Nevada Hospital Reporting
(Pursuant to NRS 449.490, Sections 2 through 4)
Demographic Information
Name of Organization St Rose Dominican Hospitals, San Matrin Campus
Location (City & State) Henderson, NV 89183
Fiscal Year Ended 6/30/2020  
Legal Entity Status Tax Exempt Organization, affiliated with CommonSpirit Health
Description of Organization
Number of Facilities Licensed Beds Staffed Beds Major Services & Centers of Excellence
A 147-bed facility offering an array of inpatient and outpatient services, including a Joint Replacement Center, Open Heart Surgery Program and a Level II NICU 147 147 Cardiology, Orthopedics, and Level II NICU
Capital Improvements
New Service Lines (List each new service line offered)
Major Facilitiy Expansion:
Description Prior Year's Cost Current Year Cost R=Replace          N= New Construction in Progress
  $0.00 $0.00    
  $0.00 $0.00    
  $0.00 $0.00    
  $0.00 $0.00    
  $0.00 $0.00    
Total $0.00 $0.00    
Major Equipment
Description Prior Year's Cost Current Year Cost R=Replace          N= New Expansion
DaVinci Xi $0.00 $2,136,964.00   X
  $0.00 $0.00    
  $0.00 $0.00    
  $0.00 $0.00    
  $0.00 $0.00    
Total $0.00 $2,136,964.00    
Other Additions and Total Additions for the Period:
Other capital additions for the period not included above $725,013.00
Total Additions for the Period (Sum of Expansion, Equipment & Other Additions) $2,861,977.00
Home Office Allocation
Describe the methodology used to allocate home office costs to the hospital        
The home office, Dignity Health, makes three types of charges to St. Rose Dominican: Corporate Office Assessment, IT Assessment, and a variety of other charges for services that are provided centrally. Each year, budgets are prepared for these functions and costs are allocated among Dignity Health facilities based on the relative size of their operating expense bases for the Corporate office and IT Assessments.
 Various other services are provided for Dignity Health hospitals including human resources, purchasing, accounting, accounts payable, payroll, reimbursement, decision support and managed care contracting. The cost of these services is allocated based upon usage.
 Additional intercompany expenses are calculated as follows:
 Workers’ Compensation Actuarial calculations based on claims experience and exposures
 Pension Actuarial calculations allocated based on service cost plus amortizations
 Malpractice Actuarial calculations based on claims experience and exposures
 Interest expense is charged to each hospital based on the amount of debt used by the facility times an average interest rate over all the debt outstanding.
Indicate services included in Hospital's Home Office Allocation:      
Information Technology Contracting Treasury Internal Audit Human Resources
Accounts Receivable Credentialing  Legal Construction Other: 
Accounts Payable Accounting Compliance Accounts Payable  
Procurement and Supply Financial Planning Quality  Payroll  
Community Benefits Structure
Hospital Mission Statement We are committed to furthering the healing ministry of Jesus. We dedicate our resources to:
 • Delivering compassionate, high-quality, affordable health services;
 • Serving and advocating for our sisters and brothers who are poor and disenfranchised; and
 • Partnering with others in the community to improve the quality of life.
Hospital Vision A vibrant, national health care system known for service, chosen for clinical excellence, standing in partnership with patients, employees and physicians to improve the health of all communities served.
Hospital Values Dignity, Collaboration, Justice, Stewardship, Excellence
Hospital Community Benefit Plan (groups to target, decision makers, goals) To provide community benefit programs designed to meet the health care needs of the residents of southern Nevada. Key programs include: Disease Management, RED Rose, Helping Hands, WIC, and the Breastfeeding program.
Mission Mapping 
  Yes No
Does your mission map to your strategic planning process? Yes  
Do you have a dedicated community benefits coordinator? Yes  
Do you have a charitable foundation? Yes  
Do you conduct teaching and research?   No
Do you operate a Level I or Level II trauma center?   No
Are you the sole provider in your geographic area of any specific clinical services? (If Yes, list services.) No
Community Health Improvements Services
Benefit $
Community Health Education $42,302.00
Community-Based Clinical Services $0.00
Health Care Support Services $0.00
Total $42,302.00
Health Professions Education
Benefit $
Physicians/Medical Students (net of Direct GME payments) $0.00
Nurses/Nursing Students $0.00
Other Health Professional Education $270,172.00
Scholarships/Funding for Professional Education $0.00
Total $270,172.00
Subsidized Health Services
Benefit $
Total Uncompensated Cost from Uncompensated Cost Report filed with DHCFP $30,979,485.00
Less: Medicaid Disproportionate Share Payments received for the Period $95,325.00
Less: Other Payments Received for these Accounts (County Supplemental Funds, etc.) $1,812,827.00
    Net Uncompensated Care $29,071,333.00
Uncompensated SCHIP (Nevada Checkup) Cost $15,722.00
Uncompensated Medicare Cost (see instructions) $11,863,205.00
Uncompensated Clinic or Other Cost $0.00
Other Subsidized Health Services $0.00
Less: Cost Reported in Another Category     $211,755.00
  Total Subsidized Health Services $40,738,505.00
Benefit $
Clinical Research $0.00
Community Health Research $0.00
Other $0.00
Total $0.00
Financial Contributions
Benefit $
Cash Donations $92,269.00
Grants $46,022.00
In-Kind Donations $30,688.00
Cost of Fund Raising for Community Programs $0.00
Total $168,979.00
Community Building Activities
Benefit $
Physical Improvements and Housing $0.00
Economic Development $0.00
Community Support $0.00
Environmental Improvements $0.00
Leadership Development and Leadership Training for Community Members $0.00
Coalition Building $0.00
Community Health Improvement Advocacy $0.00
Workforce Development  
Total $0.00
Community Benefit Operations
Benefit $
Dedicated Staff $0.00
Community Health Needs/Health Assets Assessment $0.00
Other Resources $0.00
Total $0.00
Other Community Benefits
Benefit $
(Briefly explain other community Benefits provided but not captured in sections above) $0.00
Unmet Free Care Obligation (Assessment for not meeting minimum care obligation of NRS 439B.340) $695,849.00
Other Community Benefits Subtotal $695,849.00
Total Community Benefit
Benefit $
Total $41,915,807.00
Other Community Support
Benefit $
Property Tax $0.00
Sales and Use Tax $0.00
Modified Business Tax $0.00
Commerce Tax $0.00
State UI Tax + NV Bond Factor $0.00
    Total Other Community Support $0.00
Total Community Benefits & Other Community Support
List and briefly explain educational classes offered
Health Conditions Education Disease Management: Chronic Illness and nutrition education to provide educational resources and support to increase participant knowledge, confidence and skills. Emphasize the participant’s role in managing illness.
Safety/Injury Prevention: Based on community mortality reports, provide education, skills and services to the community on safety for the prevention of injury and death. Target specific groups and needs – teens, new parents, work sites, adults and seniors. Outcome: 922 participants.
Health/Wellness & Fitness Programs: Provide free and low cost fitness programs to the community. Incorporate mind, body and spirit into these programs and teach flowing body movements that create focus, balance, core strength, flexibility and emotional wellbeing.
Pregnancy and Childbirth Classes: Promote healthy pregnancy through prenatal education classes and support. Provide programs to enhance baby safety, early bonding and development. Outreach to teens and at-risk mothers by providing scholarship programs. Educate about the labor and birthing process, taking care of baby, shaken baby syndrome and coping mechanisms.
List and briefly describe other community benefits provided to the community for which the costs cannot be captured
Safety/Injury Prevention: Based on community mortality reports, provide education, skills and services to the community on safety for the prevention of injury and death. Target specific groups and needs – teens, new parents, work sites, adults and seniors. Outcome: 922 participants.
Support Groups: Provide support to individuals working through the healing process. A study conducted by Spiegel, et al., determined that psychosocial intervention, in the form of support groups, has a positive effect on survival for patients. Outcomes: Provided 24 different support groups, 42 different meetings for a total of 14,522 encounters.
Kindness Kloset: Employees donate new clothes for patients who are being discharged with no clothing to wear home. These patients are discharged from one of the units or from the Emergency Departments at all three campuses.
Pet Blessing: Collected used towels and blankets for local animal shelters.
Bus Passes and boxed lunches are distributed to walk-ins in need at all three campuses.
Back-to-School Backpacks and Angel Tree Gifts were donated by employees for over 100 low income children.
Community Events- employees volunteer time and money by participating in community events with local charities. The hospital coordinates three teams for events such as the Rose Regatta Dragon Boat Festival, Susan G. Komen Race for the Cure, American Heart Association Heart Walk and the American Lung Association Scale the Strat climb.
Infant, Children & Parenting - Provided programs to enhance baby safety, early bonding, baby development and parenting. Outcomes: 6,111 participants.
Community Coalitions - The Nevada Statewide Maternal and Child Health Coalition (NVMCH) provide leadership to improve the physical and mental health, safety and well-being of the maternal and child population across Nevada. Outcomes: 754 active members statewide
Health Screenings: Provide low or no cost medical and health screenings for the uninsured in our community to detect the early onset of illness and disease. Provide referrals to follow up care as needed. Outcomes: Provided 1,318 screenings open to the community.
Fitness Programs: Provide free and low cost fitness programs to the community. Incorporate mind, body and spirit into these programs and teach the Enhance Fitness evidence-based curriculum that improves balance, strength, flexibility, endurance and emotional well-being. Outcomes: Offered 54 different ongoing weekly exercise programs generating 27,977 encounters.
Breastfeeding: St. Rose Dominican is committed to protecting new mothers milk supply and the nutrition of the baby. Outcomes: Maintained Baby Friendly designations for both San Martin and Siena. 300 Outpatient Lactation Consultations, 485 Phone Consultations, 355 breastpump rentals, 871 breastfeeding support group encounters, 188 prenatal breastfeeding class participants.
Discounted Services & Reduced Charges Policy & Procedures
Charity Care Policy: (attach copies of actual policies if  first filing or policy changed) Policy Effective Date: 05/09/2016
    Does the hospital have a policy? (Yes or No) Yes
    Policy covers up to what % of Federal Poverty Level? 200%
    Discounts given up to what %? 100%
    Amount of time to make arrangements (in days or months) 30 days
    Other comments Liability exceeds 30% of pt family income after all other discounts; w no ability to pay
Prompt Pay or Other Discounts: (attach copies of actual policies if first filing or policy changed) Policy Effective Date: 05/09/2016
    Does the hospital have a policy? (Yes or No) Yes
    Discounts given up to what %? 30% of balance due after Uninsured Discount, but before pt pymts.
    Amount of time to make arrangements? (in days or months) 240 days after initial bill
    Other comments An application for discount services can be submitted at any time but DH has the discretion to deny applications submitted has the discretion to deny an application if more than 240 days has passed since the first post-discharge billing notice.
Collection of Accounts Receivable Policies & Procedures
Effective Date of Policy 1/1/2016
  Yes No
Does hospital have established policy? Yes  
Does hospital make every reasonable effort to help patient to obtain coverage? (Yes or No) Yes  
Is collection policy consistent with the Fair Debt Collection Practices Act? (Yes or No) Yes  
Is the patient notified in writing of referral to collection agency? Yes, by agency  
Is the patient notified in writing prior to a lawsuit being begun? Yes  
Methods of communication with patient (e.g. phone, letter, etc.) phone and letter
Number of patient contacts before referral to collection agency 3
Number of days prior to referral to collection agency 120
Other comments None
  Yes No
Is hospital chargemaster available in accordance with NRS 449.490 (4) requirements? (Yes or No) Yes  
Is the chargemaster updated at least monthly? (Yes or No) Yes  
How is the chargemaster made available? (E.g. format, location, etc.) Electronic format sent from Optum via email to appropriate department managers
Susan Bryant, Finance Director 7/13/2021
Name and Title of Person Completing the Report: Date
Brian Kleven, NV Market CFO 7/13/2021
Name and Title of Person who Reviewed and Approved Date