2021-11-15T16:41:46-06:00 2020-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2020-01-01 942823538 MARIN GENERAL HOSPITAL MARI 4159257000 250 BON AIR ROAD GREENBRAE CA 94904 ERIC BRETTNER CFO 4159257000 2021-11-14 1 ERIC BRETTNER 999009999 MICHAEL LUMSDEN P01262236 4159561500 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z MARINHEALTH MEDICAL CENTER DAVID KLEIN MD MBA 250 BON AIR ROAD GREENBRAE CA 94904 443044275 0 X WWW.MYMARINHEALTH.ORG X 1991 CA TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES IN A COMPASSIONATE AND HEALING ENVIRONMENT. 14 12 2037 200 0 0 12899264 21075746 419752657 417508107 4978085 2448697 2158550 2011725 439788556 443044275 20784712 28161658 0 0 243235454 242683137 0 0 0 172460724 186701982 436480890 457546777 3307666 -14502502 557491090 591205169 369814934 431456036 187676156 159749133 X TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES IN A COMPASSIONATE AND HEALING ENVIRONMENT. 0 0 408882527 28161658 417508107 MARIN GENERAL HOSPITAL DBA MARINHEALTH MEDICAL CENTER IS A 327-BED INDEPENDENT HOSPITAL WITH DEEP ROOTS IN THE COMMUNITY. WE HAVE BEEN MEETING THE HEALTHCARE NEEDS OF THE NORTH BAY SINCE FIRST OPENING OUR DOORS AS MARIN GENERAL HOSPITAL IN 1952. AS MARIN'S ONLY FULL-SERVICE, ACUTE CARE HOSPITAL, WE PROVIDE COMPREHENSIVE CARE ACROSS ALL MAJOR SERVICE LINES. OUR LEVEL III TRAUMA CENTER AND EMERGENCY DEPARTMENT RECEIVE 70% OF THE COUNTY'S AMBULANCE TRAFFIC, AND WE PROVIDE LIFE-SAVING CARE FOR OUR STROKE AND HEART ATTACK PATIENTS. WE ALSO OFFER THE ONLY HOSPITAL-BASED LABOR & DELIVERY UNIT IN MARIN. ADDITIONAL SERVICES PROVIDED INCLUDE: BEHAVIORAL HEALTH; CANCER CARE; CRITICAL CARE; EMERGENCY & TRAUMA; IMAGING & RADIOLOGY; STROKE CARE; SPINE & BRAIN CARE; AND SURGERY & PROCEDURES, AMONGST MANY OTHER SPECIALTIES.AS A DISTRICT HOSPITAL, OWNED BY MARIN HEALTHCARE DISTRICT, WE ANSWER ONLY TO THE COMMUNITY WE SERVE. THIS GIVES US THE FLEXIBILITY TO PLAN CARE THAT TRULY MEETS OUR COMMUNITY'S NEEDS. BUILDING ON A DECADES-LONG RELATIONSHIP, MARINHEALTH AND UCSF HEALTH FORMED A STRATEGIC ALLIANCE IN 2019 THAT EXPANDS ACCESS TO HIGH-QUALITY CLINICAL CARE IN MARIN COUNTY AND THROUGHOUT THE NORTH BAY. 408882527 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 259 0 1 2037 1 0 0 0 0 0 0 0 0 0 0 1 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ERIC BRETTNER 4154642090 100B DRAKES LANDING SUITE 190 GREENBRAE CA 94904 LEE DOMANICO CEO THROUGH 8/2020 46.00 4.00 X X 1413113 0 45647 JON D FRIEDENBERG COO THROUGH 5/2020 46.00 4.00 X 897296 0 19928 ERIC PIFER MD CHIEF MEDICAL OFFICER THROUGH 6/2020 50.00 0.00 X 683776 0 52006 GREGORY LEE CARD CATH TECHNICIAN IV 40.00 0.00 X 577107 0 53289 KARIN REESE RN MS CHIEF NURSING OFFICER 50.00 0.00 X 596002 0 29684 LINDA LANG CHIEF HUMAN RESOURCES OFFICER 48.00 2.00 X 527325 0 43849 ERIC BRETTNER CHIEF FINANCIAL OFFICER 46.00 4.00 X 490412 0 47844 SANDY D AUGUSTUS RN CLINICAL REGISTERED NURSE III 40.00 0.00 X 432439 0 75626 CHUN LI MD CHIEF CLINICAL PHYSICIST 40.00 0.00 X 318755 0 98434 SUSAN S CUMMING MD MEDICAL DIRECTOR, PATIENT EXPERIENCE 40.00 0.00 X 332336 0 56522 ELIZABETH KOLCUN CHIEF DEVELOPMENT OFFICER 4.00 46.00 X 337879 0 49546 DAVID KLEIN MD CEO EFFECTIVE 9/2020 46.00 4.00 X X 353965 0 3542 MICHAEL K KING LEAD IR TECHNOLOGIST 40.00 0.00 X 308374 0 37628 KARIN SHAVELSON MD FAAP CHIEF MEDICAL OFFICER START 7/2020 50.00 0.00 X 168071 0 2909 DOUGLAS COHEN MD BOARD MEMBER 2.00 0.00 X 73333 0 0 ANDREA SCHULTZ CHAIR 2.00 0.50 X X 0 0 0 ROBERT PEIRCE TREAS. THROUGH 3/2020 / VICE CHAIR 2.00 0.00 X X 0 0 0 DAVID HILL SECRETARY THROUGH 12/2020 2.00 1.00 X X 0 0 0 JOSEPH C EUPHRAT TREAS. START 3/2020 / INT. SECRETARY 2.00 0.00 X X 0 0 0 JOE ABRAMS BOARD MEMBER 2.00 1.00 X 0 0 0 JOSHUA ADLER MD BOARD MEMBER 2.00 0.00 X 0 0 0 ANN KAO MD BOARD MEMBER 2.00 0.00 X 0 0 0 PAUL KIRINCIC BOARD MEMBER THROUGH 3/2020 2.00 1.00 X 0 0 0 MICHAEL K KWOK MD BOARD MEMBER 2.00 0.00 X 0 0 0 MARK R LARET BOARD MEMBER 2.00 0.00 X 0 0 0 DENISE LUCY EDD BOARD MEMBER 2.00 0.00 X 0 0 0 GENE MARIE O'CONNELL RN MS BOARD MEMBER 2.00 2.00 X 0 0 0 MARA PEREZ PHD BOARD MEMBER 2.00 0.00 X 0 0 0 WALTER B ROSE BOARD MEMBER 2.00 0.00 X 0 0 0 7510183 0 616454 802 0 1 0 PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BOULEVARD SUITE 200 NOVATO CA 94949 PHYSICIAN SERVICES 8455043 HURON CONSULTING SERVICES LLC 3005 MOMENTUM PLACE CHICAGO IL 60689 CONSULTING SERVICES 6329626 MEDEFIS INC PO BOX 5068 NEW YORK NY 10087 RN SERVICES 5318120 MARIN HOSPITALIST MEDICAL GROUP PO BOX 708 NOVATO CA 94948 PHYSICIAN SERVICES 2884934 ANESTHESIOLOGY CONSULTANTS OF MARIN PO BOX 527 LARKSPUR CA 94977 ANESTHESIA SERVICES 2657762 71 12444393 8436812 194541 21075746 NET PATIENT SERVICE REVENUE 622110 363270180 363270180 CAPITATION REVENUE 622110 45596102 45596102 OTHER OPERATING REVENUE 622110 8641825 8641825 417508107 1608687 1608687 840010 840010 1464530 0 1464530 1464530 1464530 CAFETERIA 722514 547195 547195 547195 443044275 417508107 0 4460422 X 28042559 28042559 119099 119099 5836128 1605781 4230347 179323490 162004348 17319142 9746224 8543056 1203168 33982535 29935375 4047160 13794760 12162316 1632444 1501175 1501175 458996 458996 166745 166745 68054754 55510268 12544486 2348952 2348952 593810 532351 61459 1426223 1278609 147614 11344412 10800421 543991 49236 49236 4155073 4155073 16917533 16917533 1669131 1502218 166913 MEDICAL SUPPLIES 52637797 52637797 REPAIRS 13048335 11733377 1314958 LICENSES & TAXES 2687346 2687346 RENTAL EQUIPMENT 2086645 2086645 7555819 2728992 4826827 457546777 408882527 48664250 0 54334471 68515104 8495334 8391083 187153 490346 58318266 64334699 4651102 4605577 5859263 6660982 4452789 6569966 408445468 239422259 109040712 169023209 171901590 133874288 3060461 3060461 1731007 1111007 135458942 124568447 557491090 591205169 62050513 75226125 55507840 98251727 97812758 86296325 80999661 548250 0 122668119 121909652 369814934 431456036 X 154196505 133271318 33479651 26477815 187676156 159749133 557491090 591205169 X -14502502 3413040 -540000 -16297561 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20126 20126 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO (I) THE CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS, AND (II) THE DISTRICT HOSPITAL LEADERSHIP FORUM. A PORTION OF THESE DUES PAID WERE USED FOR LOBBYING PURPOSES. 29203340 26855750 2347590 162383191 65756794 96626397 198651220 144217859 54433361 18207717 2591856 15615861 169023209 OTHER RECEIVABLES 26737058 DEPOSITS 3338004 DUE FROM RELATED ORGANIZATIONS 7754607 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 4469441 OPERATING LEASE RIGHT-OF-USE ASSETS 47557641 BENEFICIAL INTEREST IN MARINHEALTH FOUNDATION 34711696 124568447 WORKERS COMPENSATION LIABILITIES 5362433 POST-RETIREMENT HEALTH OBLIGATIONS 10757997 PENSION BENEFIT OBLIGATION 31742549 PROFESSIONAL LIABILITY OBLIGATION 1515000 UCSF CONTRACT LIABILITY 20000000 OPERATING LEASE LIABILITIES 52531673 121909652 1 1 X 1 X 400.000000000000 1 X 1 1 1 0 1 1 1429478 1429478 0.00310 37388010 7161869 30226141 0.06610 38817488 7161869 31655619 0.06920 889651 889651 0.00190 1642303 1642303 0.00360 28465677 28465677 0.06220 30997631 30997631 0.06770 69815119 7161869 62653250 0.13690 1 10325490 1810286 93666703 165320238 -71653535 X 1 1 1 1 MARIN GENERAL HOSPITAL DBA MARINHEALTH MEDICAL CENTER 250 BON AIR ROAD GREENBRAE CA 94904 WWW.MYMARINHEALTH.ORG 110000361 X X X ACUTE PSYCHIATRIC HOSPITAL MARIN GENERAL HOSPITAL DBA MARINHEALTH 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.MYMARINHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/ X 1 19 1 HTTPS://WWW.MYMARINHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/ 0 1 X 400.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X WWW.MYMARINHEALTH.ORG/PATIENTS-VISITORS/MEDICAL-CENTER-PATIENTS-VISITORS/ X WWW.MYMARINHEALTH.ORG/PATIENTS-VISITORS/MEDICAL-CENTER-PATIENTS-VISITORS/ X WWW.MYMARINHEALTH.ORG/PATIENTS-VISITORS/MEDICAL-CENTER-PATIENTS-VISITORS/ X X X X X X 1 X 0 X X X X 1 X 0 0 MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 5: A BROAD RANGE OF COMMUNITY MEMBERS PROVIDED COMMUNITY INPUT THROUGH KEY INFORMANT INTERVIEWS, GROUP INTERVIEWS, AND FOCUS GROUPS. INDIVIDUALS WITH THE KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE CONSULTED. THESE INDIVIDUALS INCLUDED REPRESENTATIVES FROM HEALTH DEPARTMENTS, SCHOOL DISTRICTS, LOCAL NON-PROFITS, AND OTHER REGIONAL PUBLIC AND PRIVATE ORGANIZATIONS AS WELL AS COMMUNITY LEADERS, CLIENTS OF LOCAL SERVICE PROVIDERS, AND OTHER INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND SUB-POPULATIONS THAT FACE UNIQUE BARRIERS TO HEALTH (E.G., RACE/ETHNIC MINORITY POPULATIONS, INDIVIDUALS EXPERIENCING HOMELESSNESS). INTERVIEWS WERE CONDUCTED WITH 31 KEY INFORMANTS BETWEEN 8/30/2018 10/15/2018 WITH REPRESENTATIVES FROM: THE MARIN FOOD POLICY COUNCIL, CANAL ALLIANCE, CITY OF SAN RAFAEL, MARIN TRANSIT, MARIN COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, RX SAFE MARIN, NATIONAL ALLIANCE OF MENTAL ILLNESS MARIN, NORTH MARIN COMMUNITY SERVICES, COSTAL HEALTH ALLIANCE, MARIN CITY HEALTH AND WELLNESS CENTER, MARIN COMMUNITY CLINICS, ROTACARE CLINIC OF SAN RAFAEL, MARIN ECONOMIC FORUM, SAN RAFAEL CHAMBER OF COMMERCE, NOVATO CHAMBER OF COMMERCE, LATINO COUNCIL OF MARIN, NORTH BAY LEADERSHIP COUNCIL, MARIN CENTER FOR INDEPENDENT LIVING, BUCKELEW PROGRAMS, WHISTLESTOP, CASA ALLEGRA, MARIN VENTURES, MARIN IHSS PUBLIC AUTHORITY, RITTER CENTER, HOMEWARD BOUND, ST. VINCENT DE PAUL SOCIETY, MARIN HOUSING AUTHORITY, WHOLE PERSON CARE, AND DOWNTOWN STREETS TEAM. IN ADDITION, THREE FOCUS GROUPS WERE HELD ON 9/5/2018, 9/21/2018, AND 10/2/2018; FOCUS GROUPS WERE CONDUCTED IN ENGLISH AND SPANISH, ENGAGING 22 COMMUNITY MEMBERS. MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 6A: MHMC CONDUCTED ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN CONJUNCTION WITH HEALTHY MARIN PARTNERSHIP, WHICH INCLUDES ALL ACUTE-CARE HOSPITALS IN MARIN COUNTY: MARINHEALTH MEDICAL CENTER, KAISER FOUNDATION HOSPITAL - SAN RAFAEL, AND SUTTER HEALTH - NOVATO COMMUNITY HOSPITAL. MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 6B: THE ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES WHO ARE MEMBERS OF HEALTHY MARIN PARTNERSHIP, WITH WHICH MARINHEALTH MEDICAL CENTER CONDUCTED ITS 2019 CHNA INCLUDE: MARIN COUNTY HEALTH & HUMAN SERVICES, HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA NORTH BAY LEADERSHIP COUNCIL, MARIN COUNTY OFFICE OF EDUCATION, MARIN COMMUNITY FOUNDATION, AND SAN RAFAEL CHAMBER OF COMMERCE. MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 11: WITH THE 2020-2022 IMPLEMENTATION STRATEGY, MARINHEALTH MEDICAL CENTER WILL ADDRESS THE HEALTH NEEDS OF: ACCESS TO HEALTHCARE; HEALTHY EATING AND ACTIVE LIVING; HOUSING AND HOMELESSNESS; MENTAL HEALTH/SUBSTANCE USE; AND VIOLENCE/INJURY PREVENTION THROUGH A COMMITMENT OF COMMUNITY BENEFIT PROGRAMS AND CHARITABLE RESOURCES.ACCESS TO CARE: ACCESS TO QUALITY HEALTHCARE IS IMPORTANT TO OVERALL HEALTH, DISEASE PREVENTION, AND REDUCING UNNECESSARY DISABILITY AND PREMATURE DEATH. IT IS ALSO AN IMPORTANT KEY DRIVER IN ACHIEVING HEALTH EQUITY. IN RESPONSE TO THIS NEED, IN 2020 MARINHEALTH MEDICAL CENTER: (I) PROVIDED FINANCIAL ASSISTANCE FOR UNINSURED/UNDERINSURED AND LOW-INCOME RESIDENTS; (II) REACHED 1,278 INDIVIDUALS THROUGH ITS COMPASSIONATE DISCHARGE PRESCRIPTIONS AND TRANSPORTATION PROGRAMS; (III) SUPPORTED PRIMARY CARE AND SPECIALTY CARE SERVICES FOR THE UNINSURED AT THE MARINHEALTH MEDICAL NETWORK CLINICS; (IV) SUPPORTED OPERATION ACCESS, WHICH BRINGS TOGETHER MEDICAL PROFESSIONALS AND HOSPITALS TO PROVIDE DONATED OUTPATIENT SURGICAL AND SPECIALTY CARE FOR THE UNINSURED AND UNDERSERVED THROUGH WAIVING HOSPITAL CHARGES AND PROVIDING GRANT FUNDS FOR OPERATIONS ACCESS CLIENTS, ULTIMATELY ALLOWING 183 UNINSURED INDIVIDUALS TO RECEIVE 254 NEEDED SURGICAL AND/OR DIAGNOSTIC SERVICES; (V) PROVIDED FREE EDUCATION, COUNSELLING, AND SUPPORT TO 2,160 BREASTFEEDING MOTHERS; (VI) ADDRESSED BARRIERS TO CARE FOR OUR MOST VULNERABLE PATIENTS AND THEIR CAREGIVERS THROUGH THE MARINHEALTH MEDICAL NETWORK SUPPORTIVE CARE CENTER, WHICH PROVIDES OUTPATIENT CARE COORDINATION AND TRANSITIONS OF CARE; AND (VII) SUPPORTED 13,054 ENROLLMENT COUNSELOR APPOINTMENTS TO LINK PATIENTS TO COMMUNITY RESOURCES INCLUDING LEGAL SERVICES, RENTAL ASSISTANCE, AND SOCIAL SECURITY BENEFITS (IN PARTNERSHIP WITH MARIN COMMUNITY CLINICS).HEALTHY EATING AND ACTIVE LIVING: WHILE RATES OF OBESITY AND DIABETES ARE LOWER IN MARIN COUNTY COMPARED TO CALIFORNIA, THERE IS A HIGH PREVALENCE OF YOUTH IN THE SERVICE AREA WHO ARE OVERWEIGHT OR OBESE, ESPECIALLY AMONG (BLACK (18%), HISPANIC (20%) AND NATIVE AMERICAN/ALASKA NATIVE POPULATIONS (24%). IN RESPONSE TO THIS NEED, IN 2020 MARINHEALTH MEDICAL CENTER: (I) MADE AVAILABLE TO THE PUBLIC THE FREE HEALTH CONNECTION ENEWSLETTER AND QUARTERLY EDUCATIONAL PODCASTS, WHICH PROVIDED EDUCATION ON HEALTHY EATING AND ACTIVE LIVING; (II) FACILITATED A CAREGIVER CLASS WITH A MARINHEALTH REGISTERED DIETITIAN TO EDUCATE 30 COMMUNITY CAREGIVERS WORKING WITH THOSE WITH DIABETES AND OTHER CHRONIC DISEASES; (III) PROVIDED FREE ADVICE TO THE PUBLIC ON NUTRITION NEEDS; (IV) THROUGH THE BRADEN DIABETES CENTER, PROVIDED FREE DIABETES SUPPORT GROUPS, LUNCH N' LEARNS, EDUCATION BOOTHS AND SCREENINGS, WHICH 218 COMMUNITY MEMBERS PARTICIPATED EITHER IN-PERSON OR VIRTUALLY IN 2020; (V) PROVIDED EDUCATION, SUPPORT GROUPS, NUTRITION CLASSES, AND QI GONG EVENTS FREE TO THE PUBLIC THROUGH THE INTEGRATIVE WELLNESS CENTER, IN WHICH 1,280 WERE SERVED EITHER IN-PERSON OR VIRTUALLY IN 2020; (VI) PROVIDED 3,500 HOUSEHOLDS IN NOVATO AND SAN RAFAEL NUTRITIOUS FOOD BOXES IN PARTNERSHIP WITH MARIN COMMUNITY CLINICS; AND (VII) DELIVERED 7,673 HOME MEALS TO SENIORS, IN PARTNERSHIP WITH WEST MARIN SENIOR SERVICES.HOUSING AND HOMELESSNESS: MARIN COUNTY'S HIGH COST OF HOUSING EXACERBATES ISSUES RELATED TO HEALTHCARE ACCESS AND AFFORDABILITY, WHICH IN TURN HAS A NEGATIVE IMPACT ON HEALTH OUTCOMES IN THE AREA. MORE THAN HALF OF RENTERS PAY 30% OR MORE OF THEIR INCOME ON RENT. HOMELESSNESS EXPOSES INDIVIDUALS TO INCREASED HEALTH RISKS, ESPECIALLY AS 63% OF MARIN'S HOMELESS POPULATIONS IS UNSHELTERED, AND IT IS DIFFICULT TO LINK PERSONS WHO ARE EXPERIENCING HOMELESSNESS TO SUPPORTIVE HOUSING AND HEALTHCARE SERVICES. IN RESPONSE TO THIS NEED, IN 2020 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 996 HOMELESS INDIVIDUALS QUALITY HEALTHCARE SERVICES, INCLUSIVE OF MEDICAL, MENTAL HEALTH, AND ALCOHOL/DRUG TREATMENT SERVICES IN PARTNERSHIP WITH RITTER CENTER, A FQHC HOMELESS SITE; (II) PROVIDED 71 HOMELESS INDIVIDUALS WITH A STABLE ENVIRONMENT TO RECUPERATE AND RECEIVE WRAPAROUND SUPPORT SERVICES TO PROMOTE ECONOMIC INDEPENDENCE, HOUSING STABILITY, AND ESTABLISH A MEDICAL HOME (IN PARTNERSHIP WITH HOMEWARD BOUND), WHICH RESULTED IN PREVENTING 671 AVOIDABLE HOSPITAL DAYS; AND (III) PROVIDED 304 LOW-INCOME INDIVIDUALS WITH FREE ACUTE MEDICAL CARE AND MEDICATIONS IN PARTNERSHIP WITH RATACARE BAY AREA CLINIC, THE ONLY FREE CLINIC IN MARIN COUNTY SERVING THE ADULT POPULATION.MENTAL HEALTH AND SUBSTANCE USE: MARIN COUNTY RESIDENTS DEMONSTRATE HIGH NEEDS IN ADDRESSING MENTAL HEALTH ISSUES, INDICATED BY RATES OF SUICIDE, MEDICATION FOR MENTAL HEALTH ISSUES, AND SUBSTANCE ABUSE TREATMENT. IN TOTAL, 15% OF MARIN COUNTY ADULTS TAKE DAILY PRESCRIPTIONS FOR MENTAL HEALTH ISSUES, WHICH IS HIGHER THAN THE CALIFORNIA RATE OF 11%. IN MARIN COUNTY, MENTAL HEALTH ISSUES FREQUENTLY COEXIST WITH SUBSTANCE ABUSE. IN RESPONSE TO THIS NEED, IN 2020 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 220 ADULTS AND TRANSITIONAL-AGE-YOUTH SUFFERING FROM SERIOUS MENTAL ILLNESS WITH SUBSTANCE USE RECOVERY SUPPORT AND EMPOWERMENT SERVICES (IN PARTNERSHIP WITH COMMUNITY ACTION MARIN); (II) PROVIDED MORE THAN 180 YOUTHS, ADULTS, SENIORS, TRANSITIONAL-AGE-YOUTH, AND LGBTQ+ INDIVIDUALS WITH BILINGUAL, CULTURALLY SENSITIVE MENTAL HEALTH COUNSELING SESSIONS (IN PARTNERSHIP WITH THE SPAHR CENTER, HUCKLEBERRY TEEN YOUTH PROGRAM, BUCKELEW PROGRAMS, COMMUNITY INSTITUTE FOR PSYCHOTHERAPY, COMMUNITY ACTION MARIN, NORTH MARIN COMMUNITY SERVICES, JEWISH FAMILY AND CHILDREN'S SERVICES, AND THE SAN GERONIMO VALLEY COMMUNITY CENTER); (III) PROVIDED 66 INDIVIDUALS WITH MULTIPLE PEER-TO-PEER BEHAVIORAL HEALTH INTERVENTIONS IN CONJUNCTION WITH NORTH MARIN COMMUNITY SERVICES; (IV) ENROLLED 12 ADULTS AND TRANSITIONAL-AGE-YOUTH SUFFERING FROM SERIOUS MENTAL ILLNESS IN TRAINING COURSES IN CUSTOMER SERVICES AND/OR FOOD SERVICE (IN PARTNERSHIP WITH COMMUNITY DEVELOPMENT CORPORATION OF MARIN'S TRANSITIONAL EMPLOYMENT PROGRAM; AND (V) PROVIDED INDIVIDUAL THERAPY TO 32 LGBTQ+ INDIVIDUALS (IN PARTNERSHIP WITH THE SPAHR CENTER).VIOLENCE AND INJURY PREVENTION: VIOLENCE AND INJURY PREVENTION COVERS A BROAD CATEGORY OF HEALTH-RELATED INDICATORS, INCLUDING PHYSICAL ABUSE AND ACCIDENTAL POISONING. THESE HEALTH-RELATED EVENTS CAN BE CONCENTRATED AMONG CERTAIN POPULATIONS. FOR EXAMPLE, DUE TO HEAVY MANUAL LABOR, MANY WORK-RELATED INJURIES AFFECT DAY LABORERS. ANOTHER EXAMPLE WOULD BE OLDER ADULTS AT HIGHER RISK OF PHYSICAL ACCIDENTS SUCH AS FALLS, WHICH IS THE LEADING CAUSE OF FATAL INJURIES IN THIS POPULATION. IN RESPONSE TO THIS NEED, IN 2020 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 257 WEST MARIN SENIORS WITH CASE MANAGEMENT SERVICES, HOME DELIVERED MEALS, AND FREQUENT CONTACT VIA PHONE, FACETIME AND ZOOM TO REDUCE ISOLATION AND FEAR DURING THE COVID-19 PANDEMIC (IN PARTNERSHIP WITH WEST MARIN SENIOR SERVICES); (II) FACILITATED HEALTH EDUCATION, SUBSTANCE USE PREVENTION, AND SEXUAL VIOLENCE PREVENTION WORKSHOPS IN WHICH 1,607 YOUTHS PARTICIPATED (IN PARTNERSHIP WITH HUCKLEBERRY YOUTH PROGRAMS), AND (III) PROVIDED 176 RIDES IN A PILOT PROGRAM TO PREVENT MISSED MEDICAL APPOINTMENTS (IN PARTNERSHIP WITH WHISTLESTOP).MARINHEALTH MEDICAL CENTER HAS CHOSEN TO CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN THE ORGANIZATION'S AREAS OF FOCUS AND EXPERTISE. KNOWING THAT THERE ARE NOT SUFFICIENT RESOURCES TO ADDRESS ALL OF THE COMMUNITY HEALTH NEEDS, MARINHEALTH MEDICAL CENTER CHOSE TO ADDRESS THOSE HEALTH NEEDS THAT HAVE THE POTENTIAL FOR THE LARGEST IMPACT. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, MARINHEALTH MEDICAL CENTER WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA: ECONOMIC SECURITY, EDUCATION, MATERNAL AND INFANT HEALTH, ORAL HEALTH, AND SOCIAL CONNECTIONS. 12 1 - MARINHEALTH ADULT ACUTE CARE CLINIC 75 ROWLAND WAY SUITE 100 NOVATO CA 94945 ADULT ACUTE CARE CLINIC 2 - MARINHEALTH BONE DENSITY TESTING 100A DRAKES LANDING ROAD SUITE 140 GREENBRAE CA 94904 BONE DENSITY TESTING CLINIC 3 - MARINHEALTH BRADEN DIABETES CENTER 1100 SOUTH ELISEO DRIVE SUITE 2 GREENBRAE CA 94903 DIABETES CENTER 4 - MARINHEALTH BREAST HEALTH CENTER 100A DRAKES LANDING ROAD SUITE 140 GREENBRAE CA 94904 BREAST HEALTH CENTER 5 - MARINHEALTH CANCER CARE 1350 SOUTH ELISEO DRIVE GREENBRAE CA 94904 CANCER CARE CENTER 6 - MARINHEALTH CT SCAN SUITE 2 BON AIR ROAD SUITE 140 GREENBRAE CA 94904 CT SCAN CENTER 7 - MARINHEALTH HEARING & SPEECH 1350 SOUTH ELISEO DRIVE SUITE 130 LARKSPUR CA 94939 HEARING & SPEECH CENTER 8 - MARINHEALTH INTEGRATIVE WELLNESS CENTER 1350 SOUTH ELISEO DRIVE SUITE 140 GREENBRAE CA 94904 INTEGRATIVE WELLNESS CENTER 9 - MARINHEALTH LACTATION SERVICES 250 BON AIR ROAD FLOOR 4 GREENBRAE CA 94904 LACTATION SERVICES CENTER 10 - MARINHEALTH OUTPATIENT IMAGING CENTER 1240 SOUTH ELISEO DRIVE SUITE 103 GREENBRAE CA 94904 OUTPATIENT IMAGING CENTER 11 - MARINHEALTH OUTPATIENT MRI 1260 SOUTH ELISEO DRIVE SUITE 100 GREENBRAE CA 94904 OUTPATIENT MRI CENTER 12 - MARINHEALTH OUTPATIENT PHYSICAL THERAPY 1350 SOUTH ELISEO DRIVE SUITE 250 GREENBRAE CA 94904 OUTPATIENT PHYSICAL THERAPY PART I, LINE 3C: TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINE (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: 1) SPECIAL CIRCUMSTANCES CHARITY CARE: A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, INELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE HOSPITAL'S CHARITY CARE ELIGIBILITY CRITERIA. 2) CATASTROPHIC CHARITY CARE: FULL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 10% OF PATIENT'S FAMILY INCOME.3) UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. 4) PROMPT PAYMENT DISCOUNT: ADDITIONAL DISCOUNT FOR PATIENTS RECEIVING THE UNINSURED DISCOUNT OF AT LEAST 10% WHO PAYS ESTIMATED BILL PRIOR TO DISCHARGE. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS ON LINES 7B, AND 7C. COST ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS ON LINES 7A, 7E, 7F, AND 7I. PART III, LINE 2: THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON SCHEDULE H, PART III, LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 4: MHMC'S AUDITED FINANCIAL STATEMENTS DOES NOT HAVE A SEPARATE BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE FOOTNOTE WHICH ADDRESSES "PATIENTS ACCOUNTS RECEIVABLE, NET" CAN BE FOUND ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT AS MEDICARE RATES ARE NON-NEGOTIABLE AND SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. BY CONTINUING TO TREAT PATIENTS ELIGIBLE TO MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. ADDITIONALLY, IRS REV. RUL. 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.ALL MEDICARE REVENUES AND COSTS WERE INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: THE MEDICAL CENTER INCLUDES AN EXTENDED PAYMENT PLAN TO ALLOW PAYMENT OF THE DISCOUNTED PRICE OVER TIME. THE MEDICAL CENTER AND THE PATIENT MAY NEGOTIATE THE TERMS OF THE PAYMENT PLAN. THE MEDICAL CENTER WILL NOT CHARGE INTEREST ON THE EXTENDED PAYMENT PLAN DEBT. AN EXTENDED PAYMENT PLAN MAY BE NEGOTIATED WITH THE PATIENT IF THE PATIENT FAILS TO MAKE ALL CONSECUTIVE PAYMENTS DURING A 90-DAY PERIOD. PRIOR TO DECLARING AN EXTENDED PAYMENT PLAN INOPERABLE THE PATIENT MUST BE: 1. CONTACTED OR ATTEMPTED TO BE CONTACTED BY TELEPHONE (LAST KNOWN NUMBER)2. GIVEN NOTICE IN WRITING THAT THE PLAN MAY BE INOPERABLE (LAST KNOWN ADDRESS)3. INFORMED THAT THERE IS AN OPPORTUNITY TO RE-NEGOTIATE THE PAYMENT PLAN.UNTIL THE PAYMENT PLAN IS DECLARED INOPERABLE, NO REPORT MAY BE MADE TO A CONSUMER CREDIT REPORTING AGENCY AND NO CIVIL ACTION MAY COMMENCE. ANY ADVANCING OF DEBT FOR COLLECTION OR REPORTING REQUIRES THE APPROVAL OF EACH PATIENT BY THE DIRECTOR OF PATIENT FINANCIAL SERVICES. ADVANCING OF DEBT COLLECTION SHALL OCCUR AFTER 150 DAYS OF AN INOPERABLE PAYMENT PLAN. CREDIT REPORTING SHALL NOT OCCUR UNTIL AFTER 150 DAYS OF THE PAYMENT PLAN BEING INOPERABLE.IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING MARINHEALTH MEDICAL CENTER'S CHARITY CARE ELIGIBILITY CRITERIA, THE PATIENT ACCOUNT MAY BE CONSIDERED CHARITY CARE, EVEN IF THEY WERE ORIGINALLY CLASSIFIED FOR COLLECTION OR AS A BAD DEBT. COLLECTION AGENCY PATIENT ACCOUNTS MEETING CHARITY CARE CRITERIA SHOULD BE RETURNED TO MARINHEALTH MEDICAL CENTER'S BILLING OFFICE AND REVIEWED FOR CHARITY CARE ELIGIBILITY. PART VI, LINE 2: IN ADDITION TO THE TRIENNIAL CHNA, HEALTH NEEDS ARE MONITORED AS FOLLOWS: (I) MARIN HEALTHCARE DISTRICT BOARD MEETINGS, WHICH INCLUDE PUBLIC COMMENTS AND WHICH THE HOSPITAL CEO ATTENDS AND SHARES COMMUNITY INPUT WITH HOSPITAL STAFF AS APPROPRIATE; (II) HOSPITAL BOARD MEMBERS ARE ALL COMMUNITY RESIDENTS AND SHARE COMMUNITY HEALTH CONCERNS WHEN APPROPRIATE; AND (III) COMMUNITY COMMENTS ON THE TRIENNIAL CHNA AND IMPLEMENTATION STRATEGY ARE COLLECTED ON THE HOSPITAL WEBSITE AND ARE MONITORED BY THE COMMUNITY RELATIONS DEPARTMENT. PART VI, LINE 3: A) CHARITY CARE INFORMATION PROVIDED AT PATIENT INTAKE: EXCEPT IN THE CASE OF EMERGENCY SERVICES, MARINHEALTH MEDICAL CENTER SHALL PROVIDE PATIENTS WITH INFORMATION REGARDING CHARITY CARE AND DISCOUNT PAYMENTS DURING THE PATIENT INTAKE PROCESS. MARINHEALTH MEDICAL CENTER SHALL ALSO PROVIDE PATIENTS WITH CONTACT INFORMATION FOR A MARINHEALTH MEDICAL CENTER EMPLOYEE OR OFFICE FROM WHICH THE PATIENT MAY OBTAIN FURTHER INFORMATION ABOUT CHARITY CARE AND DISCOUNT PAYMENTS. THE INFORMATION PROVIDED SHALL BE IN THE PRIMARY LANGUAGE(S) OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. A LANGUAGE IS A PRIMARY LANGUAGE OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA IF 5% OR MORE OF MARINHEALTH MEDICAL CENTER'S LOCAL POPULATION SPEAKS THE LANGUAGE. B) CHARITY CARE INFORMATION PROVIDED AT ALL OTHER TIMES: MARINHEALTH MEDICAL CENTER SHALL PROVIDE PATIENTS WITH INFORMATION REGARDING CHARITY CARE AND DISCOUNT PAYMENTS DURING THE INTAKE PROCESS, OR AT ANY OTHER TIME UPON PATIENT REQUEST. MARINHEALTH MEDICAL CENTER SHALL PROVIDE UNINSURED PATIENTS WITH THE MARINHEALTH MEDICAL CENTER CHARITY CARE APPLICATION FORM, THE "STATEMENT OF FINANCIAL CONDITION," IMMEDIATELY UPON PATIENT REQUEST. THE INFORMATION PROVIDED SHALL BE IN THE PRIMARY LANGUAGE(S) OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. A LANGUAGE IS A PRIMARY LANGUAGE OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA IF 5% OR MORE OF MARINHEALTH MEDICAL CENTER'S LOCAL POPULATION SPEAKS THE LANGUAGE. C) PUBLIC NOTICE AND POSTING: PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE THROUGH THIS POLICY SHOULD BE MADE BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION. NOTICES MUST BE POSTED IN AT LEAST THE EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMITTING OFFICES, AND MEDICAL CENTER OUTPATIENT SERVICE SETTINGS. POSTED NOTICES SHALL BE IN LANGUAGES REFLECTING THAT SPOKEN IN THE SERVICE AREA IS 5% OR MORE OF THE POPULATIONS SPEAK THIS LANGUAGE. POSTED NOTICES SHALL CONTAIN THE FOLLOWING INFORMATION: 1) A STATEMENT INDICATING THAT MARINHEALTH MEDICAL CENTER HAS A FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS WHO MAY NOT BE ABLE TO PAY THEIR BILL AND THAT THIS POLICY PROVIDES FOR FULL OR PARTIAL CHARITY CARE WRITE-OFF.2) IDENTIFICATION OF A MEDICAL CENTER CONTACT PHONE NUMBER THAT THE PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND ABOUT HOW TO APPLY FOR ASSISTANCE.D) INCLUDE POLICY INFORMATION ON BILLS AND STATEMENTS SENT TO PATIENTS INDICATING:1) IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR QUALIFY FOR CHARITY CARE OR DISCOUNT PAYMENT FROM MARINHEALTH MEDICAL CENTER. THE INCOME REQUIREMENTS SHALL BE STATED ON THE NOTICE.2) NOTIFICATION TO THE PATIENT THAT EMERGENCY PHYSICIANS ARE REQUIRED TO HAVE A DISCOUNT POLICY TO UNINSURED AND HIGH MEDICAL COST PATIENTS WHICH MAY HAVE DIFFERENT ELIGIBILITY CRITERIA THAN THAT OF THE MEDICAL CENTER BUT AT LEAST AT 350% OF THE FPL. 3) A MEDICAL CENTER PHONE NUMBER THAT PATIENTS MAY CALL FOR FURTHER INFORMATION. 4) POSTING NOTICE OF THE AVAILABILITY OF ASSISTANCE AND A CONTACT PHONE NUMBER ON MARINHEALTH MEDICAL CENTER'S WEB SITE. 5) PROVIDING UNINSURED PATIENTS A DOCUMENT OUTLINING THE TYPES OF FINANCIAL ASSISTANCE AVAILABLE. PART VI, LINE 4: MARINHEALTH MEDICAL CENTER IS LOCATED AT 250 BON AIR ROAD, GREENBRAE, CA 94904. THE HOSPITAL SERVICE AREA COMPRISES ALL OF MARIN COUNTY AND INCLUDES THE CITIES OF: BELVEDERE, CORTE MADERA, FAIRFAX, LARKSPUR, MILL VALLEY, NOVATO, ROSS, SAN ANSELMO, SAN RAFAEL, SAUSALITO, TIBURON, AND THE COASTAL TOWNS OF STINSON BEACH, BOLINAS, POINT REYES, INVERNESS, MARSHALL, AND TOMALES. THE SERVICE AREA WAS DETERMINED FROM THE COMMUNITIES THAT REFLECT A MAJORITY OF PATIENT ADMISSIONS. MARIN COUNTY IS NORTH OF SAN FRANCISCO BY WAY OF THE GOLDEN GATE BRIDGE. THE COUNTY INCLUDES VAST AREAS OF OPEN SPACE, INCLUDING NATIONAL PROTECTED AREAS (SUCH AS MUIR WOODS NATIONAL MONUMENT), STATE AND LOCAL PROTECTED AREAS (SUCH AS MARIN COUNTY DEPARTMENT OF PARKS AND OPEN SPACE), AND STATE PARKS (SUCH AS MOUNT TAMALPAIS). MUCH OF MARIN'S POPULATION LIVES ALONG THE HIGHWAY 101 CORRIDOR, CREATING AN URBAN ENVIRONMENT IN THE EASTERN-CENTRAL PART OF THE COUNTY AND A MORE RURAL ENVIRONMENT ALONG THE COAST AND THE HIGHWAY 1 CORRIDOR IN WEST MARIN. MARIN HAS CONSISTENTLY BEEN RANKED BY THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS AS ONE OF THE HEALTHIEST COUNTIES IN CALIFORNIA. FOR 9 OUT OF THE PAST 10 YEARS, MARIN HAS EARNED THE TOP SPOT ON THIS LIST. THERE IS MUCH TO CELEBRATE REGARDING THE POSITIVE HEALTH OUTCOMES IN OUR COUNTY YET CLEAR INEQUITIES STILL EXIST, ILLUSTRATING THAT NOT ALL MARIN COUNTY RESIDENTS ARE ABLE TO ACHIEVE POSITIVE HEALTH OUTCOMES.MARIN COUNTY IS HOME TO 260,814 RESIDENTS. WITH A MEDIAN AGE OF 46.141 AND A HIGH PERCENTAGE OF OLDER ADULTS, MARIN COUNTY IS ONE OF THE "OLDEST" COUNTIES IN THE BAY AREA. PERSONS OVER THE AGE OF 60 ARE ESTIMATED TO NUMBER 72,684, COMPRISING 28% OF THE COUNTY'S TOTAL POPULATION. BY 2030, PERSONS OVER 60 WILL ACCOUNT FOR AT LEAST 33% OF THE POPULATION. STATEWIDE, PERSONS OVER 60 ACCOUNT FOR 18% OF THE POPULATION. YOUTH, 19 AND UNDER, MAKE UP 22% OF MARIN'S POPULATION. DUE TO THE HIGH COST OF LIVING IN MARIN COUNTY, FAMILIES WITH YOUNG CHILDREN FACE SIGNIFICANT CHALLENGES. ALMOST ONE-FOURTH (23%) OF MARIN COUNTY CHILDREN ARE LIVING AT OR BELOW 199% OF THE FEDERAL POVERTY LEVEL ($50,000 FOR A FAMILY OF 4). FAMILIES MUST MAKE DIFFICULT DECISIONS ABOUT PAYING FOR HOUSING, PAYING FOR FOOD, AND PAYING FOR QUALITY CHILDCARE AND EDUCATION FOR THEIR CHILDREN. IN MARIN COUNTY, 51% OF THE POPULATION IS FEMALE AND 49% IS MALE.THE MAJORITY OF THE POPULATION IN MARIN COUNTY IS NON-HISPANIC WHITE (71.9%); 15.6% OF THE POPULATION IS HISPANIC/LATINO; 5.6% OF THE POPULATION IS ASIAN; AND 2.3% OF THE POPULATION IS BLACK/AFRICAN AMERICAN. THE REMAINING 4.6% OF THE POPULATION IS MULTIPLE RACES, OTHER RACES, NATIVE ALASKANS, NATIVE HAWAIIANS AND NATIVE AMERICANS. PART VI, LINE 5: MARINHEALTH MEDICAL CENTER IS THE ONLY FULL-SERVICE ACUTE CARE HOSPITAL IN THE COUNTY AND THE ONLY HOSPITAL WITH AN OBSTETRICAL SERVICE OR IN PATIENT BEHAVIORAL HEALTH SERVICE. IT SERVES AS THE TRAUMA CENTER FOR MARIN COUNTY AND SURROUNDING AREAS. THE BOARD OF DIRECTORS IS COMPOSED OF UNCOMPENSATED COMMUNITY RESIDENTS. ALL FUNDS ARE USED TO IMPROVE HEALTH CARE SERVICES, MAINTAIN UP-TO-DATE FACILITIES, AND SUPPORT TRAINING PROGRAMS FOR HEALTH PROFESSIONALS IN AREAS SUCH AS NURSING, PHARMACY, RADIOLOGY, RESPIRATORY THERAPY, REHABILITATION SERVICES AND BEHAVIORAL HEALTH. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS. PART VI, LINE 6: MARIN HEALTHCARE DISTRICT IS THE GENERAL MEMBER OF MARINHEALTH MEDICAL CENTER; MARIN HEALTHCARE DISTRICT IS RESPONSIBLE FOR PROMOTING THE HEALTH AND WELFARE OF THE RESIDENTS OF MARIN COUNTY, INCLUDING MAINTAINING COUNTY-WIDE ACCESS TO CARE THROUGH THE MARIN HEALTHCARE DISTRICT HEALTH CENTERS. IN ADDITION, MARINHEALTH MEDICAL CENTER OPERATES IN CONJUNCTION WITH MARINHEALTH MEDICAL NETWORK, WHICH IS A MEDICAL FOUNDATION OFFERING A WIDE RANGE OF PHYSICIANS AND PROVIDERS. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 SAN RAFAEL CHAMBER OF COMMERCE 817 MISSION AVE SAN RAFAEL CA 94901 940839470 501(C)(6) 12000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 1400 N DUTTON AVE STE 20 SANTA ROSA CA 95401 135613797 501(C)(3) 25000 GENERAL SUPPORT MARIN ECONOMIC FORUM 555 NORTHGATE DRIVE 255 SAN RAFAEL CA 94903 454194417 501(C)(3) 10000 GENERAL SUPPORT TEDXMARINORG PARTNERSHIP 644 BOLINAS ROAD FAIRFAX CA 94930 472577374 5500 GENERAL SUPPORT PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BLVD NOVATO CA 94949 271376321 501(C)(3) 27903470 GENERAL SUPPORT 3 2 SCHOLARSHIPS 43 47200 PATIENT ASSISTANCE 56 41749 EMPLOYEE ASSISTANCE - COVID RELIEF 82 24000 PROFESSIONAL DEVELOPMENT 9 3400 VOLUNTEER SUPPORT 1 2750 PART I, LINE 2: FOR GRANTS TO INDIVIDUALS, THE ORGANIZATION PRE-SCREENS THE INDIVIDUALS FOR ELIGIBILITY. GRANTS ARE PAID DIRECTLY TO THE PROVIDER OF SERVICES TO PATIENTS. THE HOSPITAL DOES NOT REQUIRE ACCOUNTING OF THE USE OF GRANT FUNDS PROVIDED, HOWEVER, THE ORGANIZATION HISTORICALLY HAS A CLOSE WORKING RELATIONSHIP WITH GRANTEES LISTED ON SCHEDULE I, PART II. IN THE CASES OF GENERAL PURPOSE GRANTS, THE GRANTEE'S CHARITABLE PURPOSE IS REVIEWED PRIOR TO THE ISSUANCE OF THE GRANT. X X X 1 1 0 0 0 0 0 0 0 LEE DOMANICO CEO THROUGH 8/2020 742570 0 355405 0 315138 0 24144 0 21503 0 1458760 0 0 0 JON D FRIEDENBERG COO THROUGH 5/2020 190333 0 360360 0 346603 0 3901 0 16027 0 917224 0 0 0 ERIC PIFER MD CHIEF MEDICAL OFFICER THROUGH 6/2020 490478 0 128525 0 64773 0 14839 0 37167 0 735782 0 0 0 GREGORY LEE CARD CATH TECHNICIAN IV 577107 0 0 0 0 0 41642 0 11647 0 630396 0 0 0 KARIN REESE RN MS CHIEF NURSING OFFICER 382630 0 141897 0 71475 0 18899 0 10785 0 625686 0 0 0 LINDA LANG CHIEF HUMAN RESOURCES OFFICER 324897 0 143521 0 58907 0 19344 0 24505 0 571174 0 0 0 ERIC BRETTNER CHIEF FINANCIAL OFFICER 404622 0 0 0 85790 0 14250 0 33594 0 538256 0 0 0 SANDY D AUGUSTUS RN CLINICAL REGISTERED NURSE III 432139 0 300 0 0 0 39745 0 35881 0 508065 0 0 0 CHUN LI MD CHIEF CLINICAL PHYSICIST 316608 0 0 0 2147 0 86376 0 12058 0 417189 0 0 0 SUSAN S CUMMING MD MEDICAL DIRECTOR, PATIENT EXPERIENCE 330067 0 0 0 2269 0 23996 0 32526 0 388858 0 0 0 ELIZABETH KOLCUN CHIEF DEVELOPMENT OFFICER 292565 0 0 0 45314 0 15541 0 34005 0 387425 0 0 0 DAVID KLEIN MD CEO EFFECTIVE 9/2020 287172 0 0 0 66793 0 0 0 3542 0 357507 0 0 0 MICHAEL K KING LEAD IR TECHNOLOGIST 308374 0 0 0 0 0 18675 0 18953 0 346002 0 0 0 KARIN SHAVELSON MD FAAP CHIEF MEDICAL OFFICER START 7/2020 155080 0 0 0 12991 0 0 0 2909 0 170980 0 0 0 PART I, LINES 4A-B LEE DOMANICO RECEIVED A SEVERANCE PAYMENT OF $140,000 DURING THE 2020 CALENDAR YEAR; IN ADDITION, JON FRIEDENBERG RECEIVED A SEVERANCE PAYMENT OF $320,000 DURING THE 2020 CALENDAR YEAR. BOTH PAYMENTS HAVE BEEN REPORTED AS TAXABLE COMPENSATION TO THE INDIVIDUALS. LEE DOMANICO ENTERED INTO A SPLIT INTEREST AGREEMENT WITH THE ORGANIZATION IN 2019 IN THE FORM OF A LIFE INSURANCE POLICY, WHEREBY THE ORGANIZATION WILL PAY PREMIUMS ON A LIFE INSURANCE POLICY THAT LEE DOMANICO WILL OWN. THERE HAS BEEN NO ADDITIONAL FUNDING TO THE SPLIT INTEREST AGREEMENT IN 2020. PART II, COLUMN (B)(III) THE "OTHER REPORTABLE COMPENSATION" IN SCHEDULE J, PART II, COLUMN (B)(III) RECEIVED BY CERTAIN MEMBERS OF THE EXECUTIVE TEAM REPRESENTS HEALTH AND WELFARE BENEFITS, DEFINED BENEFIT RETIREMENT PLAN, DISABILITY, LONG-TERM CARE INSURANCE, LIFE INSURANCE, AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE, WHICH WAS ALL INCLUDED IN THEIR FORM W-2 AS TAXABLE COMPENSATION. A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SUG7 2018-05-23 100032761 CONSTRUCT NEW HOSPITAL FACILITY/AMBULATORY SERVICES BLDG/PARKING STRUCTURE 0 0 0 A 100032761 1132761 1032931 49114356 48752713 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 LEE DOMANICO CHIEF EXECUTIVE OFFICER SPLIT-DOLLAR LIFE INSURANCE X 5000000 4605577 0 1 1 4605577 FORM 990, PART VI, SECTION A, LINE 6 MARINHEALTH MEDICAL CENTER (MHMC) HAS ONE GENERAL MEMBER, MARIN HEALTHCARE DISTRICT (MHD), A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA. IN ADDITION, THE BYLAWS PROVIDE FOR A "SPECIAL MEMBER" (WITH THE POWER TO NOMINATE 2 MEMBERS OF THE BOARD OF DIRECTORS): THE REGENTS OF THE UNIVERSITY OF CALIFORNIA ON BEHALF OF UCSF HEALTH. FORM 990, PART VI, SECTION A, LINE 7A MARIN HEALTHCARE DISTRICT (THE "GENERAL MEMBER") DOES NOT HAVE THE POWER TO APPOINT MEMBERS OF THE GOVERNING BODY; HOWEVER, THE GENERAL MEMBER DOES HAVE THE RIGHT TO REJECT ALL APPOINTEES TO THE BOARD OF DIRECTORS. THE REGENTS OF THE UNIVERSITY OF CALIFORNIA ON BEHALF OF UCSF HEALTH (THE "SPECIAL MEMBER") MAY NOMINATE TWO MEMBERS OF THE BOARD OF DIRECTORS, WHO MUST ALSO BE APPROVED BY THE GENERAL MEMBER. FORM 990, PART VI, SECTION A, LINE 7B NEITHER THE BOARD NOR ANY OFFICER OR EMPLOYEE OF MHMC MAY TAKE ANY OF THE FOLLOWING ACTIONS, OR APPROVE A SUBSIDIARY OR AN AFFILIATE TAKING THE FOLLOWING ACTIONS, WITHOUT THE PRIOR APPROVAL, OR ANY OF THE SPECIFIED ACTIONS, OF THE GENERAL MEMBER: (A) ANY CORPORATE MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THIS CORPORATION THAT WOULD CHANGE THE GENERAL MEMBER'S STATUS AS SOLE CORPORATE MEMBER OR OWNER OF THE LAND AND ASSETS LEASED BY THIS CORPORATION; (B) ANY TRANSACTION REQUIRING THE CONSENT OR APPROVAL OF THE GENERAL MEMBER PURSUANT TO THE LEASE OF THE MHMC CAMPUS AND FACILITIES BY THE GENERAL MEMBER TO THIS CORPORATION, COMMENCING DECEMBER 2, 2015, AS IT HAS BEEN OR MAY BE AMENDED ("THE LEASE"). (C) ANY MATERIAL TRANSFER BY SALE, LEASE, DEBT OR ENCUMBRANCE, OR OTHER DISPOSITION, OF ANY OF THE ASSETS OF THE CORPORATION, REAL OR PERSONAL, OUTSIDE THE ORDINARY COURSE OF HOSPITAL BUSINESS. NOTWITHSTANDING THE FOREGOING, THE FOLLOWING WILL NOT REQUIRE THE PRIOR APPROVAL OF THE GENERAL MEMBER: (I) ANY TRANSACTION AMOUNTING TO A TRANSFER OF LESS THAN TEN PERCENT (10%) OF THE ASSETS OF THE CORPORATION, AS OF THE MONTH IMMEDIATELY PRECEDING THE TRANSACTION, TO ANOTHER LEGAL ENTITY IN CONNECTION WITH AN AFFILIATION OR JOINT VENTURE INVESTMENT OR SERVICE OPERATION OFF THE MHMC CAMPUS; (II) A FINANCING TRANSACTION, INCLUDING, BUT NOT LIMITED TO, DEBT FINANCING OR BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS, EXPECTED TO AMOUNT IN TOTAL PRINCIPAL VALUE TO LESS THAN TEN PERCENT (10%) OF NET PATIENT SERVICES REVENUE, AS OF THE MONTH IMMEDIATELY PRECEDING THE TRANSACTION; (III) THE GENERAL MEMBER SHALL IN ITS DISCRETION CONSIDER EXTENDING THE ABOVE THRESHOLD REQUIREMENTS BASED ON ADDITIONAL PERCENTAGES OF TOTAL ASSETS OR PATIENT REVENUE, AND ANY SUCH ALLOWANCE SHALL COMPLY WITH APPLICABLE CALIFORNIA LAWS OR REGULATIONS GOVERNING TRANSFERS OF ASSETS OF A HEALTHCARE DISTRICT (E.G., HEALTH & SAFETY CODE SECTION 32121 (P)). (D) IN ADDITION TO THRESHOLDS FOR APPROVALS REQUIRED FOR INDIVIDUAL TRANSACTIONS DESCRIBED IN SUBSECTION (C) ABOVE, APPROVAL OF THE GENERAL MEMBER SHALL BE REQUIRED FOR ANY TRANSACTION WHICH, ON A PROFORMA BASIS, WOULD CAUSE THE CORPORATION TO BE IN VIOLATION OF ANY FINANCIAL LOAN OR BOND COVENANT, AS THEY EXIST AT THE TIME OF THE TRANSACTION, OR THAT WOULD CAUSE THE CORPORATION'S DEBT TO CAPITALIZATION RATIO TO EXCEED 50%. (E) ANY TRANSACTIONS WITH LONG-TERM (MORE THAN THREE-YEAR) LAND OR FACILITY IMPACTS (E.G., NEW CONSTRUCTION OR RENOVATION) REQUIRING GENERAL MEMBER APPROVAL PURSUANT TO THE LEASE OR COSTING THE EQUIVALENT OF TEN PERCENT (10%) OR MORE OF MHMC THEN EXISTING TOTAL ASSETS (APPROXIMATELY $27 MILLION AT DECEMBER 31, 2015). (F) ANY LONG-TERM CAMPUS DEVELOPMENT PLAN THAT RESTRICTS FUTURE LAND USE OPTIONS OR REQUIRES REGULATORY CHANGES TO LAND USE PERMITS/DESIGNATIONS WILL REQUIRE GENERAL MEMBER APPROVAL. (G) ANY TRANSACTION THAT CAUSES OR IS ANTICIPATED TO CAUSE A DOWNGRADE IN BOND RATING BY A STANDARD RATING AGENCY REQUIRES GENERAL MEMBER APPROVAL REGARDLESS OF SIZE OF THE TRANSACTION. (H) THE GENERAL MEMBER SHALL RETAIN AN INDEPENDENT AUDIT FIRM CONSISTENT WITH STANDARD INDUSTRY FINANCIAL PRACTICE ON BEHALF OF THE CORPORATION. THE AUDIT FIRM WILL THEN PROVIDE SERVICES TO MHMC'S MANAGEMENT AND ITS BOARD AS OVERSEEN BY THE MHMC BOARD AUDIT SUBCOMMITTEE. FINAL AUDIT REPORTS WILL BE PRESENTED TO THE GENERAL MEMBER (SUBJECT TO PUBLIC REVIEW), THE BOARD, AND MANAGEMENT OF MHMC. (I) CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL, OR SUBSTANTIALLY ALL (50 PERCENT OR GREATER), OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THIS CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. (J) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION. (K) BYLAW APPROVALS (L) ANY CHANGES TO THE MISSION STATEMENT OF THE CORPORATION FOR MHMC. (M) ANY CHANGES TO THE CORPORATE DISSOLUTION RIGHTS (INITIATION OF DISSOLUTION AND DISPOSITION OF ASSETS) OF THE GENERAL MEMBER. (N) APPROVAL OF INDIVIDUALS FOR BOARD MEMBERSHIP. IN ADDITION, THE SPECIAL MEMBER SHALL HAVE THE FOLLOWING RIGHTS AND PRIVILEGES: (A) TO NOMINATE INDIVIDUALS TO SERVE ON THE BOARD OF DIRECTORS AS "SPECIAL MEMBER NOMINEES; AND (B) TO APPROVE CERTAIN AMENDMENTS TO THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTANT, IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. THE DRAFT FORM 990 IS THEN REVIEWED BY THE CONTROLLER AND CFO; ADJUSTMENTS ARE MADE, AS NECESSARY. A COMPLETE COPY OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH INDIVIDUAL BOARD MEMBER AND OFFICER SIGNS AN ACKNOWLEDGEMENT FORM THAT THEY HAVE READ THE CONFLICT OF INTEREST POLICY. IN ADDITION, A DISCLOSURE STATEMENT IS COMPLETED BY ALL OFFICERS AND BOARD MEMBERS ANNUALLY. ON THIS STATEMENT THE COVERED INDIVIDUAL LISTS A WIDE RANGE OF INFORMATION WHICH INCLUDES BUSINESS RELATIONSHIPS, EMPLOYMENT RELATIONSHIPS, PROPERTY INTERESTS, AND THOSE OF RELATED PARTIES. THE CEO AND BOARD CHAIR REVIEWS THESE STATEMENTS AND MONITORS SITUATIONS THAT MAY POSE A POTENTIAL CONFLICT OF INTEREST. THE CEO AND BOARD CHAIR MAY CONSULT WITH LEGAL COUNSEL AS NECESSARY. IN THE EVENT OF A POTENTIAL CONFLICT OF INTEREST, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE AND NATURE OF THE RELATIONSHIP. THE BOARD CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE CONFLICT. UNTIL THE POTENTIAL CONFLICT IS RESOLVED, THE BOARD CHAIR MAY REQUEST THE CONFLICTED INDIVIDUAL TO LEAVE THE ROOM OR NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE CONFLICTED INDIVIDUAL SHALL REFRAIN FROM VOTING ON ANY MATTER RELATED TO THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE HOSPITAL'S BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE EXECUTIVE COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS-LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF THE HOSPITAL'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. IN ORDER TO ENSURE EXTERNAL COMPETITIVENESS, NATIONAL, CALIFORNIA AND LOCAL MARKET AREA COMPENSATION DATA COMPARISONS ARE REVIEWED. COMPETITIVE ANALYSIS INCLUDES: (A) BASE SALARY, (B) TOTAL CASH (BASE SALARY + ANNUAL INCENTIVE), AND (C) TOTAL REMUNERATION (BASE SALARY + ANNUAL INCENTIVE + BENEFITS AND LONG-TERM INCENTIVE). THIS ANALYSIS INCLUDES COMPARABLE ORGANIZATIONS AND GEOGRAPHIC CONSIDERATIONS. FOR THE MOST SENIOR EXECUTIVE POSITIONS, NATIONAL AND REGIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS THE HOSPITAL ARE MOST APPROPRIATE. ALL OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION UNDERGO A REVIEW ANNUALLY. 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. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 37,195,591. MANAGEMENT AND GENERAL EXPENSES 12,544,486. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,740,077. PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 18,314,677. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,314,677. FORM 990, PART XI, LINE 9: BENEFIT PLAN RELATED CHANGES -11,309,399. CHANGE IN BENEFICIAL INTEREST IN MARINHEALTH FOUNDATION -4,988,162. MARIN HEALTHCARE DISTRICT 100B DRAKES LANDING ROAD SUITE 250 GREENBRAE CA 94904 911886269 HEALTH CARE CA N/A 0 MARIN GENERAL HOSPITAL FOUNDATION 100B DRAKES LANDING ROAD SUITE 250 GREENBRAE CA 94904 946127213 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I MARIN GENERAL HOSPITAL 1 PRIMA MEDICAL FOUNDATION 4 HAMILTON LANDING SUITE 100 NOVATO CA 94949 271376321 PHYSICIAN MEDICAL FOUNDATION CA 501(C)(3) LINE 10 MARIN GENERAL HOSPITAL 1 0 1 1 1 1 0 0 0 1 0 1 1 1 1 1 1 1 1 1 MARIN GENERAL HOSPITAL FOUNDATION C 12244393 BOOK VALUE MARIN GENERAL HOSPITAL FOUNDATION D 50589 BOOK VALUE MARIN GENERAL HOSPITAL FOUNDATION O 774987 BOOK VALUE PRIMA MEDICAL FOUNDATION B 27903470 BOOK VALUE PRIMA MEDICAL FOUNDATION D 7671582 BOOK VALUE PRIMA MEDICAL FOUNDATION L 8455043 BOOK VALUE