,654	0	34,177
(25) HAI GAO........................................................................ STAFF NURSE III	40.0 .......................0.0		X	182,259	0	39,231
(26) WENDI THOMAS........................................................................ DIRECTOR, NURSING	40.0 .......................0.0		X	175,746	0	39,702

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,267,236	6,401,245	621,300

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	574
6	Total number of volunteers (estimate if necessary) .............	6	175
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	390,545
d	Related organizations		1d	296,000
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	379,953

g	Noncash contributions included in lines 1a-1f:$ 5,030
h Total.Add lines 1a-1f.......		1,066,498

			Business Code
2a	NET PATIENT REVENUE	622110	89,729,626	89,729,626	0	0
b	ELECTRONIC HEALTH RECORDS	622110	299,468	299,468	0	0
c	CAFETERIA	722514	89,212	89,212	0	0
d	All other program service revenue	900099	1,665	1,665	0	0
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			90,119,971

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			54,676			54,676
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....			0
8a	Gross income from fundraising events (not including $ 390,545of contributions reported on line 1c). See Part IV, line 18 ....
	a		56,246
b	Less: direct expenses ...b		157,965
c	Net income or (loss) from fundraising events..			-101,719			-101,719
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CASH PURCHASES & DISCOUNT		900099	25,180	25,180	0	0
b	REBATES & RETURNS		900099	9,861	9,861	0	0
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			35,041
12	Total revenue. See Instructions......			91,174,467	90,155,012	0	-47,043

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	9,750	9,750
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	842,667	726,239	73,457	42,971
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0	0
7	Other salaries and wages	32,068,699	30,391,128	1,534,782	142,789
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,793,126	1,674,524	113,276	5,326
9	Other employee benefits .......	9,212,694	8,648,353	475,957	88,384
10	Payroll taxes ...........	2,609,139	2,477,105	117,481	14,553
11	Fees for services (non-employees):
a	Management ......	6,672,216	6,440,784	231,432	0
b	Legal .........	406,948	0	406,948	0
c	Accounting ...........	78,800	0	78,800	0
d	Lobbying ...........	9,314	9,314	0	0
e	Professional fundraising services. See Part IV, line 17	0			0
f	Investment management fees ......	0	0	0	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	11,225,593	10,276,868	935,099	13,626
12	Advertising and promotion ....	203,361	56,256	121,461	25,644
13	Office expenses .......	2,523,486	2,418,725	80,615	24,146
14	Information technology ......	1,908,662	1,745,789	152,486	10,387
15	Royalties ..	0	0	0	0
16	Occupancy ...........	1,517,344	1,440,371	2,895	74,078
17	Travel ............	453,535	397,443	55,971	121
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0	0	0	0
19	Conferences, conventions, and meetings ....	27,822	20,732	7,090	0
20	Interest ...........	8,152	8,152	0	0
21	Payments to affiliates .......	0		0	0
22	Depreciation, depletion, and amortization ..	2,765,158	2,586,266	178,892	0
23	Insurance ...	452,538	452,538	0	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	7,409,095	7,408,847	248	0
b	CA HOSPITAL FEE PROGRAM	3,333,138	3,333,138	0	0
c	REPAIRS AND MAINTENANCE	1,012,398	1,007,317	2,835	2,246
d	LEGAL SETTLEMENT	2,000,000		2,000,000
e	All other expenses	3,149,403	2,339,095	755,585	54,723
25	Total functional expenses. Add lines 1 through 24e	91,693,038	83,868,734	7,325,310	498,994
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).	0

1	Cash–non-interest-bearing ........			2,059	1	2,059
2	Savings and temporary cash investments .........			3,347,935	2	3,262,742
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			10,231,167	4	11,189,226
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			1,255,628	8	1,302,090
9	Prepaid expenses and deferred charges ......			710,412	9	781,299
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	51,620,066
b	Less: accumulated depreciation	10b	39,352,481	14,588,740	10c	12,267,585
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			184,886	12	163,916
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			4,043,645	15	3,137,773
16	Total assets. Add lines 1 through 15 (must equal line 34)...			34,364,472	16	32,106,690

17	Accounts payable and accrued expenses .....	6,120,610	17	9,032,917
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	18,700,405	25	16,661,883
26	Total liabilities. Add lines 17 through 25..	24,821,015	26	25,694,800

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	7,168,073	27	4,115,103
28	Temporarily restricted net assets ...........	2,375,384	28	2,296,787
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	9,543,457	33	6,411,890
34	Total liabilities and net assets/fund balances ........	34,364,472	34	32,106,690