2023-05-15T19:06:03-07:00 2022-06-30 990 2021-07-01 237429117 MADERA COMMUNITY HOSPITAL MADE 5596755555 1250 E Almond Avenue Madera CA 93637 Alexcia Guerrero Staff Accountant 5596752823 2023-05-15 1 11 0 AAL2 2021 2023-04-26 12:10:37Z Karen Paolinelli 1250 E Almond Avenue Madera CA 93637 104389786 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 1094 0 0 0 1062884 62247 96455308 95758518 163961 49591 4209715 8519430 101891868 104389786 0 0 0 0 49644937 51005430 0 0 0 54752875 65242653 104397812 116248083 -2505944 -11858297 91019873 81559320 26588596 28986340 64431277 52572980 Madera Community Hospital provides Inpatient and Outpatient healthcare services to the citizens of Madera and its surrounding communities. 0 0 81663303 102560344 Delivery and Management of General Inpatient and Outpatient Healthcare Services were provided to the citizens of Madera and its surrounding communities. 0 0 0 81663303 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 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 1 181 0 1 1094 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 0.00 X 359668 0 2900 Mark J Foote Vice President - Finance 40 0 X 233650 0 2368 Eva A Singsing Clinical Coordinator, Med/Surg 40 X 181836 0 1862 Colton Lee Pfister Director of Pharmacy 40 0 X 176986 0 1787 Nicole Chan Pharmacist II 40 X 175560 0 1841 Sophie H Tang Family Nurse Practitioner 40 X 174648 0 1731 Alma Mendoza Pharmacist II 40 X 174537 0 1782 Mark J Brown Chief Nursing Officer 40 0 X 158127 0 0 Mohammad Arain Board Member 0.5 X 0 0 0 Jon Basila Board Member 0.5 0 X 0 0 0 Mike Diebert Board Member 0 X 0 0 0 Deirdre daSilva Chairman 1.00 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 Secretary 1.00 0 X 0 0 0 Robert Poythress Board Member 0.5 0 X 0 0 0 kanwal Singh 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 1635012 0 14271 88 0 1 0 ARYA Medican Group 1660 E Herndon Ave Suite 101 Fresno CA 93720 Hospital Physician Services 3509790 CCAS Central California Anesthesiology Services 2276 Ashcroft Avenue Clovis CA 93611 Hospital Physician Services 2853539 New England Sheet Metal PO Box 27409 Fresno CA 93729 Engineering 1833511 Zaks Enterprises LLC 1906 Howard Road Madera CA 93637 Securtiy Services 1060597 State of California Emergency 10901 Gold Center Drive Suite 400 Rancho Cordova CA 95670 Medical Services 960429 5 0 0 0 60547 0 1700 0 62247 Medicare 622000 24999781 24999781 0 0 Medi-Cal 622000 53378126 53378126 0 0 Other 3rd party payors 622000 16893426 16893426 0 0 Other Payors 622000 487185 487185 0 0 95758518 49591 49591 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 Covid 19 Relief Fund 622000 6752235 6752235 0 0 Non Patient food sales 722212 509287 0 0 509287 Rebates and Refunds 622000 628599 0 0 628599 629309 0 0 629309 8519430 104389786 102560344 0 1767195 X 0 0 0 0 0 0 0 0 751446 158127 593319 0 0 0 0 0 36231690 28951288 7280402 0 311782 236823 74959 0 10534191 7777471 2756720 0 3176321 2491964 684357 0 0 0 0 0 1528728 0 1528728 0 39500 0 39500 0 0 0 0 0 0 0 0 0 0 0 15501840 15501120 720 0 6280 0 6280 0 584319 125652 458667 0 1689243 0 1689243 0 0 0 0 0 291675 252375 39300 0 7816 3137 4679 0 0 0 0 0 35560 34736 824 0 324393 0 324393 0 0 0 0 0 2357108 469404 1887704 0 2212134 0 2212134 0 Supplies 13511796 11483688 2028108 0 Quality Assurance Provider Fees 5496411 0 5496411 0 Other Purchased Services 6053015 2791504 3261511 0 Physician Professional Fees 9133599 9092799 40800 0 6469236 2293215 4176021 0 116248083 81663303 34584780 0 5080082 7706097 19269501 583335 0 0 8309002 10202619 0 0 0 0 27606631 29136998 2305897 3539098 739385 973321 98893659 69583308 27601874 29310351 0 0 0 0 0 0 0 0 107501 107501 91019873 81559320 5670995 7264653 0 0 0 0 0 0 0 0 0 0 7631250 7303719 0 0 13286351 14417968 26588596 28986340 X 64431277 52572980 0 0 64431277 52572980 91019873 81559320 -11858297 0 0 0 0 0 X 1 1 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 130000 84936 214936 0 52534492 30257498 22276994 0 265048 53699 211349 0 40571431 37817703 2753728 0 5307752 1454408 3853344 29310351 0 Accrued Payroll and Related Liabilities 6751046 Due to third party payor 2135514 Quality Assurance Fees Payable 5531408 14417968 104389786 0 0 0 0 0 104389786 0 0 0 104389786 116248083 0 0 0 0 0 116248083 0 0 0 116248083 1 1 X 1 X 1 X 0 1 0 1 1 0 835 859489 0 859489 0 0 0 49666650 23128160 26538490 0 0 0 39034159 27902137 14132023 0 0 835 89560298 51030297 41530002 0 0 0 976958 0 976958 0 0 0 91450 0 91450 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 77228 0 77228 0 0 0 1145636 0 1145636 0 0 835 90705934 51030297 42675638 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 73908 0 73908 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2833 0 2833 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76741 0 76741 0 1 2809442 0 23459768 33883255 -10423487 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 19 1 1 0 1 X www.maderahospital.org X www.hospitalcouncil.org 1 19 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 completed in March, 2019. 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. The hospital has created and implemented an Implementation Plan to address the top five health needs identified in Madera County. The Implementation Plan can be found on the hospital website www.maderahospital.org. Schedule H, Part I, Line 7 The amounts included in the table for Line 7 are based on amounts taken from the hospital's Medicare Cost Report and the Annual Community Benefits Report. Schedule H, Part II Madera Community Hospital's community building activities mainly consist of training local residents in careers in healthcare. As a result, this activity promotes health in the community by raising the awareness of local residents in our training programs about healthcare topics and these people also help promote good healthcare practices with the people they interact with. Schedule H, Part III, Section A, Line 4 Bad Debt Expense is recorded in the financial statements as the amount of charges written off for each account determined to be uncollectable. The amount on Line 2 is determined by the bad debt expense reported in the financial statements times a cost-to-charge ratio from this year's Medicare Cost Report. 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 in the Medicare Cost Report for this period. The revenue was derived from actual and estimated collections 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 March 2019. 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 160,256 residents, mostly made up of western Madera County. The population is about 60.2% Hispanic, 31.7% 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 334673 0 20127 0 4868 0 2900 0 3536 0 366104 0 0 0 Mark J Foote Vice President - Finance 217303 0 13251 0 3097 0 2368 0 3133 0 239152 0 0 0 Mark J Brown Chief Nursing Officer 157457 0 0 0 670 0 0 0 914 0 159041 0 0 0 Eva A Singsing Clinical Coordinator, Med/Surg 180898 0 0 0 938 0 1862 0 4351 0 188049 0 0 0 Colton Lee Pfister Director of Pharmacy 175377 0 1350 0 259 0 1787 0 1721 0 180494 0 0 0 Nicole Chan Pharmacist II 175560 0 0 0 0 0 1841 0 8492 0 185893 0 0 0 Alma Mendoza Pharmacist II 174537 0 0 0 0 0 1782 0 3645 0 179964 0 0 0 Sophie H Tang Family Nurse Practitioner 171648 0 0 0 0 0 1731 0 1413 0 174792 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 Services 0 Pistoresi Ambulance Owner, Board Member 74273 Ambulance Services 0 Aftab Naz Board Member 17700 Physican 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 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. The Accounting Manager submits the final draft of the Form 990 and Related Schedules to the Chief Financial Officer for review. The Chief Financial Officer reviews the final draft of the Form 990 and Related Schedules before it is filed. 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 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. Form 990, Part IX, Line 11g 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 1 0 0 0 0 Madera Community Hospital Foundation c 60547 cash Madera Community Hospital Foundation o 29407 Payroll Record We received an approved Extension of Time to File an Exempt Organization Return on Notice Number CP211A dated October 31, 2022.