2024-08-14T12:56:12-05:00 2023-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2022-10-01 952821104 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENR 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 TED D SIROTTA SENIOR VP/CFO 6612002000 2024-08-14 1 1 LAWRENCE H MOHR CPA P00447603 6128764500 2024-08-13 2022 2024-08-08 14:25:15Z KEVIN KLOCKENGA 23845 MCBEAN PARKWAY VALENCIA CA 91355 466124207 0 X WWW.HENRYMAYO.COM X 1972 CA BE THE TRUSTED REGIONAL LEADER TO INSPIRE AND DELIVER OPTIMAL HEALTH AND WELLNESS. 16 13 2168 301 437576 0 9178013 6272093 435164931 435062999 8005193 6933258 6269956 5900707 458618093 454169057 13597125 5103020 0 0 173982619 183854950 0 0 0 265303296 260409697 452883040 449367667 5735053 4801390 572450898 576910432 370900682 361918092 201550216 214992340 BE THE TRUSTED REGIONAL LEADER TO INSPIRE AND DELIVER OPTIMAL HEALTH AND WELLNESS. 0 0 403924113 4805530 437605354 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS. THE HOSPITAL HAD 59,622 PATIENT DAYS DURING THE YEAR. THE HOSPITAL ALSO PROVIDED SERVICES FOR 69,960 EMERGENCY VISITS. 76% OF TOTAL HOSPITAL INPATIENT ADMITS (EXCLUDING NEWBORNS) ARE ADMITTED THROUGH THE EMERGENCY ROOM. 297490 297490 TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. 404221603 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 259 0 1 2168 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CA X RICHARD KIM 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 ROGER E SEAVER PRESIDENT/CEO (TERM 04/2023) 40.00 0.50 X X 960690 0 79748 TED D SIROTTA SR VP/CFO 40.00 X 492798 0 104833 ROBERT K PRETZLAFF SR VP CMO & CCO 40.00 X 454899 0 112751 LARRY R KIDD FORMER SR VP/CCO (TERM 03/2022) 40.00 X 458808 0 9252 RAY B MOSS VP/CIO 40.00 X 378529 0 73670 MARK A PULEO VP/CHRO 40.00 X 350831 0 74379 CARISSA BORTUGNO VP CLINICAL SUPPORT 40.00 X 264673 0 67712 EVELYN KU CNO 40.00 X 280596 0 51585 KATHRYN A ORTEGA CLINICAL RN 40.00 X 283104 0 32002 ELVIRA ALLEN CLINICAL RN 40.00 X 234907 0 33883 KYUNG R KIM DIRECTOR OF FINANCE 40.00 X 229192 0 35374 CARLOS DELGADO JR CLINICAL RN 40.00 X 223576 0 25897 JOSEPHINE J KAPLAN DIRECTOR CASE MANAGEMENT 40.00 X 229512 0 18071 KEVIN KLOCKENGA PRESIDENT/CEO (AS OF 03/2023) 40.00 0.50 X X 0 0 0 ANA FONSECA TRUSTEE 0.50 X 0 0 0 CHRIS LUECHTEFELD TRUSTEE 0.50 0.50 X 0 0 0 DALE DONOHOE TRUSTEE 0.50 X 0 0 0 DONALD KIMBALL TRUSTEE 0.50 0.50 X 0 0 0 HOLLY SCHROEDER TRUSTEE 0.50 0.50 X 0 0 0 JOHN BARSTIS MD TRUSTEE 0.50 X 0 0 0 JUDY FISH PHD TRUSTEE (TERM 03/2023) 0.50 X 0 0 0 LAKHBINDER DHANDA MD TRUSTEE 0.50 X 0 0 0 LOUIE-MARC CONTRERAS MD TRUSTEE 0.50 X 0 0 0 MARK CHAMBERLAIN TRUSTEE (TERM 03/2023) 0.50 X 0 0 0 MITZI LIKE TRUSTEE 0.50 0.50 X 0 0 0 PETER VELOZ TRUSTEE 0.50 X 0 0 0 ROBERT BENJAMIN TRUSTEE 0.50 X 0 0 0 ROSCOE MARTER MD TRUSTEE 0.50 X 0 0 0 RUSSELL HANLIN TRUSTEE 0.50 X 0 0 0 SONYA ENGLE TRUSTEE 0.50 X 0 0 0 TODD STEVENS TRUSTEE 0.50 X 0 0 0 4842115 0 719157 564 1 1 0 SODEXO INC & AFFILIATES 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 OTHER PURCHASED SERVICES 16168613 PROLINK HEALTHCARE LLC 4600 MONTGOMERY ROAD SUITE 300 CINCINNATI OH 45212 PROFESSIONAL SERVICES 12324150 INTERSTATE REHABILITATION LLC 333 E GLENOAKS BLVD SUITE 204 GLENDALE CA 61207 MEDICAL PURCHASED SERVICES 6088911 BERNARDS BROS INC 555 FIRST ST SAN FERNANDO CA 91340 CONSTRUCTION 5005222 CONVERGE TECHNOLOGY SOLUTIONS US 130 TECHNOLOGY PARKWAY PEACHTREE CORNERS GA 30092 OTHER PURCHASED SERVICES 4515946 129 6272093 6272093 HEALTHCARE SERVICES 621110 435062999 435062999 435062999 4693922 4693922 257178 257178 2931487 451949 2479538 2479538 2479538 13485359 11503201 1982158 1982158 1982158 FITNESS CENTER REVENUE 621110 2020399 2020399 SUPPORT SERVICES 621110 437576 437576 INCOME FROM CARE NETWO 621110 280000 280000 683194 241956 441238 3421169 454169057 437605354 437576 9854034 X 297490 297490 4805530 4805530 4814008 4243166 570842 130456932 115275241 15181691 4520101 3993797 526304 32756514 28913252 3843262 11307395 10180964 1126431 998425 998425 151538 151538 34235 34235 202823 202823 74416087 65848703 8567384 698410 17839 680571 4439505 2349674 2089831 8356536 7507909 848627 7766267 5121220 2645047 160539 65760 94779 101127 88285 12842 8878188 6872660 2005528 21064726 21064726 2414410 2414410 MEDICAL SUPPLIES 58105200 57436990 668210 BAD DEBT 39570869 39570869 QUALITY ASSURANCE FEES 22551479 22551479 REPAIR & MAINTENANCE 4416890 3467156 949734 6082443 2134483 3947960 449367667 404221603 45146064 0 46362926 29154668 15132377 26226791 50933178 48218130 6790718 6285518 5619814 6275801 517904279 261252251 265123029 256652028 87080265 96425045 4546861 3209808 90861730 104462643 572450898 576910432 77332275 78629300 3809813 3809813 225199111 133782615 6993164 90815000 57566319 54881364 370900682 361918092 X 192253569 201588044 9296647 13404296 201550216 214992340 572450898 576910432 X 4801390 3848590 4792144 X X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 0 1 34235 34235 0 PART II-B, LINE 1: FOR THE FISCAL YEAR ENDED 9/30/23, THE ORGANIZATION PARTICIPATED WITH THE CALIFORNIA HOSPITAL ASSOCIATION TO ADVOCATE POSITIVE HEALTHCARE POLICIES FOR HOSPITALS. 5906837 5906837 370299890 152785490 217514400 126640879 108466761 18174118 15056673 15056673 256652028 RECEIVABLE FROM HENRY MAYO NEWHALL FOUNDATION 13913995 RECEIVABLE FROM HENRY MAYO MSO 1258919 PLEDGED LEASE 2122903 OTHER RECEIVABLES 41869105 RECEIVABLE FOR HENRY MAYO CARE NETWORK 210307 OTHER CURRENT ASSETS 39693 RIGHT-OF-USE ASSET 45047721 104462643 ESTIMATED THIRD PARTY LIABILITIES 5025038 PAYABLE TO AFFILIATE 926734 OTHER LIABILITIES 8152181 LEASE OBLIGATIONS 40777411 54881364 X 418931125 3848590 45784 -39584255 -35689881 454621006 -451949 -451949 454169057 405489001 45784 451949 497733 404991268 44376399 44376399 449367667 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE ("IRC") AND A SIMILAR PROVISION OF STATE LAW. ACCORDINGLY, NO PROVISION FOR INCOME TAXES FOR THIS ENTITY HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS AT SEPTEMBER 30, 2023 AND 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -39,570,869. CHARITY CARE (GROSS CHARGES) -4,805,530. NET ASSET TRANSFER FROM HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 4,792,144. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -451,949. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 451,949. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 39,570,869. CHARITY CARE (GROSS CHARGES) 4,805,530. 1 1 X 1 X 1 X 1 1 0 1 1 1069025 1069025 0.00260 15833045 5744881 10088164 0.02460 16902070 5744881 11157189 0.02720 2796949 2796949 0.00680 4235111 4235111 0.01030 378428 378428 0.00090 7410488 7410488 0.01800 24312558 5744881 18567677 0.04520 1 39570869 59580485 87717533 -28137048 X 1 1 1 TOWER IMAGING VALENCIA OUTPATIENT RADIOLOGY SERVICE 0.50000 0.50000 2 HENRY MAYO NEWHALL URGENT CARE CLINICS LLC URGENT CARE OPERATION 0.51000 0.49000 3 KECK MEDICINE OF USC AND HENRY MAYO NEWHALL MEMORIAL HOSPITAL LLC CANCER SERVICE LINE 0.50000 1 1 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 23845 MCBEAN PKWY VALENCIA CA 91355 WWW.HENRYMAYO.COM 930000206 X X X TRAUMA CENTER HENRY MAYO NEWHALL MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE SCHEDULE H, PART V, SECTION C X 1 23 1 HTTPS://WWW.HENRYMAYO.COM/ABOUT-US/COMMUNITY-INVOLVEMENT/ 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: HENRY MAYO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN FY22, AS REQUIRED BY STATE AND FEDERAL LAW. THE CHNA IS A PRIMARY TOOL USED BY HENRY MAYO TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW IT WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUSED ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA.THE CHNA EXAMINED UP-TO-DATE DATA SOURCES FOR THE SERVICE AREA TO COMPILE COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, BIRTH INDICATORS, LEADING CAUSES OF DEATH, COVID-19, ACUTE AND CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE, AND PREVENTIVE PRACTICES. HENRY MAYO CONDUCTED TARGETED INTERVIEWS TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. THERE WERE TWENTY-ONE (21) INTERVIEWS COMPLETED IN MARCH 2022. LEADERS AND/OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE REPRESENTED IN THE SAMPLE. INPUT WAS OBTAINED FROM THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH. HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: ACCESS TO HEALTH CARE, CHRONIC DISEASES, COVID-19, HOUSING AND HOMELESSNESS AND MENTAL HEALTH WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA. THE ANALYSIS OF THE COMMUNITY INPUT RESULTED IN THE FOLLOWING PRIORITY ORDERING OF THE SIGNIFICANT HEALTH NEEDS:1. ACCESS TO HEALTH CARE2. MENTAL HEALTH3. SUBSTANCE USE4. HOUSING AND HOMELESSNESS5. CHRONIC DISEASES6. PREVENTIVE PRACTICES (SCREENINGS AND IMMUNIZATIONS)7. COVID-198. OVERWEIGHT/OBESITY (HEALTHY EATING AND PHYSICAL ACTIVITY)AS OF THE END OF THE FISCAL YEAR 09/30/23, THE FOLLOWING PROGRESS HAS BEEN MADE WITH RESPECT TO THE PRIORITIES OUTLINED IN THE CHNA AND THE IMPLEMENTATION PLAN ATTACHED: THE HOSPITAL HAS PROVIDED A NUMBER OF COMMUNITY OUTREACH AND EDUCATION PROGRAMS. ONE EXAMPLE OF THIS IS OUR GIRL TALK EDUCATIONAL SERIES. GIRL TALK IS A SERIES OF PANEL PRESENTATIONS ON HEALTH TOPICS OF PARTICULAR INTEREST TO WOMEN. THE EVENTS, HELD ON OUR HOSPITAL CAMPUS, TYPICALLY DRAW 50 TO 75 ATTENDEES. WE HOLD FIVE TO SIX EVENTS A YEAR. THE HOSPITAL ALSO PROVIDED A SERIES OF LECTURES TO COMMUNITY GROUPS ON CANCER-RELATED TOPICS.FOR SPECIFIC PLAN AND OTHER NEEDS NOT ADDRESSED, PLEASE REFER TO THE ATTACHED COMMUNITY BENEFIT REPORT, PAGES 8-10. SCHEDULE H, PART V, LINE 7A CHNA REPORT DIRECT LINK: HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/3F5A915D-E7CF-4A20-B329-E9EDC4593AD5/HENRY%20MAYO%202022%20CHNA%20REPORT%20FINAL.PDF SCHEDULE H, PART V, LINE 16A FINANCIAL ASSISTANCE POLICY (FAP): HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/0F751BD9-9EEB-4A09-BCCD-224995E0F5BB/FINANCIAL%20ASSISTANCE%20PROGRAM%2010.10.2022%20(2).PDF SCHEDULE H, PART V, LINE 16B FAP APPLICATION FORM: HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/D6CC943E-020F-4905-B76B-FC76D1A9917F/FINANCIAL%20ASSISTANCE%20PROGRAM%2010.10.2022%20APPLICATION.PDF SCHEDULE H, PART V, LINE 16C FAP PLAIN LANGUAGE SUMMARY: HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/0995F2AD-7A89-48F2-8F45-C5B237B3C5C2/MR242D-%20FINAL%20COPY.PDF PART I, LINE 3C: INDIVIDUAL OR HOUSEHOLD UNIT INCOME - UP TO 400% OF THE FPL. EMPLOYMENT STATUS SHALL BE CONSIDERED WHEN DETERMINING INCOME LEVELS. PRIOR INCOME LEVELS MAY NOT MEET THE ESTABLISHED POVERTY LEVEL GUIDELINES; HOWEVER, RECENT UNEMPLOYMENT MAY BE CONSIDERED AS THE CURRENT SOURCE OF INCOME. INDIVIDUAL OR HOUSEHOLD UNIT NET WORTH - UP TO $250,000 (EXCLUDING NET WORTH IN PRIMARY HOMES OF UP TO $500,000 AND RETIREMENT OR DEFERRED COMPENSATION PLANS). WHEN REVIEWING NET WORTH, OTHER FINANCIAL OBLIGATIONS SUCH AS HIGH MEDICAL BILLS SHOULD BE CONSIDERED. PATIENTS WITH HIGH NET WORTH THAT WOULD OTHERWISE DISQUALIFY THEM FOR FINANCIAL ASSISTANCE MAY BE CONSIDERED FOR ELIGIBILITY IF THEY HAVE, FOR EXAMPLE, UNINSURED CATASTROPHIC HEALTH CARE COSTS THAT WOULD SIGNIFICANTLY REDUCE THEIR NET WORTH. HIGH MEDICAL COSTS SHALL MEAN:1. ANNUAL OUT-OF-POCKET COSTS INCURRED BY A PATIENT AT HMNH THAT EXCEED 10% OF THE PATIENT'S FAMILY INCOME IN THE PRIOR 12 MONTHS;2. ANNUAL OUT-OF-POCKET MEDICAL EXPENSES THAT EXCEED 10% OF THE PATIENT'S FAMILY INCOME, IF THE PATIENT PROVIDES DOCUMENTATION OF THE PATIENT'S MEDICAL EXPENSES PAID BY THE PATIENT OR THE PATIENT'S FAMILY IN THE PRIOR 12 MONTHS;SELF-PAY PATIENTS ADMITTED THROUGH THE EMERGENCY DEPARTMENT, PER EMTALA GUIDELINES, WITH INSUFFICIENT INFORMATION PROVIDED BY THE PATIENT TO FULLY EVALUATE ELIGIBILITY TESTS, AND THE ABILITY TO PAY WHICH CANNOT BE RELIABLY DETERMINED, WILL BE CLASSIFIED AS CHARITY. IF INFORMATION BECOMES AVAILABLE LATER THAT WOULD DISQUALIFY THE PATIENT FROM MEETING THE FINANCIAL ASSISTANCE CRITERIA, THEN THE PATIENT ACCOUNT WILL BE RECLASSIFIED TO THE APPROPRIATE PAYER CLASS.PATIENTS WHO QUALIFY FOR MEDI-CAL, BUT WHERE HMNH DOES NOT RECEIVE PAYMENT FOR THEIR ENTIRE STAY ARE ELIGIBLE FOR CHARITY CARE FOR DENIED STAYS, DENIED DAYS OF CARE, AND NONCOVERED SERVICES. THESE DENIALS AND ANY LACK OF PAYMENT FOR NON-COVERED SERVICES PROVIDED TO MEDI-CAL PATIENTS ARE TO BE CLASSIFIED AS CHARITY. THESE PATIENTS ARE RECEIVING THE SERVICE, AND THEY DO NOT HAVE THE ABILITY TO PAY FOR IT. IN ADDITION, MEDICARE PATIENTS WHO HAVE MEDI-CAL COVERAGE FOR THEIR CO-INSURANCE/DEDUCTIBLES, FOR WHICH MEDI-CAL DOES NOT MAKE PAYMENT, AND MEDICARE DOES NOT ULTIMATELY PROVIDE BAD DEBT REIMBURSEMENT WILL ALSO BE INCLUDED AS CHARITY. THESE PATIENTS ARE RECEIVING A SERVICE FOR WHICH A PORTION OF THE RESULTING BILL IS NOT BEING REIMBURSED.TRAUMA SERVICES RENDERED TO PATIENT MEDICAL CONDITIONS MEETING THE DEFINITION OF BILLABLE TRAUMA CARE, PER OUR TRAUMA CARE AGREEMENTS WITH THE LOS ANGELES COUNTY AND THE STATE OF CALIFORNIA, WILL BE CLASSIFIED AS CHARITY CARE. THESE PATIENTS WILL NOT BE BILLED FOR THEIR SERVICES.HMNH DEEMS PATIENTS WHO ARE ELIGIBLE FOR GOVERNMENT SPONSORED, LOW-INCOME ASSISTANCE PROGRAMS (I.E., MEDI-CAL, OUT OF STATE MEDICAID, CALIFORNIA CHILDREN'S SERVICES AND ANY OTHER APPLICABLE FEDERAL, STATE, OR LOCAL LOW-INCOME PROGRAM) TO BE INDIGENT. THEREFORE, SUCH PATIENTS MAY BE CONSIDERED AS ELIGIBLE PRESUMPTIVELY UNDER THE FAP WHEN PAYMENT IS NOT MADE BY THE GOVERNMENTAL PROGRAM. RATIONALE FOR SUCH PRESUMPTIVE DETERMINATION SHALL BE DOCUMENTED IN THE PATIENT ACCOUNT. PART III, LINE 2: THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CARRYING AMOUNT OF PATIENT ACCOUNTS RECEIVABLE IS REDUCED BY BAD DEBT ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 4: FROM PAGE 16 OF THE AUDITED FINANCIAL STATEMENTS, ATTACHED:GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED OR UNDERINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGES, BY ANY CONTRACTUAL ADJUSTMENT, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENT TO NET PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE HOSPITAL HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND OTHER PATIENT BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. PART III, LINE 8: 100% INCLUDED IN THE COMMUNITY BENEFIT PACKAGE. COST METHODOLOGY IS COST ACCOUNTING SYSTEM. PART VI, LINE 2: NEEDS ASSESSMENT: HENRY MAYO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022, AS REQUIRED BY STATE AND FEDERAL LAW. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A PRIMARY TOOL USED BY HENRY MAYO TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW IT WILL REINVEST IN THE COMMUNITY, IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES, TO ADDRESS UNMET COMMUNITY NEEDS. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: HTTPS://WWW.HENRYMAYO.COM/PATIENTS-VISITORS/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE/FINANCIAL-POLICIES/ PART VI, LINE 4: COMMUNITY INFORMATION: PAGE 3-5 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 5: PAGE 6-14 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 WILLIAM S HART UNION HIGH SCHOOL DISTRICT 21380 CENTRE POINTE PARKWAY SANTA CLARITA CA 91350 611454418 206113 0 TO PROVIDE ATHLETIC TRAINERS AT HIGH SCHOOLS IN THE COMMUNITY TO HELP REDUCE INJURIES AND KEEP STUDENT ATHLETES SAFE ID ME PROMOTIONS 18401 BURBANK BLVD SUITE 116 TARZANA CA 91356 470941148 501(C)(3) 29102 0 TO SUPPORT COMMUNITY HEALTH EDUCATION BRIDGE TO HOME SCV 23752 NEWHALL AVE SANTA CLARITA CA 91321 954587823 501(C)(3) 19167 0 CAPITAL CAMPAIGN PLEDGE SANTA CLARITA VALLEY ECONOMIC 26455 ROCKWELL CANYON ROAD UNIVERSITY CENTER 263 VALENCIA CA 91355 954133918 501(C)(3) 18330 0 TO SUPPORT LOCAL ECONOMIC DEVELOPMENT SOROPTIMIST INTERNATIONAL OF VALENCIA PO BOX 801352 SANTA CLARITA CA 91380 954834196 501(C)(3) 13500 0 SPONSORSHIPS TO SUPPORT WOMEN AND GIRLS IN LOCAL COMMUNITIES UNITED STATES POSTAL SERVICE 28201 FRANKLIN PARKWAY SANTA CLARITA CA 91383 410760000 GOVERNMENT 6279 0 TO PROVIDE COMMUNITY HEALTH EDUCATION THROUGH YOUR HEALTH MAGAZINE 2021 5 1 CHARITY CARE (GROSS CHARGES) - HENRY MAYO NEWHALL HOSPITAL 746 4805530 PART I, LINE 2: THE HOSPITAL ASSISTS INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED BY PROVIDING CHARITY CARE. THIS IS APPLIED BY FOLLOWING THE HOSPITAL'S CHARITY CARE POLICY. THIS POLICY IS ADMINISTERED THROUGH THE PATIENT FINANCIAL SERVICE AND PATIENT ACCESS DEPARTMENTS OF THE HOSPITAL. PART II: THE HOSPITAL SUPPORTS (PROVIDES GRANTS TO) ORGANIZATIONS THAT EITHER DO WORK IN AREAS RELATED TO THE HEALTH NEEDS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT, AND TO ORGANIZATIONS THAT SUPPORT LOCAL ECONOMIC DEVELOPMENT. FOR THE HEALTH-RELATED ACTIVITIES WE TRACK HOW MANY PEOPLE WE REACH AT PARTICULAR EVENTS, CLASSES OR SEMINARS. FOR ECONOMIC ACTIVITIES WE SUPPORT ORGANIZATIONS THAT HAVE BROAD COMMUNITY PARTICIPATION. GRANTS ARE ALSO PROVIDED TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. PART III: PATIENTS MEETING CERTAIN CRITERIA UNDER THE CHARITY CARE POLICY MAY RECEIVE HEALTHCARE SERVICES AT NO CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. 1 X X X X 1 1 0 0 0 0 0 1 0 ROGER E SEAVER PRESIDENT/CEO (TERM 04/2023) 629093 0 274000 0 57597 0 35750 0 43998 0 1040438 0 0 0 TED D SIROTTA SR VP/CFO 382404 0 74000 0 36394 0 73769 0 31064 0 597631 0 0 0 ROBERT K PRETZLAFF SR VP CMO & CCO 423523 0 0 0 31376 0 83232 0 29519 0 567650 0 0 0 LARRY R KIDD FORMER SR VP/CCO (TERM 03/2022) 95431 0 64500 0 298877 0 5125 0 4127 0 468060 0 0 0 RAY B MOSS VP/CIO 281547 0 50500 0 46482 0 47053 0 26617 0 452199 0 0 0 MARK A PULEO VP/CHRO 274767 0 41000 0 35064 0 45431 0 28948 0 425210 0 0 0 CARISSA BORTUGNO VP CLINICAL SUPPORT 209925 0 17000 0 37748 0 38646 0 29066 0 332385 0 0 0 EVELYN KU CNO 267683 0 0 0 12913 0 27502 0 24083 0 332181 0 0 0 KATHRYN A ORTEGA CLINICAL RN 236344 0 30700 0 16060 0 14338 0 17664 0 315106 0 0 0 ELVIRA ALLEN CLINICAL RN 197300 0 29200 0 8407 0 11910 0 21973 0 268790 0 0 0 KYUNG R KIM DIRECTOR OF FINANCE 184314 0 34123 0 10755 0 11619 0 23755 0 264566 0 0 0 CARLOS DELGADO JR CLINICAL RN 187040 0 17300 0 19236 0 2318 0 23579 0 249473 0 0 0 JOSEPHINE J KAPLAN DIRECTOR CASE MANAGEMENT 167333 0 34243 0 27936 0 0 0 18071 0 247583 0 0 0 PART I, LINES 4A-B DURING THE YEAR, AN INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM THE ORGANIZATION. THE NAME AND AMOUNT ARE AVAILABLE UPON REQUEST. HENRY MAYO NEWHALL MEMORIAL HOSPITAL HAS A SERP (SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN) OF WHICH ONLY ONE OF ITS EMPLOYEES PARTICIPATES, ROGER SEAVER. THE AMOUNT OF BENEFIT PAID IN THE CURRENT YEAR INCLUDED ON SCHEDULE J, PART II, (B)(II) IS $170,000. HENRY MAYO NEWHALL MEMORIAL HOPSITAL HAS A 457(F) PLAN, OF WHICH THE FOLLOWING EMPLOYEES LISTED ON SCHEDULE J, PART II PARTICIPATE: CARISSA BORTUGNO, MARK A. PULEO, RAY B. MOSS, ROBERT K. PRETZLAFF, EVELYN KU, MARIA VARTANIAN, TED D. SIROTTA AND KEVIN KLOCKENGA. NO AMOUNTS WERE PAID DURING THE YEAR. PART I, LINE 7 BONUSES ARE TIED TO QUANTITATIVE AND QUALITATIVE CRITERIA. ONE OF THE CRITERIA FOR THE BONUSES IS EBIDA MARGIN. DURING THE YEAR, DUE TO A NATIONWIDE CLINICAL LABOR SHORTAGE AND HIGH PATIENT VOLUME DUE TO COVID-19, THE HOSPITAL OFFERED A TEMPORARY BONUS PROGRAM AND PAID A BONUS TO CLINICAL STAFF FOR EXTRA WORK SHIFTS TAKEN. A CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SCJ1 2014-02-05 70780579 FINANCE AND REFINANCE FACILITY 1 0 0 B CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EAL8 2017-02-03 115072912 FINANCE AND REFINANCE FACILITY 0 0 0 C CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EDN1 2021-03-10 33921350 REFINANCE SERIES 2013A AND 2013B BONDS 0 0 0 D CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EDW1 2021-03-10 6539029 FINANCE AND REFINANCE FACILITY 0 0 0 A 8265000 59665000 70780579 1141054 1692946 29092467 38854112 2017 0 1 1 1 B 3015000 115072912 1455316 85000000 28617596 2019 1 0 1 1 C 5230000 33921350 221771 33699579 2021 1 0 1 1 D 6539029 39029 6500000 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/28/2019 LOUIE-MARC CONTRERAS TRUSTEE 19145 PROFESSIONAL FEES AS DETERMINED AT ARMS-LENGTH AMOUNT 0 KATHERINE DUNN FAMILY MEMBER OF TRUSTEE 146308 WAGES 0 LAKHBINDER DHANDA TRUSTEE 44414 PROFESSIONAL FEES AS DETERMINED AT ARMS-LENGTH AMOUNT 0 PARTIKSHA DHANDA FAMILY MEMBER OF TRUSTEE 72115 WAGES 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS AND CHIEF FINANCIAL OFFICER REVIEWED THE ENTIRE FORM 990 RETURN BEFORE DISTRIBUTION TO THE BOARD AND PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO READ THE CONFLICT OF INTEREST POLICY AND COMPLETE A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE AND RESULTS OF ANY CONFLICT, IF ANY, WOULD BE REPORTED TO THE FULL BOARD. BOARD MEMBERS ARE AWARE AND REMINDED OF THE HOSPITAL'S FIDUCIARY RESPONSIBILITY IN REPORTING CONFLICTS OF INTEREST. THE CONFLICT OF INTEREST FORMS ARE REQUIRED TO BE UPDATED ON AN ANNUAL BASIS. IF A CONFLICT IS IDENTIFIED, THE BOARD MEMBER WOULD BE EXCUSED FROM VOTING ON ANY APPLICABLE MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATIONS'S CEO AND EXECUTIVE MANAGEMENT COMPENSATION ARE DETERMINED THROUGH THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT CONSULTANT, AND BOARD OF DIRECTOR APPROVAL. OTHER KEY EMPLOYEES AND MANAGEMENT OF THE ORGANIZATION RECEIVE PERFORMANCE REVIEWS ANNUALLY AND RATINGS ARE APPLIED THAT SUGGEST THE PERCENTAGE OF SALARY INCREASE. PERCENTAGES ARE DETERMINED THROUGH MARKET SURVEYS DONE BY HUMAN RESOURCES AND APPROVED EACH YEAR VIA THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 49,582,127. MANAGEMENT AND GENERAL EXPENSES 6,681,299. TOTAL EXPENSES 56,263,426. CONSULTING AND MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 11,500. TOTAL EXPENSES 11,500. REGISTRY: PROGRAM SERVICE EXPENSES 16,255,076. MANAGEMENT AND GENERAL EXPENSES 330,050. TOTAL EXPENSES 16,585,126. OTHER PURCHASED SERVICES - CARE NETWORK: MANAGEMENT AND GENERAL EXPENSES 416,697. TOTAL EXPENSES 416,697. OTHER SERVICES- CLINICS: MANAGEMENT AND GENERAL EXPENSES 1,139,338. TOTAL EXPENSES 1,139,338. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 4,792,144. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT PROCESS FOR THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. HENRY MAYO CARE NETWORK LLC 23845 MCBEAN PKWY VALENCIA CA 91355 824876499 HEALTHCARE NETWORK CA 280000 235645 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENRY MAYO NEWHALL CLINICS LLC 23845 MCBEAN PKWY VALENCIA CA 91355 833940984 HEALTHCARE CLINICS CA 241956 1210978 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 23845 MCBEAN PKWY VALENCIA CA 91355 953849903 RAISE FUNDS CA 501(C)(3) LINE 7 HOSPITAL 1 SANTA CLARITA HEALTHCARE ASSOCIATION 23845 MCBEAN PKWY VALENCIA CA 91355 953921194 INACTIVE CA 501(C)(3) LINE 3 HOSPITAL 0 TOWER IMAGING VALENCIA 13400 RIVERSIDE DR STE 102 SHERMAN OAKS CA 91423 201345767 RADIOLOGY SERVICES CA HOSPITAL RELATED -500430 2021544 0 0 0.50000 HENRY MAYO NEWHALL URGENT CARE CLINICS LLC 23929 MCBEAN PARKWAY STE 102 VALENCIA CA 91355 843120192 HEALTHCARE CLINICS CA HOSPITAL RELATED -234167 419920 0 0 0.51000 KECK MEDICINE OF USC AND HENRY MAYO NEWHALL 1441 EASTLAKE AVE LOS ANGELAS CA 90033 853779519 MEDICAL CENTER CA HOSPITAL RELATED -1430935 7096727 0 0 0.50000 HENRY MAYO MANAGEMENT SERVICE ORGANIZATION 23845 MCBEAN PKWY VALENCIA CA 91355 475250569 MANAGEMENT CA HOSPITAL C 11371 1366851 1.00000 1 0 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 TOWER IMAGING VALENCIA LLC J 595994 ACTUAL AMOUNT KECK MEDICINE OF USC AND HENRY MAYO NEWHALL J 470371 ACTUAL AMOUNT HENRY MAYO MSO D 300000 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION B 695796 ACTUAL AMOUNT HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION C 4588580 ACTUAL AMOUNT ACCRUED HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION C 203564 ACTUAL AMOUNT PAID HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION D 10516632 AMOUNT GUARANTEED HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION K 849738 ACTUAL AMOUNT