Sutter Visiting Nurse Association and Hospice

“Executive committee: the executive committee shall consist of the chair of the board who shall serve as chair of the committee, the vice chair, the chair of the finance and planning committee, and the president. The executive committee shall consist of four (4) members, including the corporation's chair who shall serve as chair of the committee, the vice chair, the chair of the finance and planning committee and the president of the corporation. Should one (1) or more directors hold more than one (1) of the positions listed above, then such additional directors shall be appointed by the board to serve on the committee such that there will be four (4) total members. The affairs and management of the corporation shall be supervised by the executive committee which shall have power to transact all regular business of the corporation during the period between meetings of the board, subject to any prior limitations imposed by the board. Form 990, part vi, lines 6 & 7a classes of persons and the nature of their rights: this corporation is an affiliate of sutter health, a california nonprofit public benefit corporation. Sutter health is the sole member with the right to elect at least a majority of the members of the board of directors.”

“Classes of persons, decisions requiring approval & type of voting rights: sutter health as the sole member of the organization is entitled to exercise fully all rights and privileges of members of nonprofit corporations under the california nonprofit public benefit corporation law, and all other applicable laws. The member has the rights and powers to appoint (and remove) members of the corporation's board of directors, subject to the provisions of the bylaws. In addition, the member has the right to approve the following actions of the corporation's board of directors: a. Merger, consolidation, reorganization, or dissolution of the corporation or any subsidiary or affiliate entity; b. Amendment or restatement of the articles of incorporation or the bylaws of the corporation or any subsidiary or affiliate entity; c. Adoption of operating budgets of the corporation or any subsidiary or affiliate entity, including consolidated or combined budgets of the corporation and all subsidiary organizations of the corporation; d. Adoption of capital budgets of the corporation or any subsidiary or affiliate entity; e. Aggregate operating or capital expenditures on an annual basis that exceed approved operating or capital budgets by a specified dollar amount to be determined from time to time by the general member; f. Long-term or material agreements including, but not limited to, borrowings, equity financings, capitalized leases and installment contracts; and purchase, sale, lease, disposition, hypothecation, exchange, gift, pledge, or encumbrance of any asset, real or personal, with a fair market value in excess of a dollar amount to be determined from time to time by the directors of the general member, which shall not be less than 10% of the total annual capital budget of the corporation; g. Appointment of an independent auditor and hiring of independent counsel except in conflict situations between the general member and the corporation or any subsidiary or affiliate entity; h. The creation or acquisition of any subsidiary or affiliate entity; i. Contracting with an unrelated third party for all or substantially all of the management of the assets or operations of the corporation or any subsidiary or affiliate entity; j. Approval of major new programs and clinical services of the corporation or any subsidiary or affiliate entity. The general member shall from time to time define the term "major" in this context; k. Approval of strategic plans of the corporation or any subsidiary or affiliate entity; l. Adoption of quality assurance policies not in conformity with policies established by the general member; m. Any transaction between the corporation, a subsidiary or affiliate and a director of the corporation or an affiliate of such director. In addition, the general member shall have the authority (by a vote of not less than two-thirds (2/3) of its board), to declare a major activity requiring approval.”

“Process used by management &/or governing body to review form 990: sutter health has a centralized tax department responsible for the preparation of the form 990. Annually the tax department provides training and education to affiliate personnel who assist the tax department in collecting and reviewing data to be reported on the form 990. The preparation material is reviewed by various departments including tax, finance, legal, and human resources. A national accounting firm prepares and/or reviews the return. A completed return is then reviewed by the tax department, the affiliate, and the cfo before the return is filed.”

“Process to monitor transactions for conflicts of interest: employees are educated on the conflict of interest policy and the need to make disclosure as part of annual compliance education. In addition, annually a disclosure statement is completed by all directors, officers and key employees that includes an acknowledgement that they have read the conflict of interest policy. On this statement the individual will list a wide range of information which includes business relationships, employment relationships, property interests, and those of related parties. The board may consult with the office of the general counsel as necessary. If there is a potential conflict of interest related to a particular transaction, the interested individual must disclose the existence and nature of the relationship. The board chair may appoint a disinterested person or committee to investigate the conflict. Until the potential conflict is resolved, the board chair (or committee chair as applicable) may request the individual to not participate during related presentations and discussions. In all circumstances involving an actual conflict, the interested individual shall leave the room prior to the boards final discussion and vote.”

“Process for determining top management official compensation: the compensation for the position of the top management official is determined through a quantitative point factor review of the know-how, problem solving, and accountability associated with a given position as identified in the detailed position description. Additionally, all applicable market salary survey data is reviewed to ensure the position is both internally equitable and externally competitive/market appropriate. The compensation committee of sutter health annually approves compensation, and such approval is recorded in the minutes of sutter health. The most recent approval was december 2017. Form 990, part vi, line 15b process for determining other officers or key employee compensation: for sutter health employees the compensation committee of the sutter health board of directors retains ultimate discretionary authority over all elements of compensation to assure that organizational purposes are appropriately being served. The compensation committee uses credible data sources and maintains an objective "arms length" decision-making process, ensuring the integrity of sutter's executive programs and consistency with the organization's overall mission. In order to ensure external competitiveness, national, california and local market area compensation data comparisons are reviewed. Competitive analysis includes: (a) base salary, (b) total cash (base salary + annual incentive), (c) total direct cash (base salary + annual incentive + long term incentive) and (d) total remuneration (base salary + annual incentive + benefits and long term incentive). This analysis includes comparable organizations and geographic considerations. For the most senior executive positions, national comparisons for organizations similar in size, scope and complexity as sutter health are most appropriate since it is a national marketplace in which sutter competes for executive talent. On the other hand, because california's underlying compensation structure is higher than national data (especially in the bay area), regional pay adjustments may be made. Officers and key employees of this organization undergo a review and compensation committee approval annually, and such approval is recorded in the minutes. The most recent approval was december 2017.”

“Availability of governing documents, coi policy, & financial statements: the sutter health system posts its current and past audited financial statements at sutterhealth.org. Other documents are also located at this website including the annual report, mission statement, history, and links to affiliate websites. The governing documents are not available to the public at this time. Form 990, part vii, section a compensation of board members: the following board members of the organization are full-time employees (40 hours per week) of sutter health and their sutter health salaries are reported herein. These individuals receive no compensation for their service as board members of this organization. - john mesic, md - sarah krevans - rishi sikka, md - janice potts - marcia reissig”

“Mission statement: sutter visiting nurse association and hospice, dba sutter care at home (scah) enhances the health and well-being of the people in the communities we serve through a not-for-profit commitment to compassion and excellence in home-based services and products. The sutter care at home foundation supports local home health and end-of-life care, bereavement support services, and community wellness programs provided by sutter care at home.”

“Program service accomplishments: primary exempt purpose: provide health care to patients in their homes. Service accomplishments: sutter vna & hospice is a state licensed, medicare-certified home care agency that provides a broad spectrum of multi-disciplinary services and offers a range of specialty programs to residents of northern california. Sutter vna & hospice provides health care services to patients who require these services outside of a hospital setting (primarily in the home), for which a fee is charged to cover the cost of providing these services. These services are provided to medicare, medi-cal, and private insurance patients. Charitable care is provided when deemed appropriate. The health care services provided by sutter vna & hospice include the following: - skilled nursing; nurses work with patients who have heart disease, cancer, diabetes, ostomies, aids, or other chronic diseases and illnesses, or who have recently had surgery or an acute care episode. - rehabilitation services including physical, occupational, and speech therapy. Physical and occupational therapy is provided for patients with difficulties due to strokes, amputation or fractures, surgery, and for patients who are paraplegics or quadriplegics. Speech therapy is provided for patients with speech or swallowing problems. - home infusion therapy services; provided for patients who need intravenous treatments. Services include hydration, chemotherapy, total parenteral nutrition, antibiotics, injectable medications, pain management, and enteral nutrition. - medical social work services; provides assistance to persons who need guidance in developing self-help and problem solving skills, and access to community resources. - hospice and bereavement services; helps terminally ill patients and their families who need support and care. Services include nursing care, pain management, symptom control, and bereavement counseling. - home health aides and volunteer respite care; provides aid to patients who cannot care for themselves; includes bathing and personal care, companionship, and relief for caregivers. - respiratory therapy and durable medical equipment; provides patients with respiratory therapy services, equipment, and supplies, beds, wheelchairs, and other durable medical equipment. Specialty programs: - advanced illness management: provides care management for patients with high disease burden, whose health is declining and who are at risk for death in the next 12 months. Innovative program developed to provide home-based palliative care and transition management for patients with advanced chronic illness. This team based disease management program is geared toward reducing health care utilization, lowering costs and better managing 30-day readmissions. - flu and wellness program: the flu and wellness program provides flu prevention and health screening services. Other vaccinations offered include pneumonia and tdap. Wellness services, which are offered year-round, include tb testing, cholesterol screenings, blood pressure and body composition clinics and biometric screenings. All services are delivered by licensed and professional nurses. Community benefit services in 2017, sutter vna & hospice provided $363,448 worth of community benefit. The community benefit programs and services provided include the following: - hospice bereavement groups (ex. Adult grief support groups, childrens workshops, daughter/mom loss support group, adult traumatic loss) - blood pressure clinics, flu shots, health fairs, etc. - preceptorships and internships provided for students. Charitable activity in 2017 sutter vna & hospice provided $1,637,315 worth of charity care. Charity care was provided in the form of home health services, hospice services, respiratory therapy and durable medical equipment service and products, and home infusion therapy services. Unpaid cost of medicaid in 2017 sutter vna & hospice provided $17,654,095 worth of unpaid services to medicaid”

“Other changes in fund balance: equity transfer (net) $ 5,764,483 ---------------- total $ 5,764,483”