4A (Expenses $ 93739636 including grants of $ 0) (Revenue $ 51794963)
SEE SCHEDULE O

PART V
NO CHNA WAS COMPLETED BECAUSE AS OF OCTOBER 2013 THIS ENTITY NO LONGER OPERATED A HOSPITAL.

PART I, QUESTION 3C
TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 200% OF FPG. PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES APPLIES TO UNINSURED PATIENTS THAT WHOSE FAMILY INCOMES ARE BETWEEN 201% AND 400%. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: * SPECIAL CIRCUMSTANCES CHARITY CARE: FOR UNINSURED PATIENTS WHO DO NOT MEET THE FINANCIAL ASSISTANCE CRITERIA SET FORTH BY THE ORGANIZATION, A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, ELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE ORGANIZATION'S CHARITY CARE ELIGIBILITY CRITERIA. * CATASTROPHIC CHARITY CARE: PARTIAL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 30% OF THE PATIENT'S FAMILY INCOME. PATIENTS THAT MEET THE CRITERIA WILL RECEIVE A FULL WRITE-OFF OF UNDISCOUNTED CHARGES THAT EXCEED 30% OF THEIR FAMILY INCOME. * HIGH MEDICAL COST CHARITY CARE (FOR INSURED PATIENTS): PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES FOR PATIENTS WHOSE FAMILY INCOME IS LESS THAN 350% OF FPG, MEDICAL EXPENSES EXCEED 10% OF THE PATIENT'S FAMILY INCOME, AND THE PATIENT'S INSURE HAS NOT PROVIDED A DISCOUNT. * UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAT THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. * PROMPT PAYMENT DISCOUNT: PARTIAL WRITE-OFF AVAILABLE TO UNINSURED PATIENTS WHO PAY PROMPTLY, CONSISTING OF AT LEAST A 10% DISCOUNT FOR THOSE WHO PAY WITHIN 30 DAYS OF FINAL BILLING, OR A 20% DISCOUNT IF 50% OF THE ESTIMATED BILL IS PAID PRIOR TO DISCHARGE.

PART I, QUESTION 7
COSTING METHODOLOGY USED: COST TO CHARGE RATIO UTILIZING WORKSHEET 2 METHODOLOGY.

COMMUNITY BUILDING ACTIVITIES
EDEN MEDICAL CENTER AND SAN LEANDRO HOSPITAL HAD NO COMMUNITY BUILDING ACTIVITIES REPORTED FOR 2013.

PART III, QUESTION 2
METHODOLOGY FOR CALCULATING BAD DEBT (AT COST): THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.

PART III, QUESTION 3
METHODOLOGY FOR DETERMINING THE AMOUNT OF BAD DEBT LIKELY ATTRIBUTABLE TO CHARITY CARE: AMOUNTS MAY BE INCLUDED IN BAD DEBT PENDING A CHARITY CARE DETERMINATION. UPON ELIGIBILITY THESE AMOUNTS WOULD BE RECLASSIFIED AS CHARITY CARE.

PART III, QUESTION 4
THE ORGANIZATION MAKES EVERY EFFORT TO QUALIFY THOSE ELIGIBLE FOR CHARITY CARE. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS. AUDIT FOOTNOTE THE ORGANIZATION IS AN AFFILIATE OF SUTTER HEALTH WHICH UNDERWENT A SYSTEM-WIDE AUDIT. THE AUDIT REPORT DOES NOT INCLUDE A BAD DEBT EXPENSE FOOTNOTE. PROVISION FOR BAD DEBTS IS LISTED ON A SEPARATE LINE ITEM IN THE FINANCIAL STATEMENTS. THE AUDIT DOES INCLUDE FOOTNOTES FOR PATIENT ACCOUNTS RECEIVABLE AND PATIENT SERVICE REVENUES LISTED BELOW. PATIENT ACCOUNTS RECEIVABLE AUDIT FOOTNOTE: SUTTER'S PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. SUTTER MANAGES THE RECEIVABLES BY REGULARLY REVIEWING ITS PATIENT ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE ESTIMATED BASED UPON AN EVALUATION OF HISTORICAL PAYMENTS, NEGOTIATED CONTRACTS AND GOVERNMENTAL REIMBURSEMENTS. SUTTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 90% AND 89% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2013 AND 2012 RESPECTIVELY. ADJUSTMENTS AND CHANGES IN ESTIMATES ARE RECORDED IN THE PERIOD IN WHICH THEY ARE DETERMINED. SIGNIFICANT CONCENTRATIONS OF GROSS PATIENT ACCOUNTS RECEIVABLE ARE AS FOLLOWS: MEDICARE 33% AS OF 12/31/13 29% AS OF 12/31/12 MEDI-CAL 21% AS OF 12/31/13 23% AS OF 12/31/12 DURING 2013 AND 2012, CERTAIN AFFILIATES COLLECTED ON ACCOUNTS THAT WERE PREVIOUSLY DEEMED UNCOLLECTIBLE AND RESERVED. SUCH RECOVERIES ARE RECOGNIZED IN THE PERIOD THAT CASH IS RECEIVED AND WERE NOT MATERIAL. DUE TO THE INHERENT VARIABILITY IN THIS AREA OF PATIENT RECEIVABLE COLLECTIONS, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT THE ESTIMATION MAY CHANGES BY A MATERIAL AMOUNT IN THE NEAR TERM. PATIENT SERVICE REVENUES FOOTNOTE: PATIENT SERVICE REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT PROGRAMS WITH THIRD-PARTY PAYERS. ESTIMATED SETTLEMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, PRIMARILY AS A RESULT OF FINAL COST REPORT SETTLEMENTS WITH GOVERNMENTAL AGENCIES. PATIENT SERVICE REVENUES LESS PROVISION FOR BAD DEBTS ARE REPORTED NET OF THE PROVISION FOR BAD DEBTS ON THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. SUTTER'S SELF-PAY WRITE-OFFS WERE $375 MILLION AND $370 MILLION FOR 2013 AND 2012, RESPECTIVELY.

PART III, QUESTION 7
MEDICARE COST REPORTS THAT THE ORGANIZATION FILES DO NOT INCLUDE ALL OF THE COSTS REQUIRED TO TREAT MEDICARE PATIENTS.

PART III, QUESTION 8
COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. COMMUNITY BENEFIT MEDICARE SHORTFALL THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE DEFICIT.

PART III, QUESTION 9B
COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS WILL BE GIVEN AN APPLICATION WHICH WILL DOCUMENT THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 30 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.

PART VI, QUESTION 2
SUTTER HEALTH (SH), EDEN MEDICAL CENTER (EMC), ALAMEDA HEALTH SYSTEM (AHS) AND THE COUNTY OF ALAMEDA ENTERED INTO A DONATION AND TRANSFER AGREEMENT REGARDING SAN LEANDRO HOSPITAL, WHICH CLOSED ON OCTOBER 30, 2013. THE GENERAL TERMS OF THIS AGREEMENT INCLUDED: (I) SH'S DONATION OF SLH TO AHS WITH THE REQUIREMENT THAT OWNERSHIP AND OPERATIONAL CONTROL MUST REMAIN WITH A PUBLIC ENTITY OR PUBLIC HEALTH CARE AUTHORITY AS DEFINED BY STATUE AND (II) SH'S CONTRIBUTION OF $14 MILLION TO AN OPERATING FUND. SAN LEANDRO HOSPITAL WAS LAST PART OF A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2010, AS PART OF EDEN MEDICAL CENTER. THE 2010 ASSESSMENT WAS COMMISSIONED BY EDEN MEDICAL CENTER, ALTA BATES SUMMIT MEDICAL CENTER, KAISER PERMANENTE, ST. ROSE HOSPITAL, VALLEY CARE HEALTH SYSTEM AND WASHINGTON HOSPITAL HEALTHCARE SYSTEM. THE ASSESSMENT WAS COMPLETED BY THE ALAMEDA COUNTY PUBLIC HEALTH DEPARTMENT (COMMUNITY ASSESSMENT PLANNING AND EDUCATION [CAPE]). THE CAPE UNIT PRODUCED A REPORT ON KEY HEALTH INDICATORS AGREED UPON BY ALL HOSPITALS. BASED ON THE CHNA AND MEETING WITH KEY COMMUNITY BENEFIT CONTRIBUTORS, THE FOLLOWING PRIORITIES WERE ESTABLISHED FOR SAN LEANDRO HOSPITAL FROM THE 2010 ASSESSMENT: ACCESS * PROVIDE AND IMPROVE ACCESS TO CARE, SERVICES, AND RESOURCES TO THE UNDERSERVED AND THOSE WITH LIMITED ENGLISH PROFICIENCY BY PROVIDING DIRECT SERVICE TO THE COMMUNITY. * PARTICIPATE IN COMMUNITY ORGANIZATIONS; CONTRIBUTE TO INITIATIVES AND TASK FORCES IN OUR COMMUNITY TO CONTINUALLY ASSESS THE HEALTH NEEDS OF OUR SERVICE AREA AND CONTRIBUTE OUR EXPERTISE WHEN APPROPRIATE. * PROVIDE NEEDED MEDICAL/HEALTH-RELATED RESOURCES TO THE UNDERSERVED AND INDIGENT PATIENT POPULATION AND THOSE WITH LIMITED ENGLISH PROFICIENCY. * EXPAND ACCESS TO HEALTH RISK PREVENTION EDUCATION BY PROVIDING EDUCATION IN LOCAL COMMUNITY CENTERS. * EDUCATE AND TRAIN NEW AND EMERGING HEALTH PROFESSIONALS. CHRONIC HEALTH PROBLEMS * ADDRESS PROBLEMATIC HEALTH ISSUES SUCH AS HEART DISEASE, CANCER, STROKE, DIABETES, PULMONARY HEALTH, AND OBESITY IN OUR COMMUNITY. * OFFER SCREENING OPPORTUNITIES TO HELP IDENTIFY PEOPLE WHO ARE AT HIGH RISK FOR HEART DISEASE AND DIABETES. * PROVIDE EDUCATION PROGRAMS THAT FOCUS ON IDENTIFIED HEALTH ISSUES AND OBESITY. * PARTICIPATE IN OUTREACH EVENTS WITH A FOCUS ON EDUCATION AND PREVENTION OF IDENTIFIED HEALTH ISSUES AND OBESITY. VIOLENCE/INJURY PREVENTION * PROVIDE OUTREACH AND EDUCATION OPPORTUNITIES EMPHASIZING VIOLENCE AND INJURY PREVENTION TO REDUCE THE NUMBER OF VIOLENCE AND ACCIDENT-RELATED INJURIES AND DEATHS IN OUR COMMUNITY. * PROVIDE EDUCATION, TRAINING, AND COUNSELING TO REDUCE THE NUMBER OF INJURIES AND DEATHS RELATED TO UNINTENTIONAL INJURY. * WORK WITH THE YOUTH IN THE COMMUNITY TO REDUCE VIOLENCE AND INJURY. * PARTICIPATE AND BE A RESOURCE TO COMMUNITY GROUPS FOCUSED ON VIOLENCE PREVENTION AND UNINTENTIONAL INJURY.

PART VI, QUESTION 3
"SAN LEANDRO HOSPITAL FOLLOWED A SUTTER HEALTH SYSTEM-WIDE CHARITY CARE POLICY, WHICH INCLUDED THE FOLLOWING DETAILS OF HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. COMMUNICATIONS OF FINANCIAL ASSISTANCE AVAILABILITY A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL AFFILIATES SHALL PROVIDE: * ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLION INFORMATION FOR UNINSURED PATIENTS) * PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, ""STATEMENT OF FINANCIAL CONDITION"" 2. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL AFFILIATES SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION FORM, ""STATEMENT OF FINANCIAL CONDITION"". B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS: 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE SUTTER HEALTH WEBSITE AND EACH HOSPITAL AFFILIATE WEBSITE, IF ANY. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE, COLLECTION PRACTICES, HOSPITAL AFFILIATE THIRD-PARTY LIENS, AND AFFILIATE DISPUTE INITIATION POLICY (FINANCE POLICY 14-227). C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL AFFILIATES SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGE(S) OF THE AFFILIATE'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATIONS TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL PROVIDE THE PATIENT WITH AN ESTIMATE OF THE AMOUNT THE HOSPITAL AFFILIATE WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS."

PART VI, QUESTION 4
ALAMEDA IS AN EXCEPTIONALLY LARGE COUNTY RANKING AS THE 7TH MOST POPULOUS COUNTY IN THE STATE WITH A 2010 POPULATION OF 1,510,271 CONSISTING OF 49% MEN AND 51% WOMEN WITH A MEDIAN AGE OF 36.6 YEARS. THE POPULATION DENSITY WAS 2,043.6 PEOPLE PER SQUARE MILE IN 2010 WHICH IS OVER EIGHT TIMES LARGER THAN THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. ALAMEDA'S POPULATION IS QUITE DIVERSE WITH 43% BEING WHITE, 26.1% ASIAN AND 22.5% HISPANIC OR LATINO. OVER HALF (63.2%) OF RESIDENTS SPEAK ENGLISH AT HOME WHILE 14.3% SPEAK SPANISH AT HOME (9% OF WHICH DO NOT SPEAK ENGLISH AT ALL) AND 15.2% SPEAK ASIAN OR PACIFIC ISLAND. THE MEDIAN HOUSE HOLD SIZE IS 2.72 PEOPLE WITH A 2010 AVERAGE INCOME OF $69,384 AND A MEDIAN HOUSE VALUE OF $590,900. A LARGE PORTION (85.9%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 40.3% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN ALAMEDA THE POVERTY LEVEL IN 2010 WAS AT 11.4% OF RESIDENTS, BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 10.8% IN APRIL 2010 WHICH WAS BELOW THE CALIFORNIA LEVEL OF 12.4% HOWEVER IT WAS RIGHT ABOVE THE FEDERAL LEVEL OF 9.9%. FOOD IS READILY AVAILABLE WITH 364 GROCERY STORES, 5 SUPERCENTERS/CLUB STORES, AND OVER 1,299 FULL SERVICE RESTAURANTS. THERE ARE FIVE HOSPITALS SERVING THE COMMUNITY. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 30.5% OF ADULTS BEING OBESE, 7.8% OF ADULTS WITH DIABETES AND ALMOST THREE IN TEN ADULTS HAVING HIGH BLOOD PRESSURE. FROM 2006 TO 2008 THERE WERE 27,728 DEATHS IN ALAMEDA COUNTY AND OF THOSE THE THREE LEADING CAUSES WERE HEART DISEASE, CANCER AND STROKE. IN 2008 THERE WERE 20,797 BIRTHS HOWEVER THE INFANT MORTALITY RATE WAS 4.5 PER 1,000 BIRTHS. FROM 2006 - 2008 LIFE EXPECTANCY AT BIRTH WAS 81.4 YEARS WHICH IS NEARLY THE SAME AS THE CALIFORNIA LIFE EXPECTANCY. IN 2010 13.3% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS BELOW BOTH THE STATE LEVEL OF 18.5% AND FEDERAL LEVEL OF 15.5%. IN ALAMEDA COUNTY 61.9% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 23.5% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE.

PART VI, QUESTION 5
"SUTTER HEALTH'S MISSION IS TO ""ENHANCE THE WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE, THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES."" SUTTER HEALTH'S MISSION REACHES BEYOND THE WALLS OF OUR HOSPITALS AND FACILITIES. OUR AFFILIATES FURTHER THEIR TAX-EXEMPT PURPOSE BY: * BUILDING RELATIONSHIPS OF TRUST BY WORKING COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS; * SUPPORTING NONPROFIT ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICES AND EMPLOYEE VOLUNTEERISM; AND * PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS. A FEW HIGHLIGHTS OF SAN LEANDRO HOSPITAL'S COMMUNITY BENEFIT ACTIVITIES UNTIL ITS CLOSURE ON OCTOBER 30, 2013: SLH PROVIDED INPATIENT MENTAL HEALTH SERVICES AND THE CONTINUED PROVISION OF EMERGENCY ROOM SERVICES TO MEET THE NEEDS OF A COMMUNITY WHO WOULD OTHERWISE NOT BE AFFORDED LOCAL ACCESS. AMONG THOSE SERVICES INCLUDED THE PROVISION OF BASIC LABORATORY AND RADIOLOGICAL SERVICES TO THE ROTACARE BAY AREA, INC., SAN LEANDRO CLINIC. THE CLINIC PROVIDES FREE MEDICAL CARE TO THOSE WITH THE GREATEST NEED AND LEAST ACCESS TO MEDICAL CARE. IT IS OPERATED SOLELY BY VOLUNTEERS AND SUPPORTED THROUGH GRANTS AND DONATIONS. SAN LEANDRO HOSPITAL WORKED CLOSELY WITH EDEN MEDICAL CENTER TO PROVIDE ACCESS FOR COMMUNITY GROUPS TO MEET WHO MAY NOT OTHERWISE BE ABLE TO AFFORD THE ABILITY TO MEET. SLH PROVIDED FREE MEETING ROOM SPACE TO SUPPORT GROUPS AND OTHER NOT-FOR-PROFIT ORGANIZATIONS."

PART VI, QUESTION 6
"SAN LEANDRO HOSPITAL WAS AFFILIATED WITH SUTTER HEALTH UNTIL ITS CLOSURE ON OCTOBER 30, 2013. SUTTER HEALTH IS A NOT-FOR-PROFIT NETWORK OF ALMOST 50,000 PHYSICIANS, EMPLOYEES, AND VOLUNTEERS WHO CARE FOR MORE THAN 100 NORTHERN CALIFORNIA TOWNS AND CITIES. TOGETHER, WE'RE CREATING A MORE INTEGRATED, SEAMLESS AND AFFORDABLE APPROACH TO CARING FOR PATIENTS. IT'S BETTER FOR PATIENTS: WE BELIEVE THIS COMMUNITY-OWNED, NOT-FOR-PROFIT APPROACH TO HEALTH CARE BEST SERVES OUR PATIENTS AND OUR COMMUNITIES - FOR MULTIPLE REASONS. FIRST OF ALL, IT'S GOOD FOR PATIENTS. ACCORDING TO THE JOURNAL OF GENERAL INTERNAL MEDICINE (APRIL 2000), PATIENTS TREATED AT FOR-PROFIT OR GOVERNMENT-OWNED HOSPITALS WERE TWO-TO-FOUR TIMES MORE LIKELY TO SUFFER PREVENTABLE ADVERSE EVENTS THAN PATIENTS TREATED AT NOT-FOR-PROFIT INSTITUTIONS. OUR STOCKHOLDERS ARE OUR COMMUNITIES: INVESTOR-OWNED, FOR-PROFIT HEALTH SYSTEMS HAVE A FINANCIAL INCENTIVE TO AVOID CARING FOR UNINSURED AND UNDERINSURED PATIENTS. THEY ALSO HAVE A FINANCIAL INCENTIVE TO AVOID HARD-TO-SERVE POPULATIONS AND ""UNDESIRABLE"" GEOGRAPHIC AREAS SUCH AS RURAL AREAS. FOR MANY NORTHERN CALIFORNIA'S UNDERSERVED RURAL LOCALES, SUTTER HEALTH IS THE ONLY PROVIDER OF HOSPITAL AND EMERGENCY MEDICAL SERVICES IN THE COMMUNITY. PROVIDING CHARITY CARE AND SPECIAL PROGRAMS TO COMMUNITIES: OUR COMMUNITIES' SUPPORT HELPS US EXPAND SERVICES, INTRODUCE NEW PROGRAMS AND IMPROVE MEDICAL TECHNOLOGY. ACROSS OUR NETWORK, EVERY SUTTER HOSPITAL, PHYSICIAN ORGANIZATION AND CLINIC HAS A SPECIAL STORY TO TELL ABOUT FULFILLING VITAL COMMUNITY NEEDS. OUR COMMITMENT TO COMMUNITY BENEFIT: MEETING THE HEALTH CARE NEEDS OF OUR COMMUNITIES IS THE CORNERSTONE OF SUTTER HEALTH'S NOT-FOR-PROFIT MISSION. THIS INCLUDES DIRECTLY SERVING THOSE WHO CANNOT AFFORD TO PAY FOR HEALTH CARE AND SUPPORTING PROGRAMS AND SERVICES THAT HELP THOSE IN FINANCIAL NEED. SUTTER HEALTH NOW PROVIDES AN AVERAGE OF MORE THAN $3 MILLION IN CHARITY CARE PER WEEK. IN 2013, OUR NETWORK OF PHYSICIAN ORGANIZATIONS, HOSPITALS AND OTHER HEALTH CARE PROVIDERS INVESTED $901 MILLION IN HEALTH CARE PROGRAMS, SERVICES AND BENEFITS FOR THE POOR AND UNDERSERVED. THIS INCLUDES: * THE COST OF PROVIDING CHARITY CARE; * THE UNPAID COSTS OF PARTICIPATING IN MEDI-CAL; AND * INVESTMENTS IN MEDICAL RESEARCH, HEALTH EDUCATION AND COMMUNITY-BASED PUBLIC BENEFIT PROGRAMS SUCH AS SCHOOL-BASED CLINICS AND PRENATAL CARE FOR PATIENTS. SUTTER HEALTH'S COMMITMENT TO DELIVERING CHARITY CARE TO PATIENTS CONTINUED TO GROW, REACHING ANOTHER ALL-TIME HIGH OF $166 MILLION IN 2013."

PART VI, QUESTION 7
CALIFORNIA