2022-05-09T12:24:54-05:00 2021-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-07-01 941049467 ORCHARD HOSPITAL ORCH 5308465671 240 SPRUCE STREET GRIDLEY CA 95948 STEVEN STARK CEO 5308465671 2022-05-04 1 STEVEN STARK 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2022-04-27 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVEN STARK 240 SPRUCE STREET GRIDLEY CA 95948 42779260 0 X WWW.ORCHARDHOSPITAL.COM X 1949 CA ORCHARD HOSPITAL WILL BE A HEALTH CENTER OF EXCELLENCE, NATIONALLY RECOGNIZED FOR PROVIDING QUALITY, COMPASSIONATE AND PERSONALIZED CARE THAT IMPROVES THE HEALTH AND WELL-BEING OF OUR PATIENTS AND THEIR COMMUNITIES. 8 8 340 15 0 0 1891903 7823820 32531144 34664321 64137 137723 0 153396 34487184 42779260 0 7899 0 0 16706852 18239520 0 0 140577 16639819 17243173 33346671 35490592 1140513 7288668 22277797 19685362 16465282 7192816 5812515 12492546 ORCHARD HOSPITAL WILL BE A HEALTH CENTER OF EXCELLENCE, NATIONALLY RECOGNIZED FOR PROVIDING QUALITY, COMPASSIONATE AND PERSONALIZED CARE THAT IMPROVES THE HEALTH AND WELL-BEING OF OUR PATIENTS AND THEIR COMMUNITIES. 0 0 25319328 7899 34796856 THE HOSPITAL IS AN ACUTE CARE FACILITY THAT OPERATES A 24-BED CRITICAL ACCESS HOSPITAL (CAH) WHICH PROVIDES HEALTHCARE SERVICES TO THE CITY OF GRIDLEY AND THE SURROUNDING COMMUNITY. THE HOSPITAL PROVIDED 2,569 DAYS OF PATIENT SERVICES AND THE NURSING FACILITY PROVIDED 23,069 DAYS OF SERVICE FOR THE FISCAL YEAR.THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS $120,485 FOR CHARITY CARE, $12,572,553 FOR MEDICARE, $15,179,379 FOR MEDI-CAL, AND $5,564,107 FOR OTHER THIRD-PARTY PAYORS FOR THE FISCAL YEAR. 25319328 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 80 0 340 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ANTONIO JIMENEZ 5308465671 240 SPRUCE STREET GRIDLEY CA 95948 ART COTA CHARIPERSON 2.00 X X 1400 0 0 CLARK S REDFIELD VICE CHAIR/SECRETARY 2.00 X X 1000 0 0 EDWIN A BECKER BOARD FINANCIAL OFFICER 2.00 X X 1300 0 0 JOHN T HARRIS BOARD MEMBER 2.00 X 1400 0 0 MARGARET BROWN BOARD MEMBER 2.00 X 800 0 0 JOE CUNHA BOARD MEMBER 2.00 X 900 0 0 CURT ENGEN BOARD MEMBER (THRU MARCH) 2.00 X 0 0 0 JATINDER KULLAR BOARD MEMBER 2.00 X 600 0 0 KARI WHEELER BOARD MEMBER 2.00 X 1000 0 0 STEVEN STARK CEO 40.00 1.00 X 369157 0 61923 LENNY VERSER CFO 40.00 X 92952 0 13664 TRACY ATKINS CNO 40.00 X 223888 0 11097 JASJOT DHADLI PHARMACY DIRECTOR 40.00 X 182615 0 17826 JOHN HELVEY CIO 40.00 X 166110 0 28966 THOMAS DEVINE CRNA 40.00 X 139026 0 27865 CHRISTINE HICKEY PHYSICIAN ASSISTANT 40.00 X 141016 0 17555 1323164 0 178896 26 0 1 0 REHABVISIONS 11623 ARBOR STREET OMAHA NE 68144 OUTSOURCED PT/OT/ST 680738 ABM PO BOX 52609 LOS ANGELES CA 90074 OUTSOURCED EVS 601594 NPH NURSES PROFESSIONAL HEALTH 1801 FOUNDATION LANE CHICO CA 95928 TRAVELER NURSING (RN/LVN/CAN) 571442 ISHIMOTO MDGREG 791 CALIFORNIA ST GRIDLEY CA 95948 PHYSICIAN 420633 KEUM MD JACOB SUNG 947 COLUMBUS AVE 3B NEW YORK NY 10025 PHYSICIAN 406710 20 56623 6966032 801165 7823820 PATIENT SERVICE REVENUE 621400 33925478 33925478 340B REVENUE 621400 502655 502655 236188 236188 34664321 137723 137723 132535 0 132535 132535 132535 DIETARY INCOME 900099 20861 20861 20861 42779260 34796856 0 158584 X 7899 7899 600753 600753 13629181 10114630 3446870 67681 295157 177681 116777 699 2627899 1401067 1221317 5515 1086530 569189 515100 2241 140295 140295 41811 41811 7271 7271 8732817 6742591 1958346 31880 1005886 482797 522991 98 716139 716139 10224 4678 5454 92 16261 10579 5682 74270 32539 41731 527920 266247 261673 252109 17021 235088 BAD DEBT EXPENSE 3151951 3151951 MEDICAL SUPPLIES & DRUG 1506576 1506576 LICENSES & FEES 326851 236087 90764 REPAIRS & MAINTENANCE 322404 240893 81511 410388 356903 21114 32371 35490592 25319328 10030687 140577 9669463 2399513 5431 60996 6642767 8225146 450415 456504 201258 158039 12190201 9225129 3075254 2965072 1578781 4849670 654428 570422 22277797 19685362 4886638 3378334 3495755 9500 2178933 218428 5903956 3586554 16465282 7192816 X 5043614 12377688 768901 114858 5812515 12492546 22277797 19685362 X 7288668 153838 -762475 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7271 7271 0 PART II-B, LINE 1: THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. THE ASSOCIATIONS USED A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. 106951 106951 3919153 2490223 1428930 8061664 6734906 1326758 102433 102433 2965072 CAPITAL LEASE OBLIGATIONS 1099877 MEDICARE REFUNDABLE ADVANCE 2353918 ASSETS LIMITED AS TO USE - DEFERRED RETIREMENT COMPENSATION 132759 3586554 1 1 X 1 X 350.000000000000 1 X 1 1 0 0 20984 20984 0.00060 15058351 15203288 0 0.00000 15079335 15203288 20984 0.00060 7899 7899 0.00020 7899 7899 0.00020 15087234 15203288 28883 0.00080 1 3151951 9476876 9452486 24390 X 1 1 1 1 ORCHARD HOSPITAL 240 SPRUCE STREET GRIDLEY CA 95948 WWW.ORCHARDHOSPITAL.COM 230000007 X X X X ORCHARD HOSPITAL 1 0 0 1 X X X X X X X X X X 19 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 19 1 SEE PART V, SECTION C, LINE 7D 0 1 X 350.000000000000 200.000000000000 X 1 1 X X X 1 X HTTPS://WWW.ORCHARDHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.ORCHARDHOSPITAL.COM/IMAGES/POLICY%20ATTACHMENT%20COMMUNITY%20CA X HTTPS://WWW.ORCHARDHOSPITAL.COM/IMAGES/FINANCIAL%20ASSISTANCE%20POLICY%20PL X X X X X X X 1 X 0 X X X 1 X 0 0 ORCHARD HOSPITAL PART V, SECTION B, LINE 3J: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT ALSO DESCRIBES THE FOLLOWING ITEMS:-THE HOSPITAL'S IMPLEMENTATION PLAN, WHICH IDENTIFIES AND PRIORITIZES THE NEEDS OF THE COMMUNITY AND LAYS OUT A STRATEGY TO ADDRESS EACH COMMUNITY NEED-LIST OF PARTICIPATING ORGANIZATIONS FOR COMMUNITY INPUT-LIST OF QUESTIONS ASKED TO EACH COMMUNITY MEMBER ADDRESSING THE MOST IMPORTANT FACTORS FOR A HEALTHY COMMUNITY, THE GREATEST NEEDS AFFECTING CHILDREN'S HEALTH, AND THE MOST IMPORTANT HEALTH FACTORS AND RISKY BEHAVIORS FACING THE COMMUNITY. -COMMUNITY HEALTH SURVEY WHICH LISTS SPECIFIC QUESTIONS ABOUT THE HEALTH, FAMILY, AND LIFESTYLE OF THE INTERVIEWEE AS WELL AS THE INTERVIEWEE'S VIEW OF THE COMMUNITY'S HEALTH.-LIST OF HEALTH AGENCIES AND THEIR CONTACT INFORMATION REFERENCE CHART TO SUPPORT THE INFORMATION REPORTED ON SCHEDULE H. ORCHARD HOSPITAL PART V, SECTION B, LINE 5: IN ORDER TO CAPTURE AS ACCURATE A PICTURE OF THE HEALTH NEEDS OF THE COMMUNITY AS POSSIBLE, THE HOSPITAL PARTNERED WITH BUTTE COUNTY PUBLIC HEALTH, AS WELL AS THREE NEIGHBORING HOSPITALS, ENLOE MEDICAL CENTER IN CHICO, FEATHER RIVER HOSPITAL IN PARADISE, AND OROVILLE HOSPITAL IN OROVILLE TO CONDUCT A THREE-PHASE COMMUNITY HEALTH NEEDS ASSESSMENT. PHASE 1 - A TEAM RESEARCHED PUBLICLY AVAILABLE SECONDARY DATA FROM SEVERAL ONLINE SOURCES TO OBTAIN DEMOGRAPHIC INFORMATION ABOUT MEMBERS OF THE COMMUNITY. PHASE 2 - THE TEAM COMPILED INFORMATION USED TO INITIATE IN-DEPTH DISCUSSIONS AND SHAPED THE QUESTIONS ASKED IN FOCUS GROUP MEETINGS. THE INITIATIVE INFORMED THE HOSPITAL AND THE COMMUNITY AT LARGE OF SEVERAL HEALTH AREAS WARRANTING IMPROVEMENT EFFORTS IN BUTTE COUNTY. PHASE 3 - THE TEAM LAUNCHED AN ANONYMOUS COMMUNITY HEALTH SURVEY THROUGHOUT BUTTE COUNTY AND INTO SOME OF THE SURROUNDING AREAS. ORCHARD HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL WORKED COLLABORATIVELY WITH THE FOLLOWING HOSPITALS AND PUBLIC HEALTH ENTITY TO COMPLETE THE DATA GATHERING PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT:-ENLOE MEDICAL CENTER-FEATHER RIVER HOSPITAL ADVENTIST HEALTH-OROVILLE HOSPITAL-BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH ORCHARD HOSPITAL PART V, SECTION B, LINE 6B: SEE SCHEDULE H, PART V, LINE 6A. ORCHARD HOSPITAL PART V, SECTION B, LINE 7D: NOTIFICATION TO THE PUBLIC THAT THE ORCHARD HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS AVAILABLE FOR REVIEW ON THE ORCHARD HOSPITAL WEBSITE. NOTIFICATION TO ALL OF OUR EMPLOYEES WAS MADE THROUGH A FACILITY WIDE MASS EMAIL. EMAIL INCLUDED A LINK TO THE REPORT ON OUR WEBSITE AND AN ATTACHMENT (PDF) OF THE REPORT.SCHEDULE H, PART V, SECTION B, LINES 7A & 10A:HTTPS://WWW.ORCHARDHOSPITAL.COM/DEFAULT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORTS ORCHARD HOSPITAL PART V, SECTION B, LINE 11: ORCHARD HOSPITAL THEN ADOPTED THE GOALS FOR SOUTH BUTTE COUNTY THE HOSPITAL STRATEGIC PLAN. SPECIFICALLY, AROUND (1) ACCESS TO CARE, (2) MENTAL HEALTH AND SUBSTANCE USE DISORDERS, AND (3) CHRONIC DISEASE AND CONDITIONS. THE HOSPITAL IS CONTINUING TO ADDRESS THE HEALTH CARE NEEDS IDENTIFIED BY THE CHNA. THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2019 CHNA AND HOW THEY ARE BEING ADDRESSED FOLLOW:OBESITY - COLLABORATE WITH LOCAL SCHOOLS AND PARTNER WITH SCHOOL NURSES AND THE CENTER FOR NUTRITION & ACTIVITY PROMOTION. OFFER A SUMMER PROGRAM FOR NUTRITION AND ACTIVITIES WHILE SUPPORTING PLAY 60.DIABETES - DIETICIAN AND/OR PROVIDER (MD OR FNP) WILL MEET WITH THE PATIENT THEN HAVE A 20-30-MINUTE DIABETIC COUNSELING SESSION.SUBSTANCE ABUSE/CANCER "TOBACCO" - COLLABORATE WITH THE BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH AND BUTTE COUNTY DRUG ABUSE TASK FORCE TO IMPLEMENT A SMOKING CESSATION PROGRAM. WORK WITH THE LOCAL SCHOOL DISTRICTS AND THE LOCAL PARKS AND RECREATION DEPARTMENTS TO ROLL- OUT PROGRAMS TO THE YOUTH. PROMOTION OF THIS PROGRAM WILL CONTINUE TO BE COMMUNICATED TO PATIENTS THROUGH STAFF AND PHYSICIANS. WORK WITH OUR CURRENT HUMAN RESOURCE DEPARTMENT AND HEALTHCARE INSURANCE TO OFFER INCENTIVES TO OUR EMPLOYEES FOR PARTICIPATING IN SMOKING CESSATION. THE HOSPITAL WILL ALSO BE OFFERING THE ACCESSIBLE INTERVENTION AND RESPIRATORY EDUCATION (AIRE PROGRAM) FOR THOSE THAT HAVE COPD.THE FOLLOWING IDENTIFIED NEEDS ARE NOT DIRECTLY BEING ADDRESSED THROUGH SPECIFIC OBJECTIVES OR NEW INITIATIVES DUE TO THE HOSPITAL INDIRECTLY ADDRESSING THESE NEEDS THROUGH ITS PROGRAMS AND COMMUNITY PARTNERSHIPS.-HEART DISEASE/HIGH BLOOD PRESSURE-MENTAL HEALTH ISSUES-TEEN PREGNANCY/OBSTETRICS AND GYNECOLOGY SERVICES-RESPIRATORY/LUNG DISEASE/COPD-STROKE-SUICIDEFOR MANY OF THESE PRIORITIES, THE HOSPITAL HAS CONTINUED TO WORK WITH COUNTY WIDE INITIATIVES ON AN ON-GOING BASIS. THE DETAILED IMPLEMENTATION STRATEGY FOR EACH PRIORITY CAN BE FOUND IN APPENDIX 6 OF THE CHNA. ORCHARD HOSPITAL PART V, SECTION B, LINE 16J: THE HOSPITAL'S WEBSITE HIGHLIGHTS THE HOSPITAL'S COMMITMENT TO PROVIDING QUALITY CARE TO PATIENTS IN THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. VISITORS TO THE WEBSITE AND THE HOSPITAL ARE INFORMED OF THE AVAILABILITY OF THE SERVICES OF FINANCIAL COUNSELORS TO ASSIST THEM IN OBTAINING FINANCIAL ASSISTANCE. THE UNCOMPENSATED CARE (CHARITY CARE) POLICY IS COMMUNICATED TO HOSPITAL PATIENTS THROUGH POSTED SIGNS IN THE HOSPITAL BUSINESS OFFICE AND ADMITTING AREAS AND THROUGH MESSAGES ON BILLING STATEMENTS TO PATIENTS. IN FINANCIAL CLASSES ASSOCIATED WITH SELF-PAY ACCOUNTS OR ASSOCIATED WITH SPONSORED ACCOUNTS WITH DEDUCTIBLE OR CO-PAYMENT RESPONSIBILITIES, UNINSURED, AND/OR LOW-INCOME PATIENTS ARE REFERRED TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL MAKES PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY AND THE APPLICATION FORM AVAILABLE UPON REQUEST AND WITHOUT CHARGE. 2 1 - ORCHARD HOSP MEDICAL SPECIALTY CENTER 284 SPRUCE STREET GRIDLEY CA 95948 RURAL HEALTH CLINIC 2 - ORCHARD HOSP MED SPECIALTY CENTER-OROVILLE 2445 ORO DAM BLVD SUITE 8 OROVILLE CA 95965 RURAL HEALTH CLINIC PART I, LINE 3C: HTTPS://WWW.ORCHARDHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE PART I, LINE 7: THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES DERIVED FROM WORKSHEET 2, FOR AMOUNTS REPORTED IN THE TABLE (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, MEDICAID PROVIDER TAXES, TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING EXPENSES). PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,151,951. PART III, LINE 2: THE COSTING METHODOLOGY USED BY THE HOSPITAL INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE. PART III, LINE 3: THE HOSPITAL DID NOT TRACK THE AMOUNT OF BAD DEBT EXPENSE THAT COULD RESONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING THE YEAR. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS AND UNINSURED PATIENT DISCOUNTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON HISTORICAL LOSS EXPERIENCE AND CONSIDERING RECEIVABLES FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE FOR. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES HISTORICAL LOSS EXPERIENCE ON REVENUE FROM ALL PAYORS AND CONSIDERS TRENDS IN THE AGING OF RECEIVABLES. BASED ON THESE FACTORS, THE ORGANIZATION ESTIMATES THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: NONE OF THE MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS IS TREATED AS CHARITY CARE OR A COMMUNITY BENEFIT. ONLY THOSE PATIENTS THAT MET THE FINANCIAL ASSISTANCE POLICY REQUIREMENTS ARE CONSIDERED CHARITY CARE PATIENTS. MEDICARE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR PURSUANT TO THE FACILITY'S DESIGNATION AS "CRITICAL ACCESS HOSPITAL." PART III, LINE 9B: ALL COLLECTION ACTIVITY CEASES WHEN A PATIENT IS DECLARED ELIGIBLE FOR UNCOMPENSATED CARE OR QUALIFIES FOR GOVERNMENT PROGRAMS. PART VI, LINE 2: AS PART OF THE HOSPITAL'S COMMITMENT TO IMPROVE THE QUALITY OF LIFE AND HEALTH OF THE RESIDENTS OF THE COMMUNITIES THE HOSPITAL SERVES, THE HOSPITAL PERFORMS A STRATEGIC PLAN IN WHICH HOSPITAL OFFICIALS MEET WITH COMMUNITY LEADERS TO REQUEST INPUT ON THE COMMON NEEDS OF THE SURROUNDING COMMUNITIES. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY AND COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.ORCHARDHOSPITAL.COM/DEFAULT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-REPORTS. ANY ADDITIONAL HEALTH CARE NEEDS OF THE COMMUNITY ARE EVALUATED AS THEY COME UP, BASED ON CHANGES IN THE COMMUNITY. PART VI, LINE 3: FINANCIAL ASSISTANCE CONTACT INFORMATION IS MADE AVAILABLE ON THE HOSPITAL WEBSITE, POSTED IN BUSINESS SERVICE AREA, IN ADMISSIONS, AND ON BILLING STATEMENTS. FINANCIAL COUNSELORS DISCUSS WITH PATIENTS THE AVAILABILITY OF CARE. A COUNTY ELIGIBILITY PERSON IS ON-SITE FOR THREE DAYS A WEEK TO HELP PATIENTS SIGN UP FOR MEDICAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY (FAP) IS MADE AVAILABLE TO ANY PATIENTS WHO REQUEST A COPY. AN APPLICATION FOR ELIGIBILITY DETERMINATION FOR UNCOMPENSATED CARE IS PROVIDED UPON DISCHARGE. IF INSURANCE IS INADEQUATE, THE FAP IS DISCUSSED WITH THOSE PATIENTS. PART VI, LINE 4: THE HOSPITAL PRIMARILY SERVICES THE TOWNS OF BIGGS, GRIDLEY AND RICHVALE WHICH ARE LOCATED IN BUTTE COUNTY, CA AND THE TOWN OF LIVE OAK, WHICH IS LOCATED IN SUTTER COUNTY, CA. THE POPULATION OF GRIDLEY, BIGGS, AND RICHVALE AMOUNTS TO OVER 10,500. THE 2020 CENSUS DATA SHOWS THAT THE MEDIAN HOUSEHOLD INCOME FOR BUTTE COUNTY IS $52,537 WHICH IS LOWER THAN THE STATE AND NATION. APPROXIMATELY 17.3% OF BUTTE COUNTY RESIDENTS ARE AT OR BELOW POVERTY LEVEL. APPROXIMATELY 22% OF BUTTE COUNTY RESIDENTS ARE RECEIVING MEDICAID. APPROXIMATELY 86.06% OF PATIENTS SEEN AT THE HOSPITAL ARE MEDICARE OR MEDICAID INSURED. THE HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL IN GRIDLEY, AS WELL AS ALONG THE HIGHWAY 99 CORRIDOR BETWEEN SACRAMENTO AND RED BLUFF. PART VI, LINE 5: THE HOSPITAL IS DEDICATED TO UNDERSTANDING AND MEETING THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. AS A PART OF THIS COMMITMENT, MOST OF THE BOARD MEMBERS LIVE IN THE COMMUNITY AND ARE NOT EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE HOSPITAL. THE HOSPITAL IS ALSO DEDICATED TO PROVIDING THE FINEST HEALTHCARE TO THE COMMUNITY. THEREFORE, IF THERE ARE ANY SURPLUS FUNDS, THE HOSPITAL REINVESTS THOSE FUNDS INTO THE FACILITY OF EQUIPMENT. X X X 0 0 0 0 0 0 0 0 0 STEVEN STARK CEO 304081 0 25000 0 40076 0 32178 0 29745 0 431080 0 0 0 TRACY ATKINS CNO 193619 0 7500 0 22769 0 6603 0 4494 0 234985 0 0 0 JASJOT DHADLI PHARMACY DIRECTOR 179650 0 0 0 2965 0 6084 0 11742 0 200441 0 0 0 JOHN HELVEY CIO 145171 0 7500 0 13439 0 5941 0 23025 0 195076 0 0 0 THOMAS DEVINE CRNA 127521 0 8450 0 3055 0 5035 0 22830 0 166891 0 0 0 CHRISTINE HICKEY PHYSICIAN ASSISTANT 138145 0 0 0 2871 0 4778 0 12777 0 158571 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE CFO WHO REVIEWS THE FORM, SCHEDULES, AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS DISTRIBUTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CFO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST STATEMENT IS COMPLETED BY THE BOARD OF DIRECTORS ON A PERIODIC BASIS. ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE ARE CONSIDERED DURING THE DECISION-MAKING PROCESS FOR ALL TRANSACTIONS. ANY DIRECTOR INVOLVED IN A POTENTIAL CONFLICT OF INTEREST IS EXCLUDED FROM VOTING ON THAT DECISION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD USES COMPARABILITY DATA THAT INCLUDES THE CALIFORNIA HOSPITAL ASSOCIATION ANNUAL SURVEY TO DETERMINE THE COMPENSATION AMOUNT. IF ANY BOARD MEMBER HAS A CONFLICT OF INTEREST REGARDING COMPENSATION, THE BOARD MEMBER DOES NOT PARTICIPATE IN THE DECISION-MAKING PROCESS OR VOTE. THE DECISION IS DOCUMENTED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. REQUESTED INFORMATION IS PRINTED AND AVAILABLE TO THE INTERESTED PARTY AT THE OFFICE. FORM 990, PART IX, LINE 11G PHYISCIAN SERVICES: PROGRAM SERVICE EXPENSES 4,540,335. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,540,335. THERAPIST SERVICES: PROGRAM SERVICE EXPENSES 625,777. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 625,777. OTHER CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 492,471. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 492,471. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,084,008. MANAGEMENT AND GENERAL EXPENSES 1,958,346. FUNDRAISING EXPENSES 31,880. TOTAL EXPENSES 3,074,234. FORM 990, PART XI, LINE 9: RESTRICTED CONTRIBUTIONS RELEASED FROM NET ASSETS -762,475. ORCHARD HOSPITAL FOUNDATION 240 SPRUCE STREET GRIDLEY CA 95948 680474996 SUPPORT CA 501(C)(3) LINE 12A, I ORCHARD HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0