2019-04-30T19:04:37-05:00 2017-12-31 HOLTHOUSE CARLIN & VAN TRIGT LLP 3011 TOWNSGATE ROAD SUITE 400 WESTLAKE VILLAGE CA 91361 990 2017-01-01 340714583 CITY HOSPITAL ASSOCIATION % MELISSA BRACONE CITY 3303857200 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 MIKE HEATHER CFO 3303857200 2019-04-30 true Stephanie Wilkinson P01231617 8053748555 174.46.231.234 95206420191205000008 2019-04-30 P 3DE82CF03C4C669F244574ECA69CF31BB07201F8 3DE82CF03C4C669F244574ECA69CF31BB07201F8 2017 2019-02-21 02:37:17Z EAST LIVERPOOL CITY HOSPITAL KEITH RICHARDSON 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 83303668 false X www.elch.org X 1905 OH THE ORGANIZATION IS ORGANIZED AND OPERATED TO PROVIDE THE PEOPLE OF THE TRI-STATE AREA HIGH QUALITY HEALTH SERVICES. 8 6 646 17 217900 11760 0 17560 76234832 82891296 450393 196093 18661428 107858 95346653 83212807 0 2500 0 0 27676390 30059386 0 0 0 37463607 41153438 65139997 71215324 30206656 11997483 34457288 56691528 4250632 13492661 30206656 43198867 X THE ORGANIZATION PROVIDES HIGH QUALITY, COMPASSIONATE HEALTH CARE SERVICES WITHIN THE AVAILABLE RESOURCES. HEALTHCARE SERVICES WILL BE PROVIDED TO PREVENT ILLNESS, RELIEVE SUFFERING, AID IN HEALTH RESTORATION AND TO PROMOTE WELLNESS. THE ORGANIZATION PROVIDES SERVICES TO ANY PERSON, WITHOUT DISCRIMINATION. false false 54366387 2500 82777586 THE ORGANIZATION PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO AFFORD ESSENTIAL MEDICAL SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THE ORGANIZATION'S COMMITMENT TO SERVE ALL MEMBERS OF THE ORGANIZATION'S COMMUNITY WITH FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COSTS, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY HAVE BEEN CONSIDERED WHERE THE NEED AND AN INDIVIDUAL'S INABILITY TO PAY EXIST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. THE ORGANIZATION PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE ORGANIZATION CONSIDERS THESE AMOUNTS AS UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. THE ORGANIZATION IS LOCATED IN EAST LIVERPOOL, OHIO AND SERVICES THE SURROUNDING COMMUNITIES; STAFFING 152 BEDS FOR ACUTE CARE, INTENSIVE CARE, NURSERY, AND SKILLED NURSING IN THIS MEDICALLY UNDERSERVED AREA. DURING 2017, THE ORGANIZATION PROVIDED NUMEROUS BENEFITS TO THE SURROUNDING COMMUNITY, INCLUDING FINANCIAL SUPPORT THROUGH THE COMMUNITY BENEFIT INITIATIVE PROGRAM. COMMUNITY EDUCATION AND WELLNESS PROGRAMS - THE ORGANIZATION OFFERED THE FOLLOWING TO THE COMMUNITY FREE OR AT A NOMINAL CHARGE: HEALTH FAIRS CPR CLASSES CHILDBIRTH CLASSES GARFIELD ELEMENTARY WELLNESS PROGRAM COVER THE UNINSURED PROGRAM HEARTSAVER FIRST AID CLASSES ADVANCE CARDIAC LIFE SUPPORT HEALTHCARE PROVIDE RECERTIFICATION BREAST FEEDING SUPPORT PASTORAL OUTREACH PROGRAMS DIABETES EDUCATION ARTHRITIS AQUATICS CLASSES SMOKING CESSATION CLASSES BASICS IN BABYSITTING CLASSES AUTISM SUPPORT GROUP CONDUCTED HOSPITAL TOURS FOR AREA SCHOOLS AND COMMUNITY GROUPS SERVED AS AN OBSERVATION SITE FOR THE HIGH SCHOOL FOR HEALTH PROFESSIONS DEVELOPED BY THE PUBLIC SCHOOLS HOSTED SEVERAL SHADOW STUDENTS FROM AREA SCHOOLS SERVED AS HOST SITE FOR OHIO HIGHER EDUCATION TELECOMMUNICATION SYSTEM OPERATED A PHYSICIAN REFERRAL LINE FREE TO THE COMMUNITY HOSTED PROGRAMS FOR STUDENT NURSES AND RADIOLOGY TECHNICIANS IN TRAINING PROVIDED FOOD TO NEEDY FAMILIES FOR THANKSGIVING, AND GIFTS TO NEEDY CHILDREN FOR CHRISTMAS TO THE SALVATION ARMY DAY OF CARING, DAY OF GIVING PROGRAM - MONEY AND FOOD DRIVE 54366387 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false true false false false false false true false false false true 71 0 true 646 true true true false false false false false false false false false X 8 6 false true true false false false false true true false false true true true true true true true true false X MELISSA BRACONE 3303862633 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 KEITH RICHARDSON CEO/DIRECTOR 40.0 0.3 X X 322960 0 1140 JOSEPH LUDOVICI DIRECTOR 1.0 0.0 X 0 0 0 PETE WICKS PRESIDENT (UNTIL 10/17) 1.0 0.0 X X 0 0 0 ROBERT O'HARA DIRECTOR 1.0 0.0 X 0 0 0 TAMMIE MCINTOSH DIRECTOR 1.0 0.0 X 0 0 0 JOSEPH SHEMASEK CHAIRMAN 1.0 0.3 X 0 0 0 DAVID HAMILTON DIRECTOR 1.0 0.0 X 0 0 0 GRETCHEN NICKELL DO DIRECTOR 1.0 40.0 X 0 372204 18700 MARK MANGANO DIRECTOR 1.0 0.0 X 0 0 0 TARUN GHOSH CFO (UNTIL 08/17) 40.0 0.3 X 144727 0 0 MIKE SARIAN CHAIR/PRESIDENT 0.0 10.0 X 0 0 0 MIKE HEATHER CFO 0.0 10.0 X 0 0 0 DONALD THOMPSON SECRETARY/GENERAL COUNSEL 0.0 5.0 X 0 0 0 MADAN REDDY TREASURER 0.0 5.0 X 0 0 0 TROY SCHELL SEC./GEN.COUNSEL (until 8/17) 0.0 5.0 X 0 0 0 JAYNE ROSE CNO 40.0 0.0 X 153030 0 100 NICHOLAS PETRUSKA PHARMACIST 40.0 0.0 X 122110 0 1698 WILLIAM SMITH DIRECTOR OF PHARMACY 40.0 0.0 X 136301 0 3356 FRANK MADER DIRECTOR OF INFO. SERVICES 40.0 0.0 X 110433 0 158 TODD MORANDO DIRECTOR OF EMERGENCY DEPT 40.0 0.0 X 110519 0 314 1100080 372204 25466 9 false true false MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 303682289 DIETARY SERVICES 1309277 OHIO VALLEY Anesthetists LLC 425 WEST 5TH STREET EAST LIVERPOOL OH 43920 ANESTHESIA 1112583 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING 959525 HOSPITAL BUSINESS SERVICES INC 3300 E GUASTI ROAD 3RD FLOOR ONTARIO CA 91761 BUSINESS OFFICE SERV 1462764 PRIME HEALTHCARE MANAGEMENT II INC 3300 E GUASTI ROAD 3RD FLOOR ONTARIO CA 91761 MANAGEMENT 5359150 42 X 17560 17560 NET PATIENT REVENUE 621500 82673396 82673396 LAB SERVICES 621500 210874 210874 THERAPY SERVICES 621500 7026 7026 82891296 185921 185921 0 0 0 0 0 101033 90861 10172 10172 10172 0 0 0 0 0 0 0 0 0 CAFETERIA/VENDING 900099 57215 57215 PURCHASE DISCOUNTS 900099 16494 16494 OTHER OPERATING INCOME 900099 17713 17713 16436 12768 3668 107858 83212807 82777586 217900 199761 X 2500 2500 0 0 0 467687 280612 187075 0 22528458 13517075 9011383 183519 183519 5220816 5220816 1658906 1211001 447905 4280087 4280087 3078 3078 181262 181262 0 0 0 10842896 10282197 560699 139900 120314 19586 164929 111747 53182 0 0 1214866 728920 485946 72137 62038 10099 0 0 426608 426608 0 2528459 2528459 0 985258 985258 BAD DEBT EXPENSE 8145688 8145688 MEDICAL SUPPLIES 5592043 5032839 559204 TAXES AND LICENSES 2598103 2598103 REPAIRS AND MAINTENANCE 1744556 1046734 697822 2233568 1881959 351609 71215324 54366387 16848937 0 X 12540247 6787360 0 2021131 0 0 10071657 11289141 0 0 0 0 0 0 409414 477259 316257 272412 14042623 5318781 7522207 8723842 2151617 145005 0 0 0 0 1445889 1343222 0 25632156 34457288 56691528 775961 5195252 0 0 0 0 0 0 0 0 0 0 0 213091 0 0 3474671 8084318 4250632 13492661 X 30206656 43198867 0 0 0 0 30206656 43198867 34457288 56691528 11997483 994728 X false true X true false X false false false false false true 1181 false false false 1181 false PART II-B, LINE 1F AMOUNT REPORTED IN PART II-B, LINE 1F REPRESENTS PORTION OF DUES PAID TO TRADE ASSOCIATIONS THAT IS ATTRIBUTABLE TO LOBBYING ACTIVITES. 918703 918703 5707632 2595686 3111946 253305 75000 178305 6968306 2559217 4409089 194677 88878 105799 8723842 DUE FROM PRIME HEALTHCARE FDN 23133368 DUE FROM OHIO VALLEY HOME 1344641 DUE FROM MEDICARE 1154147 25632156 0 CAPITAL LEASES 2162465 REVOLVING CREDIT FACILITY 2592780 DUE TO AFFILIATES 2560849 IBNR 768224 8084318 X SCHEDULE D, PART X, LINE 2 THE LITERATURE RELATED TO UNCERTAIN TAX POSITIONS PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS AND ALSO PROVIDES GUIDANCE ON VARIOUS RELATED MATTERS SUCH AS DE-RECOGNITION, INTEREST, PENALTIES AND DISCLOSURES REQUIRED. THE COMPANY DOES NOT HAVE ANY ENTITY-LEVEL UNCERTAIN TAX POSITIONS. true true true X true X true true false false 1372426 947407 425019 0.00670 102100535 87736040 14364495 0.22780 3347 2876 471 0.00000 103476308 88686323 14789985 0.23450 103476308 88686323 14789985 0.23450 true 8145688 3502627 19385267 19364396 20871 X true true 1 1 EAST LIVERPOOL CITY HOSPITAL 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 www.elch.org 11418 X X EAST LIVERPOOL CITY HOSPITAL 1 false false true X X X X X X X X X 16 true true true true X SEE SECTION C X true 16 true SEE SECTION C false true X 100 400. X X true true X X true X SEE SECTION C X SEE SECTION C X X X X true X true X X X X true X false false SCHEDULE H, PART V, SECTION B, LINES 6A & 6B PARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE: COLUMBIANA COUNTY EDUCATIONAl SERVICE CENTER, COLUMBIANA COUNTY GENERAL HEALTH DISTRICT, COLUMBIANA COUNTY MENTAL HEALTH AND RECOVERY SERVICES BOARD, COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY, EAST LIVERPOOL CITY HEALTH DEPARTMENT, EAST LIVERPOOL CITY HOSPITAL, RIVER VALLEY PHYSICIANS, SALEM CITY HEALTH DEPARTMENT, AND SALEM REGIONAL MEDICAL CENTER. SCHEDULE H, PART V, SECTION B, LINE 16A FINANCIAL ASSISTANCE POLICY AVAILABLE ON THE HOSPITAL FACILITY'S WEBSITE: http://www.elch.org/documents/ELCH-financial-assistance-full-policy-new.pd f SCHEDULE H, PART V, SECTION B, LINE 5 Primary qualitative data to reflect input from the broad community and vulnerable populations was collected specifically for this assessment and included a total of seventeen in-depth stakeholder interviews, four focus groups reflecting 49 participants, and 417 surveys completed by individuals representing diverse constituent groups. In addition to gathering input from focus groups and stakeholder interviews, input and guidance also came from the community representatives, who served on the Columbiana County Health Partners Steering Committee. Seventeen stakeholder interviews were conducted from January 21- April 16, 2016 by members of the Steering Committee. Stakeholders interviewed included individuals with expertise in the following disciplines and/or organizational affiliations. Stakeholders Interviewed: - School Districts - Case Management at each hospital - Catholic Charities - Juvenile Justice System - Local Government/ County Commissioners - Community Resource Center - Health and Human Service Providers - Food Pantry - Mental Health and Recovery - Youth Services - Visiting Nurses Association - Faith-Based Organizations Providing Assistance - Hispanic Community SCHEDULE H, PART V, SECTION B, LINE 11 East Liverpool City Hospital, Salem Regional Center and the Columbiana County General Health Districts have been collaborating on their county-wide CHNA planning efforts since 2013, and have addressed at least two of Ohios health priorities in each planning cycle. In addition, the local health departments and hospitals have aligned with a three-year timeline for conducting assessments and planning, beginning in 2013 and continuing into the 2016 CHNA planning cycle. Columbiana Countys existing population health planning infrastructure will continue to collaborate on the development of future strategies to be determined by the Columbiana County Health Partners as a result of this CHNA, including identifying enhanced opportunities to: - Determine priorities, objectives, implementation strategies, ongoing evaluation and a communication plan - Standardize assessment timelines and provide an integrated definition of community - Efficiently collect and share population-level and clinical data - Pursue collaborative partnerships for implementing evidence-based, community health improvement activities - Define standards for tracking progress and evaluating the impact of implemented activities During the May 2, 2016 Columbiana County Health Partners CHNA Work Group meeting, the participants agreed that the 2016 CHNA initiatives should focus on three major priority categories as selected from the Prioritization Surveys 52 options. these were sorted and ranked by the prioritization criteria of Magnitude and Impact. The three major priority categories selected include: Obesity, Mental Health/Substance Abuse, and Tobacco Use/Cancer Prevention. SCHEDULE H, PART V, SECTION B, LINE 7A CHNA REPORT AVAILABLE ON THE HOSPITAL FACILITY'S WEBSITE: http://www.elch.org/documents/ColumbianaCountyCHNAFinalFullReport_2016-edi t9-15.pdf SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION PLAN AVAILABLE ON THE HOSPITAL FACILITY'S WEBSITE: http://www.elch.org/documents/IMPLEMENTATIONPLAN2016-East-Liverpool-City-H ospital.pdf SCHEDULE H, PART V, SECTION B, LINE 16C PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE ON A WEBSITE (LIST URL): http://www.elch.org/Patients-Visitors/Insurance-Financial-Info.aspx SCHEDULE H, PART III, SECTION A, LINE 2 THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 THE HOSPITAL CONTENDS THAT THE ENTIRE AMOUNT OF THE MEDICARE SURPLUS SHOULD ALSO BE CONSIDERED AS A COMMUNITY BENEFIT. THE REASON FOR THIS IS THAT THE MEDICARE RATES ARE SET UNILATERALLY BY THE FEDERAL GOVERNMENT AND THE HOSPITAL AGREES TO SERVICE THESE PATIENTS AT THESE RATES AS PART OF OUR MISSION AND SERVICE TO THE COMMUNITY. THE COST INCLUDED ON LINE 6 COMES FROM THE MEDICARE COST REPORT WHICH THE FEDERAL GOVERNMENT HAS SET UP AS THEIR WAY TO CAPTURE AND SEGREGATE THE COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS. SCHEDULE H, PART III, SECTION C, LINE 9B THE HOSPITAL PRACTICE IS THAT UPON VERIFICATION THAT A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, THE HOSPITAL DISCONTINUES COLLECTION EFFORTS AND MAKES THE APPROPRIATE ADJUSTMENT TO THE PATIENT'S ACCOUNT BASED UPON THE PATIENT'S INDIVIDUAL CIRCUMSTANCES. SCHEDULE H, PART VI, LINE 2 ONGOING EFFORTS AND EVALUATION OF MANAGEMENT, STAFF, PHYSICIANS WITH FEEDBACK FROM PATIENTS AND COMMUNITY. DEMOGRAPHIC RESEARCH AND STUDIES ALSO UTILIZED TO DETERMINE TYPE AND QUANTITY OF SERVICES NEEDED BY SPECIALTY TO BEST SERVE OUR COMMUNITY. SCHEDULE H, PART VI, LINE 3 INFORMATION REGARDING FINANCIAL ASSISTANCE AND CHARITY CARE IS MADE AVAILABLE AT TIME OF REGISTRATION, ON THE HOSPITAL'S WEBSITE, AND ON PATIENT STATEMENTS. APPLICATIONS ARE ALSO MADE AVAILABLE TO PATIENTS AT TIME OF REGISTRATION IF APPROPRIATE. In order to ensure that patients are aware of the existence of the Financial Assistance Policy, the Hospital widely disseminates the existence and terms of this Policy throughout its service area. In addition to other appropriate efforts to inform the community about the Policy in a way targeted to reach community members most likely to need financial assistance, the following actions ARE taken: A. WRITTEN NOTICE TO ALL PATIENTS Each patient who is seen, whether admitted or not, shall receive the Plain Language Summary. The notice shall be provided in non-English languages spoken by a substantial number of the patients served by the Hospital. B. POSTING OF NOTICES The financial assistance policy shall be clearly and conspicuously posted in locations that are visible to the patients in the following areas: (1) Emergency Department; (2) Billing Office; (3) Admissions Office; and (4) other outpatient settings. The notice shall be provided in non-English languages spoken by a substantial number of the patients served by the Hospital. C. Notice to Accompany Billing statements Every post-discharge statement shall include a copy of the notice. Each bill that is sent to a patient who has not provided proof of coverage by a third party at the time care is provided or upon discharge must include a statement of charges for services rendered by the Hospital. These notices shall be provided in non-English languages spoken by a substantial number of the patients served by the Hospital. D. AVAILABILITY OF FINANCIAL ASSISTANCE DOCUMENTS The Hospital shall post a copy of this Policy, the Plain Language Summary and the financial assistance application on its website and make all such documents available for free download. Such documents shall be available in the emergency room and admissions office and by mail upon request. The documents shall be provided in non-English languages spoken by a substantial number of the patients served by the Hospital. E. ACCESSIBILITY TO LIMITED ENGLIGH PROFICIENT INDIVIDUALS The Hospital shall make translations of this Policy, the Plain Language Summary, and the financial assistance application available in any language that is the primary language of the lesser of one thousand (1,000) individuals or five percent (5%) of the population of the communities served by the Hospital. SCHEDULE H, PART VI, LINE 4 Columbiana County, Ohio Columbiana County is located in northeastern Ohio and is one of Ohio's 32 Appalachian counties. It is bordered on the north by Mahoning County; on the east by Pennsylvania; on the south by the Ohio River and West Virginia; and on the west by Jefferson, Carroll and Stark Counties. Over half of the county's total population of 105,686 lives in unincorporated rural areas, with villages and towns some distance apart. The county has two major geographic concentrations of development and population. The northern corridor between the cities of Salem and East Palestine, (including the villages of Washingtonville, Leetonia, Columbiana and New Waterford and the four townships of Perry, Salem, Fairfield and Unity); extend along a 20-mile distance bordering Mahoning County to the north, and contain almost 48% of the county's population. The southern corridor extends for about 10 miles from the Village of Wellsville to East Liverpool, (including St. Clair Township) and contains 11% of the county's total population. EAST LIVERPOOL CITY HOSPITAL IS THE ONLY HOSPITAL WITHIN 20 MILES OF THE CITY. THE HOSPITAL SERVES PATIENTS WITHIN A 10-15 MILE RADIUS INCLUDING PATIENTS FROM NEIGHBORING PENNSYLVANIA AND WEST VIRGINIA. MOST RESIDENTS HAVE LIVED HERE ALL THEIR LIVES AND THE COMMUNITY SERVED IS COMPRISED OF A SIGNIFICANT BIAS OF SENIOR CITIZENS.A SIGNIFICANT BIAS OF SENIOR CITIZENS. SCHEDULE H, PART VI, LINE 5 EAST LIVERPOOL CITY HOSPITAL HAS AN OPEN MEDICAL STAFF, A COMMUNITY BOARD OF TRUSTEES AND IS EXTREMELY GENEROUS WITH FUNDING COMMUNITY CHARITIES AND DONATING EMPLOYEE TIME TO SERVE THE GENERAL POPULATION OF THE AREA SERVED. THIS INCLUDES PARTICIPATING IN COMMUNITY HEALTH FAIRS, SCHOOL PROGRAMS, AND FREE PUBLIC SPEAKING REGARDING TOPICS RECOGNIZED AS IMPLEMENTATION PRIORITIES IN THE 2016 CHNA. ELCH OFFERS FREE SMOKING CESSATION, DIABETES EDUCATION, AND HEALTH NUTRITION TO ALL COMMUNITY MEMBERS. PERCENT OF TOTAL EXPENSE BAD DEBT EXPENSE OF $8,145,688 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. Disclosure pursuant to Revenue Procedure 2015-21: Professional advisors to Prime Healthcare Foundation, Inc., the indirect sole member of the hospital, identified that the hospitals financial assistance policy (FAP) did not contain every provision required under Treasury Regulations Section 1.501(r)-4 and may not have been consistently available on the hospitals website. These issues were identified by auditors on July 21, 2017 and by legal counsel on August 4, 2017. ALL IDENTIFIED ISSUES WERE CORRECTED DURING late 2017 AND EARLY 2018 AND THE UPDATED FAP WAS ADOPTED BY THE BOARD ON MAY 24, 2018. THE FAP, FAP PLAIN LANGUAGE SUMMARY, AND FINANCIAL ASSISTANCE APPLICATION (INCLUDING TRANSLATIONS THEREOF, AS APPLICABLE) HAVE BEEN POSTED ON THE HOSPITAL WEBSITE. IN OTHER WORDS, EFFECTIVE AS OF SUCH 2018 DATE, THE HOSPITAL CAN CHECK ALL OF THE BOXES IN PART V, LINE 16(A) THROUGH AND INCLUDING LINE 16(I). A revised FAP was prepared that meets the requirements of the final regulations. This revised FAP was reviewed and approved by the board of directors of the hospital. The updated FAP is widely publicized, including on the hospitals website, in paper form by mail and in key hospital areas such as admissions and emergency room, through inclusion of information in billing statements, and conspicuous signage at the facility. It was also brought to the attention of management that the FAP, Plain Language Summary, and/or application form have at times inadvertently not been posted on the hospitals website. The dates during which this problem existed are not clear. Safeguards have been put in place to communicate with responsible personnel and highlight the importance of web access, and the newly-revised FAP contains an explicit procedural requirement that the policy be posted on the hospitals website. Despite these inadvertent failures, the hospital has at all times had a financial assistance program in effect that is consistent with the intent of Code Section 501(r) and has publicized the availability of charity care and discounted care through a written summary notice provided to all patients, conspicuous notices posted in the emergency department and admissions office, and notices included in billing statements to patients who have not provided proof of insurance. Therefore the hospital does not believe there have been qualifying individuals who were unaware of the program. SCHEDULE H, PART III, SECTION A, LINE 3 The amount of bad debt attributable to patients eligible under the organization's financial assistance policy is from the 2017 Medicare Cost Report. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM City Hospital Association is a subsidiary of Prime Healthcare Foundation, Inc. (PHF). PHF and its subsidiaries are their own health system managed by Prime Healthcare Management II, Inc. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT THIS IS NOT APPLICABLE TO CITY HOSPITAL ASSOCIATION. SCHEDULE H, PART III, SECTION A, LINE 4 The Companys patient accounts receivable are reduced by allowances for contractual adjustments and doubtful accounts. In evaluating the collectability of patient accounts receivable, the Company analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowances for both contractual adjustments and doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of these allowances. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and co-payment balances due for which third-party coverage exists for part of the bill), the Company records a provision for doubtful accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the expected rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. X X true true false false false false false false false false false KEITH RICHARDSON CEO/DIRECTOR 288960 0 34000 0 0 0 0 0 1140 0 324100 0 0 0 GRETCHEN NICKELL DO DIRECTOR 0 225525 0 143929 0 2750 0 1200 0 17500 0 390904 0 0 JAYNE ROSE CNO 145030 0 8000 0 0 0 0 0 100 0 153130 0 0 0 PART I, LINE 1A: CITY HOSPITAL ASSOCIATION ALLOWS COMPANION TRAVEL BY EXECUTIVES ONLY WHEN IT SERVES A JUSTIFIED BUSINESS PURPOSE. IF IT IS LATER DETERMINED THAT THERE WAS NOT A JUSTIFIED BUSINESS PURPOSE, THIS WILL RESULT IN TAXABLE COMPENSATION TO THE EXECUTIVE IN QUESTION. CITY HOSPITAL ASSOCIATION PROVIDES A MEMBERSHIP TO AN AREA SOCIAL CLUB IN ORDER FOR EXECUTIVES TO CONDUCT HOSPITAL BUSINESS. ANY PERSONAL USE BY THE EXECUTIVES IS INCLUDED IN THAT EXECUTIVE'S TAXABLE WAGES. METHODS TO ESTABLISH COMPENSATION OF CEO/EXECUTIVE DIRECTOR PART 1, LINE 3 A RELATED ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY OFFICER COMPENSATION IS ESTABLISHED BY PRIME HEALTHCARE MANAGEMENT II, INC. IN ACCORDANCE WITH A MANAGEMENT AGREEMENT. WRITTEN EMPLOYMENT CONTRACTS ARE FORWARDED TO THE FACILITY ONCE EXECUTED. COMPENSATION SURVEY OR STUDIES ARE UTILIZED. 0 PRIME HEALTHCARE MANAGEMENT IIINC SEE PART V 5359150 MANAGEMENT FEES true Hospital Business Services Inc SEE PART V 1462764 BUSINESS OFFICE SERVICES true PART IV, LINEs (1) AND (2), COLUMN (B) ENTITY IS INDIRECTLY, CONSTRUCTIVELY OWNED MORE THAN 35% BY AN OFFICER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B: Information is compiled by the finance department and the Form 990 is prepared by an outside accounting firm. Once prepared, the forms are reviewed by outside counsel prior to filing and then the returns are provided to the board for their review contemporaneously with their filing. FORM 990, PART VI, SECTION B, LINE 12C: ALL DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST, ON THE PART OF ANY MEMBERS OF THE BOARD OF TRUSTEES, ON ANY ISSUE, SHOULD BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD OF TRUSTEES AND MADE A MATTER OF RECORD. ANY MEMBER OF THE BOARD OF TRUSTEES HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST, ON ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT A DISCLOSURE WAS MADE AND THE ABSTENTION FROM VOTING. FORM 990, PART VI, SECTION B, LINES 15A AND 15B: A RELATED ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY OFFICER COMPENSATION IS ESTABLISHED BY PRIME HEALTHCARE MANAGEMENT II, INC. IN ACCORDANCE WITH A MANAGEMENT AGREEMENT. WRITTEN EMPLOYMENT CONTRACTS ARE FORWARDED TO THE FACILITY ONCE EXECUTED. COMPENSATION SURVEY OR STUDIES ARE UTILIZED. FORM 990, PART VI, SECTION C, LINE 19: THE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 3: THE ORGANIZATION IS BEING MANAGED BY PRIME HEALTHCARE MANAGEMENT II,INC., AN AFFILIATE OF PRIME HEALTHCARE FOUNDATION,INC. WILDFIRE DISASTER RELIEF EXTENSION DISCLOSURE On November 13, 2018, the Internal Revenue Service announced in CA-2018-13 that victims of wildfires that took place beginning on November 8, 2018 in California may qualify for tax relief. The relief applies to affected taxpayers in certain counties of California. The announcement indicates that it is applicable to tax-exempt organizations that operate on a calendar-year basis and had previously been granted an automatic extension to file until November 15, 2018. Since the organization engages a tax preparer in the covered disaster area (Ventura county) to prepare its Federal Form 990, Return of Organization Exempt from Income Tax, and the records necessary to file the calendar-year 2017 Federal Form 990 are located in the covered disaster area, the postponed due date for the Federal Form 990 is now April 30, 2019. The organization respectfully requests relief from any late filing penalty or interest. FORM 990, PART VI, SECTION A, LINE 4: THE ORGANIZATION'S BYLAWS WERE AMENDED AND RESTATED ON FEBRUARY 1, 2016. THE SIGNIFICANT CHANGES TO THE BYLAWS ARE AS FOLLOW: - THE ORGANIZATION'S DIRECT CONTROLLING ENTITY AND SOLE MEMBER IS PRIME HEALTHCARE FOUNDATION - EAST LIVERPOOL, LLC. PRIME HEALTHCARE FOUNDATION, INC. ("PHF"), A DELAWARE NONPROFIT, NON-STOCK CORPORATION EXEMPT FROM TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE IS THE SOLE MEMBER OF PRIME HEALTHCARE FOUNDATION - EAST LIVERPOOL, LLC. - THE GOVERNING BOARD MAY NOMINATE QUALIFIED INDIVIDUALS BUT THE SOLE MEMBER HAS THE AUTHORITY TO SELECT THE CEO. THE CEO IS APPOINTED BY THE MEMBER TO MANAGE THE DAY-TO-DAY BUSINESS AFFAIRS AND ADMINISTRATION. THE CEO REPORTS TO THE GOVERNING BOARD, WHILE MAINTAINING CONTINUING COMMUNICATION WITH THE MEMBER AND STAFF. - The Governing Board has delegated to the CEO broad authority and responsibility, including but not limited to the following: (a) carrying out the directives of the Governing Board; (b) providing orientation for new Governing Board Members and continuing education for all Governing Board Members and reviewing their performance. Continuing education shall include, but not be limited to, education related to (i) the organization's Mission, Vision and Values (ii) the organization's safety and quality goals, (iii) the organization's organizational structure and decision making process, (iv) the development of a budget for the organization and the interpretation of the organization's financial statements, (v) the patient population served by the organization and any issues related to such population, (vi) the individual and interdependent responsibilities and accountability of the Governing Board, the organization's senior management, and the Medical Staff leadership as they relate to supporting the organization's mission of providing safe and quality care, and (vii) applicable laws and regulations; (c) identifying a nurse leader to serve as the Chief Nursing Officer/Director of Nursing who will, among other things, participate in decision making at the executive level; (d) identifying a qualified individual to serve as the Chief Financial Officer of the organization, who will, among other things, participate in financial planning, reporting and management; (e) establishing and managing such non-Medical Staff departments of the organization as he deems necessary; (f) serving as the liaison among the organization's Member, health care delivery organizations corporately and functionally related to the organization, the Governing Board, the Medical Staff, the AHP Staff, and organization employees; (g) supporting the organization's performance improvement programs and its initiatives and the organization's patient safety program; (h) negotiating, entering into, administering, modifying, and terminating such contracts (including contracts with Practitioners for the rendering of services at or to the organization) for the organization as he may deem necessary; (i) performing or delegating the performance of all personnel, financial, strategic planning, and other management functions within the organization, except to the extent that such functions are explicitly and exclusively reserved to the Governing Board or to the Medical Staff pursuant to these Bylaws; (j) Perfecting and submitting to the Governing Board for approval a plan of organization of the personnel and others concerned with the operation of the organization. This plan of organization shall clearly outline the chain of administrative command and accountability, which shall be operational in the absence of the CEO (or similarly appointed officer). The CEO shall further provide a liaison between the general and professional staff of the organization and the Governing Board; (k) Preparing an annual budget showing the expected receipts and expenditures of the organization as required by the Governing Board; (l) Assuring that all physical properties and fixed and movable equipment are kept in good state of repair and operating condition; (m) Supervising all business such as the collection of accounts, purchases and issuance of supplies, and making all proper efforts to collect the funds due so as to maintain the financial solvency of the organization; (n) Developing criteria to select, employ, evaluate, control and discharge all employees as authorized by the Governing Board; (o) Providing for such personnel policies as are necessary to foster and maintain a work environment responsive to changing business conditions, regulatory requirements, and fairness to the employees of the organization. Criteria utilized in establishing job performance expectations and evaluation indicators will apply to contracted and payroll staff. The criteria for clinical providers shall reflect the skills needed to accomplish age appropriate assessments and treatment plans; such age appropriate assessment and treatment planning criteria shall also be developed with the collaboration of the Medical Staff for their utilization in recommendations concerning reappointment and Clinical Privileges; (p) Cooperating with the Medical Staff and securing like cooperation on the part of those concerned with the rendering of high quality professional services to all patients. Providing the necessary administrative, fiscal and personnel resources to assist the Medical Staff and departmental/service staff in implementing the organization's performance improvement, risk management and safety programs; (q) Attending all meetings of the Governing Board and its committees when requested to do so; (r) Submitting regularly to the Governing Board and to the Member periodic reports showing the professional services and financial activities of the organization, and preparing and submitting such other special reports as may be required by the Governing Board or the Member, including those reports attesting to there being one level of care for patients with the same health problem regardless of payer source or other non-medical factor; and facilitating the reporting by the general staff of the organization to the Governing Board quality assessment results and findings; (s) Performing any other duties as directed by the Governing Board that are in the best interests of the organization; (t) Serving as liaison officer and channel of communications for official communications between the Governing Board, organization administration, and the Medical Staff; (u) Continually providing and updating the capital expenditures plan as required by applicable laws and regulations and as directed by the Governing Board; (v) Preparing a strategic plan for the organization (a "Strategic Plan") and submitting the plan to the Governing Board for approval. Such submission for approval shall be at least once every five years with annual updates to each Governing Board as to the progress of the completion of the activities called for in the Strategic Plan; (W) Assuring that the implementation of the organization's programs and services is cost effective; (x) Reviewing and acting promptly upon reports of authorized planning, regulatory and accrediting agencies. The CEO shall undertake corrective action for any deficiencies reported by such agencies, and shall prepare documentation of such corrective action when necessary, to be made available to licensing, accrediting, or any governmental agency for the organization's accreditation or plan of correction survey; (y) Receiving, as authorized agent of the organization, the service of any documents, including reports of inspections and consultations and civil and administrative process; and (z) Subject to the approval of the Member, appointing a qualified individual to act in the CEO's temporary absence. individual to act in the CEO's temporary absence. FORM 990, PART VI, SECTION A, LINE 4: THE ORGANIZATION'S BYLAWS WERE AMENDED AND RESTATED ON FEBRUARY 1, 2016. THE SIGNIFICANT CHANGES TO THE BYLAWS ARE CONTINUED AS FOLLOWS: - The Medical Staff shall be established by and accountable to the Governing Board and shall operate as a part of the ORGANIZATION. Only the Medical Staff Bylaws, rules, and regulations as are recommended by the Medical Staff and adopted and approved by the Governing Board shall be effective. - The Governing Board retains the right to recommend amendments to the Medical Staff Bylaws as necessary for the operation of the organization and as necessary for compliance with applicable laws, the requirements of the Joint Commission, the Healthcare Facilities Accreditation Program, or other similar deemed status accrediting agency, whichever is applicable, other accrediting bodies, and the requirements of the organization. - The Medical Staff Bylaws shall include a mechanism whereby the Medical Executive Committee makes recommendations to the Governing Board regarding certain matters. - In order for any licensed Practitioner to practice in the organization, such individual must first be appointed to either the Medical Staff or the AHP Staff and be granted specific Clinical Privileges. - From time to time, the organization may engage one or more physicians as a medico-administrative officer under such terms and conditions as are specified in an engagement contract. - The Governing Board will cooperate with auxiliary and associate organizations to assist in the fulfillment of the purposes of the organization. FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:850383 FORM 990 PART IX LINE 11G DESCRIPTION:RECRUITING TOTAL FEES:62013 FORM 990 PART IX LINE 11G DESCRIPTION:LABORATORY SERVICE CONTRACTS TOTAL FEES:176547 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICE CONTRAC TOTAL FEES:42098 FORM 990 PART IX LINE 11G DESCRIPTION:BUSINESS OFFICE SERVICES TOTAL FEES:1462764 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:15611 FORM 990 PART IX LINE 11G DESCRIPTION:INFORMATION SERVICE CONTRACTS TOTAL FEES:358229 FORM 990 PART IX LINE 11G DESCRIPTION:OPERATION SERVICE CONTRACTS TOTAL FEES:303118 FORM 990 PART IX LINE 11G DESCRIPTION:BIOMED SERVICE CONTRACTS TOTAL FEES:524991 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:146929 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:1081140 FORM 990 PART IX LINE 11G DESCRIPTION:LABORATORY FEES TOTAL FEES:126507 FORM 990 PART IX LINE 11G DESCRIPTION:WOUND CARE CLINIC FEES TOTAL FEES:589134 FORM 990 PART IX LINE 11G DESCRIPTION:LINEN CARE PROFEESIONAL FEES TOTAL FEES:277837 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION PROF FEES TOTAL FEES:3214631 FORM 990 PART IX LINE 11G DESCRIPTION:ANESTHESIA PROFESSIONAL FEES TOTAL FEES:900488 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PROFESSIONAL FEES TOTAL FEES:528640 FORM 990 PART IX LINE 11G DESCRIPTION:BEHAVORIAL HEALTH PROF FEES TOTAL FEES:181836 PRIME HEALTHCARE FOUNDATION INC 3300 E GUASTI ROAD SUITE 300 ONTARIO CA 91761 208065139 HOSPITAL/MGMT DE 501(C)(3) 3 NA false OHIO VALLEY HOME HEALTH SERVICES 425 WEST FIFTH STREET EAST LIVERPOOL OH 43920 341014198 HEALTHCARE OH 501(c)(3) 10 PHF-EAST LIV false KNAPP MEDICAL CENTER 1401 E 8TH STREET-PO BOX 1110 WESLACO TX 78596 741393060 HOSPITAL TX 501(C)(3) 3 PHF false MID-VALLEY PHYSICIANS ASSOCIATION 1401 E 8TH STREET WESLACO TX 78596 742755150 SUPPORT TX 501(C)(3) 11A KMC false KNAPP MEDICAL GROUP 1402 E 8TH STREET WESLACO TX 78596 271619835 HEALTHCARE TX 501(C)(3) 3 KMC false CALIFORNIA UNIVERSITY OF SCIENCE AND MED 3300 E GUASTI ROAD SUITE 300 ONTARIO CA 91761 464141445 EDUCATION CA 501(C)(3) 2 PHF false MISSION HOSPITAL INC 900 SOUTH BRYAN ROAD MISSION TX 78572 742206635 HOSPITAL TX 501(C)(3) 3 PHF-MISSION false MISSION HOSPITAL FOUNDATION 900 SOUTH BRYAN ROAD MISSION TX 78572 542076455 SUPPORT TX 501(C)(3) 11A MISSION HOSP false MISSION DOCTORS GROUP 906 SOUTH BRYAN ROADSUITE 209 MISSION TX 78572 742798500 HEALTHCARE TX 501(C)(3) 3 MISSION HOSP false false false false false false false false false false false false true true true false true false false false