2024-05-13T15:22:39-07:00 2023-06-30 990 2022-07-01 237429117 MADERA COMMUNITY HOSPITAL MADE 5596755555 1250 E Almond Avenue Madera CA 93637 Karen Paolinelli CEO 5596752823 2024-05-07 Karen Paolinelli 999009999 1 1 11 0 AAL2 2022 2023-04-26 12:10:37Z Karen Paolinelli 1250 E Almond Ave Madera CA 93637 46289974 0 X www.maderahospital.org X 1971 CA Madera Community Hospital is dedicated to actively promoting and maintaining the health and well being of residents throughout the Central Valley of California. 15 11 984 0 0 0 62247 400000 95758518 43218740 49591 20708 8519430 2650526 104389786 46289974 0 0 0 0 51005430 29588377 0 0 0 65242653 44461536 116248083 74049913 -11858297 -27759939 81559320 59433595 28986340 34620554 52572980 24813041 Madera Community Hospital provides Inpatient and Outpatient healthcare services to the citizens of Madera and its surrounding communities. 0 0 42590106 0 44622253 Delivery and Management of General Inpatient and Outpatient Healthcare Services were provided to the citizens of Madera and its surrounding communities. 0 0 0 42590106 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 180 0 1 984 1 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X Karen Paolinelli 5596755504 1250 E Almond Avenue Madera CA 93637 Karen Paolinelli Exec Director/CEO 40 0 X 354319 0 3050 Mark J Foote Vice President - Finance 40 0 X 288705 0 2878 Jeanine Gillmeister Chief Nursing Officer 40 0 X 193594 0 0 Eva A Singsing Med/Surg Clinical Coordinator 40 0 X 187785 0 1873 Colton Lee Pfister Director of Phamacy 40 0 X 182542 0 1845 Alma Mendoza Pharmacist II 40 0 X 181819 0 1856 Cindy Burgamy-Stevens Family Nurse Practition 40 0 X 177315 0 1773 Mathew F Kobzeff Pharmacist II 40 0 X 173703 0 1775 Mohammad Arain Board Member 0.5 0 X 0 0 0 Jon Basila Board Member 0.5 0 X 0 0 0 Deirdre daSilva Chairman 1 0 X 0 0 0 Anita Eden Board Member 0.5 0 X 0 0 0 Stell Manfredi Board Member 1.00 0 X 0 0 0 Jay Mahil Board Member 0.5 0 X 0 0 0 Aftab Naz Board Member 0.5 0 X 0 0 0 Wally Nishimoto Board Member 0.5 0 X 0 0 0 Bruce Norten Board Member 0.5 0 X 0 0 0 Monte Pistoresi Board Member 0.5 0 X 0 0 0 Robert Poythress Board Member 0.5 0 X 0 0 0 Cyril Rebel Board Member 0.5 0 X 0 0 0 Don Warnock Board Member 0.5 0 X 0 0 0 Jan Zitek Board Member 0.5 0 X 0 0 0 1739782 0 15050 96 0 1 0 SnapMeditech Inc PO Box 200352 Dallas TX 753200352 Nurse Staffing 5381634 New England Sheet Metal PO Box 27409 Fresno CA 93729 Engineering 4195181 NuWest Group Holding LLC PO Box 940 Roseville CA 95661 Nurse Staffing 4153798 ARYA Medical Group 1660 E Herndon Ave Ste 101 Fresno CA 93720 Hospital Physician Services 3695471 Davis Wright Tremaine LLP 920 Fifth Avenue Suite 3300 Seattle WA 981041610 Attorney Services 1746329 58 0 0 0 390000 0 10000 0 400000 Medicare 622000 26710319 26710319 0 0 Medi-Cal 622000 11517032 11517032 0 0 Other 3rd Party Payers 622000 1312591 1312591 0 0 Other Payors 622000 3678798 3678798 0 0 0 0 0 0 43218740 20708 20708 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Covid 19 Relief Fund 622000 1382805 1382805 0 0 Non Patient Food Sales 722212 438878 0 0 438878 Rebates and Refund 622000 419844 0 0 419844 408999 0 0 408999 2650526 46289974 44622253 0 1267721 X 836618 193594 643024 0 0 0 0 0 20465990 15331175 5134815 0 191428 137866 53562 0 5240361 3985828 1254533 0 2853980 1351173 1502807 0 0 0 0 0 943121 0 943121 0 67500 0 67500 0 0 0 0 0 0 0 0 0 0 0 8364624 8364624 0 0 1000 0 1000 0 258472 56244 202228 0 1271892 0 1271892 0 0 0 0 0 178547 148565 29982 0 10578 4395 6183 0 0 0 0 0 35622 35427 195 0 694388 0 694388 0 0 0 0 0 2312000 428887 1883113 0 1739406 0 1739406 0 Supplies 9415034 5910333 3504701 0 Quality Assurance Provider Fees 2971371 0 2971371 0 Other Purchased Services 3657018 1317835 2339183 0 Physician Professional Fees 4330407 4310007 20400 0 8210556 1014153 7196403 74049913 42590106 31459807 0 7706097 4386380 583335 0 0 0 10202619 0 0 0 0 0 29136998 22166355 3539098 1130273 973321 189296 103366570 71888380 29310351 31478190 0 0 0 0 0 0 0 0 107501 83101 81559320 59433595 7264653 8780527 0 0 0 0 0 0 0 0 0 0 7303719 11149107 0 0 14417968 14690920 28986340 34620554 X 52572980 24813041 0 0 52572980 24813041 81559320 59433595 -27759939 0 0 0 0 0 X 1 1 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 130000 84936 214936 0 52536787 31888878 20647909 0 265048 80034 185014 0 43165935 38453362 4712573 0 7183864 1466106 5717758 31478190 0 Accrued Payroll and Related Liabilities 9006184 Due to third party payor 992234 Quality Assurance Fees Payable 3601945 Notes and Leases - Unsecured 1090557 14690920 1 1 X 1 X 1 X 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1198755 0 9196787 13283042 -4086255 X 1 1 1 1 Madera Community Hospital 1250 E Almond Avenue Madera CA 93637 www.maderahospital.org X X X A 2 Madera Community Hospital Family Health Services 1210 E Almond Avenue Madera CA 93637 www.maderahospital.org Provider-Based Rural Health Clinic A 3 Chowchilla Medical Center Clinic 285 Hospital Drive Chowchilla CA 93610 www.maderahospital.org Provider-Based Rural Health Clinic A 4 Madera Community Hospital Outpatient Center 1270 E Almond Avenue Madera CA 93637 www.maderahospital.org Provider-Based Outpatient Laboratory and Radiology Services A A 0 0 1 X X X X X X X X X 22 1 1 0 1 X www.maderahospital.org X www.hospitalcouncil.org 1 22 1 www.maderahospital.org 0 0 1 X 200 350 1 1 X X X 1 X www.maderahospital.org X www.maderahospital.org X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Group A Madera Community Hospital participated in the 4-County Community Health Needs Assessment that was published in June 2022. There were many local focus groups convened within the 4-county area. Participants in the interviews in Madera County included the Madera County Public Health Director, the Executive Director of First 5 of Madera County, Madera Community Hospital CEO and management, Valley Children's Hospital CEO and management and various other local stakeholders. More information about how the Community Health Needs Assessment can be found on the hospital website at www.maderahospital.org. Schedule H, Part V, Section B, Line 6a-Group A Adventist Health Central Valley Network, Kaweah Delta Medical Center, Sierra View District Hospital, Coalinga Regional Medical Center, San Joaquin Valley Rehabilitation Hospital, Tulare Regional Medical Center, Community Medical Centers, Valley Children's Hospital, Kaiser Permanente, Saint Agnes Medical Center, Madera Community Hospital. Schedule H, Part V, Section B, Line 11-Group A Madera Community Hospital has designs and implemented programs to meet the health needs of the community as identified in the most recent and previous Community Health Needs Assessment (CHNA). The hospital has created and implemented an Implementation Plan to address the top five health needs identified in Madera County. The Implementation Plan was updated for 06/30/22 - 06/30/25 and approved by the Board of Directors on June 30, 2022 could be found on the hospital website www.maderahospital.org, but with the Hospital closure and chapter 11 filing, the website was streamlined for bankruptcy notices and removed. The CHNA report and Implementation Plan have been attached. Schedule H, Part I, Line 7 Annual Community Benefits reports not prepared at June 30,2023 due to hospital closure January 10,2023, therefore no information is available. Schedule H, Part III, Section A, Line 4 The text of the footnote describing bad debt expense in Note A on page 6 of the attached Audited Financial Statements under the paragraph titled "Patient accounts receivable". Due to MCH's closure no Audited Financial Statements were obtained. During the closure process, the bad debt and charity policy were consistently maintained with prior years. Therefore providing prior years information for reference. Schedule H, Part III, Section B, Line 8 All of the shortfall reported on Line 7 is treated as a community benefit cost as they are the unreimbursed costs of providing services to Medicare patients residing in our community. The costs were calculated using prior year Medicare Cost Report ratios and applied to the stub period revenue. The revenue was derived from actual billings on Medicare accounts. Schedule H, Part III, Section C, Line 9b The Bad Debt Collection policy contains procedures for contracted debt collection agencies to return accounts to the hospital if the debtor qualifies for the hospital's Financial Assistance program. Schedule H, Part VI, Line 2 Madera Community Hospital participated in a 4-county Community Health Needs Assessment that was published in June 2022. Various focus groups were formed from members of the local communities to discuss the health needs. Data from a variety of sources was also used to identify certain health needs that need to be address in the hospital's service area. Schedule H, Part VI, Line 3 There are notices on each billing statement that goes to the patient regarding information about the Hospital's Financial Assistance policy. All self-pay patients are given a pamphlet about the availability of the financial assistance program and their access to public benefit programs. There is information also displayed in all public registration areas. Schedule H, Part VI, Line 4 The direct service area of the hospital contains about 160,000 residents, mostly made up of western Madera County. The population is about 60% Hispanic, 32% White/Caucasian, with a mix of other ethnicities. The population has a high number of Medicaid and Medicare patients, many low income families and is generally an agriculture-based economy. Most of the County is part of a Health Professional Shortage Area (HPSA). Schedule H, Part VI, Line 5 Madera Community Hospital is the only local hospital serving all ages in a wide geographic area. It is governed by a community-based, volunteer Board of Trustees. The Medical Staff is open to any qualified practitioner that meets credentialing criteria. The hospital is one of the largest employers in the area, tries to hire employees locally and sponsors programs for high school students and others to enter nursing and other medical fields. The hospital promotes a wide number of programs to support the better health of the residents it serves. All of the various community health and educational programs done by or sponsored by Madera Community Hospital are fully discussed in the Community Benefit Report for this year. Schedule H, Part VI, Line 6 The hospital is a free-standing, community-based, 501(c)(3) organization and is not affiliated with any health system. Schedule H, Part VI, Line 7 California 0 0 0 0 0 0 0 0 0 Karen Paolinelli Exec Director/CEO 349295 0 0 0 5023 0 3050 0 4355 0 361723 0 0 0 Mark J Foote Vice President - Finance 282549 0 0 0 6156 0 2878 0 1560 0 293143 0 0 0 Jeanine Gillmeister Chief Nursing Officer 192643 0 0 0 951 0 0 0 1440 0 195034 0 0 0 Eva A Singsing Med/Surg Clinical Coordinator 181769 0 0 0 1016 0 1873 0 4520 0 189178 0 0 0 Colton Lee Pfister Director of Phamacy 182234 0 0 0 308 0 1845 0 1940 0 186327 0 0 0 Alma Mendoza Pharmacist II 181819 0 0 0 0 0 1856 0 3821 0 187496 0 0 0 Cindy Burgamy-Stevens Family Nurse Practition 177315 0 0 0 0 0 1773 0 0 0 179088 0 0 0 Mathew F Kobzeff Pharmacist II 173703 0 0 0 0 0 1775 0 3821 0 179299 0 0 0 Schedule J, Part I, Line 3 The Board of Trustees reviews and approves the salary for the CEO on an annual basis. The Board uses the California Hospital Association Executive Salary Survey when determining the salary for the CEO. Creative Copy Family Member of Owner 31695 Printing Service 0 Pistoresi Ambulance Owner, Board Member 74273 Ambulance Services 0 Aftab Naz Board Member 17700 Physician Services 0 Kanwal Singh Board Member 201653 Physician Services 0 Form 990, Part VI, Section B, Line 11b The Staff Accountant prepares the draft of the Form 990 and Related Schedules and submits them to the Accounting Manager for review. The Interim Chief Financial Officer completes Schedule H and assists in answering the questions related to the governance of the organization. All financial information is tied back to the Audited Financial Statements, but with hospital closure, bankruptcy and very real liquidation presence, a fiscal 2023 audit was not deemed a prudent use of funds and was not performed. All financial information was tied to the general ledger, which has been maintained consistently pre and post hospital closure. The Accounting Manager submits the final draft of the Form 990 and Related Schedules to the Interim Chief Financial Officer for review. Form 990, Part VI, Section B, Line 12c For any conflicts of interest or complaints of such, an investigation is conducted by the Human Resources Department, Compliance Officer or the Board of Trustees. Depending upon the outcome of the investigation, re-education, training and counseling are conducted as necessary. Form 990, Part VI, Section B, Line 15 Each officer or key employee receives a written performance evaluation on an annual basis. All rate changes are made in accordance with the hospital's wage and salary plan. The hospital uses the California Hospital Association Executive Salary Survey in setting the annual compensation rates. The CEO is reviewed by a Board of Trustees Committee annually. The VP-Finance/CFO, Chief Operating Officer and Chief Nursing Officer are reviewed annually by the CEO. Form 990, Part VI, Section C, Line 19 The Audited Financial Statements thru June 30, 2022 and the Form 990 are available upon request in the Hospital's Administration office during normal business hours. They are also part of the information that is available to the public on the California Office of Statewide Health and Planning Department website. The Conflict of Interest policy and the Governing documents are currently not available for public inspection. The hospitals Financial Statement from March 30,2023 forward are part of the monthly reports to the U.S. Trustee's office and are publically available to all those who subscribe to the U.S. bankruptcy court reports. Form 990, Part IX, Line 11g 1 Form 990, Part IX, Line 24e 1 Madera Community Hospital Foundation 1250 E Almond Avenue Madera CA 93637 942514197 Fundraising CA 501(c)(3) 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Madera Community Hospital Foundation c 390000 CASH