2019-08-14T13:40:52-05:00 2018-09-30 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2017-10-01 941294954 VALLEY CHILDREN'S HOSPITAL VALL 5593533000 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 MICHELE WALDRON CFO 5593533000 2019-08-13 1 TRACY S PAGLIA P00366884 2099556100 2019-08-13 12.129.4.211 2019-08-13 16:31:07 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 BE861C6778D90A5D3E7861ABDDE45BE6309F51A4 2017 2019-02-21 02:37:17Z MICHELE WALDRON 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 1403971919 0 X WWW.VALLEYCHILDRENS.ORG X 1949 CA PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTHCARE SERVICES TO CHILDREN 14 11 3570 424 0 0 24828237 34039952 532224270 614207247 48604582 24789411 19645264 20176687 625302353 693213297 13187157 38678604 0 0 291045351 302339673 0 0 0 254453232 293519984 558685740 634538261 66616613 58675036 1214830788 1540317940 228566436 473320364 986264352 1066997576 X TO PROVIDE HIGH QUALITY COMPREHENSIVE HEALTHCARE SERVICES TO CHILDREN REGARDLESS OF THEIR ABILITY TO PAY AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN. 0 0 87389889 38678604 334519190 SEE SCHEDULE O 411596659 0 279688057 SEE SCHEDULE O 498986548 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 319 0 1 3570 1 1 1 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X MICHELE WALDRON CFO 5593533000 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 TODD SUNTRAPAK CEO 17.50 32.50 X X 1448458 0 231125 DR LINDA FRALEY BOARD MEMBER (TERMED 12/31/2017) 1.00 1.00 X 0 0 0 DAVE NALCHAJIAN BOARD SECRETARY/TREASURER/VICE CHAIR 1.00 1.00 X X 0 0 0 RILEY WALTER BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL HANSON BOARD MEMBER 1.00 X 0 0 0 BILL SMITTCAMP BOARD CHAIR 1.00 1.00 X X 0 0 0 KIM RUIZ BECK BOARD MEMBER 1.00 1.00 X 0 0 0 JEANNINE CAMPOS GRECH BOARD TREASURER/ CHAIR 1.00 1.00 X X 0 0 0 FRED LANINGHAM MD CHIEF OF STAFF (TERMED 2/2018) 1.00 X 75000 0 0 ADAM HOLMES CHIEF OF STAFF 1.00 X 0 0 0 JOSE ELGORRIAGA BOARD MEMBER 1.00 X 0 0 0 MENDY LAVAL BOARD MEMBER 1.00 X 0 0 0 ROB YRACEBURU BOARD MEMBER 1.00 X 0 0 0 ALLISON KARAHADIAN BOARD MEMBER (TERMED 1/2018) 1.00 X 0 0 0 VICKI BURKHALTER BOARD MEMBER 1.00 X 0 0 0 SISSY DALENA WOOD BOARD MEMBER 1.00 X 0 0 0 DEBRA FLORES PRESIDENT & COO 40.00 X X 149415 0 0 MICHELE R WALDRON SENIOR VP, CFO 18.50 31.50 X 760513 0 131999 DAVID CHRISTENSEN SENIOR VP, CPE 27.00 18.00 X 871294 0 129257 BEVERLY HAYDEN-PUGH SENIOR VP, CLINICAL INTEGRATION/CNO 18.00 27.00 X 719995 0 119050 JESSIE HUDGINS VP, FACILITIES 40.00 X 448671 0 121104 NATALE PONTICELLO JR SENIOR VP, CHIEF PEOPLE OFFICER 29.00 11.00 X 468794 0 67565 JANE WILLSON SENIOR VP, CHIEF STRATEGY OFFICER 8.00 32.00 X 553768 0 102626 DAVID SINGH VP, CHIEF OPERATING OFFICER VCMG 20.00 20.00 X 463533 0 68414 MICHAEL GOLDRING PRESIDENT, VCMG 12.00 28.00 X 627717 0 94711 STEPHANIE VANCE FINANCE, VP 40.00 X 374680 0 85242 JOEL BROWNELL MD VP, CHIEF MEDICAL INFORMATION OFFICE 40.00 X 438755 0 83167 KAREN DAHL VP, QUALITY & PATIENT SAFEY 40.00 X 492690 0 78881 KEVIN SHIMAMOTO VP AND CIO 40.00 X 455495 0 75519 DANIEL DAVIS VP, PATIENT CARE 40.00 X 351517 0 82626 DANIELLE BARRY VP, REVENUE CYCLE MGMT 40.00 X 294556 0 65037 WILLIAM CHALTRAW SENIOR VP/CHIEF LEGAL OFFICER 40.00 X 465757 0 77675 BRIAN SMULLIN VP MANAGED CARE 40.00 X 268617 0 44974 DAVID HODGE JR VP ANCILLARY SERVICES 40.00 X 323438 0 50267 LYNNE ASHBECK SVP, COMMUNITY ENGAGEMENT & POPULATION WELLNESS 40.00 X 231690 0 0 YVONNE WOOD MANAGER PATIENT THROUGHPUT 40.00 X 237470 0 48367 PAUL LEBBY NEURODEVELOPMENT PROGRAM DIRECTOR 40.00 X 231370 0 33183 AMY BOLING RN IV CRITICAL CARE 40.00 X 240494 0 45770 JOLIE LIMON EXECUTIVE DIRECTOR MEDICAL EDUCATION 40.00 X 304167 0 17677 TRACY BLAIR EXEC DIR/DEP GENERAL COUNSEL 40.00 X 264263 0 21190 11562117 0 1875426 695 0 1 0 VALLEY CHILDREN'S MEDICAL GROUP 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 SUBSPEC PHYSICIAN SERVICES 57925000 PEDIATRIC ANETHESIA ASSOCIATES 6235 N FRESNO ST STE 103 FRESNO CA 93710 ANETHESIA/CRITICAL CARE 12323668 SODEXO INC & ASSOCIATES PO BOX 360170 PITTSBURGH PA 152516170 HOUSEKEEPING SERVICES 5375436 TECH KNOWLEDGE ASSOC 1 CENTERPOINT DR ST 200 LA PALMA CA 906232529 BIOMED EQIPMENT MAINTENANCE 3825381 ZUMWALT CONSTRUCTION INC 5520 E LAMONA AVE FRESNO CA 93727 CONSTRUCTION SERVICES 3754161 98 7902144 25688948 448860 11373 34039952 PATIENT SERVICES 900099 610224759 610224759 MANAGEMENT SERVICES 541610 3835988 3835988 LAB SERVICES 900099 146500 146500 614207247 17756832 17756832 1276392 1276392 396876 323309 73567 73567 73567 715911220 1382 710124791 31624 5786429 -30242 5756187 5756187 612978 278898 334080 334080 CAFETERIA REVENUE 900099 3091619 3091619 16677421 16677421 19769040 693213297 614207247 0 44966098 X 38457549 38457549 221055 221055 17942536 17942536 195376428 158787431 36588997 11593644 10378037 1215607 60523459 44289452 16234007 16903606 12684052 4219554 3088608 100912 2987696 2249303 2249303 179376 179376 3271802 3271802 67378903 67019561 359342 3770689 93375 3677314 82409571 74446181 7963390 6058678 6058678 5768036 4083912 1684124 836037 302940 533097 260798 74855 185943 6865072 5333015 1532057 25562148 15077838 10484310 3264480 359 3264121 HOSPITAL FEE PROGRAM 41708611 41708611 PURCHASED SERVICES 24617210 18329810 6287400 BAD DEBT 7072241 7072241 DUES 2075543 228373 1847170 7082878 296989 6785889 634538261 498986548 135551713 0 13685 14394 216742357 389975007 401514 560199 79144610 75373277 8662016 9763049 14653449 19488786 550093276 279415258 260158665 270678018 332510847 321908138 235911898 296311715 9492668 19506083 57139079 136739274 1214830788 1540317940 60099865 53631715 106083936 115615136 52851435 313604713 228566436 473320364 X 976330656 1032895353 9933696 34102223 986264352 1066997576 1214830788 1540317940 X 58675036 8598776 13459412 X 0 1 X 1 0 X 0 1 0 1 0 0 1 7910 0 1 1526465 1534375 0 PART II-B, LINE 1 VALLEY CHILDREN'S HOSPITAL HAS HAD DIRECT CONTACT WITH AND HAS ENCOURAGED OTHERS TO HAVE DIRECT CONTACT WITH LOCAL, STATE AND FEDERAL LEGISLATORS REGARDING CHILDREN'S HEALTH CARE PUBLIC POLICY. THESE CONTACTS HAVE PROVIDED INFORMATION REGARDING THE PROVISION OF HEALTH CARE SERVICES TO CHILDREN, THE ANTICIPATED EFFECT ON CHILDREN'S HEALTH OF PENDING LEGISLATIVE PROPOSALS, AND REQUESTS FOR ASSISTANCE IN SUPPORTING ACCESS TO CHILDREN'S HEALTH CARE BY MAINTAINING CURRENT STATE AND FEDERAL FUNDING LEVELS FOR MEDI-CAL AND OTHER PUBLIC PROGRAMS. EXPENSES ASSOCIATED WITH THIS ACTIVITY ARE LESS THAN 1% OF TOTAL HOSPITAL EXPENDITURES. VALLEY CHILDREN'S HOSPITAL HAS MADE NO CONTRIBUTIONS TO ANY POLITICAL CANDIDATE OR ELECTED OFFICIAL. SALARIES RELATED TO LOBBYING $7,910 ASSOCIATION DUES RELATED TO LOBBYING NACH 36,622 NACH CONTRIBUTION 2,900 ASSOCIATION FOR HEALTHCARE RESOURCE PROFESSIONALS 74 ASSOCIATION OF AMERICAN MEDICAL COLLEGES 477 CALIFORNIA CHAMBER OF COMMERCE 115 CALIFORNIA CHILDREN'S HOSPITAL ASSOCIATION 1,437,725 CALIFORNIA HOSPITAL ASSOCIATION/AMERICAN HOSP ASSOC 20,661 CHILDREN'S SPECIALTY CARE COALITION 4,810 HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIF. 22,961 NATIONAL ASSOCIATION OF EPILEPSY CENTERS 120 TOTAL EXPENDITURES RELATED TO LEGISLATIVE MATTERS $1,534,375 14953094 14953094 305310536 111260933 194049603 3881003 3028547 852456 199982975 142487704 57495271 25965668 22638074 3327594 270678018 LIMITED PARTNERSHIPS 229737617 F HEDGE FUNDS 66574098 F 296311715 DISPROPORTIONATE SHARE FUNDS RECEIVABLE 8267286 INSURANCE RECEIVABLE 8045954 PROVIDER FEE RECEIVABLE 35005031 457 TRUST FUNDS 3095143 OTHER 11314804 ADVANCE MED FOUNDATION 20194280 PREPAID LEASE ASSET 2440603 PROPOSITION 3 AND PROPOSITION 61 RECEIVABLE 23859167 SPLIT DOLLAR POLICIES 24517006 136739274 MALPRACTICE RESERVE 6106055 ACCRUED PENSION LIABILITY 10685396 457 LIABILITY 3095143 1732 LIABILITY 1208005 WORKERS COMP 4761990 INS LIABILITY 3419010 DC SERP LIABILITY 1860747 VPA HOLDINGS - INVESTMENT DEFICIT 585832 BONDS 281882535 313604713 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 41334949 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 10160147 0 0 0 0 0 0 51495096 0 51495096 1 0 0 0 0 0 1 1 1 X 1 X 1 0 1 1 241142 241142 0.00040 445163394 409380017 35783377 0.05700 60145 13921 46224 0.00010 445464681 409393938 36070743 0.05750 1463146 1463146 0.00230 9039178 929724 8109454 0.01290 957572 318001 639571 0.00100 34334162 34334162 0.05470 45794058 1247725 44546333 0.07090 491258739 410641663 80617076 0.12840 1 2383191 0 208345 385307 -176962 X 1 1 2 1 VALLEY CHILDREN'S HOSPITAL 9300 VALLEY CHILDRENS PLACE MADERA CA 936368761 WWW.VALLEYCHILDRENS.ORG 040000160 X X A 2 VALLEY CHILDREN'S HOME CARE 7555 N DEL MAR AVE FRESNO CA 93711 WWW.VALLEYCHILDRENS.ORG 040000160 X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.VALLEYCHILDRENS.ORG X 1 16 1 WWW.VALLEYCHILDRENS.ORG 0 1 X 200.000000000000 350.000000000000 X X X 1 1 X X X X 1 X WWW.VALLEYCHILDRENS.ORG X WWW.VALLEYCHILDRENS.ORG X WWW.VALLEYCHILDRENS.ORG X X X X X X X 1 X 0 X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: VALLEY CHILDREN'S HOSPITAL, - FACILITY 2: VALLEY CHILDREN'S HOME CARE FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: IN ORDER TO CONDUCT THE REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR FRESNO, KINGS, MADERA AND TULARE COUNTIES, HOSPITAL LEADERS FROM EACH COUNTY, INCLUDING VALLEY CHILDREN'S HOSPITAL, ENGAGED WITH THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA TO FORM THE HOSPITAL COUNCIL COMMUNITY BENEFIT WORKGROUP. THIS WORKGROUP REPRESENTS 15 HOSPITALS THROUGHOUT THE FOUR COUNTIES. UNDER THEIR DIRECTION, CONSULTANTS REVIEWED THE SECONDARY DATA IN THE REGION IN ORDER TO BEGIN LOOKING FOR EVIDENCE OF HEALTH NEEDS, TO DESIGN A COMMUNITY ENGAGEMENT PROCESS TO SOLICIT FEEDBACK ON THESE NEEDS, AND TO CREATE A PROCESS TO PRIORITIZE THESE NEEDS BASED ON COMMUNITY INPUT. CONSULTANTS FROM LEAP SOLUTIONS REVIEWED THREE SOURCES TO DETERMINE WHAT THE MOST COMMON HEALTH NEEDS ARE FOR CONSIDERATION IN A CHNA. INCLUDED IN THE REVIEW WERE METRICS OR INDICATORS IDENTIFIED BY THE CENTER FOR DISEASE CONTROL (CDC) AND METRICS USED BY HEALTHY PEOPLE 2020 INITIATIVE, A COLLABORATION OF THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES AND OTHER FEDERAL AGENCIES AND RESEARCH INSTITUTIONS. CONSULTANTS ALSO REVIEWED THE LIST OF THE MOST COMMONLY IDENTIFIED HEALTH NEEDS ACROSS KAISER PERMANENTE'S CHNA DATA PLATFORM (WWW.CHNA.ORG). AFTER REVIEWING ALL THE LISTS, THE CONSULTANTS FOUND THAT THE 15 POTENTIAL HEALTH NEEDS IDENTIFIED BY THE CHNA DATA PLATFORM ALIGN WELL WITH THOSE DEFINED BY THE CDC AND THOSE USED BY THE HEALTHY PEOPLE 2020 INITIATIVE. THEY WERE ADOPTED FOR USE IN THIS CHNA TO GUIDE THE PRIMARY AND SECONDARY DATA COLLECTION. THESE HEALTH NEEDS ARE: - ACCESS TO CARE - BREATHING PROBLEMS (ASTHMA) - CANCERS - CLIMATE AND HEALTH - CARDIOVASCULAR DISEASE/STROKE (HEART DISEASE) - DIABETES - ECONOMIC SECURITY - HIV/AIDS/STDS - MATERNAL, INFANT AND CHILD HEALTH - MENTAL HEALTH - OBESITY - ORAL HEALTH - OVERALL HEALTH - SUBSTANCE ABUSE - VIOLENCE/INJURY PREVENTIONTHE NEXT STEP IN THE CHNA PROCESS REQUIRED ENGAGING THE COMMUNITY TO SOLICIT THEIR PERCEPTIONS OF THE MOST PRESSING HEALTH NEEDS IN THE COMMUNITY. THIS EFFORT INCLUDED CHNA SURVEYS, FOCUS GROUPS AND KEY STAKEHOLDER INTERVIEWS WITH PUBLIC HEALTH DIRECTORS, HOSPITAL CEOS AND NONPROFIT ORGANIZATION LEADERS SERVING UNIQUE SEGMENTS OF THE COMMUNITY (I.E. THE DISABLED, POOR, OR UNIQUE ETHNIC GROUPS). THESE THREE METHODOLOGIES WERE USED IN ORDER TO REACH COMMUNITY MEMBERS WHO MIGHT BE MORE COMFORTABLE SHARING THEIR PERSPECTIVES ON AN INDIVIDUAL SURVEY VERSUS ATTENDING A FOCUS GROUP. IN ORDER TO LEVERAGE THE OPPORTUNITY TO USE A CONSISTENT SET OF QUESTIONS ACROSS ALL FOUR COUNTIES, THE WORKGROUP SELECTED A CHNA SURVEY DESIGNED BY THE HEALTHY MADERA COALITION WITH THE COUNTY PUBLIC HEALTH DEPARTMENT STAFF. THIRTY-SIX QUESTIONS CENTERED ON KEY HEALTH CONCERNS AND FACTORS THAT INFLUENCE THE HEALTH OF THE COMMUNITY AND INCLUDED DEMOGRAPHIC. THE CHNA SURVEY FOCUSED ON: - COMMUNITY HEALTH NEEDS, - ENVIRONMENTAL FACTORS THAT INFLUENCE THE HEALTH OF THE COMMUNITY, - BEHAVIORS THAT IMPACT HEALTH - BARRIERS TO GETTING HEALTH CARE IN THEIR COUNTY - INDICATORS OF A HEALTHY COMMUNITY, AND - FACTORS IN THEIR COMMUNITIES NEEDING MOST IMPROVEMENT. THE SURVEY WAS PROVIDED THROUGH SURVEY MONKEY, AN ONLINE WEB PLATFORM, IN BOTH SPANISH AND ENGLISH AND CORRESPONDING WEBSITE LINKS WERE EMAILED TO HOSPITAL AND FACILITY STAFF AS WELL AS COMMUNITY MEMBERS. THE SURVEY LINK WAS CONFIGURED TO ALLOW FOR CONFIDENTIALITY OF RESPONSES AND THE SURVEY WAS AVAILABLE FROM JULY 1, 2015 TO DECEMBER 2, 2015. TWO COMMUNITY ORGANIZATIONS WERE CONTRACTED TO ASSIST WITH THE COMMUNITY OUTREACH EFFORTS. THESE WERE: FRESNO METRO MINISTRYA NONPROFIT ESTABLISHED IN 1970 WITH A MISSION TO ADVOCATE FOR THE HEALTH AND WELL-BEING OF THE COMMUNITY AND CENTRO LA FAMILIA ADVOCACY SERVICESA NONPROFIT WORKING TO EMPOWER LOW INCOME PEOPLE TO ACCESS LIFE SUSTAINING RESOURCES THROUGH EDUCATION, TRAINING AND SOCIAL SERVICES. IN ADDITION, THE MADERA COUNTY DEPARTMENT OF PUBLIC HEALTH AND CAMARENA HEALTH, A FEDERALLY QUALIFIED HEALTH CENTER, ASSISTED WITH THE OUTREACH EFFORTS IN THEIR OWN COUNTY AND PROVIDED THE COMMUNITY SURVEY USED FOR THIS CHNA. FOCUS GROUPSA TOTAL OF 15 FOCUS GROUPS WERE CONDUCTED RANGING IN SIZE FROM 4 TO 24 PARTICIPANTS. THE FOCUS GROUPS WERE ATTENDED BY HOSPITAL AND FACILITY STAFF, COMMUNITY LEADERS FROM NONPROFIT AND FAITH-BASED ORGANIZATION AND ELECTED OFFICIALS AND RESIDENTS. THESE SESSIONS WERE CONDUCTED PRIMARILY IN ENGLISH. OTHER FOCUS GROUPS WERE COMPRISED OF PRIMARILY RESIDENTS, INCLUDING MOTHERS AND YOUTH, AND WERE CONDUCTED IN ENGLISH AND SPANISH. CHILDCARE WAS PROVIDED AT TWO OF THE FOCUS GROUPS. ALL OF THE FOCUS GROUPS FOLLOWED THE SAME FORMAT AND AGENDA: - AN INTRODUCTION AND OVERVIEW OF THE CHNA PROCESS AND PURPOSE- A REVIEW OF EIGHT KEY HEALTH INDICATORS TO UNDERSTAND HOW THE COUNTIES RANKED IN COMPARISON WITH CALIFORNIA AND THE UNITED STATES- A REVIEW OF HOW OTHER RESIDENTS AND HEALTH CARE WORKERS RESPONDED TO THE CHNA SURVEY AND WHETHER THOSE ATTENDING AGREE OR DISAGREE WITH MOST COMMON RESPONSES TO THE ABOVE-MENTIONED FIVE KEY QUESTIONS (Q11, Q12, Q13, Q14 AND Q16- A LARGE GROUP DISCUSSION WAS FACILITATED ON THREE ADDITIONAL QUESTIONS THAT WERE USED TO SEEK THE GROUP'S CONSENSUS ON: WHAT ARE SOME KEY SERVICES YOU BELIEVE WOULD HELP ADDRESS THESE CHALLENGES FROM THE FOLLOWING OPTIONS: 1. MORE COMMUNITY CLINICS/AMBULATORY CENTERS 2. MORE REGIONAL INITIATIVES ON COMMUNITY HEALTH 3. ENGAGING NONPROFITS IN COORDINATED CARE 4. USING COMMUNITY ADVISORY COUNCILS 5. MORE PATIENT SUPPORT GROUPS 6. MORE HEALTH EDUCATION FAIRS/ EVENTS 7. MORE UPSTREAM HEALTH INTERVENTIONS 8. OTHER: WHAT ONE EFFORT WOULD MAKE THE GREATEST IMPACT ON HEALTH OUTCOMES IN YOUR COMMUNITY FROM THE FOLLOWING OPTIONS: 1. MORE DISEASE PREVENTION EFFORTS 2. MORE COORDINATED CARE PROGRAMS/SERVICES 3. MORE UPSTREAM HEALTH INITIATIVES 4. BETTER COMMUNITY INFRASTRUCTURE TO SUPPORT HEALTHY LIVING 5. IMPROVED HEALTH EDUCATION 6. IMPROVED ENVIRONMENTAL CONDITIONS 7. IMPROVED ECONOMIC CONDITIONS 8. OTHER ARE YOU AWARE OF ANY NEW PROGRAMS OR SERVICES THAT WERE CREATED IN THE LAST THREE YEARS THAT HAVE THE POTENTIAL TO ADDRESS YOUR COMMUNITY'S HEALTH NEEDS?IN ORDER TO KEEP EACH OF THE FOCUS GROUPS TO A 60-MINUTE FORMAT, IT WAS NECESSARY TO CHOOSE AMONG A SIGNIFICANT AMOUNT OF SECONDARY DATA TO SHARE WITH PARTICIPANTS. THE CONSULTANTS SELECTED HEALTH INDICATORS DIRECTLY LINKED TO THE RESULTS OF THE 2013 HOSPITAL COUNCIL REGIONAL CHNA REPORT PRODUCED FOR THE SAME FOUR COUNTIES. THIS ALLOWED THE FOCUS GROUP PARTICIPANTS TO CONTINUE DISCUSSING ASTHMA, OBESITY, ACCESS TO CARE, MENTAL HEALTH AND SOCIOECONOMIC FACTORS THAT WERE CONCERNS RAISED IN 2013 CHNA.KEY STAKEHOLDER INTERVIEWSTHE WORKGROUP IDENTIFIED APPROXIMATELY 95 KEY STAKEHOLDERS IN THE REGION WHO WOULD BE IMPORTANT TO INTERVIEW. CONSULTANTS CONTACTED EACH STAKEHOLDER OFFERING TO CONDUCT PHONE OR IN-PERSON INTERVIEWS. PARTICIPANTS IN THIS EFFORT INCLUDED: COUNTY PUBLIC HEALTH DIRECTORS, HOSPITAL EXECUTIVES AND NONPROFIT LEADERS WHO SERVE THE COMMUNITY WITH SOCIAL, HEALTH, OR EDUCATIONAL SUPPORT SERVICES. THESE KEY STAKEHOLDERS WERE SELECTED AS THEY COULD PROVIDE A UNIQUE PERSPECTIVE ON THE HEALTH OF THE COMMUNITY, HEALTH CARE DELIVERY SYSTEMS AND OVERALL CONDITIONS THAT INFLUENCE HEALTH BEHAVIORS. IN ADDITION, THE CHNA COMMUNITY OUTREACH ALSO INVOLVED THE TULE RIVER NATION ELDERS AND TRIBAL COUNCIL MEMBERS IN TULARE COUNTY. EACH STAKEHOLDER WAS GIVEN THE OPPORTUNITY TO REVIEW THE KEY HEALTH INDICATORS FOR THEIR COUNTY AND THEN WAS ASKED TO RANK RESPONSES TO THE FIVE KEY QUESTIONS REVIEWED BY THE FOCUS GROUPS.IDENTIFYING HEALTH NEEDSIN ORDER TO IDENTIFY THE HEALTH NEEDS IN THIS CHNA REPORT, THE WORKGROUP AND HEALTH OFFICERS FROM EACH COUNTY'S DEPARTMENT OF PUBLIC HEALTH MET NOVEMBER 12, 2015 TO REVIEW THE SURVEY DATA AND A SUMMARY OF SECONDARY DATA ON THE HEALTH NEEDS FOR ALL FOUR COUNTIES. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A: - ADVENTIST HEALTH CENTRAL - HANFORD- ADVENTIST HEALTH CENTRAL - REEDLEY- ADVENTIST HEALTH CENTRAL - SELMA- COMMUNITY REGIONAL MEDICAL CENTER FRESNO- CLOVIS COMMUNITY MEDICAL CENTER- COALINGA REGIONAL MEDICAL CENTER- KAISER PERMANENTE FRESNO REGION - KAWEAH DELTA HEALTH CARE DISTRICT - MADERA COMMUNITY HOSPITAL - SAINT AGNES MEDICAL CENTER - SAN JOAQUIN VALLEY REHABILITATION HOSPITAL- SIERRA VIEW DISTRICT HOSPITAL- TULARE REGIONAL MEDICAL CENTER FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: - HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA- MADERA COUNTY PUBLIC HEALTH DEPARTMENT- CENTRO LA FAMILIA- FRESNO METRO MINISTRY FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13B: 200% OR LESS FEDERAL POVERTY GUIDELINES (FPG) - FULL CHARITABLE DISCOUNT $0 CHARGES.201%-350% FPG - LOW INCOME DISCOUNT NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.350% - HIGH MEDICAL COST DISCOUNT, INCOME FOR THE LAST 12 MONTHS DOES NOT EXCEED 350% OF FPG AND THEY HAVE NOT RECEIVED A DISCOUNTED RATE FROM THE HOSPITAL AS A RESULT OF THEIR THIRD-PARTY INSURANCE COVERAGE AND THEIR ANNUAL OUT-OF-POCKET MEDICAL EXPENSES. FOR THE PRIOR 12 MONTHS EXCEED 10% OF THEIR FAMILY'S ANNUAL INCOME. NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.351% AND GREATER THAN FPG - PROMPT PAY DISCOUNT 25% DISCOUNT FROM CHARGES FOR PATIENTS WHO PAY THEIR BALANCE IN FULL WITHIN 30 DAYS. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 16J: ADDITIONALLY THE POLICY IS SENT BY US POSTAL SERVICE TO COMMUNITY AGENCIES TO BE DISTRIBUTED.IN CONNECTION WITH A REVIEW IN JULY 2018 OF COMPLIANCE BY VALLEY CHILDREN'S HOSPITAL (THE ORGANIZATION") WITH THE FINAL REGULATIONS UNDER 501(R) OF THE CODE (THE "JULY 2018 REVIEW"), TWO COMPLIANCE ITEMS WERE IDENTIFIED AND CORRECTED AS PROMPTLY AFTER DISCOVERY AS WAS REASONABLE: A. ADOPTION OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ("FAP") AND EMERGENCY MEDICAL CARE POLICY (TOGETHER WITH THE FAP, THE "POLICIES, AND EACH A "POLICY") PURSUANT TO TREAS. REG. 1.501(R)-4(D)(1). 1. ISSUE: THE BOARD OF TRUSTEES (THE "BOARD"), AN AUTHORIZED BODY OF THE HOSPITAL FACILITY (AS DEFINED IN TREAS. REG. 1.501(R)-1(B)(4)), ADOPTED THE FAP ON AUGUST 14, 1991. THE BOARD ADOPTED THE EMERGENCY MEDICAL CARE POLICY IN MAY 1999. EACH POLICY WAS PERIODICALLY UPDATED, INCLUDING IN RESPONSE TO THE REGULATIONS UNDER 501(R) OF THE CODE. EACH AMENDED POLICY WAS APPROVED BY THE CHIEF EXECUTIVE OFFICER ("CEO") OF THE ORGANIZATION, BASED ON THE ORGANIZATION'S UNDERSTANDING THAT THE BOARD HAD DELEGATED TO THE CEO THE AUTHORITY TO APPROVE UPDATED VERSIONS OF EACH POLICY. THE CEO IS PERMITTED UNDER STATE LAW TO ACT ON BEHALF OF THE BOARD. DURING THE JULY 2018 REVIEW, THE ORGANIZATION WAS NOT ABLE TO LOCATE A RECORD OF DELEGATION OF AUTHORITY BY THE BOARD TO THE CEO TO ADOPT REVISED VERSIONS OF THE POLICIES. NO PERSONS WERE AFFECTED BY SUCH ERROR, WHICH WAS DUE TO ADMINISTRATIVE OVERSIGHT. 2. CORRECTION: ON NOVEMBER 18, 2018, THE BOARD (I) ADOPTED THE CURRENT, REVISED VERSION OF EACH POLICY, AND (II) DELEGATED AUTHORITY TO THE CEO TO ADOPT FUTURE REVISIONS TO EITHER POLICY. 3. PRACTICES/PROCEDURES: AS DESCRIBED ABOVE, THE ORGANIZATION UPDATED ITS PRACTICES AND PROCEDURES BY DOCUMENTING THE DELEGATION OF AUTHORITY BY THE BOARD TO THE CEO TO ADOPT REVISED VERSIONS OF THE POLICIES.B. STATEMENTS REQUIRED TO BE INCLUDED IN THE FAP PURSUANT TO TREAS. REG. 1.501(R)-4(B). 1. ISSUE: DURING THE JULY 2018 REVIEW, THE ORGANIZATION IDENTIFIED CERTAIN ASPECTS OF ITS FAP WHICH COULD BE UPDATED IN ORDER TO MORE CLEARLY COMPLY WITH THE REGULATIONS UNDER 501(R) OF THE CODE. IN PARTICULAR, THE FAP: A) IMPLIED BUT DID NOT EXPRESSLY STATE IN THE "LOW INCOME DISCOUNT" SECTION OF THE FAP THAT A FAP-ELIGIBLE INDIVIDUAL MAY NOT BE CHARGED MORE THAN AMOUNTS GENERALLY BILLED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE (SEE TREAS. REG. 1.501(R)-1(B)(24)(VII)); B) INDICATED THAT CERTAIN PROVIDERS DELIVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IN THE HOSPITAL FACILITY WERE NOT REQUIRED TO FOLLOW THE FAP BUT DID NOT INCLUDE AN ITEMIZED LIST OF SUCH PROVIDERS AS INDICATED IN IRS NOTICE 2015-46 (SEE TREAS. REG. 1.501(R)-4(B)(1)(III)(F)); AND C) DISCLOSED THE OFFICE, DEPARTMENT, COMMITTEE OR OTHER BODY WHICH WAS GENERALLY IN CHARGE OF MANAGING THE DECISIONS RELATING TO THE FAP BUT DID NOT EXPRESSLY STATE THAT SUCH OFFICE, DEPARTMENT, COMMITTEE OR OTHER BODY HAD FINAL AUTHORITY OR RESPONSIBILITY FOR DETERMINING THAT THE ORGANIZATION HAS MADE REASONABLE EFFORTS TO DETERMINE WHETHER AN INDIVIDUAL IS FAP-ELIGIBLE AND MAY THEREFORE ENGAGE IN AN EXTRAORDINARY COLLECTION ACTION AGAINST THE INDIVIDUAL (SEE TREAS. REG. 1.501(R)-4(B)(4)(I)(C)). THE ORGANIZATION IS NOT AWARE OF ANY PERSONS AFFECTED BY THESE POINTS REQUIRING ADDITIONAL CLARIFICATION. 2. CORRECTION: PROMPTLY UPON LEARNING OF THE OMISSIONS DESCRIBED ABOVE, THE ORGANIZATION REVISED ITS FAP TO PROVIDE FURTHER CLARIFICATION WITH RESPECT TO EACH OF THESE POINTS. AS DESCRIBED ABOVE, THE BOARD APPROVED THE REVISED FAP ON NOVEMBER 18, 2018. 3. PRACTICES/PROCEDURES: AS THE JULY 2018 REVIEW FACILITATED THE PROMPT IDENTIFICATION AND CORRECTION OF THE OMISSIONS DESCRIBED ABOVE, NO FURTHER CHANGES WERE NECESSARY TO THE ORGANIZATION'S PRACTICES OR PROCEDURES. TO ENSURE CONTINUED COMPLIANCE, THE ORGANIZATION WILL PERIODICALLY REVIEW THE FAP TO ENSURE THAT IT IS COMPLIANT WITH 501(R) OF THE CODE AND THE REGULATIONS THEREUNDER.C. WIDELY PUBLICIZING THE FAP PURSUANT TO TREAS. REG. 1.501(R)-4(B)(II). 1. ISSUE: DURING THE JULY 2018 REVIEW, THE ORGANIZATION BECAME AWARE THAT THE PLAIN LANGUAGE SUMMARY OF THE FAP APPLICABLE TO EACH HOSPITAL FACILITY INCLUDED THE GENERAL WEBSITE ADDRESS FOR THE HOSPITAL RATHER THAN THE DIRECT WEBSITE ADDRESS WHERE AN INDIVIDUAL CAN OBTAIN COPIES OF THE FAP AND FAP APPLICATION FORM (SEE TREASURY REGULATION 1.501(R)-1(B)(24)(III)). 2. CORRECTION: PROMPTLY UPON LEARNING OF THE ISSUE DESCRIBED ABOVE, THE ORGANIZATION REVISED ITS PLAIN LANGUAGE SUMMARY OF THE FAP TO INCLUDE THE DIRECT WEBSITE ADDRESS WHERE AN INDIVIDUAL CAN OBTAIN COPIES OF THE FAP AND FAP APPLICATION FORM. 3. PRACTICES/PROCEDURES: AS THE JULY 2018 REVIEW FACILITATED THE PROMPT IDENTIFICATION AND CORRECTION OF THE ISSUE DESCRIBED ABOVE, NO FURTHER CHANGES WERE NECESSARY TO THE ORGANIZATION'S PRACTICES OR PROCEDURES. TO ENSURE CONTINUED COMPLIANCE, THE ORGANIZATION WILL PERIODICALLY REVIEW THE PLAIN LANGUAGE SUMMARY OF THE FAP TO ENSURE THAT IT IS COMPLIANT WITH 501(R) OF THE CODE AND THE REGULATIONS THEREUNDER. PART I, LINE 7: CHARITY CARE AT COST WAS CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE DECISION SUPPORT SYSTEM WAS USED TO CALCULATE COST-TO-CHARGE FOR DETERMINING UNREIMBURSED MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THIS DECISION SUPPORT SYSTEM ADDRESSES ALL PATIENT SEGMENTS (I.E INPATIENT, OUTPATIENT, ETC.). 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 $ 7,072,241. PART III, LINE 4: FOOTNOTE DESCRIBING BAD DEBT EXPENSE: SEE PAGE 14, NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS.COSTING METHODOLOGY:ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE ESTIMATED BASED ON HISTORICAL WRITE-OFF PERCENTAGES AND REVIEW OF LARGE BALANCE SELF-PAY ACCOUNTS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBT IF SUBSEQUENTLY COLLECTED. THE COST OF BAD DEBT WRITE-OFFS WERE CALCULATED BY APPLYING THE OVERALL COST TO CHARGE RATIO OF THE ORGANIZATION TO THE CHARGES WRITTEN OFF. PART III, LINE 8: MEDICARE ALLOWABLE COST IS CALCULATED USING THE FILED 2018 MEDICARE COST REPORT. MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMPONENT OF COMMUNITY BENEFIT BECAUSE REIMBURSEMENT IS NOT NEGOTIABLE AND DOES NOT COVER THE COST TO PROVIDE SERVICES. ADDITIONALLY, THE MAJORITY OF THE HOSPITAL'S MEDICARE PATIENTS WOULD BE COVERED BY MEDI CAL IF THEY DID NOT FALL UNDER THE MEDICARE COVERAGE OPTION. PART III, LINE 9B: COLLECTION ATTEMPTS ARE DISCONTINUED ONCE CHARGES ARE DETERMINED TO BE ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE; INSURANCE COLLECTION ATTEMPTS CONTINUE AS APPROPRIATE. PART VI, LINE 2: COMMUNITY HEALTH NEEDS ASSESSMENT: VALLEY CHILDREN'S HOSPITAL'S COMMUNITY BENEFITS PROGRAM IS BASED ON A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). CONSISTENT WITH STATE AND FEDERAL LAW, VALLEY CHILDREN'S HOSPITAL COMPLETES A FORMAL CHNA AT LEAST ONCE EVERY THREE YEARS. VALLEY CHILDREN'S HOSPITAL'S 2018 COMMUNITY BENEFITS PROGRAM IS BUILT UPON THE OUTCOMES OF A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT THAT INCLUDED THE FOLLOWING ACTIVITIES:JOINT NEEDS ASSESSMENT -VALLEY CHILDREN'S HOSPITAL PARTNERED WITH HOSPITALS IN A FOUR-COUNTY REGION TO CONDUCT AN ASSESSMENT OF HEALTH NEEDS FOR BOTH CHILDREN AND ADULTS. COUNTIES COVERED INCLUDED MADERA, KINGS, FRESNO, AND TULARE. THROUGH THEIR REGIONAL HOSPITAL ASSOCIATION, THE HOSPITALS CONTRACTED JOINTLY WITH LEAP SOLUTIONS TO FACILITATE THE CHNA, WHICH WAS CONDUCTED BETWEEN OCTOBER 2015 AND FEBRUARY 2016 AND PUBLISHED IN MARCH 2016. LEAP SOLUTIONS, LLC FOLLOWED SEVERAL STEPS TO ENSURE THAT THE HOSPITALS WOULD HAVE ADEQUATE INFORMATION FROM WHICH TO IDENTIFY POSSIBLE ACTIONS. FIRST, IT WAS IMPORTANT TO REVIEW THE WORK THAT HAD BEEN DONE IN THE PAST AND IDENTIFY OPPORTUNITIES FOR IMPROVEMENT. SECOND, IT WAS ESSENTIAL TO AGREE UPON THE DATA TO BE USED FOR THE REPORT IN ORDER TO APPLY A CONSISTENT SET OF KEY SOCIAL DETERMINANTS OF HEALTH IN EACH OF THE FOUR COUNTIES. SUPPLEMENTAL ASSESSMENT ACTIVITY - IN ADDITION TO THE LEAP SOLUTIONS' FACILITATED ASSESSMENT, VALLEY CHILDREN'S HOSPITAL STAFF ACCESSED OTHER RESOURCES TO FURTHER ASSESS CHILDREN'S HEALTH CARE NEEDS THROUGHOUT THE HOSPITAL'S ENTIRE SERVICE AREA. RESOURCES INCLUDED DATA SOURCES AS WELL AS CONVERSATIONS WITH LOCAL HEALTH CARE PROVIDERS AND ADVOCATES. DATA SOURCES INCLUDED KIDSDATA.ORG, THE CALIFORNIA HEALTH INTERVIEW SURVEY DATA, THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH'S PEDIATRIC NUTRITION SURVEILLANCE DATA, AND THE CALIFORNIA CHILD WELFARE INDICATORS PROJECT AT THE UNIVERSITY OF CALIFORNIA AT BERKELEY. LOCAL PROVIDERS AND ADVOCATES CONSULTED INCLUDED FEDERALLY QUALIFIED HEALTH CENTERS, INDIVIDUAL PEDIATRICIANS, THE CENTRAL CALIFORNIA CHILDREN'S INSTITUTE AND THE CENTRAL VALLEY HEALTH POLICY INSTITUTE.VALLEY CHILDREN'S HOSPITAL STAFF ALSO REMAINED ACTIVELY ENGAGED IN A NUMBER OF COMMUNITY-BASED ORGANIZATIONS AND INITIATIVES IN 2018. THIS CONTINUOUS ENGAGEMENT KEPT THE HOSPITAL CLOSE TO THE ISSUES MOST IMPACTING THE HEALTH AND WELLBEING OF CHILDREN IN ITS SERVICE AREA AND ALLOWED THE HOSPITAL TO MAKE ADJUSTMENTS TO ITS COMMUNITY BENEFITS PROGRAM ACTIVITIES AS APPROPRIATE. PART VI, LINE 4: COMMUNITY INFORMATION: AS THE ONLY PEDIATRIC SPECIALTY HOSPITAL LOCATED IN CENTRAL CALIFORNIA, VALLEY CHILDREN'S HOSPITAL'S PRIMARY SERVICE AREA EXTENDS FROM SACRAMENTO IN THE NORTH TO KERN COUNTY IN THE SOUTH, AND PICKS UP MUCH OF THE CENTRAL COAST AND EASTERN SIERRA AS WELL. THE SERVICE AREA INCLUDES 11 COUNTIES AND IS HOME TO OVER 1.4 MILLION CHILDREN AGES 0-20. IN 2018, VALLEY CHILDREN'S HOSPITAL HAD 12,040 INPATIENT CASES, 114,452 EMERGENCY DEPARTMENT VISITS AND A COMBINED 297,563 OUTPATIENT CENTER, REGIONAL SPECIALTY CARE CENTER AND DAY SURGERY VISITS. MEDI-CAL BENEFITS COVERED 76% OF THE HOSPITAL'S TOTAL INPATIENT DAYS AND 76% OF THE OUTPATIENT VISITS AT VALLEY CHILDREN'S HOSPITAL. ALMOST TWO-THIRDS OF THE HOSPITAL'S INPATIENT POPULATION CONSISTED OF CHILDREN 4 YEARS OF AGE OR YOUNGER AND OVER 75% WERE AN ETHNICITY OTHER THAN CAUCASIAN. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: VALLEY CHILDREN'S HOSPITAL PARTNERS WITH A VARIETY OF COMMUNITY-BASED ORGANIZATIONS TO HELP ADDRESS ISSUES IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT, INCLUDING THE FOLLOWING. CHILD ABUSE PREVENTION - PREVENTING AND PROTECTING CHILDREN FROM ABUSE AND NEGLECT FORM THE CORNERSTONE OF THE GUILD'S OF CHILDREN'S HOSPITAL CHILD ABUSE PREVENTION AND TREATMENT CENTER. IN PARTNERSHIP WITH A NUMBER OF PRIVATE AND PUBLIC AGENCIES, THE PROGRAM PROVIDED EDUCATION, LEADERSHIP, AND DIRECT SERVICES FOR CHILDREN WHO WERE VICTIMS OF ABUSE AND TO PARENTS AND COMMUNITY-BASED ORGANIZATIONS TO HELP PREVENT ABUSE.CAPACITY FOR MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN - VALLEY CHILDREN'S HOSPITAL RECOGNIZES THE CRITICAL ROLE THAT COMMUNITY BASED PROVIDERS AND ORGANIZATIONS PLAY IN MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN AND IS COMMITTED TO MAKING SURE THEY HAVE THE CLINICAL SKILLS TO TAKE CARE OF THIS PATIENT POPULATION. TO HELP ENSURE THESE CHILDREN RECEIVE MEDICALLY APPROPRIATE CARE AT SCHOOL, VALLEY CHILDREN'S HOSPITAL PARTNERED WITH THE CALIFORNIA SCHOOL NURSE ORGANIZATION AND INDIVIDUAL SCHOOL DISTRICTS TO PROVIDE TRAINING TO SCHOOL NURSES ON A VARIETY OF CLINICAL PROCEDURES AND TOPICS CRITICAL TO KEEPING CHILDREN HEALTHY. ADDITIONALLY, VALLEY CHILDREN'S HOSPITAL PARTICIPATED IN AND HOSTED THE SCHOOL HEALTH ADVISORY PANEL'S QUARTERLY MEETINGS. THE PANEL IS A CONSORTIUM OF SCHOOL DISTRICT HEALTH DIRECTORS THROUGHOUT THE CENTRAL VALLEY THAT SERVES AS A LINK BETWEEN SCHOOL-BASED HEALTH CARE PROFESSIONALS AND CHILDREN'S HOSPITAL FOR THE PURPOSE OF IDENTIFYING AND ADDRESSING EMERGING ISSUES IMPACTING THE HEALTH AND WELLBEING OF STUDENTS IN GRADES K-12. VALLEY CHILDREN'S HOSPITAL PROVIDED SIGNIFICANT OUTREACH EDUCATION TO REFERRING HOSPITALS AND COMMUNITY BASED ORGANIZATIONS TO MAKE SURE THEY HAVE THE CLINICAL EXPERTISE NEEDED TO CARE FOR MEDICALLY COMPLEX CHILDREN. IN FY2018, VALLEY CHILDREN'S PROVIDED CONTINUING MEDICAL EDUCATION TO MORE THAN 500 COMMUNITY-BASE PRIMARY CARE PHYSICIANS. PEDIATRIC SUBSPECIALTY PHYSICIANS FROM VALLEY CHILDREN'S SERVED AS FEATURED FACULTY, PROVIDING COMMUNITY-BASED PHYSICIANS WITH GUIDANCE ON A VARIETY OF PEDIATRIC MEDICAL CONDITIONS INCLUDING CHRONIC DIARRHEA, CONCUSSION MANAGEMENT, CONSTIPATION IN CHILDREN, DIABETIC KETOACIDOSIS MANAGEMENT, GROWTH AND PUBERTY DISORDERS, EVALUATION AND DIAGNOSIS OF MALABSORPTION AND MALDIGESTION DISORDERS, IMAGING OF SPORTS INJURIES, INHERITED AND ACQUIRED BONE MARROW FAILURE, NEONATAL ABSTINENCE SYNDROME AND VALLEY FEVER. PROGRAMS WERE PROVIDED AT LOCATIONS THROUGHOUT THE VALLEY CHILDREN'S SERVICE AREA, INCLUDING BAKERSFIELD, HANFORD, MADERA, MERCED, MODESTO, POTERVILLE, REEDLEY AND VISALIA.VALLEY CHILDREN'S PARTICIPATED IN A NUMBER OF INITIATIVES SUPPORTING THE HEALTHY DEVELOPMENT OF CHILDREN BOTH DURING PREGNANCY AND DURING THE FIRST THREE YEARS OF LIFE. EXAMPLES INCLUDE THE FOLLOWING.FRESNO COUNTY PRE-TERM BIRTH INITIATIVE: FRESNO COUNTY HAS ONE OF CALIFORNIA'S HIGHEST RATES OF PREMATURE BIRTH WITH 1 OUT OF EVERY 9 BABIES BORN TOO EARLY. PREMATURE BIRTH CAN CAUSE SERIOUS PHYSICAL AND MENTAL DISABILITIES, OR EVEN DEATH, BEFORE THE BABY'S FIRST BIRTHDAY. OVER A 10-YEAR PERIOD, THE FRESNO COUNTY PRE-TERM BIRTH INITIATIVE IS WORKING TO IMPROVE THE HEALTH OF FRESNO MOTHERS AND REDUCE THE RATE OF PREMATURE BABIES. USING AN APPROACH CALLED COLLECTIVE IMPACT, PARTNERS ACROSS MANY SECTORS HAVE COME TOGETHER TO CREATE CHANGE IN FRESNO COUNTY. VALLEY CHILDREN'S HAS BEEN AN ACTIVE PARTICIPANT IN THIS INITIATIVE, WITH VALLEY CHILDREN'S SENIOR VICE PRESIDENT FOR COMMUNITY ENGAGEMENT AND POPULATION WELLNESS SERVING AS CHAIR OF THE INITIATIVE'S STEERING COMMITTEE. CRADLE TO CAREER: BOTH FRESNO AND STANISLAUS COUNTIES HAVE BEGUN FORMAL CRADLE TO CAREER INITIATIVES FOR THE PURPOSE OF CONVENING PUBLIC AND PRIVATE SECTOR STAKEHOLDERS TO WORK TOGETHER TO IMPROVE OUTCOMES FOR CHILDREN IN THEIR COMMUNITIES, FROM PRE-CONCEPTION TO COLLEGE AND/OR VOCATIONAL TRAINING. VALLEY CHILDREN'S PARTICIPATES IN BOTH INITIATIVES AND HAS BEEN A STRONG VOICE FOR THE INCLUSION OF OUTCOMES AND INDICATORS FOCUSED ON CHILD HEALTH AND WELLNESS. HELP ME GROW FRESNO COUNTY: HELP ME GROW IS A COORDINATED SYSTEM OF EARLY IDENTIFICATION AND REFERRAL FOR CHILDREN AGES 0-5 WHO ARE AT RISK FOR DEVELOPMENTAL DELAYS. IN FY2018, VALLEY CHILDREN'S SUPPORTED THE IMPLEMENTATION OF HELP ME GROW IN ITS PEDIATRIC PRIMARY CARE PRACTICES IN FRESNO COUNTY BY PROMOTING THE USE OF A SPECIFIC DEVELOPMENTAL ASSESSMENT AND SCREENING TOOL THAT IS PART OF THE HELP ME GROW MODEL. MARCH OF DIMES: VALLEY CHILDREN'S PARTNERED CLOSELY WITH THE MARCH OF DIMES TO ADVOCATE ON BEHALF OF POLICIES AT THE STATE AND FEDERAL LEVEL THAT PROMOTE HEALTHY PREGNANCIES AND HEALTHY BABIES. ADDITIONALLY, VALLEY CHILDREN'S DIRECTOR OF COMMUNITY AND GOVERNMENT RELATIONS CHAIRED THE MARCH OF DIMES OF CALIFORNIA'S ADVOCACY AND GOVERNMENT AFFAIRS COMMITTEE IN FY2018. MENTAL HEALTH ISSUES AND CHALLENGES ASSOCIATED WITH CHILD AND ADOLESCENT MENTAL HEALTH CONTINUED TO BE A MAJOR CONCERN IN FY2018. TO HELP IDENTIFY POTENTIAL REGIONAL SOLUTIONS, VALLEY CHILDREN'S SUPPORTED OR PARTICIPATED IN A NUMBER OF ACTIVITIES. VALLEY CHILDREN'S STAFF PROVIDED TEEN SUICIDE PREVENTION EDUCATION TO STUDENTS AND STAFF AT AREA HIGH SCHOOLS. IN ADDITION, VALLEY CHILDREN'S STAFF EITHER LED OR PARTICIPATED IN A NUMBER OF COMMUNITY-BASED COLLABORATIVES FOCUSED ON PREVENTING CHILD MENTAL ILLNESS AND/OR EARLY IDENTIFICATION AND TREATMENT OF CHILD MENTAL ILLNESS. VALLEY CHILDREN'S STAFF CHAIRED AN INITIATIVE CALLED COMMUNITY CONVERSATIONS, A SO-MEMBER COLLABORATIVE ADDRESSING ISSUES OF MENTAL HEALTH, HOMELESSNESS AND THE IMPACT ON FAMILIES. A NUMBER OF VALLEY CHILDREN'S STAFF ALSO SERVED AS MEMBERS OF THE FRESNO SUICIDE PREVENTION COLLABORATIVE AND MADERA COUNTY SUICIDE EDUCATION AND AWARENESS COLLABORATIVE. INJURY PREVENTION - VALLEY CHILDREN'S OPERATES AN INJURY PREVENTION PROGRAM TO INCREASE COMMUNITY AWARENESS OF CHILDHOOD INJURIES AND THOSE MEASURES THAT CAN BE TAKEN TO DECREASE THEIR PREVALENCE THROUGHOUT CENTRAL CALIFORNIA. IN FY2018, THE PROGRAM RECORDED 15,519 CONTACTS WITH CHILDREN, PARENTS, HEALTHCARE PROFESSIONAL AND OTHERS AT 184 DIFFERENT COMMUNITY, MEDIA AND PROFESSIONAL EVENTS CONCERNING THE FOLLOWING TOPICS: CHILD PASSENGER SAFETY, ABUSIVE HEAD TRAUMA, PEDESTRIAN SAFETY, SAFE SLEEP, TRAUMATIC BRAIN INJURY (HELMET SAFETY), HALLOWEEN SAFETY, POISON PREVENTION, RESPONDING TO A BLEEDING EMERGENCY, DRIVER SAFETY AND AWARENESS (INCLUDING DRUNK/DISTRACTED DRIVING), BABY BASICS, MEDICATION SAFETY, CHOKING PREVENTION, HOME SAFETY, CONCUSSION PREVENTION AND MANAGEMENT, BICYCLE SAFETY, PEDIATRIC TRAUMA, WATER SAFETY AND SUICIDE PREVENTION. THE MISSION OF VALLEY CHILDREN'S HOSPITAL IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO CHILDREN REGARDLESS OF THEIR ABILITY TO PAY AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN. THE HOSPITAL OPERATES AN OPEN MEDICAL STAFF AND IS AN INDEPENDENT NON PROFIT ORGANIZATION GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES WHICH IS THEREFORE ACCOUNTABLE TO OUR COMMUNITY AND ONLY OUR COMMUNITY. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 HINDS HOSPICE 2490 W SHAW 101 FRESNO CA 93711 770071360 501(C)(3) 7500 DONATION/SPONSORSHIP RONALD MCDONALD HOUSE 9161 RANDALL WAY MADERA CA 93736 942864490 501(C)(3) 7500 SPONSORSHIP BEST BUDDIES INTERNATIONAL INC 100 SE SECOND ST2200 MIAMI FL 33131 521614576 501(C)(3) 10000 DONATION MARJAREE MASON CENTER INC 1600 M STREET FRESNO CA 93721 941156639 501(C)(3) 12500 SPONSORSHIP SAN JOAQUIN VALLEY RIVER PARKWAY 11605 OLD FRIANT ROAD FRESNO CA 93730 770196692 501(C)(3) 15000 DONATION MARCH OF DIMES PO BOX 673667 MARIETTA GA 30006 131846366 501(C)(3) 20000 SPONSORSHIP CENTRAL VALLEY COMM FOUNDATION 5260 N PALM AVE 122 FRESNO CA 93704 770478025 501(C)(3) 22500 DONATION AMERICAN HEART ASSOCIATION PO BOX 4002030 DE MOINES IA 50340 135613797 501(C)(3) 40000 SPONSORSHIP FOUNDATION OF CLOVIS SCHOOLS 1000 S GARFIELD AVE ALHAMBRA CA 91801 954457939 501(C)(3) 50000 DONATION VALLEY CHILDREN'S MEDICAL GROUP 9300 VALLEY CHILDRENS PLACE MADERA CA 936368782 464150987 501(C)(3) 33960095 DONATION VALLEY CHILDREN'S HEALTHCARE 9300 VALLEY CHILDRENS PLACE MADERA CA 936368782 464150987 501(C)(3) 4244687 DONATION 11 0 NURSING SCHOLARSHIP 8 26270 EDUCATION SCHOLARSHIP - RESPIRATORY FOCUS 1 797 CAFETERIA MEALS 12033 0 74003 FMV MEAL COUPONS FOR PATIENT FAMILIES TAXI, BUS AND TRANSIT SERVICES 574 0 119985 BOOK SUBSIDIZATION OF BUS AND TRANSIT SERVICES PART I, LINE 2: NURSING SCHOLARSHIPS ARE DESIGNED TO HELP EMPLOYEES MEET FINANCIAL NEEDS THAT ARE NOT COVERED BY OTHER TUITION REIMBURSEMENT PROGRAMS. A SCHOLARSHIP COMMITTEE REVIEWS APPLICATIONS BI-ANNUALLY BASED ON CERTAIN CRITERIA. RECIPIENTS ARE CHOSEN BY THE COMMITTEE AND THE CHIEF NURSING OFFICER APPROVES THE SELECTIONS. ALL RECIPIENTS ARE EMPLOYEES OF THE HOSPITAL AND THE HOSPITAL IS MADE AWARE WHEN THE RECEIPIENT COMPLETES THEIR EDUCATION. OTHER SERVICES ARE PURCHASED FROM VARIOUS VENDORS AND ARE SUPPLIED TO PATIENTS AND THEIR FAMILIES. THE RECORDS FOR THESE PURCHASED SERVICES ARE MAINTAINED BY THE HOSPITAL. X 1 1 X X X X 0 1 0 1 1 1 1 0 0 TODD SUNTRAPAK CEO 915510 0 289090 0 243858 0 206725 0 24400 0 1679583 0 183737 0 MICHELE R WALDRON SENIOR VP, CFO 514873 0 121343 0 124297 0 117359 0 14640 0 892512 0 100758 0 DAVID CHRISTENSEN SENIOR VP, CPE 583059 0 138582 0 149653 0 104857 0 24400 0 1000551 0 126747 0 BEVERLY HAYDEN-PUGH SENIOR VP, CLINICAL INTEGRATION/CNO 419731 0 100075 0 200189 0 109290 0 9760 0 839045 0 177581 0 JESSIE HUDGINS VP, FACILITIES 258363 0 72951 0 117357 0 106464 0 14640 0 569775 0 61263 0 NATALE PONTICELLO JR SENIOR VP, CHIEF PEOPLE OFFICER 299821 0 77679 0 91294 0 67565 0 0 0 536359 0 45341 0 JANE WILLSON SENIOR VP, CHIEF STRATEGY OFFICER 347803 0 82024 0 123941 0 97746 0 4880 0 656394 0 82580 0 DAVID SINGH VP, CHIEF OPERATING OFFICER VCMG 308531 0 74393 0 80609 0 68414 0 0 0 531947 0 60246 0 MICHAEL GOLDRING PRESIDENT, VCMG 436800 0 106114 0 84803 0 84951 0 9760 0 722428 0 56800 0 STEPHANIE VANCE FINANCE, VP 256019 0 63012 0 55649 0 65722 0 19520 0 459922 0 36694 0 JOEL BROWNELL MD VP, CHIEF MEDICAL INFORMATION OFFICE 328621 0 79768 0 30366 0 68527 0 14640 0 521922 0 29568 0 KAREN DAHL VP, QUALITY & PATIENT SAFEY 369838 0 88179 0 34673 0 74001 0 4880 0 571571 0 15640 0 KEVIN SHIMAMOTO VP AND CIO 341488 0 82604 0 31403 0 70639 0 4880 0 531014 0 9662 0 DANIEL DAVIS VP, PATIENT CARE 281155 0 63901 0 6461 0 72866 0 9760 0 434143 0 0 0 DANIELLE BARRY VP, REVENUE CYCLE MGMT 241334 0 52884 0 338 0 45517 0 19520 0 359593 0 0 0 WILLIAM CHALTRAW SENIOR VP/CHIEF LEGAL OFFICER 369829 0 77035 0 18893 0 58155 0 19520 0 543432 0 0 0 BRIAN SMULLIN VP MANAGED CARE 247826 0 20210 0 581 0 25454 0 19520 0 313591 0 0 0 DAVID HODGE JR VP ANCILLARY SERVICES 268243 0 39024 0 16171 0 30747 0 19520 0 373705 0 0 0 LYNNE ASHBECK SVP, COMMUNITY ENGAGEMENT & POPULATI 224512 0 0 0 7178 0 0 0 0 0 231690 0 0 0 YVONNE WOOD MANAGER PATIENT THROUGHPUT 236469 0 758 0 243 0 28847 0 19520 0 285837 0 0 0 PAUL LEBBY NEURODEVELOPMENT PROGRAM DIRECTOR 230988 0 0 0 382 0 23423 0 9760 0 264553 0 0 0 AMY BOLING RN IV CRITICAL CARE 235022 0 1123 0 4349 0 21370 0 24400 0 286264 0 0 0 JOLIE LIMON EXECUTIVE DIRECTOR MEDICAL EDUCATION 303437 0 0 0 730 0 12797 0 4880 0 321844 0 0 0 TRACY BLAIR EXEC DIR/DEP GENERAL COUNSEL 224178 0 39258 0 827 0 16310 0 4880 0 285453 0 0 0 PART I, LINE 1A TODD SUNTRAPAK CHARTERED AN AIRPLANE TO ATTEND THREE MEETINGS DURING THE YEAR INCLUDING A CURRICULUM AND INSTRUCTION STEERING COMMITTEE (CISC) MEETING, A MEETING AT CHILDREN'S HOSPITAL LOS ANGELES AND TO ATTEND THE HOSPITAL COUNCIL SEARCH COMMITTEE INTERVIEWS. IN ADDITION TODD SUNTRAPAK, MICHELE WALDRON AND BEVERLY HAYDEN-PUGH CHARTERED AN AIRPLANE TO ATTEND THE PARTNERS IN CARE TRIBUTE RECEPTION IN LOS ANGELES. NO PART OF THE EXPENSE WAS TREATED AS TAXABLE COMPENSATION TO ANY OF THE EMPLOYEES. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS INCLUDE 1) A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), 2) A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES AND 3) A NONCONTRIBUTORY, NONQUALIFIED DEFERRED COMPENSATION PLAN FOR A SELECT GROUP OF MANAGEMENT CALLED THE DEFINED CONTRIBUTION SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN (DCSERP) AND 4) A SPLIT DOLLAR LIFE INSURANCE PROGRAM AVAILABLE TO CERTAIN KEY EXECUTIVES (SEE SCHEDULE L PART V FOR A BROADER DESCRIPTION). TODD SUNTRAPAK, JOEL BROWNELL, DAVID HODGE JR, DANIELLE BARRY, LYNNE ASHBECK, BRIAN SMULLIN AND DANNY DAVIS ARE ELIGIBLE TO CONTRIBUTE TO THE DEFERRED COMPENSATION PLAN, BUT NO CONTRIBUTIONS WERE MADE. $1,025,896 WAS PAID OUT OF THE DCSERP PLAN DURING THE YEAR. EMPLOYEE AND EMPLOYER CONTRIBUTIONS TO THE DEFERRED COMPENSATION PLAN, EMPLOYER CONTRIBUTIONS TO THE DCSERP, AND THE CHANGE IN ACTUARIAL VALUE OF SERP BENEFITS FOR CALENDAR YEAR 2017 ARE AS FOLLOWS: MICHELE WALDRON - DEFERRED COMPENSATION PLAN $18,000; DCSERP $76,341; NOT ELIGIBLE FOR SERP TODD SUNTRAPAK - DEFERRED COMPENSATION PLAN $0; DCSERP $170,555; NOT ELIGIBLE FOR SERP BEVERLY HAYDEN-PUGH - DEFERRED COMPENSATION PLAN $18,000; DCSERP $61,042; CHANGE IN SERP ACTUARIAL VALUE $0 JESSIE HUDGINS - DEFERRED COMPENSATION PLAN $36,000; DCSERP $61,042; CHANGE IN SERP ACTUARIAL VALUE $20,014 DAVID CHRISTENSEN - DEFERRED COMPENSATION PLAN $18,000; DCSERP $84,537; NOT ELIGIBLE FOR SERP JANE WILLSON - DEFERRED COMPENSATION PLAN $18,000; DCSERP $51,561; CHANGE IN SERP ACTUARIAL VALUE $10,270 DAVID SINGH - DEFERRED COMPENSATION PLAN $18,000; DCSERP $46,775; CHANGE IN SERP ACTUARIAL VALUE $0 STEPHANIE VANCE - DEFERRED COMPENSATION PLAN $18,000; DCSERP $39,566; NOT ELIGIBLE FOR SERP NATALIE PONTICELLO - DEFERRED COMPENSATION PLAN $36,000; DCSERP $47,245; NOT ELIGIBLE FOR SERP MICHAEL GOLDRING - DEFERRED COMPENSATION PLAN $18,000; DCSERP $64,631; NOT ELIGIBLE FOR SERP JOEL BROWNELL - DEFERRED COMPENSATION PLAN $0; DCSERP $48,207; NOT ELIGIBLE FOR SERP KAREN DAHL - DEFERRED COMPENSATION PLAN $18,000; DCSERP $53,856; NOT ELIGIBLE FOR SERP KEVIN SHIMAMOTO - DEFERRED COMPENSATION PLAN $18,000; DCSERP $50,424; NOT ELIGIBLE FOR SERP DAVID HODGE AND LYNNE ASHBECK - NOT ELIGIBLE FOR DCSERP OR SERP DANIEL DAVIS - DEFERRED COMPENSATION PLAN $0; DCSERP $40,246; NOT ELIGIBLE FOR SERP DANIELLE BARRY - DEFERRED COMPENSATION PLAN $0; DCSERP $32,474; NOT ELIGIBLE FOR SERP BRIAN SMULLIN - DEFERRED COMPENSATION PLAN $0; DCSERP $20,924; NOT ELIGIBLE FOR SERP WILLIAM CHALTRAW - DEFERRED COMPENSATION PLAN $18,000; DCSERP $52,103; NOT ELIGIBLE FOR SERP PART I, LINE 5 AN EXECUTIVE INCENTIVE PLAN HAS BEEN ESTABLISHED THAT ALLOWS FOR PAYMENT OF INCENTIVES BASED ON BOTH NETWORK WIDE AND INDIVIDUAL GOALS. SUCH GOALS ARE RELATED TO A VARIETY OF METRICS INCLUDING REVENUE, OPERATIONAL AND QUALITY RESULTS OF THE HOSPITAL AND ITS RELATED ENTITIES. THE INCENTIVE PLAN HAS BEEN APPROVED BY THE COMPENSATION COMMITTEE OF THE VALLEY CHILDREN'S HEALTHCARE BOARD OF TRUSTEES. THE COMMITTEE REVIEWS THE FORECASTED PAYOUTS AT THE END OF EACH YEAR BASED ON THE FINANCIAL AND OPERATING RESULTS. PART I, LINE 6 SEE EXPLANATION FOR LINE 5, ABOVE TODD SUNTRAPAK CURRENT OFFICER SEE BELOW X 10434500 10623095 0 1 1 MICHELE WALDRON CURRENT OFFICER SEE BELOW X 8325373 8325373 0 1 1 DAVID CHRISTENSEN CURRENT KEY EMPLOYEE SEE BELOW X 5013793 5013793 0 1 1 WILLIAM CHALTRAW CURRENT KEY EMPLOYEE SEE BELOW X 2014651 2014651 0 1 1 25976912 PART II, COLUMN C: THE ORGANIZATION PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS THROUGH AN ALTERNATIVE FUNDING ARRANGEMENT THE IRS CALLS "COLLATERAL ASSIGNMENT SPLIT DOLLAR" (CASD). ALTHOUGH THE IRS REQUIRES REPORTING IN THE LOAN SECTION OF THE SCHEDULE L, CASD IS NOT AN ACTUAL LOAN NO FUNDS ARE TRANSFERRED TO THE EXECUTIVES. RATHER, THE "LOAN" TREATMENT APPLIES BECAUSE AFTER THE EXECUTIVES HAVE RECEIVED RETIREMENT BENEFITS, THE ORGANIZATION RECOVERS ALL OF ITS OUTLAYS PLUS INTEREST. FORM 990 PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROGRAM SERVICE ONE I. DESCRIPTION OF PROGRAM SERVICE ONE OVER 60 YEARS AGO, OUR FOUNDING MOTHERS HAD A DREAM TO CARE FOR CHILDREN IN A HOSPITAL AS SPECIAL AS ITS PATIENTS. VALLEY CHILDREN'S HOSPITAL HAS FLOURISHED EVER SINCE, CARING FOR HUNDREDS OF THOUSANDS OF CHILDREN. OUR MISSION GUIDES US AS WE TRAVEL THE ROAD TO OUR FUTURE ALONGSIDE STAFF, PHYSICIANS, CHILDREN, FAMILIES, OUR COMMUNITY AND OUR PARTNERS THROUGHOUT THE REGION. MISSION THE MISSION OF VALLEY CHILDREN'S HOSPITAL IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO CHILDREN REGARDLESS OF THEIR ABILITY TO PAY, AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN. VISION OUR VISION CAPTURES THE PATH WE'VE TRAVELED AND SHOWCASES OUR COMMITMENT AND PASSION TO BE THE BEST. OUR CLEAR FOCUS IS TO CONTINUE TO PROVIDE THE BEST CARE AND THE BEST QUALITY PEDIATRIC SERVICES AVAILABLE ANYWHERE WITH A VISION TO BECOME THE NATION'S BEST CHILDREN'S HOSPITAL. CORE VALUES THE FOLLOWING CORE ORGANIZATIONAL VALUES GUIDE THE INVESTMENTS AND SUPPORT PROVIDED BY VALLEY CHILDREN'S HOSPITAL'S COMMUNITY BENEFITS PROGRAM. EXCELLENCE - WE DEPEND ON EXCEPTIONAL PEOPLE TO PROVIDE EXCEPTIONAL QUALITY HEALTH CARE AND SERVICES THROUGHOUT VALLEY CHILDREN'S HOSPITAL. WE SET HIGH STANDARDS AND WE SUPPORT EACH OTHER AS WE STRIVE TO ACHIEVE THEM. WE INVEST IN EACH OTHER AND WE VALUE THE INDIVIDUAL AND CULTURAL DIFFERENCES THAT MAKE US STRONG. WE ARE PROUD OF OUR SUPERIOR SERVICES AS MEASURED BY QUALITY OUTCOMES. COMPASSIONATE CARE - WE TREAT EVERY CHILD, EVERY FAMILY, EACH OTHER, OUR VISITORS AND OUR VENDORS WITH RESPECT, KINDNESS, HOPE, JOY AND GOOD HUMOR. WE DISPLAY OUR HELPFUL, HEALING, FAMILY-CENTERED SPIRIT AT EVERY OPPORTUNITY. WE RECOGNIZE THE IMPORTANCE OF PLAYFULNESS IN HUMAN INTERACTION AND IN THE HEALTH OF CHILDREN. WE LOOK FOR WAYS TO EASE SUFFERING AND PROVIDE COMFORT. INTEGRITY - WE ARE HONEST, ETHICAL AND RESPONSIBLE IN OUR WORK AND IN THE WAY WE DEAL WITH OTHERS. WE KEEP OUR PROMISES AND ADMIT OUR MISTAKES. WE KNOW OURSELVES AND WE AVOID HIDDEN AGENDAS. BY THE WAY WE LIVE OUR LIVES EVERYDAY, WE ARE WORTHY OF THE TRUST PEOPLE PLACE IN US. INNOVATION - WE EMBRACE CHANGE, CREATIVITY, CONTINUOUS LEARNING AND PERSONAL GROWTH. WE INCORPORATE NEW IDEAS, TECHNOLOGY AND METHODS TO IMPROVE THE HEALTH CARE AND SERVICES WE PROVIDE. WE ANTICIPATE FUTURE TRENDS AND WE CREATE STRATEGIC PLANS TO INSURE FUTURE GROWTH AND CONTINUED VITALITY. COLLABORATION - WE BUILD ENDURING INTERNAL AND EXTERNAL RELATIONSHIPS, JOINING WITH COLLEAGUES ACROSS ORGANIZATIONAL BOUNDARIES TO IMPROVE THE CARE AND SERVICES WE PROVIDE. WE ENCOURAGE AND REWARD BOTH INDIVIDUAL AND TEAM ACHIEVEMENTS. WE PUT THE COMMON GOOD AHEAD OF NARROW INTERESTS. STEWARDSHIP - WE ARE RESOURCEFUL, ADAPTABLE AND RESILIENT. WE HAVE A "CAN DO" ATTITUDE THAT GETS THE JOB DONE. WE ARE FISCALLY RESPONSIBLE AND EFFICIENT WITH OUR TIME. WE PROTECT OUR RESERVES AND MANAGE OUR OPERATING COSTS IN ORDER TO INVEST IN THE NEXT GENERATION OF KIDS. WE ARE EACH PERSONALLY DEDICATED TO MAKING VALLEY CHILDREN'S HOSPITAL BETTER BECAUSE WE WERE HERE. COMMITMENT TO THE COMMUNITY AS A NOT-FOR-PROFIT ORGANIZATION GOVERNED BY ITS OWN BOARD OF TRUSTEES, VALLEY CHILDREN'S HOSPITAL IS SOLELY COMMITTED TO ADDRESSING THE MEDICAL NEEDS OF OUR REGION'S SICKEST CHILDREN. WITH 358 BEDS AT SEPTEMBER 30, 2018, A MEDICAL STAFF OF OVER 650 PHYSICIANS AND APPROXIMATELY 3,400 TOTAL EMPLOYEES, VALLEY CHILDREN'S HOSPITAL OFFERS ACCESSIBILITY TO OVER 40 FETAL, NEONATAL AND PEDIATRIC SUBSPECIALTIES, ALL COMMITTED TO PROVIDING THE HIGHEST LEVEL OF QUALITY CARE POSSIBLE. EXAMPLES INCLUDE THE HOSPITAL'S NEONATAL AND PEDIATRIC INTENSIVE CARE UNITS THAT MAINTAIN LOW MORTALITY RATES, WHEN COMPARED NATIONALLY, WHILE TREATING SOME OF THE SICKEST CHILDREN. WHILE PROVIDING EXCEPTIONAL CARE IS THE SINGLE GREATEST CONTRIBUTION THE HOSPITAL MAKES FOR OUR CHILDREN AND THEIR FAMILIES, THE HOSPITAL ALSO APPRECIATES THAT IT IS UNIQUELY POSITIONED TO SUPPORT THE NEEDS OF CHILDREN IN OTHER WAYS AS WELL. AS AN EXTENSION OF THE HOSPITAL'S MISSION AND VISION, THE GOAL OF VALLEY CHILDREN'S HOSPITAL'S COMMUNITY BENEFITS PROGRAM IS TO ADVANCE THE HEALTH AND WELLBEING OF UNDERSERVED, MEDICALLY NEEDY CHILDREN THROUGH COLLABORATION AND COMMON CONCERN. II. SERVICE AREA DEMOGRAPHICS AND PATIENT VOLUME SERVICE AREA DEMOGRAPHICS AS THE ONLY PEDIATRIC SPECIALTY HOSPITAL LOCATED IN CENTRAL CALIFORNIA, VALLEY CHILDREN'S HOSPITAL'S SERVICE AREA EXTENDS FROM SACRAMENTO COUNTY IN THE NORTH TO KERN COUNTY IN THE SOUTH, AND PICKS UP MUCH OF THE CENTRAL COAST AND EASTERN AS WELL. VALLEY CHILDREN'S HOSPITAL'S PATIENT VOLUME IN 2018, VALLEY CHILDREN'S HOSPITAL HAD 12,040 INPATIENT CASES, 114,452 EMERGENCY DEPARTMENT VISITS AND A COMBINED 297,563 OUTPATIENT CENTER, REGIONAL SPECIALTY CARE CENTER AND DAY SURGERY VISITS. MEDI-CAL COVERED 76% OF THE HOSPITAL'S TOTAL INPATIENT DAYS AND 76% OF TOTAL OUTPATIENT VISITS AT THE HOSPITAL. FORM 990, PART III, LINE 4A III. COMMUNITY BENEFITS PROGRAM ACCORDING TO THE CATHOLIC HEALTH ASSOCIATION, COMMUNITY BENEFITS ARE GENERALLY DEFINED AS THOSE ACTIVITIES THAT PROVIDE TREATMENT AND/OR PROMOTE HEALTH AND HEALING IN RESPONSE TO IDENTIFIED COMMUNITY NEEDS, AND MEET AT LEAST ONE OF THE FOLLOWING OBJECTIVES: - IMPROVE ACCESS TO HEALTH CARE SERVICES - ENHANCE HEALTH OF THE COMMUNITY - ADVANCE MEDICAL OR HEALTH CARE KNOWLEDGE - RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT OR PRIVATE, COMMUNITY-BASED EFFORTS ALSO INCLUDED IN THE DEFINITION IS THE PROVISION OF CHARITY CARE AND THE UNREIMBURSED COST OF PROVIDING HEALTH CARE SERVICES TO THOSE ENROLLED IN PUBLIC PROGRAMS, INCLUDING MEDI-CAL. IN FY 2018, VALLEY CHILDREN'S HOSPITAL PROVIDED COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS WITHIN ITS SERVICE AREA. A SUMMARY OF THE HOSPITAL'S COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS IN 2018: *COMMUNITY HEALTH EDUCATION CLINICAL PARTNERSHIPS VALLEY CHILDREN'S CLINICAL PARTNERSHIP PROGRAM BRINGS TOGETHER INSTITUTIONS FOCUSED ON ENHANCING NEONATAL AND PEDIATRIC CARE, REGARDLESS IF THE ILL OR INJURED CHILD BECOMES A VALLEY CHILDREN'S PATIENT. THIS EFFORT HELPS PREVENT CHILDREN FROM BEING TRANSFERRED OR REFERRED UNNECESSARILY TO VALLEY CHILDREN'S, AS WELL AS POTENTIALLY IDENTIFIES EARLIER WHEN A CHILD NEEDS ADVANCED PEDIATRIC CARE. WITH IMPROVED COMMUNICATION AND TOOLS, WE DECREASE STRESS FOR PATIENTS AND FAMILIES AND INCREASE PROVIDER CONFIDENCE IN PROVIDING PEDIATRIC CARE, WHILE ENHANCING PERFORMANCE AT BOTH INSTITUTIONS. THE GOALS OF OUR CLINICAL PARTNERSHIPS INCLUDE PROVIDING: -IMPROVED QUALITY AND CONFIDENCE IN PROVIDING PEDIATRIC CARE -MORE CARE DELIVERED CLOSER TO HOME -ENHANCED, COORDINATED CARE IN 2018, VALLEY CHILDREN'S SUPPORTED 13 CLINICAL PARTNERS. INJURY PREVENTION VALLEY CHILDREN'S OPERATES AN INJURY PREVENTION PROGRAM TO INCREASE COMMUNITY AWARENESS OF CHILDHOOD INJURIES AND THOSE MEASURES THAT CAN BE TAKEN TO DECREASE THEIR PREVALENCE THROUGHOUT CENTRAL CALIFORNIA. IN FY2018, THE PROGRAM RECORDED 15,519 CONTACTS WITH CHILDREN, PARENTS, HEALTHCARE PRFESSIONALS AND OTHERS AT 184 DIFFERENT COMMUNITY, MEDIA, AND PROFESSONALS EVENTS, COVERING THE FOLLOWING TOPICS: CHILD PASSANGER SAFETY, SAFE SLEEP, TRAUMATIC BRAIN INJURY (HELMET SAFETY), HALLOWEEN SAFETY, POISON PREVENTION, RESPONDING TO A BLEEDING EMERGENCY, DRIVER SAFETY AWARENESS (INCLUDING DRUNK/ DISTRACTED DRIVING), BABY BASICS, MEDICATION SAFETY, CHOKING PREVENTION, HOME SAFETY, CONCUSSION PREVENTION AND MANAGEMENT, BICYCLE SAFETY, PEDIATRIC TRAUMA, WATER SAFETY AND SUICIDE PREVENTION. REGARDING BICYCLE SAFETY, VALLEY CHILDREN'S DISTRIBUTED 525 BICYCLE HELMETS TO CHILDREN AND FAMILIES WHOSE EXISTING HELMETS DID NOT MEET MINIMUM SAFETY STANDARDS OR WHO DID NOT HAVE HELMETS AT ALL. REGARDING CAR SEAT SAFETY, VALLEY CHILDREN'S CONDUCTED SAFETY CHECKS ON 561 CAR SEATS AND DISTRIBUTED 349 CAR SEATS TO FAMILIES WHOSE EXISTING CAR SEATS DID NOT MEET MINIMUM SAFETY STANDARDS OR WHO SIMPLY DID NOT HAVE A CAR SEAT AND NEEDED ONE. HEALTHCARE LITERACY VALLEY CHILDREN'S PROVIDED ACCESS TO ON-LINE EDUCATIONAL INFORMATION VIA THE HEALTH ENCYCLOPEDIA LINK ON ITS WEBSITE. HEALTH ENCYCLOPEDIA CONTAINS THOUSANDS OF PAGES OF INFORMATION ON PEDIATRIC DISEASES, CONDITIONS AND TREATMENTS, AS WELL AS SECTIONS ON HOW TO KEEP KIDS HEALTHY. THE ENCYCLOPEDIA IS AVAILABLE IN ENGLISH AND SPANISH. MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN VALLEY CHILDREN'S RECOGNIZES THE CRITICAL ROLE THAT COMMUNITY-BASED PROVIDERS AND ORGANIZATIONS PLAY IN MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN AND IS COMMITTED TO MAKING SURE THEY HAVE THE CLINICAL SKILLS TO TAKE CARE OF THIS PATIENT POPULATION. THE HOSPITAL PROVIDED OUTREACH EDUCATION TO HOSPITAL STAFF AND COMMUNITY-BASED ORGANIZATIONS TO MAKE SURE THEY HAVE THE CLINICAL EXPERTISE NEEDED TO CARE FOR MEDICALLY COMPLEX CHILDREN, INCLUDING CHILDREN WITH TRACHEOSTOMIES AND VENTILATORS. ADAPTIVE SPORTS PROGRAM VALLEY CHILDREN'S ADAPTIVE SPORTS PROGRAM PROVIDES FREE RECREATIONAL AND ATHLETIC EXPERIENCES FOR CHILDREN, ADOLESCENTS AND YOUNG ADULTS WITH DISABILITIES, REGARDLESS OF WHETHER THEY HAVE BEEN OR CURRENTLY ARE PATIENTS AT VALLEY CHILDREN'S. THE ONLY ONE OF ITS KIND IN CENTRAL CALIFORNIA, THE PROGRAM IS DESIGNED FOR INDIVIDUALS WITH PHYSICAL IMPAIRMENTS AND CONDITIONS RANGING FROM CEREBRAL PALSY TO SPINAL CORD INJURIES. DISABLED YOUTH UP TO AGE 21 ARE ESPECIALLY ENCOURAGED TO ATTEND. * HEALTH CARE SUPPORT SERVICES VALLEY CHILDREN'S PROVIDED HEALTH CARE SUPPORT SERVICES TO HELP ADDRESS THE HEALTH CARE NEEDS OF CHILDREN AND THEIR FAMILIES, AT HOME, AT SCHOOL, AND IN THE COMMUNITY. CHILD ABUSE PREVENTION THE GUILDS OF VALLEY CHILDREN'S HOSPITAL CHILD ABUSE PREVENTION AND TREATMENT CENTER'S MISSION IS TO PROVIDE COMPREHENSIVE SERVICES TO CHILDREN, DEPENDENT ADULTS AND THEIR FAMILIES THROUGH A MULTIDISCIPLINARY, CHILD-FRIENDLY PROGRAM, AND TO MEET THE PHYSICAL AND EMOTIONAL NEEDS OF VICTIMS OF CHILD ABUSE. THE CENTER'S VISION IS TO BE THE PREMIER PROVIDER IN CENTRAL CALIFORNIA FOR DIAGNOSTIC PHYSICAL ABUSE ASSESSMENTS, FOSTER CARE MEDICAL CLEARANCE EXAMINATIONS AND PEDIATRIC SEXUAL ASSAULT EVALUATIONS, INCLUDING CHILDREN WHO HAVE BEEN VICTIMS OF COMMERCIAL SEXUAL EXPLOITATION. ADDITIONALLY, THE CENTER'S PROVIDERS, KNOWN AS THE CHILD ADVOCACY TEAM, REGULARLY TESTIFY IN BOTH DEPENDENCY AND CRIMINAL COURTS THROUGHOUT THE VALLEY. THE CENTER IS RECOGNIZED IN CENTRAL CALIFORNIA AND AROUND THE STATE AS A LEADER IN ADVOCACY,INJURY PREVENTION, CLINICAL RESEARCH AND ACADEMIC TRAINING. IN FY2018, THE CENTER BECAME A MEMBER OF THE CHILD ADVOCACY CENTERS OF CALIFORNIA, CENTRAL CHAPTER. MEMBERSHIP PROVIDES A NUMBER OF BENEFITS AND OPPORTUNITIES TO EXPAND EFFORTS IN CHILD ABUSE PREVENTION AND TREATMENT. ACCORDING TO THE REPORT "CHILD MALTREATMENT 2017," AN ESTIMATED 4.1 MILLION REFERRALS INVOLVING THE SUSPECTED MALTREATMENT OF ABOUT 7.5 MILLION CHILDREN WERE MADE TO CHILD PROTECTIVE SERVICES (CPS) AGENCIES IN THE UNITED STATES IN 2017. THIS IS AN INCREASE OF APPROXIMATELY 91,000 REFERRALS FROM 2016. IN CALIFORNIA, AN ESTIMATED 400,190 SUSPECTED CHILD MALTREATMENT REPORTS WERE COMPLETED, OF WHICH ABOUT 86,700 REPORTS CAME FROM VALLEY CHILDREN'S SERVICE AREA. THE CENTER INCLUDES THE CHILD ADVOCACY CLINIC, WHICH OPERATES FIVE DAYS A WEEK AND SEES APPROXIMATELY 1,000 CHILDREN EACH YEAR. CENTER PROVIDERS ALSO ARE AVAILABLE SEVEN DAYS A WEEK, 24 HOURS A DAY FOR EMERGENCY COVERAGE. THE CENTER INCLUDES AN INPATIENT COMPONENT THAT EVALUATES ABOUT 100 CHILDREN YEARLY IN THE PEDIATRIC EMERGENCY DEPARTMENT, ACUTE-CARE FLOORS AND PEDIATRIC INTENSIVE CARE UNIT. THESE CHILDREN ARE EVALUATED FOR SUSPECTED PHYSICAL ABUSE, SEXUAL ABUSE AND NEGLECT. THE STAFF INCLUDES CHILD ABUSE PEDIATRICIANS, NURSE PRACTITIONERS SPECIALIZED IN CHILD MALTREATMENT, FORENSIC NURSES, SOCIAL WORKERS, FORENSIC INTERVIEWERS, A CENTER COORDINATOR, A LICENSED MENTAL HEALTH PROVIDER AND SUPPORT STAFF. IN ADDITION TO THE CLINICAL SERVICES OFFERED BY THE CENTER, A MULTI-DISCIPLINARY INTERVIEWING CENTER IS ALSO AVAILABLE FOR VICTIMS OR WITNESSES OF CRIMES. FORENSIC INTERVIEWING SERVICES ARE REQUESTED BY LAW ENFORCEMENT AND/OR CPS. THE PURPOSE OF THE FORENSIC INTERVIEWING PROGRAM COMPONENT IS TO REDUCE THE NUMBER OF INTERVIEWS AND DECREASE THE NUMBER OF INDIVIDUALS WHO WILL TALK TO THE VICTIM. THE CENTER STRIVES TO PROVIDE A WELCOMING, CHILD-FRIENDLY ENVIRONMENT WHERE CHILDREN/DEPENDENT ADULTS CAN FEEL SAFE AND BE INTERVIEWED BY A TRAINED PROFESSIONAL. THERE IS ONGOING COLLABORATION WITH EXTERNAL COMMUNITY PARTNERS AND OTHER HOSPITAL SERVICES INCLUDING SUBSPECIALTY CLINICS, PATIENT AND FAMILY SERVICES, INTERPRETER SERVICES, RADIOLOGY, DIAGNOSTIC CLINICAL LABORATORIES, CHILD LIFE SERVICES AND PASTORAL CARE. THE CENTER WORKS CLOSELY WITH LAW ENFORCEMENT, CPS AND DISTRICT ATTORNEYS' OFFICES IN THEIR INVESTIGATIVE EFFORTS OF CHILD MALTREATMENT. COLLABORATIVE EFFORTS INCLUDE CASE CONSULTATION AND MONTHLY SUSPECT CHILD ABUSE AND NEGLECT (SCAN) MEETINGS FACILITATED BY OUR CHILD ADVOCACY CLINIC IN AN EFFORT TO TRACK, MONITOR AND ADVOCATE FOR THE HEALTH AND SAFETY OF AT-RISK CHILDREN THROUGHOUT THE VALLEY. FORM 990, PART III, LINE 4A FOR PREVENTION EDUCATION, THE CENTER COLLABORATES WITH INTERNAL AND EXTERNAL PARTNERS TO PROVIDE EDUCATION TO PARENTS, CAREGIVERS, HEALTHCARE PERSONNEL, TEACHERS AND MANDATED REPORTERS OF SUSPECTED CHILD MALTREATMENT. THESE PARTNERS INCLUDE VALLEY CHILDREN'S TRAUMA DEPARTMENT'S INJURY PREVENTION TEAM, SAFE KIDS, CHILD ABUSE PREVENTION COUNCILS OF CALIFORNIA, COMPREHENSIVE YOUTH SERVICES, CPS, EXCEPTIONAL PARENTS UNLIMITED, SEXUAL ASSAULT RESPONSE TEAMS (SART) AND COUNCIL PUBLIC HEALTH DEPARTMENTS. ENROLLMENT IN HEALTH INSURANCE VALLEY CHILDREN'S IDENTIFIED AND PROVIDED ENROLLMENT ASSISTANCE TO UNINSURED AND UNDER-INSURED PATIENTS WHO QUALIFIED FOR MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES PROGRAM, OR THE VALLEY CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. ONCE ELIGIBILITY WAS DETERMINED, VALLEY CHILDREN'S STAFF ASSISTED THE FAMILY WITH COMPLETING NECESSARY APPLICATIONS AND SUBMITTING THEM TO THE APPROPRIATE AGENCIES. FOOD FOR FAMILIES VALLEY CHILDREN'S DIETARY DEPARTMENT PROVIDED MEAL COUPONS TO BREAST-FEEDING MOMS WHOSE INFANTS WERE AT VALLEY CHILDREN'S. ADDITIONALLY, THROUGH A PROGRAM CALLED MEALS OF THE HEART, WHICH IS SPONSORED BY RONALD MCDONALD CHARITIES OF CENTRAL CALIFORNIA, VALLEY CHILDREN'S SOCIAL WORK TEAM PROVIDED PATIENTS' FAMILIES WITH MEAL COUPONS WHEN THEY ARRIVED AND WERE NOT PREPARED FOR A LONG STAY AT THE HOSPITAL. THE SOCIAL WORK TEAM ALSO WORKS CLOSELY WITH THE CALIFORNIA CHILDREN'S SERVICES PROGRAM TO PROVIDE FOOD FOR ELIGIBLE FAMILIES. VALLEY CHILDREN'S ALSO RECEIVED SUPPORT FROM A NUMBER OF OTHER ORGANIZATIONS, INCLUDING THE MENDIBURU MAGIC FOUNDATION BASED IN BAKERSFIELD, THE ROMAN CATHOLIC DIOCESE OF FRESNO, AND THE SWEET NECTAR SOCIETY THAT EITHER DONATED FOOD TO VALLEY CHILDREN'S TO DISTRIBUTE TO NEEDY FAMILIES OR DONATED CASH TO GIVE TO FAMILIES TO PURCHASE FOOD. LITERACY PROGRAM VALLEY CHILDREN'S HEALTHCARE IS UNIQUELY POSITIONED TO MAKE A DIFFERENCE IN THE LITERACY OF CHILDREN THROUGHOUT OUR SERVICE AREA. IT IS THE AIM OF OUR LITERACY PROGRAM TO PUT A NEW, AGE- APPROPRIATE BOOK INTO THE HANDS OF EVERY CHILD WHO COMES INTO OUR HOSPITAL. IN FY2018, WE PROVIDED 1,500-2,000 NEW BOOKS A MONTH TO OUR INPATIENTS AND OUTPATIENTS. FOR MANY FAMILIES IN THE CENTRAL VALLEY, BOOKS ARE A LUXURY. THE AREA IS AMONG THE POOREST IN THE NATION WITH 41 PERCENT OF THE AREA'S CHILDREN AGES 0-5 LIVING IN HOUSEHOLDS WHERE THE INCOME IS BELOW THE FEDERAL POVERTY LEVEL. NOT COINCIDENTALLY, THE VALLEY IS ALSO ONE OF THE LEAST LITERATE PARTS OF THE COUNTRY. STUDIES HAVE SHOWN THAT CHILDREN FROM POOR SOCIO-ECONOMIC ENVIRONMENTS CAN START KINDERGARTEN HAVING HEARD 30 MILLION FEWER WORDS THAN THEIR MORE AFFLUENT PEERS. READING TO CHILDREN CAN SHIFT THIS KIND OF TREND. HOWEVER, ASKING FINANCIALLY STRAPPED FAMILIES TO PUT BOOKS FOR THEIR CHILDREN AHEAD OF OTHER VITAL PRIORITIES IS UNREALISTIC. THAT IS WHY OUR PROGRAM WANTS TO HELP THEM TAKE THE LUXURY OUT OF LITERACY. PUTTING BOOKS INTO THE HANDS OF FAMILIES THAT CANNOT AFFORD THEM CAN GO A LONG WAY IN INCREASING LITERACY RATES AND PERFORMANCE IN SCHOOL, HIGHLIGHTING THE IMPORTANCE OF MAKING BOOKS A PART OF NORMAL LIFE FOR EVERY CHILD WHO VISITS VALLEY CHILDREN'S. TRANSPORTATION GIVEN THE CENTRAL VALLEY'S LARGELY RURAL LANDSCAPE AND HIGH CONCENTRATION OF POVERTY, TRANSPORTATION HAS LONG BEEN A CHALLENGE FOR MANY FAMILIES. VALLEY CHILDREN'S CONTINUES TO WORK WITH THE COMMUNITY TO IMPROVE PUBLIC TRANSPORTATION AND ACCESS TO CARE. VALLEY CHILDREN'S SOCIAL WORK DEPARTMENT ASSISTED FAMILIES WITH TRANSPORTATION BY PROVIDING GAS CARDS, TAXI VOUCHERS, AMTRAK TICKETS AND BUS TOKENS. VALLEY CHILDREN'S ALSO SUBSIDIZED BUS AND OTHER PUBLIC TRANSIT SERVICES FROM THE CITY OF FRESNO AND KINGS COUNTY. *SOCIAL AND ENVIRONMENTAL IMPROVEMENT ACTIVITIES VALLEY CHILDREN'S SUPPORTED A NUMBER OF PROGRAMS AND ACTIVITIES TO IMPROVE THE CAPACITY OF COMMUNITIES TO PROMOTE HEALTH AND WELLNESS AMONG CHILDREN. CHILDHOOD OBESITY PREVENTION IN FY2018, VALLEY CHILDREN'S FORMALLY DEVELOPED A REGIONAL APPROACH TO REDUCING THE CHILDHOOD OBESITY EPIDEMIC IN THE CENTRAL VALLEY. THE "COMMUNITIES FOR HEALTHY KIDS" INITIATIVE IS A MULTI-SECTOR PARTNERSHIP BETWEEN HEALTHCARE PROVIDERS, HEALTH PLANS, SCHOOLS, COMMUNITY-BASED ORGANIZATIONS, PUBLIC HEALTH DEPARTMENTS AND THE AGRICULTURE INDUSTRY TO INCREASE ACCESS TO AND CONSUMPTION OF HEALTHY FOODS AND BEVERAGES AND TO INCREASE OPPORTUNITIES FOR AND PARTICIPATION IN PHYSICAL ACTIVITY. THE PURPOSE OF THIS EFFORT IS TO ALIGN AND SUPPORT EXISTING PARTNERSHIPS ACROSS FRESNO, MADERA AND KINGS COUNTIES IN AN EFFORT TO REDUCE. CHILDHOOD OBESITY IN THE CENTRAL VALLEY THROUGH EDUCATION, ADVOCACY AND THE COORDINATED IMPLEMENTATION OF IDENTIFIED STRATEGIES. FURTHERMORE, VALLEY CHILDREN'S HAS IDENTIFIED FOOD INSECURITY AS A CRITICAL SOCIAL DETERMINANT OF HEALTH THAT IMPACTS THE HEALTH AND WELLBEING OF OUR PATIENTS AND FAMILIES. CHILDREN WHO ARE FOOD INSECURE LACK ACCESS TO AFFORDABLE AND HEALTHY FOODS WHICH LEADS TO ADVERSE HEALTH OUTCOMES, INCLUDING INCREASED OBESITY RATES. ADDRESSING FOOD INSECURITY WITHIN THE HEALTHCARE SETTING PROVIDES VALLEY CHILDREN'S THE ABILITY TO FURTHER FOSTER THE HEALTH OF OUR PATIENTS AND COMMUNITIES. TO SUPPORT THIS EFFORT, VALLEY CHILDREN'S LAUNCHED A PILOT PROJECT AT ONE OF ITS COMMUNITY-BASED PRIMARY CARE PEDIATRIC PRACTICES. PROVIDERS AT THE PRACTICE SCREEN THEIR PATIENTS FOR FOOD INSECURITY. IF FOUND TO BE AT-RISK, PATIENTS ARE CONNECTED TO NUTRITION PROGRAMS AND EMERGENCY FOOD RESOURCES. ADDITIONAL SUPPORT IN FY 2018 INCLUDED THE FOLLOWING ACTIVITIES: -VALLEY CHILDREN'S CONVENED A CONTINUING MEDICAL EDUCATION EVENT ON CHILDHOOD OBESITY PREVENTION FOR COMMUNITY PROVIDERS IN FRESNO, MADERA, MERCED, KINGS AND TULARE COUNTIES TO RAISE AWARENESS ABOUT WAYS TO ADDRESS CHILDHOOD OBESITY WITHIN THE CLINICAL SETTING. - VALLEY CHILDREN'S SERVED ON THE STEERING COMMITTEE FOR THE FRESNO COUNTY HEALTH IMPROVEMENT PARTNERSHIP, CO-CHAIRED THE FRESNO COUNTY DIABETES COLLABORATIVE AND PARTICIPATED IN THE LIVE WELL MADERA COUNTY DIABETES AND OBESITY WORKGROUP, THE KINGS COUNTY DIABESITY COALITION AND THE TULARE COUNTY DIABETES AND OBESITY WORKGROUP. EARLY CHILD DEVELOPMENT AND CARE COORDINATION VALLEY CHILDREN'S PARTICIPATED IN A NUMBER OF INITIATIVES SUPPORTING THE HEALTHY DEVELOPMENT OF CHILDREN BOTH DURING PREGNANCY AND INTO THE FIRST 3-5 YEARS OF LIFE. EXAMPLES INCLUDE THE FOLLOWING: FRESNO COUNTY PRE-TERM BIRTH INITIATIVE: FRESNO COUNTY HAS ONE OF CALIFORNIA'S HIGHEST RATES OF PREMATURE BIRTH WITH 1 OUT OF EVERY 9 BABIES BORN TOO EARLY. PREMATURE BIRTH CAN CAUSE SERIOUS PHYSICAL AND MENTAL DISABILITIES, OR EVEN DEATH, BEFORE THE BABY'S FIRST BIRTHDAY. OVER A 10-YEAR PERIOD, THE FRESNO COUNTY PRE-TERM BIRTH INITIATIVE IS WORKING TO IMPROVE THE HEALTH OF FRESNO MOTHERS AND REDUCE THE RATE OF PREMATURE BABIES. USING AN APPROACH CALLED COLLECTIVE IMPACT, PARTNERS ACROSS MANY SECTORS HAVE COME TOGETHER TO CREATE CHANGE IN FRESNO COUNTY. VALLEY CHILDREN'S HAS BEEN AN ACTIVE PARTICIPANT IN THIS INITIATIVE, WITH VALLEY CHILDREN'S SENIOR VICE PRESIDENT FOR COMMUNITY ENGAGEMENT AND POPULATION WELLNESS SERVING AS CHAIR OF THE INITIATIVE'S STEERING COMMITTEE. CRADLE TO CAREER: BOTH FRESNO AND STANISLAUS COUNTIES HAVE BEGUN FORMAL CRADLE TO CAREER INITIATIVES FOR THE PURPOSE OF COVENING PUBLIC AND PRIVATE SECTOR STOCKHOLDERS TO WORK TOGETHER TO IMPROVE OUTCOMES FOR CHILDREN'S IN THEIR COMMUNITIES, FROM PRE-CONCEPTION TO COLLEGE AND/OR VOCATIONAL TRAINING. VALLEY CHILDREN'S PARTICIPATES IN BOTH INITIATIVES AND HAS BEEN A STRONG VOICE FOR THE INCLUSION OF OUTCOMES AND INDICATORS FOCUSED ON CHILD HEALTH AND WELLNESS. HELP ME GROW FRESNO COUNTY: HELP ME GROW IS A COORDINATED SYSTEM OF EARLY IDENTIFICATION AND REFERRAL FOR CHILDREN AGES 0-5 WHO ARE AT RISK FOR DEVELOPMENTAL DELAYS. IN FY2018, VALLEY CHILDREN'S SUPPORTED THE IMPLEMENTATION OF HELP ME GROW IN ITS PEDIATRIC PRIMARY CARE PRACTICES IN FRESNO COUNTY BY PROMOTING THE USE OF A SPECIFIC DEVELOPMENTAL ASSESSMENT AND SCREENING TOOL THAT IS PART OF THE HELP ME GROW MODEL. MARCH OF DIMES: VALLEY CHILDREN'S PARTNERED CLOSELY WITH THE MARCH OF DIMES TO ADVOCATE ON BEHALF OF POLICIES AT THE STATE AND FEDERAL LEVEL THAT PROMOTE HEALTHY PREGNANCIES AND HEALTHY BABIES. ADDITIONALLY, VALLEY CHILDREN'S DIRECTOR OF COMMUNITY AND GOVERNMENT RELATIONS CHAIRED THE MARCH OF DIMES OF CALIFORNIA'S ADVOCACY AND GOVERNMENT AFFAIRS COMMITTEE IN FY2018. MENTAL HEALTH ISSUES AND CHALLENGES ASSOCIATED WITH CHILD AND ADOLESCENT MENTAL HEALTH CONTINUED TO BE A MAJOR CONCERN IN 2017. TO HELP IDENTIFY POTENTIAL REGIONAL SOLUTIONS, VALLEY CHILDREN'S SUPPORTED OR PARTICIPATED IN A NUMBER OF ACTIVITIES. VALLEY CHILDREN'S STAFF PROVIDED TEEN SUICIDE PREVENTION EDUCATION TO STUDENTS AND STAFF AT AREA HIGH SCHOOLS. FORM 990, PART III, LINE 4A IN ADDITION, VALLEY CHILDREN'S STAFF EITHER LED OR PARTICIPATED IN A NUMBER OF COMMUNITY-BASED COLLABORATIVES FOCUSED ON PREVENTING CHILD MENTAL ILLNESS AND / OR EARLY IDENTIFICATION AND TREATMENT OF CHILD MENTAL ILLNESS. VALLEY CHILDREN'S STAFF CHAIRED AN INITIATIVE CALLED COMMUNITY CONVERSATIONS, WHICH IS A 50 MEMBER COLLABORATIVE ADDRESSING ISSUES OF MENTAL HEALTH, HOMELESSNESS AND THE IMPACT ON FAMILIES. A NUMBER OF VALLEY CHILDREN'S STAFF ALSO SERVED AS MEMBERS OF THE FRESNO SUICIDE PREVENTION COLLABORATIVE AND MADERA COUNTY SUICIDE EDUCATION AND AWARENESS COLLABORATIVE. FORM 990 PART III, LINE 4B: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROGRAM SERVICE TWO COMMITMENT TO MEDI-CAL - VALLEY CHILDREN'S HOSPITAL'S COMMITMENT TO SERVING ITS COMMUNITY IS EVIDENCED BY THE LARGE NUMBER OF PATIENTS SERVES THAT ARE COVERED BY MEDI-CAL. IN 2018, 76% OF HOSPITAL INPATIENT DAYS WERE COVERED BY MEDI-CAL. THE COMBINED NET EFFECT OF TOTAL MEDI-CAL REIMBURSEMENT AND DISPROPORTIONATE SHARE FUNDING IN RELATION TO THE COST OF THESE SERVICES RESULTED IN A NET LOSS TO THE HOSPITAL IN 2018 OF $123,786,726. THIS FIGURE IS SEPARATE FROM AND DOES NOT INCLUDE THE COMMUNITY BENEFIT ACTIVITIES AND EXPENSES NOTED IN PREVIOUS SECTIONS, AND ALSO EXCLUDES THE REVENUE AND EXPENSES ASSOCIATED WITH THE HOSPITAL FEE PROGRAM, WHICH IS DESCRIBED IN MORE DETAIL BELOW. HOSPITAL FEE PROGRAM - IN 2009, CALIFORNIA IMPLEMENTED THE HOSPITAL FEE PROGRAM THROUGH WHICH HOSPITALS IN CALIFORNIA, INCLUDING VALLEY CHILDREN'S HOSPITAL, RECEIVED SUPPLEMENTAL MEDI-CAL PAYMENTS. CALIFORNIA IMPLEMENTED THE PROGRAM TO HELP OFFSET A PORTION OF HOSPITAL MEDI-CAL PAYMENT SHORTFALLS ACCRUED OVER CURRENT AND PRIOR YEARS. THE PROGRAM WAS FUNDED BY A QUALITY ASSURANCE FEE PAID BY HOSPITALS THAT THE STATE THEN USES TO COLLECT ADDITIONAL FEDERAL FUNDING. HOSPITAL FEE PROGRAMS LIKE CALIFORNIA'S ARE ALLOWABLE UNDER FEDERAL LAW, AND THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES APPROVED CALIFORNIA'S PROGRAM. IN 2018, VALLEY CHILDREN'S HOSPITAL RECOGNIZED PROGRAM REVENUE OF $88,003,350, NET OF THE HOSPITAL'S QUALITY ASSURANCE FEE AND HOSPITAL CONTRIBUTIONS TO THE CALIFORNIA HEALTH FOUNDATION AND TRUST (CHFT). CHFT WAS ESTABLISHED UNDER THE PROGRAM FOR THE PURPOSE OF SUPPORTING CHARITABLE ACTIVITIES. CHARITY CARE - IN KEEPING WITH OUR MISSION, VALLEY CHILDREN'S HOSPITAL CONTINUES TO ACCEPT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. IN 2018, CHILDREN'S HOSPITAL PROVIDED $241,142 IN CHARITY CARE. THE AMOUNT REPRESENTS COSTS ASSOCIATED WITH PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE HOSPITAL'S CHARITY CARE POLICY WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES IN RELATION TO THE COST OF THESE SERVICES. CHARITY CARE INCLUDES COUNTY INDIGENT AND FREE CARE, WHICH IS BASED ON THE PATIENT'S INABILITY TO PAY FOR SERVICES. IN ORDER TO ASSIST FAMILIES WITH ONGOING CARE NEEDS, VALLEY CHILDREN'S HOSPITAL'S FINANCIAL ASSISTANCE POLICY REQUIRES PATIENT FAMILIES TO APPLY FOR APPROPRIATE GOVERNMENT FUNDING IN CONJUNCTION WITH APPLYING FOR FINANCIAL ASSISTANCE (CHARITY CARE). AS A RESULT, MANY FAMILIES QUALIFY FOR GOVERNMENT PROGRAMS AND DO NOT ULTIMATELY REQUIRE CHARITY CARE. THE HOSPITAL'S CHARITY CARE AMOUNT IS SEPARATE FROM AND DOES NOT INCLUDE THE COMMUNITY BENEFIT ACTIVITIES AND EXPENSES NOTED IN PREVIOUS SECTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE AMENDED AND RESTATED BYLAWS OF VALLEY CHILDREN'S HOSPITAL, EFFECTIVE 10/17/13, ESTABLISHED VALLEY CHILDREN'S HEALTHCARE AS THE SOLE MEMBER OF THE CORPORATION. CERTAIN MEMBER RIGHTS, INCLUDING THE RIGHT TO APPROVE, FIX THE NUMBER, ELECT, AND REMOVE ELECTED TRUSTEES, ARE INCLUDED IN THESE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A SEE ANSWER FOR LINE 6 ABOVE FORM 990, PART VI, SECTION A, LINE 7B SEE ANSWER FOR LINE 6 ABOVE FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE FORM 990 IS UPLOADED TO A SECURED BOARD PORTAL PRIOR TO THE FILING DATE. BOARD MEMBERS ARE ASKED TO REVIEW THE FORM 990 AND PRESENT ANY QUESTIONS THEY MAY HAVE TO THE CFO. CHANGES CAN THEN BE MADE IF WARRANTED BEFORE THE 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARD OF TRUSTEES MAINTAINS A CONFLICT OF INTEREST POLICY WITHIN THE HOSPITAL'S CORPORATE BYLAWS. THE POLICY REQUIRES EACH TRUSTEE TO DISCLOSE PERSONAL FINANCIAL INTERESTS BY EXECUTING ANNUAL STATEMENTS AND REPORTING SPECIFIC INTERESTS ON AN AD HOC BASIS. A STANDING GOVERNANCE COMMITTEE IS TASKED TO REVIEW DISCLOSED INTERESTS, TO ASSESS WHETHER A CONFLICT OF INTEREST EXISTS AND MAKE RECOMMENDATIONS REGARDING FURTHER ACTION AS MAY BE NECESSARY TO MITIGATE OR ELIMINATE A CONFLICT. THE HOSPITAL MAINTAINS A SEPARATE BUT SIMILAR POLICY GOVERNING INDIVIDUALS EMPLOYED IN COVERED POSITIONS. FORM 990, PART VI, SECTION B, LINE 15 AS PROVIDED BY THE VALLEY CHILDREN'S HEALTHCARE BYLAWS, A COMPENSATION COMMITTEE HAS BEEN ESTABLISHED THAT CONSISTS OF A CHAIR AND AT LEAST THREE MEMBERS OF THE BOARD OF TRUSTEES. THE PRIMARY ROLE OF THE COMMITTEE IS TO ENSURE THAT COMPENSATION IS REASONABLY RELATED TO THE DUTIES PERFORMED FOR THE NETWORK AND WITH THE COMPETITIVE EMPLOYMENT MARKET. DUTIES AND ACTIVITIES SPECIFIC TO CEO, OFFICER, AND KEY EMPLOYEES OF THE ORGANIZATION INCLUDE: 1) PERIODIC REVIEW BASED ON THE INDEPENDENT ADVICE OF AN EXTERNAL QUALIFIED COMPENSATION CONSULTANT 2) REVIEW OF MARKET DATA FOR EQUIVALENT POSITIONS 3) REVIEW AND APPROVAL OF TERMS AND CONDITIONS OF THE CEO'S EMPLOYMENT AND OVERSIGHT TO ASSURE FORMAL AND TIMELY PERFORMANCE ASSESSMENTS ARE CONDUCTED 4) REVIEW AND APPROVAL OF EXECUTIVE LEVEL COMPENSATION TO ASSURE THAT TERMS AND CONDITIONS OF EMPLOYMENT ARE MARKET COMPETITIVE FORM 990, PART VI, SECTION C, LINE 19 A COPY OF VALLEY CHILDREN'S HOSPITAL'S ARTICLES OF INCORPORATION IS ON FILE WITH THE CALIFORNIA SECRETARY OF STATE. A COPY OF THE CORPORATE BYLAWS OF VALLEY CHILDREN'S HOSPITAL IS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CONFLICT OF INTEREST MANAGEMENT IS DESCRIBED IN ARTICLE 10 OF THE BYLAWS. THE ANNUAL FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 62,412,321. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,412,321. PROFESSIONAL FEES - OTHER: PROGRAM SERVICE EXPENSES 4,607,240. MANAGEMENT AND GENERAL EXPENSES 320,629. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,927,869. CONSULTING & MANAGEMENT FEES - ON PARENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 38,713. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,713. FORM 990, PART XI, LINE 9: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 13,459,412. 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