4A (Expenses $ 8299124630 including grants of $ 171669107) (Revenue $ 8976263281)
Dignity Health, Formerly Catholic Healthcare West, is a California nonprofit public benefit corporation headquartered in San Francisco, California. Dignity Health, together with its subsidiary corporations, is one of the largest not-for-profit acute healthcare delivery systems in the United States as measured by annual revenue. Dignity Health operated 40 hospitals throughout major California markets and in the Phoenix, Arizona and Las Vegas and Reno, Nevada metropolitan markets during the year ended June 30, 2012. Dignity Health's and its subordinate corporations' facilities included approximately 8,400 licensed acute care beds and approximately 800 licensed skilled nursing beds as of 6/30/12. Dignity Health maintains prominent market shares in many of its service areas, and many of its hospitals rank among the finest in the nation. With a significant presence in Sacramento, San Francisco, Southern California, San Joaquin Valley, Central Coast, Central California, Northern California and Santa Cruz, Dignity Health's California operations are well dispersed throughout the state. Dignity Health's hospitals operate emergency rooms that are open to all persons regardless of ability to pay; have open medical staffs with privileges available to all qualified physicians in the area; have governing bodies in which primarily independent persons representative of the community comprise a majority; engage in the training and education of healthcare professionals; and participate in Medicaid, Medicare, CHAMPUS, Tricare and/or other government-sponsored healthcare programs. This organization is a public benefit corporation exempt from taxation under section 501(c)(3) of the internal revenue code.

Part I, Line 6a and 6b
EACH TAX-EXEMPT HOSPITAL FACILITY LISTED IN SCHEDULE H, PART V, PREPARES A SEPARATE COMMUNITY BENEFIT REPORT. CALIFORNIA HOSPITALS SUBMIT THEIR REPORTS TO THE OFFICE OF STATEWIDE HEALTH PLANNING DEPARTMENT AND NEVADA HOSPITALS SUBMIT THEIR REPORTS TO THE NEVADA DEPARTMENT OF HEALTH AND HUMAN SERVICES. DIGNITY HEALTH INCLUDES A CONSOLIDATED COMMUNITY BENEFIT REPORT IN ITS ANNUAL AUDITED FINANCIAL STATEMENTS FOR ITS HOSPITALS AND THE HOSPITALS OF RELATED ORGANIZATIONS THAT ARE CONSOLIDATED FOR FINANCIAL REPORTING PURPOSES (SEE PART VI, LINE 7). DIGNITY HEALTH'S FINANCIAL STATEMENTS ARE POSTED ON DIGNITY HEALTH'S EXTERNAL WEB SITE. SUMMARIES OF THE INDIVIDUAL HOSPITALS' REPORTS ARE POSTED ONLINE AND FULL REPORTS ARE AVAILABLE BY REQUEST.

Part I, Line 7b, 7g and 7i
"Part I, Line 7b Included in community benefit expense for Medicaid, column (c), is $283.4 million of quality assurance fees assessed to Dignity Health in accordance with the California provider fee programs. Included in direct offsetting revenue for Medicaid, column (d), is $492.6 million in supplemental payments received under these programs. Part I, Line 7g DIGNITY HEALTH REPORTED $5,592,140 OF SUBSIDIZED HEALTH SERVICES ASSOCIATED WITH PHYSICIAN CLINICS AS THESE SERVICES ARE PROVIDED TO THE COMMUNITIES AT A FINANCIAL LOSS. IF DIGNITY HEALTH DID NOT PROVIDE THESE SERVICES, THEY WOULD BE UNAVAILABLE IN THE COMMUNITY, THERE WOULD BE INSUFFICIENT AVAILABILITY IN THE COMMUNITY, OR THE SERVICE WOULD BECOME THE RESPONSIBILITY OF THE GOVERNMENT OR ANOTHER TAX-EXEMPT ORGANIZATION. Part I, Line 7i Included in cash and in-kind contributions for community benefit is $17.3 million in grants to a fund established by the California Health Foundation and Trust (""CHFT""). CHFT was established for several purposes, including aggregating and distributing financial resources to support charitable activities at various hospitals and health systems in California."

Part I, Line 7, column (f)
THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) IS $827,350,057 AND HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN COLUMN (F).

Part I, Line 7
FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, DIGNITY HEALTH USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO PATIENTS. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT EACH INDIVIDUAL HOSPITAL WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE CALCULATION ON WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN AGGREGATED FOR EACH PATIENT BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH SERVICES PROVIDED TO EACH PATIENT. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF PAYMENT ASSISTANCE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR PAYMENT ASSISTANCE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS.

Part II - COMMUNITY BUILDING ACTIVITIES
"AT DIGNITY HEALTH, EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITIES WE SERVE GO BEYOND PROVIDING HEALTH SERVICES. DIGNITY HEALTH'S ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND SERVICES OF THE ORGANIZATION. DIGNITY HEALTH TAKES A PROACTIVE APPROACH TO ADDRESSING THE SOCIAL AND ECONOMIC BARRIERS TO GOOD HEALTH AND SUPPORTS THE WORLD HEALTH ORGANIZATION DEFINITION OF HEALTH AS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. THROUGH THE DIGNITY HEALTH COMMUNITY INVESTMENT PROGRAM, LOW INTEREST LOANS AND LINES OF CREDIT ARE PROVIDED TO NON-PROFITS THAT ARE ADDRESSING SOME OF THE SOCIAL DETERMINANTS, INCLUDING AFFORDABLE HOUSING AND SERVICES, VITAL TO A COMMUNITY'S HEALTH. OFTEN THE LARGEST EMPLOYER IN THE COMMUNITY, DIGNITY HEALTH HOSPITALS PARTICIPATE IN ECONOMIC DEVELOPMENT COUNCILS AND LOCAL CHAMBERS OF COMMERCE. GRANTS ARE OFFERED TO COMMUNITY ORGANIZATIONS FOR THE PURPOSE OF ECONOMIC DEVELOPMENT OR TO HELP ENSURE A CONTINUUM OF CARE FOR THE COMMUNITY. YOUTH PROGRAMS FOCUS ON ACTIVITIES TO DETER DELINQUENCY, DEVELOP LEADERSHIP SKILLS, ENHANCE LITERACY AND ACADEMIC SUCCESS, IMPROVE HEALTH, CULTIVATE COMMUNITY RESPONSIBILITY, PROVIDE EDUCATION WITH CULTURAL ENRICHMENT AND OFFER CAREER EXPLORATION OPPORTUNITIES. THERE ARE ONGOING EFFORTS TO REDUCE COMMUNITY ENVIRONMENTAL HAZARDS IN THE AIR, WATER AND GROUND, AS WELL AS THE SAFE REMOVAL OF OTHER TOXIC WASTE PRODUCTS. LIFE AND CIVIC SKILLS TRAINING PROGRAMS ARE OFFERED, INCLUDING CAREER DEVELOPMENT TO ENSURE GAINFUL EMPLOYMENT IN AN ERA OF UNPRECEDENTED UNEMPLOYMENT. DIGNITY HEALTH HOSPITALS OPEN THEIR DOORS TO COMMUNITY GROUPS AND ALSO REPRESENT THE HOSPITALS ON COMMUNITY COALITIONS THAT FOCUS ON THE WELL-BEING OF THEIR RESPECTIVE COMMUNITIES. DIGNITY HEALTH ADVOCACY REPRESENTATIVES ARE TIRELESS AS THEY STRIVE TO IMPROVE ACCESS TO HEALTHCARE, PROMOTE THE HEALTH OF THE PUBLIC, AND ADVOCATE FOR SOCIAL JUSTICE AND HUMAN RIGHTS. IN MEDICALLY UNDERSERVED AREAS, EFFORTS TO RECRUIT PHYSICIANS AND OTHER HEALTH PROFESSIONALS ARE ONGOING, AS ARE THE PARTNERSHIPS WITH COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE. MANY DIGNITY HEALTH HOSPITALS OFFER HEALTH CAREER MENTORING PROJECTS AND PROVIDE SCHOOL-BASED AND COMMUNITY PROGRAMS THAT DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. COMMUNITY BUILDING - PHYSICAL IMPROVEMENTS / HOUSING o EMPLOYEES PARTNERED WITH REBUILDING TOGETHER TO MAKE CRITICAL REPAIRS TO THREE HOMES IN THE LAS VEGAS VALLEY FOR LOW-INCOME, DISABLED AND/OR AGING RESIDENTS. THIS PROJECT STRIVES TO PRESERVE AFFORDABLE HOME OWNERSHIP AND REVITALIZE COMMUNITIES. IN ADDITION, DIGNITY HEALTH'S DOMINICAN HOSPITAL IN SANTA CRUZ SUBSIDIZES LOW INCOME HOUSING. COMMUNITY BUILDING - ECONOMIC DEVELOPMENT o LEADERSHIP STAFF MEMBERS OF SEVERAL DIGNITY HEALTH FACILITIES ACTIVELY PARTICIPATE IN CHAMBERS OF COMMERCE, CIVIC ORGANIZATIONS AND COALITIONS AIMED AT ENSURING THE ECONOMIC DEVELOPMENT, GROWTH AND STABILITY OF THEIR LOCAL COMMUNITIES. COMMUNITY BUILDING - COMMUNITY SUPPORT o DIGNITY HEALTH FACILITIES LEAD OR COLLABORATE WITH OTHER COMMUNITY-BASED ORGANIZATIONS IN SUPPORT OF THE SUCCESS OF CHILDREN, YOUTH AND FAMILIES, WHICH ALSO ENGAGES AND STRENGTHENS THE SCHOOL COMMUNITY. COMMUNITY BUILDING - ENVIRONMENTAL IMPROVEMENTS o THE COMMITMENT OF DIGNITY HEALTH TO IMPROVE AND SUSTAIN OUR ENVIRONMENT IS CODIFIED BY POLICIES, INCLUDING A PURCHASING POLICY WHICH PURSUES MULTIPLE ENVIRONMENTAL GOALS. FIRST, DIGNITY HEALTH SEEKS TO REDUCE WASTE AT ITS SOURCE BY REDESIGNING PROCESSES AND PURCHASING PRACTICES TO REDUCE THE AMOUNT OF VIRGIN MATERIALS PURCHASED. SECOND, ONCE A PROCUREMENT NEED IS IDENTIFIED, DIGNITY HEALTH ATTEMPTS TO PURCHASE GOODS WITH RECYCLED CONTENT THAT CAN SPECIFICALLY BE RECYCLED AND HAVE A LOW LIFE CYCLE IMPACT ON THE ENVIRONMENT. ONCE PURCHASES REACH THE END OF THEIR INITIAL USE, DIGNITY HEALTH FOCUSES ON REUSE WITHIN THE HOSPITAL, TRANSFER TO ANOTHER USER (SUCH AS COMMUNITY ORGANIZATIONS), RECYCLING, AND FINALLY, PROPER WASTE DISPOSAL. o MARIAN MEDICAL CENTER IS ONE OF ONLY A FEW HOSPITALS IN THE NATION TO HAVE A COGENERATION PLANT THAT OPERATES ON METHANE GAS. THE 2000 SQUARE FOOT FACILITY USES WASTE METHANE GAS TO PRODUCE AS MUCH AS ONE MEGAWATT OF ELECTRICITY. THE COGENERATION PROCESS SIGNIFICANTLY REDUCES METHANE EMISSIONS IN THE ENVIRONMENT AND OFFSETS THE USE OF NON-RENEWABLE RESOURCES SUCH AS COAL, NATURAL GAS AND OIL. COMMUNITY BUILDING - LEADERSHIP DEVELOPMENT / TRAINING FOR COMMUNITY MEMBERS o DIGNITY HEALTH HOSPITALS ARE COMMITTED TO BUILDING HEALTHIER COMMUNITIES THROUGH LEADERSHIP DEVELOPMENT, PARTICULARLY OF ADOLESCENT, TEEN AND YOUNG ADULT LEADERSHIP, AND CAREER DEVELOPMENT. COMMUNITY BUILDING - COALITION BUILDING o THE DIGNITY HEALTH MISSION STATEMENT SPECIFICALLY CALLS UPON US ""TO PARTNER WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE."" DIGNITY HEALTH FACILITIES PROVIDE REPRESENTATION ON COMMUNITY COALITIONS AND COLLABORATIVE PARTNERSHIPS TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY, AND HOST AND/OR PARTICIPATE IN COMMUNITY COALITION MEETINGS AND SPECIFIC PROJECTS AND INITIATIVES. COMMUNITY BUILDING - ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT o STAFF AT DIGNITY HEALTH HOSPITALS THROUGHOUT THE SYSTEM ADVOCATE ON BEHALF OF THE POOR AND DISENFRANCHISED, PARTICULARLY FOR IMPROVED ACCESS TO HEALTH CARE SERVICES AS WELL AS FOR ENVIRONMENTAL IMPROVEMENTS. o DIGNITY HEALTH ALSO ADVOCATES FOR SOCIAL JUSTICE AND HUMAN RIGHTS, THROUGH DUES AND GIFTS TO ORGANIZATIONS THAT SUPPORT SOCIAL JUSTICE, AND BY ADVOCATING FOR SOCIAL JUSTICE, ENVIRONMENTAL RESPONSIBILITY AND HUMAN RIGHTS THROUGH INVESTMENTS AS SHAREHOLDERS. COMMUNITY BUILDING - WORKFORCE DEVELOPMENT o DIGNITY HEALTH AND ITS ASSOCIATED FACILITIES ARE COMMITTED TO THE DEVELOPMENT OF THE HEALTH CARE WORKFORCE AND ACTIVELY ENGAGE IN THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN MEDICALLY UNDERSERVED AREAS. DIGNITY HEALTH SUPPORTS THE TRAINING AND RECRUITMENT OF UNDERREPRESENTED MINORITIES AND PARTICIPATES IN COMMUNITY WORKFORCE BOARDS AND PARTNERSHIPS o SEVERAL DIGNITY HEALTH FACILITIES, AS WELL AS THE ORGANIZATION ITSELF, HAVE PARTNERED WITH LOCAL COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE AND ACTIVELY ENGAGE IN HEALTH CAREER MENTORING PROGRAMS."

Part III, Section A, Line 4
THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. DIGNITY HEALTH PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS AT OR BELOW 200% OR 500%, RESPECTIVELY, OF THE FEDERAL POVERTY LEVEL. DIGNITY HEALTH ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, DISCOUNTS FOR THE MEDICALLY INDIGENT, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 25% FOR PATIENTS SEEN AT CALIFORNIA AND ARIZONA FACILITIES, AND 30% FOR PATIENTS SEEN AT NEVADA FACILITIES. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DIGNITY HEALTH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR PAYMENT ASSISTANCE UPON ADMISSION. DIGNITY HEALTH'S PAYMENT ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT NO SERVICES THAT HAVE QUALIFIED AS CHARITY ARE REPORTED AS BAD DEBT. AS SUCH, DIGNITY HEALTH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY. THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2012, RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCES FOR CHARITY AND DOUBTFUL ACCOUNTS: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED. DIGNITY HEALTH REGULARLY REVIEWS ACCOUNTS AND CONTRACTS AND PROVIDES APPROPRIATE CONTRACTUAL ALLOWANCES, RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS THAT ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. MANAGEMENT PERIODICALLY REVIEWS THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORICAL EXPERIENCE, TRENDS IN HEALTH CARE COVERGE, AND OTHER COLLECTION INDICATORS.

Part III, Section B, Line 8
DIGNITY HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. IN HOSPITALS, ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL OF $520.0 MILLION, AS REPORTED BELOW IN PART VI, LINE 6, WHICH IS NET OF PRIOR YEAR COST REPORT SETTLEMENTS OF $53.9 MILLION, CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY DIGNITY HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. THIS SHORTFALL INCLUDES $410.0 MILLION REPORTED ON PART III, SECTION B, LINE 7, FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS ADDITIONAL AMOUNTS RELATED TO THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS FOR DIGNITY HEALTH'S HOSPITALS.

Part III, Section C, Line 9b
DIGNITY HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. DIGNITY HEALTH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR PAYMENT ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE DIGNITY HEALTH FACILITY OR BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED PAYMENT ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'S PATIENT PAYMENT ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, DIGNITY HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT. DIGNITY HEALTH DOES NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF EACH HOSPITAL PATIENT PAYMENT ASSISTANCE DEPARTMENT. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, DIGNITY HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.

PART V, SECTION B - FACILITY POLICIES AND PRACTICES
LINE 10 DIGNITY HEALTH OPERATES TWO FOR-PROFIT HOSPITALS THROUGH JOINT VENTURE ARRANGEMENTS. THESE HOSPITALS ARE SPECIALTY HOSPITALS THAT PRIMARILY PROVIDE ELECTIVE SURGERY TO PATIENTS. SOUTHWEST ORTHOPEDIC AND SPINE HOSPITAL PROVIDES A 35% DISCOUNT TO ALL SELF-PAY PATIENTS. LINE 13G SEE BELOW FOR PART VI, LINE 3 - PATIENT EDUCATION ON ELIGIBILITY FOR ASSISTANCE FOR ADDITIONAL DISCLOSURES RELATED TO DIGNITY HEALTH'S PAYMENT ASSISTANCE PROGRAM. ADDITIONAL MEASURES TAKEN TO PUBLICIZE DIGNITY HEALTH'S PAYMENT ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS, A COPY OF THE CHARITY CARE APPLICATION, A TELEPHONE NUMBER FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM, AVAILABLITY OF INFORMATION IN LANGUAGES OTHER THAN ENGLISH, CONTACT INFORMATION FOR FINANCIAL COUNSELORS OR OTHER REPRESENTATIVES WHO CAN PROVIDE INFORMATION, AND THE FACILITY'S WEBPAGE ADDRESS WHERE ADDITIONAL INFORMATION AND APPLICATIONS CAN BE ACCESSED. LINE 19D AT ALL OF DIGNITY HEALTH'S TAX-EXEMPT HOSPITALS, PATIENTS WHO ARE APPLYING FOR DISCOUNTS UNDER THE DISCOUNT PROVISION POLICY WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES. PATIENTS WHOSE INCOME IS ABOVE 350% BUT NOT MORE THAN 500% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT 135% OF THE AVERAGE RATES OF PAYMENT THE DIGNITY HEALTH FACILITY WOULD RECEIVE FOR PROVIDING SERVICES TO PATIENTS COVERED BY MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFITS IN WHICH THE HOSPITAL PARTICIPATES, WHICHEVER IS GREATER. SOUTHWEST ORTHOPEDIC AND SPINE HOSPITAL DOES NOT HAVE A LIMIT ON THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR DISCOUNTED EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AS A MAJORITY OF THE CARE PROVIDED IS ELECTIVE RATHER THAN EMERGENCY OR OTHER MEDICALLY NECESSARY, HOWEVER, A 35% DISCOUNT IS PROVIDED TO ALL SELF-PAY PATIENTS. THOSE ELIGIBLE FOR CHARITY CARE ARE NOT CHARGED ANY AMOUNT.

PART VI, LINE 2 - NEEDS ASSESSMENT
IN ACCORDANCE WITH DIGNITY HEALTH POLICY AND CALIFORNIA STATE SENATE BILL 697, ALL OF DIGNITY HEALTH'S TAX-EXEMPT HOSPITALS ASSESS THE HEALTHCARE NEEDS OF THEIR RESPECTIVE COMMUNITIES ONCE EVERY THREE YEARS. THIS INFORMATION IS UTILIZED IN DEVELOPING A STRATEGY TO ADDRESS PRIORITIZED NEEDS AND IMPROVE THE HEALTH OF THE COMMUNITIES DIGNITY HEALTH SERVES. MANY DIGNITY HEALTH HOSPITALS CONDUCT ASSESSMENTS THROUGH THE AUSPICES OF MULTI-HOSPITAL CONSORTIA. OTHER DIGNITY HEALTH HOSPITALS HIRE OUTSIDE ORGANIZATIONS TO COMPILE DATA AND SOME UTILIZE EXISTING DATA COLLECTED AND MADE ACCESSIBLE BY OTHER ORGANIZATIONS, INCLUDING PUBLIC HEALTH DEPARTMENTS. QUANTITATIVE INDICATOR DATA ARE COLLECTED FROM SECONDARY DATA SOURCES, WHICH MAY INCLUDE CENSUS DATA, PUBLIC HEALTH ASSESSMENTS, THE LOCAL DEPARTMENT OF EDUCATION, AND LAW ENFORCEMENT RECORDS. PRIMARY DATA TO CAPTURE THE PERSPECTIVES OF THE COMMUNITIES' RESIDENTS MAY BE CONDUCTED THROUGH FOCUS GROUPS, IN-PERSON INTERVIEWS, COMMUNITY FORUMS, NEIGHBORHOOD SURVEYS OR THROUGH TELEPHONE INTERVIEWS. DIGNITY HEALTH ALSO USES UTILIZATION DATA TO ASSESS THE DEMAND FOR CARE FOR PERSONS PRESENTING WITH AMBULATORY CARE SENSITIVE CONDITIONS THAT EVIDENCE SUGGESTS COULD HAVE BEEN AVOIDED, AT LEAST IN PART, THROUGH MORE PROACTIVE OUTPATIENT CARE. HOSPITALS, COMMUNITY LEADERS, AND POLICY MAKERS USE SUCH DATA TO IDENTIFY COMMUNITY NEED LEVELS, TARGET RESOURCES, AND TRACK THE IMPACT OF PROGRAMMATIC AND POLICY INTERVENTIONS. IN ADDITION, DIGNITY HEALTH, IN PARTNERSHIP WITH THOMSON REUTERS (FORMERLY SOLUCIENT), DEVELOPED A COMMUNITY NEED INDEX (CNI), WHICH PROVIDES AN AGGREGATE SCORE OF THE SOCIOECONOMIC BARRIERS THAT PUT RESIDENTS AT GREATER RISK OF NEEDING HEALTH SERVICES. THE CNI AGGREGATES FIVE SOCIOECONOMIC INDICATORS LONG KNOWN TO CONTRIBUTE TO HEALTH DISPARITY, WHICH ARE INCOME, CULTURE/LANGUAGE, EDUCATION, HOUSING STATUS, AND INSURANCE COVERAGE, AND APPLIES THEM TO EVERY ZIP CODE IN THE UNITED STATES. EACH ZIP CODE IS THEN GIVEN A SCORE RANGING FROM 1.0 (LOW NEED) TO 5.0 (HIGH NEED). RESIDENTS OF COMMUNITIES WITH THE HIGHEST CNI SCORES WERE SHOWN TO BE TWICE AS LIKELY TO EXPERIENCE PREVENTABLE HOSPITALIZATION FOR MANAGEABLE CONDITIONS, SUCH AS EAR INFECTIONS, PNEUMONIA OR CONGESTIVE HEART FAILURE, AS COMMUNITIES WITH THE LOWEST CNI SCORES. THE CNI PROVIDES COMPELLING EVIDENCE FOR ADDRESSING SOCIOECONOMIC BARRIERS WHEN CONSIDERING HEALTH POLICY AND LOCAL HEALTH PLANNING. THE TOOL HIGHLIGHTS HEALTH CARE DISPARITIES BETWEEN GEOGRAPHIC REGIONS AND ILLUSTRATES THE ACUTE NEEDS OF SEVERAL NOTABLE GEOGRAPHIES, INCLUDING INNER CITY AND RURAL AREAS. FURTHER, IT SHOULD ENABLE HEALTH CARE PROVIDERS, POLICYMAKERS, AND OTHERS TO ALLOCATE RESOURCES WHERE THEY ARE MOST NEEDED, USING A STANDARDIZED, QUANTITATIVE TOOL. THE CNI PROVIDES DIGNITY HEALTH WITH AN IMPORTANT MEANS TO STRATEGICALLY ALLOCATE RESOURCES WHERE IT WILL BE MOST EFFECTIVE IN MAINTAINING A HEALTHY COMMUNITY. ADDITIONAL INFORMATION ABOUT THE CNI IS ACCESSIBLE ON DIGNITY HEALTH'S WEBSITE: HTTP://WWW.DIGNITYHEALTH.ORG/WHO_WE_ARE/COMMUNITY_HEALTH/STGSS044508

PART VI, LINE 3 - PATIENT EDUCATION ON ELIGIBILITY FOR ASSISTANCE
COMMUNICATION OF THE PAYMENT ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC FOR DIGNITY HEALTH'S WHOLLY OWNED HOSPITALS: INFORMATION ABOUT DIGNITY HEALTH'S PAYMENT ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S PAYMENT ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. PAYMENT ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE DIGNITY HEALTH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES DIGNITY HEALTH'S FACILITIES SERVE. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS WITH ANNUAL INCOMES LESS THAN $250,000 RECEIVE AN UNINSURED DISCOUNT OF 25% FOR SERVICES PROVIDED IN A CALIFORNIA OR ARIZONA FACILITY, AND 30% FOR SERVICES PROVIDED IN A NEVADA FACILITY, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A PAYMENT ASSISTANCE APPLICATION. PAYMENT ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON DIGNITY HEALTH'S WEBSITE AT WWW.DIGNITYHEALTH.ORG. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S PAYMENT ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. UNINSURED PATIENTS RECEIVE COPIES OF THE PAYMENT ASSISTANCE AND MEDICAID APPLICATIONS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. IT IS DIGNITY HEALTH'S POLICY THAT AT THE TIME OF PATIENT BILLING, DIGNITY HEALTH FACILITIES PROVIDE TO ALL UNINSURED PATIENTS THE SAME BILLING INFORMATION CONCERNING SERVICES AND CHARGES PROVIDED TO ALL OTHER PATIENTS WHO RECEIVE CARE AT DIGNITY HEALTH FACILITIES. IF PAYMENT ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED PAYMENT ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR PAYMENT ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF DIGNITY HEALTH REQUIRE ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S PAYMENT ASSISTANCE PROGRAM AND A COPY OF THE PAYMENT ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE DIGNITY HEALTH FACILITY STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR PAYMENT ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR PAYMENT ASSISTANCE.

PART VI, LINE 4 - COMMUNITY INFORMATION
DIGNITY HEALTH DELIVERS CARE TO DIVERSE COMMUNITIES ACROSS ARIZONA,CALIFORNIA AND NEVADA. FOLLOWING IS A SUMMARY OF THE COMMUNITIES SERVED BY DIGNITY HEALTH, INCLUDING THE DEMOGRAPHICS OF EACH COMMUNITY. DIGNITY HEALTH HOSPITALS DEFINE THE COMMUNITY AS THE GEOGRAPHIC AREA SERVED BY THE HOSPITAL, CONSIDERED ITS PRIMARY SERVICE AREA. THIS IS BASED ON A PERCENTAGE OF HOSPITAL DISCHARGES AND IS ALSO USED IN VARIOUS OTHER DEPARTMENTS OF THE SYSTEM AND HOSPITAL, INCLUDING STRATEGY AND PLANNING: ARROYO GRANDE COMMUNITY HOSPITAL (AGCH) - AGCH SERVES THE SOUTHERN PART OF SAN LUIS OBISPO COUNTY INCLUDING THE CITIES OF ARROYO GRANDE, GROVER BEACH, OCEANO, PISMO BEACH AND SHELL BEACH AND THE NORTHERN PART OF THE CITY OF NIPOMO. ARROYO GRANDE COMMUNITY HOSPITAL CONDUCTED ITS NEEDS AND ASSETS ASSESSMENT FOR 2011/2012 BY UTILIZING SECONDARY DATA FROM VARIOUS OTHER AGENCIES SUCH AS KIDSDATA.ORG; CHILDREN IN LUCIA MAR UNIFIED SCHOOL DISTRICT 2010, HUNGER IN AMERICA, HUNGER IN SAN LUIS OBISPO COUNTY, 2010; UNITED STATES CENSUS BUREAU 2009; CHILDREN NOW, CALIFORNIA REPORT CARD 2010; ACTION FOR HEALTHY COMMUNITIES COMPREHENSIVE REPORT 2010; AND CALIFORNIA CANCER FACTS & FIGURES 2010. OTHER SECONDARY DATA COMES FROM LOCAL COMMUNITY-BASED ORGANIZATIONS WHO WORK IN PARTNERSHIP WITH AGCH TO ASSESS THE COMMUNITY, PARTICIPATE IN HEALTHCARE PROGRAM DESIGN AND PARTNER TO RESEARCH FUNDING FOR PROGRAMS OFFERED FOCUSING ON THE DISPROPORTIONATE UNMET HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. ARROYO GRANDE COMMUNITY DEMOGRAPHICS -POPULATION 76,494 -DIVERSITY 67% CAUCASIAN, 26.4% HISPANIC, 3.0% ASIAN, 0.7% AFRICAN AMERICAN, 2.9% OTHER -AVERAGE INCOME $76,346 -UNINSURED 15.14% -UNEMPLOYMENT 4.1% -NO HS DIPLOMA 12% -RENTERS 29.4% -CNI SCORE 3.4 -MEDICAID PATIENTS 8.5% -OTHER AREA HOSPITALS 2 CALIFORNIA HOSPITAL MEDICAL CENTER (CHMC) - THE COMMUNITY THAT CHMC SERVES IS DEFINED AS CHMC'S PRIMARY AND SECONDARY SERVICE AREA AND IS LOCATED IN CENTRAL/DOWNTOWN AND SOUTH CENTRAL LOS ANGELES. CHMC POOLED ITS RESOURCES WITH FIVE OTHER HOSPITALS AND ONE GROUP OF COMMUNITY CLINICS TO COLLECT INFORMATION ABOUT THE HEALTH AND WELL-BEING OF RESIDENTS IN THEIR SERVICE COMMUNITY. THE REPORT WAS DEVELOPED USING BOTH QUANTITATIVE AND QUALITATIVE DATA SOURCES. TO THE EXTENT NECESSARY, SECONDARY OR EXISTING DATASETS WERE ACCESSED TO UPDATE THE PREVIOUS NEEDS ASSESSMENT. DATA SOURCES FOR THIS PURPOSE INCLUDE REPORTS FROM THE LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES, INCLUDING THE LOS ANGELES HEALTH SURVEY, AND ADDITIONAL DATA ON LIVE BIRTHS AND DEATHS. THE PROJECT TEAM UTILIZED 2009 PROJECTION DATA. CALIFORNIA HOSPITAL MEDICAL CENTER IS LOCATED IN A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA AND SERVES A MEDICALLY UNDERSERVED POPULATION. CALIFORNIA HOSPITAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 1,278,702 -DIVERSITY 5.1% CAUCASIAN, 64.7% HISPANIC, 5.6% ASIAN, 22.9% AFRICAN AMERICAN, 1.7% OTHER -AVERAGE INCOME $44,966 -UNINSURED 40.66% -UNEMPLOYMENT 7.5% -NO HS DIPLOMA 42.20% -RENTERS 66% -CNI SCORE 5 -MEDICAID PATIENTS 33.35% -OTHER AREA HOSPITALS 6 CHANDLER REGIONAL MEDICAL CENTER - A COMMUNITY NEEDS ASSESSMENT WAS COMPLETED THROUGH ARIZONA STATE UNIVERSITY'S HEALTH INFORMATION AND RESEARCH CENTER. MULTIPLE DATA SOURCES WERE INCLUDED IN THE ANALYSIS INCLUDING A COMBINATION OF QUALITATIVE INFORMATION (E.G. SURVEY RESULTS) AND QUANTITATIVE INFORMATION (E.G. ARIZONA HEALTHGRADES ADMINISTRATIVE HEALTH DATA). QUANTITATIVE INFORMATION WAS INCLUDED TO PROVIDE THE BEST PICTURE OF THE COMMUNITY'S HEALTH. SECONDARY DATA WAS OBTAINED FROM THE DIGNITY HEALTH CNI, THE U.S. CENSUS BUREAU, AND THE ARIZONA DISEASE CONTROL AND PREVENTIONS BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND A MEDICALLY UNDERSERVED POPULATION IN SEVERAL ZIP CODES OF THE SERVICE AREA. CHANDLER REGIONAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 853,712 -DIVERSITY 59.48% CAUCASIAN, 25.10% HISPANIC, 5.30% ASIAN, 4.80% AFRICAN AMERICAN, 5.32% OTHER -AVERAGE INCOME $73,599 -UNINSURED 19.39% -UNEMPLOYMENT 5.8% -NO HS DIPLOMA 11.60% -RENTERS 31.9% -CNI SCORE 2.8 -MEDICAID PATIENTS 17.76% -OTHER AREA HOSPITALS 2 PRIMARY SERVICE AREA -OTHER SERVICE HOSPITALS 12 SECONDARY SERVICE AREA DOMINICAN HOSPITAL - THE PRIMARY SERVICE AREA IS SANTA CRUZ COUNTY WHICH COVERS 441 SQUARE MILES, AND IS A RELATIVELY ISOLATED COMMUNITY. THE TWO MAJOR CITIES ARE SANTA CRUZ, LOCATED ON THE NORTHERN SIDE OF THE MONTEREY BAY, AND WATSONVILLE, SITUATED IN THE SOUTHERN PART OF THE COUNTY. OTHER INCORPORATED AREAS IN THE COUNTY INCLUDE THE CITIES OF SCOTTS VALLEY AND CAPITOLA. APPROXIMATELY 51% OF THE POPULATION LIVES IN THE UNINCORPORATED PARTS OF THE COUNTY, INCLUDING THE TOWNS OF APTOS, DAVENPORT, FREEDOM, SOQUEL, FELTON, BEN LOMOND AND BOULDER CREEK, AND DISTRICTS SUCH AS THE SAN LORENZO VALLEY, LIVE OAK AND PAJARO. DOMINICAN HOSPITAL PARTNERS WITH THE UNITED WAY OF SANTA CRUZ COUNTY IN CONVENING A CONSORTIUM OF PUBLIC AND PRIVATE HEALTH, EDUCATION, HUMAN SERVICE AND CIVIC ORGANIZATIONS IN THE SPONSORSHIP OF THE COMMUNITY ASSESSMENT PROJECT OF SANTA CRUZ COUNTY (CAP). UNDER THE GUIDANCE OF THE CAP STEERING COMMITTEE, APPLIED SURVEY RESEARCH, A NOT-FOR-PROFIT SOCIAL RESEARCH FIRM, MANAGES THE ASSESSMENT, COLLECTING SECONDARY (PRE-EXISTING) DATA AND CONDUCTING THE ANNUAL COMMUNITY SURVEY FOR PRIMARY (PUBLIC OPINION) DATA. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND A MEDICALLY UNDERSERVED POPULATION. DOMINICAN HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 230,387 -DIVERSITY 55.1% CAUCASIAN, 36.9% HISPANIC, 4% ASIAN, 0.9% AFRICAN AMERICAN, 3.1% OTHER -AVERAGE INCOME $84,016 -UNINSURED 15.85% -UNEMPLOYMENT 5.6% -NO HS DIPLOMA 17.4% -RENTERS 38.3% -CNI SCORE 2.9 -MEDICAID PATIENTS 14.50% -OTHER AREA HOSPITALS 2 FRENCH HOSPITAL MEDICAL CENTER (FHMC) - THE PRIMARY SERVICE AREA FOR FHMC IS SAN LUIS OBISPO, MORRO BAY, LOS OSOS, ATASCADERO AND PASO ROBLES. A SECONDARY SERVICE AREA IS IDENTIFIED AS ARROYO GRANDE, PISMO BEACH, GROVER BEACH, OCEANO, AND AVILA BEACH. FRENCH HOSPITAL MEDICAL CENTER CONDUCTED ITS NEEDS AND ASSETS ASSESSMENT FOR FY 2011/2012 FOR THE PRIMARY SERVICE AREA BY UTILIZING SECONDARY DATA FROM VARIOUS AGENCY REPORTS SUCH AS: ACTION FOR HEALTHY COMMUNITIES 2010 REPORT, CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS), CHILDREN'S NOW CALIFORNIA REPORT CARD 2010, CALIFORNIA CANCER FACTS AND FIGURES-2010, THE HEALTH STATUS REPORT SAN LUIS OBISPO COUNTY PUBLIC HEALTH DEPARTMENT 2010 AND, THE COMMUNITY NEEDS INDEX. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. FRENCH HOSPITAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 233,399 -DIVERSITY 70.3% CAUCASIAN, 21.0% HISPANIC, 3.4% ASIAN, 2.1% AFRICAN AMERICAN, 3.2% OTHER -AVERAGE INCOME $71,165 -UNINSURED 19.27% -UNEMPLOYMENT 4.8% -NO HS DIPLOMA 11.50% -RENTERS 35.1% -CNI SCORE 3.4 -MEDICAID PATIENTS 10.84% -OTHER AREA HOSPITALS 3 GLENDALE MEMORIAL HOSPITAL - THE HOSPITAL SERVES RESIDENTS FROM A BROAD GEOGRAPHIC AREA. ITS PRIMARY SERVICE AREA ENCOMPASSES 29 ZIP CODES IN THE COUNTY OF LOS ANGELES. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. IN 2010, FMA COMMUNITY HEALTH CONSULTING PREPARED THE ASSESSMENT ON BEHALF OF THE THREE NOT-FOR-PROFIT HOSPITALS SERVING THE GLENDALE COMMUNITY: GLENDALE MEMORIAL HOSPITAL AND HEALTH CENTER, GLENDALE ADVENTIST MEDICAL CENTER AND VERDUGO HILLS HOSPITAL. THREE APPROACHES, INCLUDING SECONDARY DATA AND INFORMATION, ASSET MAPPING AND QUALITATIVE AND QUANTITATIVE PRIMARY RESEARCH WERE UTILIZED. FMA COMMUNITY HEALTH CONSULTANTS SUMMARIZED KEY DEMOGRAPHIC, SOCIOECONOMIC AND HEALTH STATUS INDICATORS FOR EACH HOSPITAL'S SERVICE AREA. DEMOGRAPHIC INFORMATION WAS ANALYZED USING PUBLISHED INFORMATION FROM THE 2000 AND 2010 U.S. BUREAU OF THE CENSUS AND AS AVAILABLE THROUGH NIELSEN CLARITAS, INC., A PRIVATE VENDOR OF DEMOGRAPHIC AND OTHER RELATED INFORMATION, CREATED ON HEALTHYCITY.ORG. FURTHER INFORMATION WAS OBTAINED THROUGH MORE THAN 30 COMMUNITY-BASED SERVICE ORGANIZATIONS. GLENDALE MEMORIAL HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 1,147,351 -DIVERSITY 32.8% CAUCASIAN, 48.1% HISPANIC, 13.3% ASIAN, 3.5% AFRICAN AMERICAN, 2.3% OTHER -AVERAGE INCOME $61,822 -UNINSURED 27.74% -UNEMPLOYMENT 6.8% -NO HS DIPLOMA 26.60% -RENTERS 59.2% -CNI SCORE 4.6 -MEDICAID PATIENTS 22.79% -OTHER AREA HOSPITALS 2 MARIAN MEDICAL CENTER - MARIAN MEDICAL CENTER, LOCATED IN NORTHERN SANTA BARBARA COUNTY, HAS THE SANTA MARIA VALLEY AS ITS LARGEST SERVICE AREA. THE FOUR LARGEST COMMUNITIES IN MARIAN'S PRIMARY SERVICE AREA ARE THE CITY OF SANTA MARIA, THE CITY OF GUADALUPE, THE UNINCORPORATED PORTION OF NORTH COUNTY THAT INCLUDES ORCUTT, SISQUOC AND TEPESQUET WITH NIPOMO, AN UNINCORPORATED COMMUNITY OF APPROXIMATELY 13,000 PEOPLE IN SOUTHERN SAN LUIS OBISPO COUNTY. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA AND A MEDICALLY UNDERSERVED POPUL

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ST. BERNARDINE MEDICAL CENTER - THE PRIMARY SERVICE AREA ENCOMPASSES NINE CITIES COVERING 17 ZIP CODES THAT INCLUDE BLOOMINGTON, COLTON, CRESTLINE, FONTANA, HESPERIA, HIGHLAND, RIALTO, YUCAIPA AND SAN BERNARDINO. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. IN FY11 ST. BERNARDINE MEDICAL CENTER (SBMC), IN COLLABORATION WITH COMMUNITY HOSPITAL OF SAN BERNARDINO (CHSB), CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT. BIEL CONSULTING WAS ENGAGED TO CONDUCT THE ASSESSMENT FOR THE PRIMARY SERVICE AREA OF THE HOSPITAL. CHSB AND SBMC DEVELOPED A LIST OF 25 KEY STAKEHOLDERS (INDIVIDUALS, AGENCIES, ORGANIZATIONS, AND COALITIONS) WHO ARE WELL ALIGNED IN THE ONGOING MISSION AND COLLABORATION TO MEET THE UNMET NEEDS OF THE SERVICE AREA. BIEL CONSULTING USED THIS LIST TO COLLECT PRIMARY DATA THROUGH STAKEHOLDER INTERVIEWS. EXECUTIVE OFFICERS/ADMINISTRATORS WERE ALSO INTERVIEWED. EIGHT FOCUS GROUPS (SIX ENGLISH AND TWO SPANISH) WERE CONDUCTED WITH 90 AREA RESIDENTS WHO ARE CLIENTS OF COMMUNITY ORGANIZATIONS IN THE SERVICE AREA AND 107 PUBLIC SURVEYS WERE COMPLETED BY HARD PAPER COPY OR VIA THE INTERNET THROUGH A SURVEY LINK POSTED ON THE SBMC WEBSITE. SECONDARY DATA WAS OBTAINED FROM SEVERAL RESOURCES, INCLUDING CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, ENVIRONMENTAL SYSTEMS RESEARCH INSTITUTE, INC. (ESRI), HOUSING AUTHORITY OF SAN BERNARDINO COUNTY, HUD, U.S. BUREAU OF THE CENSUS, CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT, CALIFORNIA DEPARTMENT OF EDUCATION, CALIFORNIA HEALTH INTERVIEW SURVEY AND NATIONAL CANCER INSTITUTE. ST. BERNARDINE MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 1,127,424 -DIVERSITY 28.9% CAUCASIAN, 55.7% HISPANIC, 4.5% ASIAN, 8.5% AFRICAN AMERICAN, 2.4% OTHER -AVERAGE INCOME $59,401 -UNINSURED 25.43% -UNEMPLOYMENT 8.0% -NO HS DIPLOMA 25.90% -RENTERS 31.60% -CNI SCORE 4.5 -MEDICAID PATIENTS 23.59% -OTHER AREA HOSPITALS 5 ST. ELIZABETH COMMUNITY HOSPITAL - ST. ELIZABETH COMMUNITY HOSPITAL (SECH) IS LOCATED IN TEHAMA COUNTY. THE COUNTY IS BORDERED BY GLENN COUNTY TO THE SOUTH, TRINITY AND MENDOCINO COUNTIES TO THE WEST, SHASTA COUNTY TO THE NORTH, AND BUTTE AND PLUMAS COUNTIES TO THE EAST. THE COUNTY IS SITUATED IN THE NORTHERN PORTION OF THE SACRAMENTO VALLEY, AND IS DIVIDED IN HALF BY THE SACRAMENTO RIVER. THE HOSPITAL SERVICE AREA INCLUDES RED BLUFF, GERBER, CORNING, LOS MOLINOS AND COTTONWOOD. THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. ST. ELIZABETH COMMUNITY HOSPITAL IS COMMITTED TO INVOLVING AND INFORMING THE RESIDENTS OF TEHAMA COUNTY IN A COMMUNITY NEEDS ASSESSMENT SURVEY PROCESS. THE SECH COMMUNITY BENEFIT TEAM UTILIZED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THROUGH A PARTNERSHIP WITH THE SIMPSON COLLEGE BACHELORS OF NURSING ASPIRE STUDENTS AND CALIFORNIA STATE UNIVERSITY, CHICO'S HEALTH SERVICES ADMINISTRATION PROGRAM. A MIXED METHODOLOGY WAS EMPLOYED VIA PAPER SURVEYS AND IDENTICAL WEB-BASED SURVEYS VIA SURVEY MONKEY.COM. THE SAMPLE DESIGN UTILIZED FOR THIS EFFORT CONSISTED OF A RANDOM SAMPLE OF 450 INDIVIDUALS LIVING IN TEHAMA COUNTY AGED 18 AND OLDER. SURVEY RESPONSES FROM THE COMMUNITY WERE OBTAINED IN PERSON BY ATTENDING VARIOUS HEALTH AGENCY AND COMMITTEE MEETINGS, HEALTH AND EDUCATION FAIRS AND ONLINE THROUGH COMMUNITY EMAIL LISTS PROVIDED BY THE LOCAL CHAMBERS OF COMMERCE. ADDITIONALLY ANNOUNCEMENTS REGARDING THE SURVEY WERE MADE IN THE LOCAL NEWSPAPERS THAT INCLUDED THE ELECTRONIC LINK ADDRESS BY WHICH THE SURVEY WAS ACCESSED. ONCE DATA WAS OBTAINED, IT WAS THEN ANALYZED BY EVALUATING PUBLISHED REPORTS FROM NATIONAL SOURCES SUCH AS HEALTHY PEOPLE 2020 OR THE 2010 US CENSUS TO QUANTITATIVELY COMPARE DATA COLLECTED IN 2011 CHNA. DATA WAS THEN COMPARED QUALITATIVELY BY QUANTIFYING STATISTICS NUMERICALLY AND COMPARING AGAINST SECONDARY DATA SOURCES. ST. ELIZABETH HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 86,414 -DIVERSITY 68.9% CAUCASIAN, 24.7% HISPANIC, 1.4% ASIAN, 0.5% AFRICAN AMERICAN, 4.5% OTHER -AVERAGE INCOME $49,847 -UNINSURED 29.24% -UNEMPLOYMENT 5.6% -NO HS DIPLOMA 20.90% -RENTERS 33.8% -CNI SCORE 4.4 -MEDICAID PATIENTS 23.22% -OTHER AREA HOSPITALS 1 ST. JOHN'S PLEASANT VALLEY HOSPITAL AND ST. JOHN'S REGIONAL MEDICAL CENTER - COMMUNITY IS DEFINED AS THE RESIDENT POPULATION WITHIN THE HOSPITALS' SERVICE AREAS. ST. JOHN'S PLEASANT VALLEY HOSPITAL IN CAMARILLO AND ST. JOHN'S REGIONAL MEDICAL CENTER IN OXNARD SERVE ALL OF VENTURA COUNTY. THE PRIMARY SERVICE AREAS INCLUDE CAMARILLO, OXNARD AND PORT HUENEME. THE HOSPITALS SERVE A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. THE ST. JOHN'S COMMUNITY ADVISORY BOARD PARTNERED WITH OTHER HEALTHCARE ORGANIZATIONS TO FORM THE COMMUNITY NEEDS ASSESSMENT COLLABORATIVE GROUP. THE INNOVATIVE RESEARCH GROUP WAS CONTRACTED TO CONDUCT TELEPHONE SURVEYS OF VENTURA COUNTY. A COMBINATION OF RANDOM SAMPLING AND SIMPLE RANDOM SAMPLING METHODS WERE USED. THE POPULATION WAS DIVIDED INTO TWENTY-THREE ZIP CODE AREAS FOR THE SURVEY. ST. JOHN'S PLEASANT VALLEY HOSPITAL COMMUNITY DEMOGRAPHICS -POPULATION 222,842 -DIVERSITY 27.0% CAUCASIAN, 60.8% HISPANIC, 8.2% ASIAN, 1.9% AFRICAN AMERICAN, 2.1% OTHER -AVERAGE INCOME $ 83,468 -UNINSURED 12.01% -UNEMPLOYMENT 6.2% -NO HS DIPLOMA 28.40% -RENTERS 36.2% -CNI SCORE 3.5 -MEDICAID PATIENTS 15.84% -OTHER AREA HOSPITALS 4 ST. JOHN'S REGIONAL MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 236,827 -DIVERSITY 16.1% CAUCASIAN, 72.8% HISPANIC, 6.9% ASIAN, 2.3% AFRICAN AMERICAN, 1.9% OTHER -AVERAGE INCOME $70,214 -UNINSURED 12.86% -UNEMPLOYMENT 6.2% -NO HS DIPLOMA 34.50% -RENTERS 41.1% -CNI SCORE 4.1 -MEDICAID PATIENTS 16.96% -OTHER AREA HOSPITALS 5 ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER - ST. JOSEPH'S HOSPITAL DRAWS APPROXIMATELY 90% OF ITS PATIENTS FROM MARICOPA COUNTY WITH THE REMAINDER DRAWING FROM FROM OUTSIDE MARICOPA COUNTY BUT WITHIN ARIZONA, OR FROM OUTSIDE THE STATE. (NOTE: 61% OF THE POPULATION OF THE STATE OF ARIZONA RESIDES WITHIN MARICOPA COUNTY.) THE HOSPITAL SERVES A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER ASSESSES THE NEEDS OF THE COMMUNITY ON AN ONGOING BASIS AND USES THE ASSESSMENT CONDUCTED BY THE ARIZONA STATE UNIVERSITY CENTER FOR HEALTH INFORMATION AND RESEARCH (CHIR) AND OTHER SOURCES THROUGHOUT THE YEAR. CHIR UTILIZES THE ARIZONA HEALTH QUERY, A COMMUNITY HEALTH DATA SYSTEM CREATED BY THE VOLUNTARY PARTICIPATION OF HEALTH CARE INSURERS AND PROVIDERS. THE DATA COMBINES INFORMATION ABOUT MORE THAN SEVEN MILLION PERSONS PROVIDING INFORMATION ABOUT THE PRIMARY SERVICE AREA (MARICOPA COUNTY) AND THE SECONDARY SERVICE AREA (THE REST OF THE STATE OF ARIZONA). ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER COMMUNITY DEMOGRAPHICS -POPULATION 3,262,225 -DIVERSITY 51.4% CAUCASIAN, 36.1% HISPANIC, 3.4% ASIAN, 5.2% AFRICAN AMERICAN, 3.9% OTHER -AVERAGE INCOME $62,976 -UNINSURED 19.39% -UNEMPLOYMENT 6.2% -NO HS DIPLOMA 18.4% -RENTERS 32.2% -CNI SCORE 3.8 -MEDICAID PATIENTS 17.76% -OTHER AREA HOSPITALS 38 ST. JOSEPH'S MEDICAL CENTER/ST. JOSEPH'S BEHAVIORAL HEALTH CENTER - THE PRIMARY SERVICE AREA OF ST. JOSEPH'S MEDICAL CENTER (SJMC) AND ST. JOSEPH'S BEHAVIORAL HEALTH CENTER IS STOCKTON AND THE SECONDARY SERVICE AREA IS SAN JOAQUIN COUNTY. SJMC ALSO SERVES AS A REFERRAL FOR TERTIARY CARE FOR SURROUNDING COUNTIES, WHICH INCLUDE ALPINE, AMADOR, CALAVERAS, MARIPOSA, STANISLAUS AND TUOLUMNE COUNTIES. THE HOSPITALS SERVE A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. APPLIED SURVEY RESEARCH CONDUCTED THE 2011 NEEDS ASSESSMENT FOR A CONSORTIUM OF HOSPITALS AND AGENCIES IN THE STOCKTON SERVICE AREA, INCLUDING: ST. JOSEPH'S MEDICAL CENTER, DAMERON HOSPITAL, COMMUNITY PARTNERSHIP FOR FAMILIES OF SAN JOAQUIN, SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, SAN JOAQUIN COUNTY OFFICE OF EDUCATION, ST. MARY'S INTERFAITH COMMUNITY SERVICES, FIRST FIVE OF SAN JOAQUIN, COMMUNITY MEDICAL CENTERS, UNIVERSITY OF THE PACIFIC, HEALTH PLAN OF SAN JOAQUIN, KAISER PERMANENTE, SUTTER TRACY COMMUNITY HOSPITAL, HEALTHIER COMMUNITY COALITION OF SAN JOAQUIN AND THE BREAST FEEDING COALITION OF SAN JOAQUIN. PRIMARY DATA WERE OBTAINED FROM A TELEPHONE SURVEY AND FACE-TO-FACE SURVEY OF SAN JOAQUIN COUNTY RESIDENTS. SECONDARY DATA WERE COLLECTED FROM A VARIETY OF SOURCES, INCLUDING BUT NOT LIMITED TO: US CENSUS, FEDERAL, STATE AND LOCAL GOVERNMENT AGENCIES; ACADEMIC INSTITUTIONS; ECONOMIC DEVELOPMENT GROUPS; HEALTH CARE INSTITUTIONS; AND COMPUTERIZED SOURCES THROUGH ONLINE DATABASES AND THE INTERNET. ST. JOSEPH'S HOSPITAL / ST. JOSEPH'S BEHAVIORAL HEALTH CENTER COMMUNITY DEMOGRAPHICS -POPULATION 362,584 -DIVERSITY 39.5% CAUCASIAN, 40.0% HISPANIC, 11.4% ASIAN, 5.4% AFRICAN AMERICAN, 3.7% OTHER -AVERAGE INCOME $57,497 -UNINSURED 28.03% -UNEMPLOYMENT 9.9% -NO HS DIPLOMA 29.40% -RENTERS 40.2% -CNI SCORE 4.6 -MEDICAID PATIENTS 27.60% -OTHER AREA HOSPITALS 7 ST. MARY MEDICAL CENTER, LONG BEACH - ST. MARY MEDICAL CENTER IS LOCATED IN LONG BEACH, CA, THE SECOND LARGEST CITY IN LOS ANGELES COUNTY AND 34TH IN THE NATION. ST. MARY MEDICAL CENTER ALSO SERVES

PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH
USE OF SURPLUS FUNDS - AS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, DIGNITY HEALTH REINVESTS ALL OF ITS SURPLUS FUNDS FROM ITS OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR US TO DELIVER ON OUR MISSION, INCLUDING ENSURING THAT EVERYONE IN THE COMMUNITIES WE SERVE HAS ACCESS TO HEALTHCARE. OPEN MEDICAL STAFF - MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS GATHERS AND VERIFIES CREDENTIALS, ALLOWS THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND TO ULTIMATELY MAKE A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES. CREDENTIALS VERIFICATION IS THE DETERMINATION WHETHER A PRACTITIONER'S CREDENTIALS ARE AUTHENTIC AND VALID. THE ROLE OF THE BOARD - THE DIGNITY HEALTH BOARD OF DIRECTORS ESTABLISHES KEY MEASURES OF SYSTEM-WIDE COMMUNITY BENEFIT PERFORMANCE AND RECEIVES REGULAR REPORTS ON PROGRESS TOWARD ESTABLISHED GOALS. DIGNITY HEALTH HOSPITAL COMMUNITY BOARDS AND SUBSIDIARY BOARDS (COMMUNITY BOARDS), WHICH ARE RATIFIED BY THE DIGNITY HEALTH BOARD, ARE RESPONSIBLE FOR ENSURING THE HOSPITALS DEVELOP PROGRAMS TO ADDRESS THE DISPROPORTIONATE UNMET HEALTH-RELATED NEEDS OF THE COMMUNITIES THE HOSPITALS SERVE. IN ADDITION, COMMUNITY BOARDS ENSURE THE DEVELOPMENT OF COMMUNITY BENEFIT INITIATIVES TO PROMOTE THE BROADER HEALTH OF THE COMMUNITY. IN FULFILLING THESE RESPONSIBILITIES, THE COMMUNITY BOARD MAY DESIGNATE A COMMUNITY HEALTH COMMITTEE OF THE BOARD TO INCLUDE AT LEAST TWO BOARD MEMBERS, WITH A MAJORITY REPRESENTATION FROM A RANGE OF COMMUNITY STAKEHOLDERS WHO HAVE KNOWLEDGE OF THE COMMUNITY. THE COMMUNITY BOARD, OR BOARD COMMITTEE, PARTICIPATES IN THE PROCESS OF ESTABLISHING PROGRAM PRIORITIES BASED ON COMMUNITY NEEDS ASSESSMENTS AND DEVELOPING THE HOSPITAL'S COMMUNITY BENEFIT PLAN AND MONITORING PROGRESS TOWARD IDENTIFIED GOALS. IF APPLICABLE, MEMBERS OF THE COMMITTEE ENSURE THAT THE COMMUNITY BOARD IS REGULARLY BRIEFED ON ACTIVITIES AND DEVELOPMENTS AND THAT THE COMMITTEE HAS INFORMATION FROM THE COMMUNITY BOARD AND MANAGEMENT NEEDED TO MAKE INFORMED DECISIONS. THE COMMUNITY BOARD IS ALSO RESPONSIBLE FOR REVIEW AND APPROVAL OF THE ANNUAL HOSPITAL COMMUNITY BENEFIT PLAN AND REPORT. DIGNITY HEALTH PROVIDES HOSPITAL SERVICES AND CARRIES OUT OUR MISSION AT THE FOLLOWING FACILITIES IN CALIFORNIA, ARIZONA AND NEVADA. FOR DETAILED INFORMATION ON THE SERVICES AND COMMUNITY BENEFITS PROVIDED AT THESE FACILITES, PLEASE VISIT THEIR INDIVIDUAL WEB SITES, WHICH ARE PROVIDED BELOW. ARROYO GRANDE COMMUNITY HOSPITAL HTTP://WWW.ARROYOGRANDEHOSPITAL.ORG/ CALIFORNIA HOSPITAL MEDICAL CENTER HTTP://WWW.CHMCLA.ORG/ CHANDLER REGIONAL HOSPITAL HTTP://WWW.CHANDLERREGIONAL.ORG/ DOMINICAN HOSPITAL HTTP://WWW.DOMINICANHOSPITAL.ORG FRENCH HOSPITAL MEDICAL CENTER HTTP://WWW.FRENCHMEDICALCENTER.ORG GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER HTTP://WWW.GLENDALEMEMORIAL.COM MARIAN REGIONAL MEDICAL CENTER HTTP://WWW.MARIANMEDICALCENTER.ORG/ MERCY GENERAL HOSPITAL HTTP://WWW.MERCYGENERAL.ORG/ MERCY GILBERT MEDICAL CENTER HTTP://WWW.MERCYGILBERT.ORG MERCY HOSPITAL OF FOLSOM HTTP://WWW.MERCYFOLSOM.ORG/ MERCY HOSPITAL OF BAKERSFIELD HTTP://WWW.MERCYBAKERSFIELD.ORG/ MERCY SOUTHWEST HOSPITAL HTTP://WWW.MERCYBAKERSFIELD.ORG/ MERCY MEDICAL CENTER MERCED HTTP://WWW.MERCYMERCEDCARES.ORG/INDEX.HTM MERCY MEDICAL CENTER MT. SHASTA HTTP://WWW.MERCYMTSHASTA.ORG/ MERCY MEDICAL CENTER REDDING HTTP://REDDING.MERCY.ORG/ MERCY SAN JUAN MEDICAL CENTER HTTP://WWW.MERCYSANJUAN.ORG/ METHODIST HOSPITAL OF SACRAMENTO HTTP://WWW.METHODISTSACRAMENTO.ORG/ NORTHRIDGE HOSPITAL MEDICAL CENTER HTTP://WWW.NORTHRIDGEHOSPITAL.ORG SAINT MARY'S REGIONAL MEDICAL CENTER HTTP://WWW.SAINTMARYSRENO.ORG/ SEQUOIA HOSPITAL HTTP://WWW.SEQUOIAHOSPITAL.ORG/ ST. BERNARDINE MEDICAL CENTER HTTP://WWW.STBERNARDINEMEDCTR.ORG/ ST. ELIZABETH COMMUNITY HOSPITAL HTTP://REDBLUFF.MERCY.ORG/ ST. JOHN'S PLEASANT VALLEY HOSPITAL HTTP://WWW.STJOHNSHEALTH.ORG/ ST. JOHN'S REGIONAL MEDICAL CENTER HTTP://WWW.STJOHNSHEALTH.ORG/ ST. JOSEPH'S BEHAVIORAL HEALTH CENTER HTTP://WWW.STJOSEPHSCANHELP.ORG/ ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER HTTP://WWW.STJOSEPHS-PHX.ORG ST. JOSEPH'S MEDICAL CENTER HTTP://WWW.STJOSEPHSCARES.ORG/ ST. MARY MEDICAL CENTER HTTP://WWW.STMARYMEDICALCENTER.ORG/ ST. MARY'S MEDICAL CENTER HTTP://WWW.STMARYSMEDICALCENTER.ORG/ ST. ROSE DOMINICAN HOSPITAL - ROSE DE LIMA CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ ST. ROSE DOMINICAN HOSPITAL - SAN MARTIN CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ ST. ROSE DOMINICAN HOSPITALS - SIENA CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ WOODLAND HEALTHCARE HTTP://WWW.WOODLANDHEALTHCARE.ORG ST. ROSE DOMINICAN HOSPITALS - SIENA CAMPUS HTTP://WWW.STROSEHOSPITALS.ORG/ WOODLAND HEALTHCARE HTTP://WWW.WOODLANDHEALTHCARE.ORG

PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM
AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 2012, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 108,530 188,380,000 2.0% Unpaid Costs of Medicaid/Medi-Cal 1,060,508 571,491,000 6.0% Other Means-tested Programs 280,517 66,067,000 0.7% Community Services: Community Health Services 525,831 53,467,000 0.6% Health Professions Education 86 27,000 0.0% Subsidized Health Services 193,751 28,297,000 0.3% Donations 155,219 33,140,000 0.3% Community Building Activities 12,811 1,623,000 0.0% Community Benefit Operations 3,884 8,911,000 0.1% Total Community Services for the poor 891,582 125,465,000 1.3% Total Benefits for the Poor 2,341,137 951,403,000 10.0% Benefits for the Broader Community: Community Services: Community Health Services 585,949 17,034,000 0.2% Health Professions Education 68,974 69,132,000 0.7% Subsidized Health Services 9,430 2,210,000 0.0% Research 26,281 30,049,000 0.3% Donations 165,149 7,584,000 0.1% Community Building Activities 38,641 3,138,000 0.0% Community Benefit Operations 87 1,446,000 0.0% Total Benefits for the Broader Community 894,511 130,593,000 1.3% Total Community Benefits 3,235,648 1,081,996 11.3% Unpaid Costs of Medicare 1,116,214 519,981,000 5.4% Total Community Benefits including Cost of Medicare 4,351,862 1,601,977,000 16.7%

STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI
CA,NV,