2018-11-13T12:58:58-06:00 2017-12-31 ERNST & YOUNG US LLP 18101 VON KARMAN AVENUE SUITE 1700 IRVINE CA 92612 990 2017-01-01 951115230 POMONA VALLEY HOSPITAL MEDICAL CENTER % JULI HESTER POMO 9098659500 1798 N Garey Avenue Pomona CA 91767 JULI HESTER TREASURER/CFO 9098659881 2018-11-13 true KARA ADAMS P00023315 9497942300 164.57.159.253 33577420183175000033 2018-11-13 P 856506003E7717BB4C5FA0BAF50AAA2B61E0405F 10EB7846AD20B1D43308ADEF888308A1C0E2799A 2017 2019-02-21 02:37:17Z Richard E Yochum 1798 N Garey Ave Pomona CA 91767 679123478 false X www.pvhmc.org X 1903 CA SEE SCHEDULE O 23 19 3632 1192 305597 0 9152375 2198980 580459762 673116365 1257718 1269438 4272730 2350346 595142585 678935129 1369022 1345635 0 0 298193477 324777995 0 0 0 254269556 278791927 553832055 604915557 41310530 74019572 509587600 631286011 121461796 170104156 388125804 461181855 X POMONA VALLEY HOSPITAL MEDICAL CENTER IS A NOT-FOR-PROFIT REGIONAL MEDICAL CENTER DEDICATED TO PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE SERVICES TO RESIDENTS OF THE GREATER POMONA VALLEY. false false 561080818 1345635 675313078 SEE SCHEDULE O 561080818 true true false true false false false false false true true false false true true false false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true 365 0 true 3632 true true true false false false false false false false false false X 23 19 false false false false false false false true true false false true true true true true true true true true false CA X JULI HESTER 9098659881 1798 N GAREY AVENUE POMONA CA 91767 RICHARD YOCHUM PRESIDENT/CEO 36.0 4.0 X X 2898881 0 408323 KEVIN MCCARTHY CHAIR (PART YEAR) 2.0 2.0 X X 0 0 0 BILL MCCOLLUM VICE CHAIR 2.0 0.0 X X 0 0 0 ROSANNE BADER VICE CHAIR 2.0 0.0 X X 0 0 0 RICHARD FASS CHAIR 2.0 0.0 X X 0 0 0 DWARAKNATH P REDDY DIRECTOR 2.0 0.0 X 53946 0 0 LESTER HOLSTEIN MD DIRECTOR 2.0 0.0 X 59130 0 0 M HELLEN RODRIGUEZ MD DIRECTOR 2.0 2.0 X 0 0 0 JANE GOODFELLOW DIRECTOR 2.0 0.0 X 0 0 0 RICHARD P CREAN DIRECTOR (PART YEAR) 2.0 2.0 X 0 0 0 JOHN TODD DIRECTOR 2.0 0.0 X 0 0 0 RONALD T VERA DIRECTOR 2.0 0.0 X 0 0 0 STEPHEN MORGAN DIRECTOR 2.0 0.0 X 0 0 0 CURTIS MORRIS DIRECTOR 2.0 2.0 X 0 0 0 JOHN LANDHERR DIRECTOR 2.0 0.0 X 0 0 0 JAN PAULSON DIRECTOR 2.0 0.0 X 0 0 0 TONY SPANO DIRECTOR 2.0 0.0 X 0 0 0 BILL STEAD DIRECTOR 2.0 0.0 X 0 0 0 CID PINEDO DIRECTOR 2.0 0.0 X 0 0 0 REGINALD WEBB DIRECTOR 2.0 0.0 X 0 0 0 ROGER GINSBURG DIRECTOR 2.0 0.0 X 0 0 0 GEORGE SAPP DIRECTOR 2.0 0.0 X 0 0 0 KENNETH BROWN MD DIRECTOR 2.0 0.0 X 0 0 0 PAT HOLT DIRECTOR 2.0 0.0 X 0 0 0 ELMER PINEDA MD DIRECTOR 2.0 2.0 X 63021 0 0 MICHAEL NELSON ASST. TREASURER/SECRETARY 39.0 1.0 X 646244 0 371011 CHRIS ALDWORTH ASST SECRETARY 40.0 0.0 X 315533 0 27840 JULI HESTER TREASURER/CFO 39.0 1.0 X 380603 0 43958 DARLENE SCAFFIDDI VP OF NURSING 40.0 0.0 X 412312 0 43958 KENNETH K NAKAMOTO VP MED STAFF AFF 40.0 0.0 X 413438 0 33647 KENT HOYOS CIO 40.0 0.0 X 421853 0 44911 RAY INGE VP HUMAN RESOURCES & PAYROLL 40.0 0.0 X 363276 0 39207 MICHAEL VESTINO VP, SUPPORT SERVICES 40.0 0.0 X 315175 0 29280 JOSEPH BAUMGARTNER DIRECTOR OF PHYSICAL THERAPY 40.0 0.0 X 311850 0 33771 6655262 0 1075906 866 false true false PREMIER FAMILY MEDICINE ASSOC 1770 North Orange Grove POMONA CA 91767 MEDICAL SERVICES 11510736 HOSPITALIST CORP OF THE INLAND EMPI 840 TOWNE CENTER DRIVE POMONA CA 91767 MEDICAL SERVICES 2532863 Institute of Trauma Acute Care In 3680 E Imperial Hwy Suite 502 LYNWOOD CA 90262 MEDICAL SERVICES 4129500 CHAPARRAL MEDICAL GROUP 840 TOWNE CENTER DRIVE POMONA CA 91767 MEDICAL SERVICES 2386746 Pursuit Healthcare Advisors 515 Pennsylvania Avenue Ste 100 FORT WASHINGTON PA 19034 consulting 2547819 68 0 244874 1837435 116671 0 2198980 Patient Care Revenue 622110 671991762 671991762 0 0 340B PHARMACY PROGRAM 900099 674091 674091 Physician Office Rental 621111 144915 144915 0 0 Non-Patient Lab Revenue 621511 305597 305597 0 673116365 1264675 1264675 4763 4763 0 341982 188349 153633 0 153633 153633 0 0 0 0 0 0 0 0 0 0 Food Sales 722212 1312156 1312156 0 0 Rebates & Refunds 622110 604009 604009 0 0 Health Education 923110 86304 86304 0 0 194244 194244 0 0 2196713 678935129 675007481 305597 1423071 1345635 1345635 0 0 0 0 0 0 4966955 121425 4845530 0 0 143620 0 0 247069464 240744834 6181010 0 12686600 12052270 634330 0 41492657 40448982 1043675 0 18562319 17895939 666380 0 0 0 0 0 1785370 397971 1387399 0 262259 0 262259 0 33711 33711 0 0 0 0 0 0 0 0 67522289 58137552 9384737 0 1471317 1167292 304025 0 14543522 12521972 2021550 0 9108197 7842158 1266039 0 0 0 0 0 10504680 9044529 1460151 0 336970 270473 66497 0 0 0 0 0 433142 350998 82144 0 117261 100962 16299 0 0 0 0 0 30248688 26044120 4204568 0 4303174 3705033 598141 0 Medical Supplies 66028634 56850654 9177980 0 California Hospital Fee 50914715 50914715 0 0 Capitation Expense 18260260 18260260 0 0 Dues & subscriptions 1259792 1259792 0 0 1657946 1425921 232025 604915557 561080818 43834739 0 0 26711546 790993 28780602 47516977 0 0 98724510 82856446 0 0 0 0 1412306 2506742 2918638 4233370 8785692 8528572 800198918 480924008 272470907 319274910 5827951 2565866 0 0 -4528821 -5557717 0 0 68484269 168569852 509587600 631286011 81417095 114293811 0 0 0 0 15585000 9360000 0 0 0 0 0 25031624 0 0 24459701 21418721 121461796 170104156 X 387004366 459992909 415392 482896 706046 706050 388125804 461181855 509587600 631286011 X 74019572 0 0 0 0 -963521 X false true X true false X false false false 0 false 0 false 0 false 0 false 0 false 0 true 33711 33711 false SCHEDULE C, PART II-B, LINE 1I LOBBY EXPENSE LOBBYING EXPENSE IS INCLUDED IN THE ANNUAL DUES FOR THE HOSPITAL ASSOCIATION OF CALIFORNIA AND CHA/CAHHS. 7659098 108531 910419 8678048 6991692 923136 375083 630813 7659098 7711079 340670 -34511 1025546 6991692 9702737 245470 361425 2598553 7711079 8449302 181102 1072333 9702737 0.06150 0.88210 0.05640 false true true 5817860 15351756 21169616 227125060 107164523 119960537 15573422 10568883 5004539 464388630 363190602 101198028 71942190 71942190 319274910 MALPRACTICE RECEIVABLE 7278220 WORKERS COMP RECEIVABLE 804318 RETIREMENT PLAN ASSETS 628358 INTEREST RECEIVABLE 9183815 HOSPITAL FEE RECEIVABLE 150675141 168569852 0 SELF INSURANCE LIABILITIES 18712149 DEFERRED COMPENSATION 2706572 21418721 SCHEDULE D, PART V, LINE 4 POMONA VALLEY HOSPITAL MEDICAL CENTER HAS A PERMANENTLY RESTRICTED ENDOWMENT FROM A RESTRICTED DONATION RECEIVED THROUGH A UNITRUST. THE INCOME FROM THIS IS USED TO SUPPORT THE HOSPITAL'S OPERATIONS. IN ADDITION, POMONA VALLEY HOSPITAL MEDICAL CENTER FOUNDATION HAS ENDOWMENTS THAT CONSIST OF FUNDS RAISED FOR VARIOUS PROJECTS AS DESIGNATED BY THE HOSPITAL BOARD, INCLUDING THE ROBERT AND BEVERLY LEWIS FAMILY CANCER CENTER ENDOWMENT FUND, WHICH IS DISTRIBUTED TO THE HOSPITAL FOR PROJECTS INVOLVING EDUCATION, SCREENINGS AND SUPPORT GROUPS. THE ENDOWMENTS HELD BY THE FOUNDATION ARE INCLUDED IN THE AMOUNTS REPORTED ON PART V OF SCHEDULE D. true true X true X true X true true false true true 5344725 5344725 0.00880 297579378 289738291 7841087 0.01300 302924103 289738291 13185812 0.02180 80 47471 3919884 1726555 2193329 0.00360 23 9836 5256571 811477 4445094 0.00730 17 73 3971963 3971963 0.00660 2 60 132391 132391 0.00020 1 1104375 1104375 0.00180 123 57440 14385184 2538032 11847152 0.01950 123 57440 317309287 292276323 25032964 0.04130 1 1 525 525 0.00000 8 1570 12140 12140 0.00000 1 40 310 310 0.00000 2 200 110506 110506 0.00020 16 20159 267766 26506 241260 0.00040 28 21970 391247 26506 364741 0.00060 false 13794516 71612177 68994617 2617560 X true true 1 1 Pomona Valley Hospital Medical Center 1798 N Garey Avenue Pomona CA 91767 WWW.PVHMC.ORG 930000128 X X X X POMONA VALLEY HOSPITAL MEDICAL CENTER 1 false false true X X X X X X X X X 15 true false true true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 200. 400. X X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 The 2015 Community Needs Assessment included input from Los Angeles County SPA 3 and SPA 4 public health officer, Christin Mondy. In a telephone interview conducted on December 5, 2014, PVHMC research objectives included identifying community health concerns, barriers to care, recommendations for community benefit programs, and recommendations for collaboration in the community. Public health needs identified included physical fitness and nutrition needs, high incidence of diabetes, substance abuse, concerns for safety in the community as it relates to physical activity among children, homelessness, and lack of routine preventative care. Public health recommendations for collaboration and implementation of community benefit programs included increasing communication of available education and classes offered at PVHMC, providing programs for healthy food and nutrition education, and providing diabetes education and management resources. The Institute of Applied Research (IAR) is pleased to present the results of its 2015 Community Needs Assessment for Pomona Valley Hospital Medical Center (PVHMC). Whereas in 2009 and 2012 IAR contributed to the needs assessment by collecting primary data for the study, the 2015 report summarizes IARs results of both primary data and secondary data collection, as well as focus groups composed primarily of individuals representing minority and low-income individuals (a medically underserved population). Primary data was collected via telephone survey and consisted of input from 333 residents- including low income, medically-underserved and minority members- within eleven communities that we serve. Telephone interviews were conducted by the Institute of Applied Research at California State University, San Bernardino using computer assisted telephone interviewing (CATI) equipment and software. The surveys were conducted between January 7 and January 10, 2015. Surveys were conducted on a variety of days and times Wednesday, Thursday, and Friday from 3:00 p.m. to 9:00 p.m.; and Saturday 10:00 a.m. to 5:00 p.m. in order to maximize the chances of completing a survey with the selected respondents. A total of 333 residents were surveyed from the eleven cities within PVHMCs service area, resulting in a 95 percent level of confidence and an accuracy of +/- 5.4%. A total of 12% of the surveys were conducted in Spanish. Primary data was collected via a telephone survey from residents within PVHMCs service area to determine their perceptions and needs regarding various health issues, and to see if there have been any changes since the 2009 and 2012 data in previous needs assessments. Specific issues and questions included: Demographic profile (including self-reported health evaluation); Health insurance coverage: insurance coverage, type of insurance, reason(s) for no coverage; Barriers to receiving needed health services; Utilization of health care services for routine primary/preventative care: how long since last physical, childrens preventative care and immunizations; adults routine health screening tests; Utilization of urgent care services; Need for specialty health care: chronic or ongoing health problems, adequate help dealing with disease, unmet needs; History of getting screened for cancer (and reasons for not being screened); Experience with and evaluation of PVHMC: reasons for selecting PVHMC, health care services, classes, support groups, emergency room, improving the health of the community; and Suggestions for ways PVHMC can improve the health of the community. In addition, secondary data were collected from a variety of sources regarding health status indicators and major health influencers for PVHMCs service area: Health status indicators: cardiovascular disease, diabetes, cancer, high blood pressure, obesity, leading cause of death. These indicators were compared to Healthy People 2020 goals at the SPA (Service Planning Area) 3 level, Los Angeles County level, and San Bernardino County level; Major health influencers: smoking/tobacco use, physical activity levels, health insurance coverage. These indicators were compared to Healthy People 2020 goals at the SPA 3 level, Los Angeles County level, and San Bernardino County level. Finally, IAR conducted a focus group consisting of representatives of low-income, minority, and medically underserved populations. On January 20, 2015, IAR had the opportunity to meet with six community leaders representing minorities and medically underserved individuals. More specifically, these leaders represented the homeless, low income, youth and adults, and domestic violence victims. They are on the front lines, providing services such as: delivering comprehensive health care for individuals of all ages; organizing fitness programs for families and individuals who are trying to regain or maintain a healthy lifestyle; working with victims of domestic violence who have suffered emotional and physical trauma and need counseling, intervention, shelter, transitional housing, and anger management services; providing primary care; overseeing services such as emergency food and shelter, and a community Farmers Market; and engaging in community outreach and health care coverage enrollment. PVHMC representatives conducted two additional focus groups studies on October 2, 2014 and again on January 6, 2015 with stakeholders in the community: Community Senior Services, a not-for-profit organization primary serving the needs of our senior population, and The Health Consortium of the Greater San Gabriel Valley, comprised of representatives from various health organizations and federally qualified health clinics whose primary focus is on improving the health and well-being of Los Angeles Countys SPA 3 through collaborative partnerships that strengthen the healthcare safety net. Every attempt was made to solicit primary, secondary, and health-related information relative to the communities we serve. In some instances, PVHMCs ability to assess the health needs was limited by lack of existing data at the city and county level. Additionally, in some instances, comparable health-related data was limited across both counties in which our primary service area encompasses. SCHEDULE H, PART V, SECTION B, LINE 6B POMONA VALLEY HOSPITAL MEDICAL CENTER CONDUCTED ITS CHNA WITH CALIFORNIA STATE UNIVERSITY SAN BERNARDINO'S INSTITUTE OF APPLIED RESEARCH. SCHEDULE H, PART V, SECTION B, LINE 7A CHNA URL https://www.pvhmc.org/About-Us/Community-Services.aspx SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY URL https://www.pvhmc.org/About-Us/Community-Services.aspx SCHEDULE H, PART V, SECTION B, LINE 11 Significant health needs identified in our 2015 community needs assessment are health education classes and support groups, diabetes, obesity, high blood pressure, Alzheimers and dementia, access to primary and specialty care, care coordination, transportation, promotoras, mental health services, and better promotion of what PVHMC already offers to the community. PVHMC prioritized these needs into three overarching themes as a framework for PVHMC to organize, maintain, and implement community benefit programs and services. These prioritized health needs are chronic disease management, health education and support groups, and access to care. The community needs assessment and health needs priorities were adopted by our governing Board of Directors on May 7, 2015. Community health needs were determined to be significant through evaluation of primary and secondary data, whereby those identified health needs were prioritized based upon: (1) community respondents and key informants identified the need to be significant, or largely requested specific services that they would like to see Pomona Valley Hospital Medical Center provide in the community (2) feasibility of providing interventions for the unmet need identified in the community, in such that Pomona Valley Hospital Medical Center currently has, or has the current means of developing the resources to meet the need, and (3) alignment between the identified health need and Pomona Valley Hospital Medical Centers mission, vision, and strategic plan. In support of PVHMC's Community Health Needs Assessment (CHNA), and ongoing Community Benefit Plan initiatives, Pomona Valley Hospital Medical Centers supporting Implementation Strategy documents the priority health needs for which PVHMC will address in the community and translates our CHNA data and research into actual strategies and objectives that can be carried out to improve health outcomes. PVHMC determined a broad, flexible approach was best as strategies and programs for community benefit are budgeted annually and may be adjusted during this 12-month period of time. Accordingly, the Implementation Strategy will be continuously monitored for progress in addressing our community's health needs and will serve as a tool around which our community benefit programs will be tailored. PVHMC is addressing the needs of Chronic Disease Management through the following strategies: Providing glucose screenings at health fairs and events (local and on-campus); Providing free education classes to promote cardiovascular health and risk reduction; Offering free blood pressure screenings at health fairs and events (local and on-campus); Publishing and distributing free information on cardiovascular health, diabetes, cancer treatment, and available resources to address these conditions; Providing care coordination services that seek to assure patients are positioned for a safe discharge home; Providing Cancer Care Patient Coordinators and Social Services to guide patients with making appointments, receiving financial assistance, and enrolling in support groups; providing free cancer care support groups and wellness classes with emphasis on the social, emotional, nutritional, and physical aspects of chronic disease. The following programs and services are provided by PVHMC, specifically designated to address Priority Need 1, Chronic Disease Management: Stead Heart and Vascular Center lectures and classes for cardiovascular health; Saving Strokes Event; Community blood pressure screenings; Diabetic Education Fair (on-campus); Nutrition education; The Robert and Beverly Lewis Family Cancer Care Center education, wellness classes, workshops, forums, and events; Cancer Program Annual publication; Stead Heart and Vascular Center publications. PVHMC is addressing the community needs for Health Education and Support Services through the following strategies: Providing free or low-cost health education classes, wellness support groups, and other health improvement services both at PVHMC and out in a community setting; Collaborating with community partners and participate in community-wide initiatives to improve the health of the community; Increasing awareness of available classes offered at PVHMC through reaching out directly to the community and other organizations through written and verbal communication and publications; Developing education, resources, and/or classes that promote healthy eating, disease prevention, and weight management; Participating and hosting speaking engagements to communicate to the community about health and services in the community; Providing comprehensive, culturally sensitive health forums, support groups, and workshops that provide hands-on healthy lifestyle support to the community. The following programs and services provided by PVHMC are specifically designated to address Priority Need 2 Health Education and Support Services: The Robert and Beverly Lewis Family Cancer Care Center wellness classes, support groups, early detection and prevention lectures, and community forums; Womens and Childrens Services health and education classes; Stead Heart and Vascular Center Risk Reduction Class; cardiac education; Cancer Program Annual Report; Health Fairs/Community Events; Hands-Only CPR; Sleep Disorders Meetings; Nutrition education; Hospital tours in English, Spanish, and Chinese; Inpatient smoking cessation education; Inpatient asthma education and "Every 15 minutes" drunk driving education. PVHMC is addressing the community needs for Priority Area 3, Access to Care, through the following strategies: Providing on-site enrollment assistance for appropriate health insurance plans; participation in the hospital presumptive eligibility program; Increasing community awareness about health services offered, wellness classes, and support groups; Providing discharge transportation for vulnerable patients who are otherwise unable to get home; Providing free, low-cost or reduced-cost health services, medications, and medical devices; Providing free or reduced cost screenings and immunizations at local health fairs; Collaborating with primary care providers and clinics to improve access to preventative and specialty care; Working closely with PVHMC's Family Medicine Residency Program through UCLA to increase the number of primary care physicians in the region; expanding the emergency department to increase PVHMC's capacity to care for patients needing emergency treatment, trauma services, surgery, and primary care. Programs and services provided by PVHMC, specifically designated to address Priority Need 3 Access to Care are: PVHMC Family Medicine Residency Program; Sports Injury Evening Clinic providing free and low cost sports injury examinations and x-rays; Enrollment assistance in appropriate health plans for our patients who are admitted without insurance; Discharge transportation services for our vulnerable patients; ambulance transports; Free and low cost medication assistance; Free and low cost immunizations provided in the community. Of the health needs identified through our needs assessment, PVHMC will not address the mental health, Alzheimer's and Dementia, "Promotorastransportation needs in our implementation strategy. PVHMC evaluated its capacity to serve the mental health, Alzheimers and Dementia services, "Promotorastransportation needs of our community. PVHMC does not have a licensed psychiatric facility, or the current capacity, to provide inpatient and outpatient mental health treatment services. While PVHMC has some services in place to assist with mental health and substance abuse, such as emergent psychiatric consultations, mental health referrals, and smoking cessation education, it was determined that this critical need is best served by others. PVHMC does not currently have trained "Promotoras" staff to perform peer-to-peer education out in the community. PVHMC does not currently have in place, or the current capacity to develop an Alzheimers and Dementia services program; however, PVHMC does seek to continue to address this need indirectly through our social services and care coordination efforts with local community-based organizations. Additionally, while PVHMC does have in place some transportation services to assist patients, it was determined that this need at a community-wide level is best served by others. Accordingly, PVHMC will continue to support Tri-City Mental Health, Prototypes, the Department of Mental Health, the YWCA of the San Gabriel and Inland Communities, Community Senior Services, and other community based organizations that directly provide these services to address these needs. We are strongly committed to our relationships with these organizations and continuously seek partnerships and opportunities to directly address these needs in the future. Our services show how the communitys needs drive the conception and establishment of the services we provide and contribute to its g SCHEDULE H, PART V, SECTION B, LINE 13H CALIFORNIA STATE REGULATIONS SCHEDULE H, PART V, SECTION B, LINE 15E The hospital will provide guidance and/or direct assistance to patients or their family representative as necessary to facilitate completion of FAP applications. Financial counselors, eligibility services liaisons and/or patient account representatives are available to provide guidance over the phone or meet in person. SCHEDULE H, PART V, SECTION B, LINE 16A FINANCIAL ASSISTANCE POLICY URL https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assi stance-Program.aspx SCHEDULE H, PART V, SECTION B, LINE 16B FINANCIAL ASSISTANCE POLICY APPLICATION URL https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assi stance-Program.aspx SCHEDULE H, PART V, SECTION B, LINE 16C FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARY URL https://www.pvhmc.org/Patients-Visitors/Financial-Questions/Financial-Assi stance-Program.aspx SCHEDULE H, PART V, SECTION B, LINE 16J THE HOSPITAL FACILITY PUBLICIZED THE FINANCIAL ASSISTANCE POLICY BY MAKING A SUMMARY AVAILABLE IN THE FOLLOWING WAYS: - ATTACHING TO BILLING INVOICES - POSTING IN THE EMERGENCY/WAITING ROOMS - POSTING IN THE ADMISSIONS OFFICES - PROVIDING, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL - PROVIDING THE POLICY UPON REQUEST 20 PVHMC Radiation Therapy 1910 Royalty Drive Pomona CA 91767 RADIATION THERAPY PVHMC Imaging Claremont 1601 Monte Vista Avenue Claremont CA 91711 DIAGNOSTIC CENTER PVHMC Imaging Chino Hills 2140 Grand Avenue Suite 125 Chino Hills CA 91709 DIAGNOSTIC CENTER PVHMC Physical Therapy Claremont 1601 Monte Vista Av Claremont CA 91711 DIAGNOSTIC CENTER PVHMC Sleep Center 2140 Grand Avenue Suite 125 Chino Hills CA 91709 DIAGNOSTIC CENTER PVHMC Women's Imaging 1910 Royalty Drive Pomona CA 91767 DIAGNOSTIC CENTER PVHMC Cancer Center OP 1910 Royalty Drive pomona CA 91767 REHABILITATION CENTER PVHMC Covina OP Physical Therapy Clinic 420 W Rowland Street Covina CA 91723 REHABILITATION CENTER PVHMC Physical Therapy Chino Hills 2140 Grand Avenue Suite 125 Chino Hills CA 91709 REHABILITATION CENTER Pomona Valley Health Center 1770 N Orange Grove Pomona CA 91767 OUTPATIENT PHYSICIAN CLINIC PVHMC Imaging Crossroads 3110 Chino Avenue Suite 150 Chino Hills CA 91709 DIAGNOSTIC CENTER PVHC Chino Hills 2140 Grand Avenue Suite 125 Chino Hills CA 91709 OUTPATIENT PHYSICIAN CLINIC PVHMC Claremont Urgent Care 1601 Monte Vista Avenue Claremont CA 91711 OUTPATIENT PHYSICIAN CLINIC PVHMC Crossroads URgent Care 3110 Chino Avenue Suite 150 Chino Hills CA 91709 OUTPATIENT PHYSICIAN CLINIC PVHC Claremont Primary Care 1601 Monte Vista Avenue Claremont CA 91711 OUTPATIENT PHYSICIAN CLINIC PVHMC Crossroads Primary Care 3110 Chino Avenue Suite 150 Chino Hills CA 91709 OUTPATIENT PHYSICIAN CLINIC Pomona Valley Imaging Center Grandview 13768 Roswell Avenue Suite 103 Chino Hills CA 91709 DIAGNOSTIC CENTER Children's Outpatient Clinic 1770 N Orange Grove Pomona CA 91767 DIAGNOSTIC PVHMC Claremont Aquatic Therapy Pool 481 S Indian Hill Blvd claremont CA 91711 REHABILITATION CENTER PVHMC Imaging Western University 309 Pomona Mall Pomona CA 91767 DIAGNOSTIC CENTER SCHEDULE H, PART I, LINES 7B & 7I THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE ON JANUARY 1, 2010. AMENDING LEGISLATION, TO CONFORM TO CHANGES REQUESTED BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES DURING THE APPROVAL PROCESS, WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE SEPTEMBER 8, 2010. THE PRIMARY LEGISLATION AND AMENDING LEGISLATION CONTAIN TWO COMPONENTS. THE QUALITY ASSURANCE FEE ACT (QAF ACT) GOVERNS THE "HOSPITAL FEE"QUALITY ASSURANCE FEE" (QA FEE) PAID BY PARTICIPATING HOSPITALS. THE MEDI-CAL HOSPITAL PROVIDER STABILIZATION ACT GOVERNS SUPPLEMENTAL MEDI-CAL PAYMENTS (SUPPLEMENTAL PAYMENTS) MADE TO PROVIDERS FROM THE FUND. HOSPITAL PARTICIPATION IS MANDATORY, WITH LIMITED EXCEPTIONS. THE QAF ACT WAS FURTHER EXPANDED FOR 30 MONTHS FROM JULY 1, 2011 THROUGH DECEMBER 31, 2013 (30-MONTH PROGRAM). THE 30-MONTH PROGRAM IS THE THIRD HOSPITAL FEE (QAF-3) IMPLEMENTED IN CALIFORNIA, AND IT DECOUPLES THE FEE-FOR-SERVICE COMPONENT FROM THE MANAGED CARE COMPONENT OF THE PROGRAM. THE FOURTH HOSPITAL FEE (QAF-4) FOR THE 36 MONTHS FROM JANUARY 1, 2014 TO DECEMBER 31, 2016, LIKE THE 30-MONTH PROGRAM, DECOUPLES THE FEE-FOR-SERVICE COMPONENT FROM THE MANAGED CARE COMPONENT OF THE PROGRAM. FOR QAF-4, THE PORTION OF THE LEGISLATION ADDRESSING THE FEE-FOR-SERVICE COMPONENT WAS APPROVED IN DECEMBER 2014, AND THE MANAGED CARE NON-MEDICAID EXPANSION PORTION FROM JANUARY 1, 2014 TO JUNE 30, 2014, WAS APPROVED IN JUNE 2015. THE MEDICAL CENTER EXPENSED PAYMENTS TO DEPARTMENT OF HEALTH CARE SERVICES IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS FOR THE QA FEE IN THE AMOUNT OF $50,914,715 IN 2017 AND $44,064,166 in 2016 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN C. THE MEDICAL CENTER ALSO RECORDED PLEDGE PAYMENTS OF $1,104,375 in 2017 AND $1,171,828 in 2016 IN CONJUNCTION WITH THE PROGRAM, WHICH IS REPORTED ON SCHEDULE H, PART I, LINE 7I, COLUMN C. THE QA FEE AND PLEDGE PAYMENTS ARE RECORDED IN CALIFORNIA HOSPITAL FEE QUALITY ASSURANCE FEE AND PLEDGE PAYMENTS WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE MEDICAL CENTER RECOGNIZED SUPPLEMENTAL PAYMENTS OF $190,845,000 IN 2017 INCLUDED ON SCHEDULE H, PART I, LINE 7B, COLUMN D, WHICH PERTAINS TO THE PERIOD JANUARY 1, 2017 TO DECEMBER 31, 2017, FOR THE FEE-FOR-SERVICE PORTION, AND JANUARY 1, 2014 TO JUNE 30, 2016, FOR THE MANAGED CARE NON-MEDICAID EXPANSION PORTION. THE INCLUSION OF THESE AMOUNTS ON LINE 7B OF PART I IN THE CURRENT YEAR DECREASES THE PERCENTAGE OF THE TOTAL EXPENSE, AS COMPARED TO 2009 (THE LAST YEAR BEFORE THE PROGRAM WAS IN EFFECT). SCHEDULE H, PART I, LINES 7A-7I LINE 7A USED COST-TO CHARGE METHODOLOGY USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. LINE 7B USED COST-TO CHARGE METHODOLOGY USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. LINE 7E USED ACTUAL AMOUNTS PER THE GENERAL LEDGER. LINE 7F USED ACTUAL AMOUNTS PER THE GENERAL LEDGER. LINE 7G USED ACTUAL AMOUNTS PER THE GENERAL LEDGER. LINE 7H USED ACTUAL AMOUNTS PER THE GENERAL LEDGER. LINE 7I USED ACTUAL AMOUNTS PER THE GENERAL LEDGER. SCHEDULE H, PART I, LINE 7F HEALTH PROFESSION EDUCATION Pomona Valley Hospital Medical Center is committed to creating a healthy community in the Pomona Valley region, and in realizing this commitment, assists local schools (e.g. Chaffey College, Western University of Health Sciences, Mount San Antonio College, Citrus College) in meeting requirements for their Nursing programs and to provide health profession externships, Preceptorship, and clinical experience for respiratory, radiology, social services and dietetic students alike. Pomona Valley Hospital Medical Center works with local area middle and high schools to introduce careers in health care by inviting them to tour our hospital and by visiting them on their campus. Our Family Medicine Residency Program trains 20 physicians each year to develop outstanding clinical skills, compassion, and excellent communication and leadership abilities. The residency is affiliated with the David Geffen School of Medicine at UCLA. SCHEDULE H, PART I, LINE 7G Subsidized Health Services None of the money identified under the subsidized health services category pertains to a physician clinic in our Community Benefit Report. SCHEDULE H, PART II Community Building Activities Pomona Valley Hospital Medical Center participates on the steering committee for the Los Angeles County service planning area (SPA 3s) health planning group (San Gabriel Valley Health Consortium). We participate to look at access to care, promotion of health and access and availability of specialty care, and how this need particularly affects our most vulnerable and medically underserved populations. PVHMC also participates in the Pomonas promise coalition and hosts the violence prevention groups, looking at violence in the community as a social determinant of health. Pomona Valley Hospital Medical Center assists local schools (e.g. Chaffey College, Western University of Health Sciences, Mount San Antonio College, Citrus College) in meeting requirements for their Nursing programs, our education department serves on the advisory boards to these schools. The costs and persons served associated are reflected on Lines 3 & 8 of Part II as Community Support and Workforce Development. Pomona Valley Hospital Medical Center supports the economic development of the community by allowing local not-for-profit organizations to participate in creating a sponsorship ad for their organization in our hospitals program books for community events. The costs and persons served associated with conducting our needs assessment are reflected on Line 2 of Part II as Economic Development. Pomona Valley Hospital Medical Center is one of 13 designated Disaster Resource Centers (DRC) in Los Angeles County as part of the National BioTerrorism Hospital Preparedness Program. As the DRC for the region, Pomona Valley Hospital Medical Center is responsible for 12 umbrella facilities in the area and coordinates drills, training, and sharing of plans to bring together the community and our resources for disaster preparedness. SCHEDULE H, PART III, LINE 2 THE BAD DEBT EXPENSE IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE MEDICAL CENTER'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED RELATED TO SELF-PAY PATIENTS, INCLUDING BOTH UNINSURED PATIENTS AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THEIR BALANCE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE MEDICAL CENTER'S POLICIES. SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE IS AN ESTIMATE OF THE AMOUNT OF REVENUE DUE FROM PATIENTS COMPRISED OF 1) BALANCES DUE FROM PATIENTS AFTER INSURANCE HAS PAID WHICH MAINLY INCLUDES DEDUCTIBLES, COINSURANCE AND COPAYMENTS, AND 2) BALANCES DUE FROM UNINSURED PATIENTS WHICH INCLUDE BALANCES DISCOUNTED IN ACCORDANCE WITH THE HOSPITALS PARTIAL CHARITY POLICY FOR THOSE PATIENTS WHO QUALIFY AND OTHER BALANCES DUE FROM UNINSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY. THE METHODOLOGY COMBINES HISTORICAL BAD DEBT WRITE-OFF TRENDS AS A PERCENTAGE OF GROSS REVENUES. THE METHODOLOGY ALSO RECOGNIZES MANY ACCOUNTS ARE WRITTEN OFF AS A BAD DEBT DUE TO LACK OF INFORMATION NEEDED TO QUALIFY THE PATIENT FOR CHARITY DISCOUNTS BUT SUBSEQUENTLY DETERMINED TO QUALIFY FOR CHARITY AFTER ADDITIONAL INFORMATION IS OBTAINED. THE LAG IN RECLASSIFYING A BAD DEBT TO CHARITY IS BUILT INTO THE METHODOLOGY USING THE HISTORICAL RATIO OF BAD DEBT EXPENSE VS. CHARITY ADJUSTMENTS. AS SUCH, THE ESTIMATED BAD DEBT EXPENSE SHOULD ONLY INCLUDE TRUE BAD DEBTS NOT PATIENTS WHO MAY BE ELIGIBLE UNDER THE HOSPITALS CHARITY POLICY. SCHHEDULE H, PART III, LINE 4 THE BAD DEBT FOOTNOTE CAN BE FOUND ON PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO. THE SOURCE OF INFORMATION IS THE MEDICARE COST REPORT. SCHEDULE H, PART III, LINE 9B THE HOSPITAL'S CREDIT AND COLLECTION POLICY APPLIES TO ALL PATIENTS WHO RECEIVE SERVICES AT POMONA VALLEY HOSPITAL MEDICAL CENTER WHO HAVE A FINANCIAL OBLIGATION TO THE HOSPITAL. THIS POLICY DEFINES THE REQUIREMENTS AND PROCESSES USED BY THE HOSPITAL BUSINESS OFFICE WHEN MAKING PAYMENT ARRANGEMENTS WITH INDIVIDUAL PATIENTS OR THEIR ACCOUNT GUARANTORS. THE CREDIT AND COLLECTION POLICY SPECIFIES THE STANDARDS AND PRACTICES USED BY THE HOSPITAL FOR THE COLLECTION OF DEBTS ARISING FROM THE PROVISION OF SERVICES TO PATIENTS AT PVHMC. THESE PRACTICES ARE APPLIED CONSISTENTLY TO PATIENTS WHOSE BALANCE RESULTS FROM AN UNPAID DEDUCTIBLE, COINSURANCE AND/OR COPAY, PATIENTS WHO HAVE BEEN APPROVED FOR FINANCIAL ASSISTANCE IN WHICH THEIR BALANCE IS DISCOUNTED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, PATIENTS WHO HAVE AGREED TO THE TERMS OF A PROMPT PAYMENT DISCOUNT AS WELL AS PATIENTS WHO HAVE NOT AGREED TO THE TERMS OF A DISCOUNT PROGRAM. IN THE EVENT THAT A PATIENT OR PATIENT'S GUARANTOR HAS MADE A DEPOSIT PAYMENT, OR OTHER PARTIAL PAYMENT FOR SERVICES AND SUBSEQUENTLY IS DETERMINED TO QUALIFY FOR FULL CHARITY CARE OR DISCOUNT PARTIAL CHARITY CARE, ALL AMOUNTS PAID WHICH EXCEED THE PAYMENT OBLIGATION, IF ANY, AS DETERMINED THROUGH THE FINANCIAL ASSISTANCE PROGRAM PROCESS, SHALL BE REFUNDED TO THE PATIENT WITH INTEREST. HOWEVER, SINCE THE APPLICATION PROCESS FOR PARTIAL CHARITY CARE MAY BE APPLIED TO ALL PRE-EXISTING ACCOUNT BALANCES OUTSTANDING AT THE TIME OF CHARITY QUALIFICATION, A PATIENT OVERPAYMENT ON ONE ACCOUNT MAY REDUCE THE PATIENT'S OUTSTANDING OBLIGATION ON ANOTHER ACCOUNT AFTER A PARTIAL CHARITY DISCOUNT HAS BEEN APPLIED. THE HOSPITAL WILL REVIEW ALL OF THE PATIENT'S ACCOUNTS AND COMPLETE A RECONCILIATION OF DISCOUNTED AMOUNTS DUE LESS TOTAL AMOUNTS PAID TO DETERMINE IF THE PATIENT OVERPAID. INTEREST SHALL BEGIN TO ACCRUE ON THE FIRST DAY THAT PAYMENT BY THE PATIENT IS RECEIVED BY THE HOSPITAL. INTEREST AMOUNTS SHALL BE ACCRUED AT THE INTEREST RATE SET FORTH IN SECTION 685.010 OF THE CODE OF CIVIL PROCEDURE. IN THE EVENT THAT THE AMOUNT OF INTEREST AND/OR THE AMOUNT OWED TO THE PATIENT IS IN THE SMALL BALANCE RANGE AS DEFINED BY THE HOSPITAL'S SMALL BALANCE POLICY, THE BALANCE WILL BE PROCESSED IN ACCORDANCE WITH THE SMALL BALANCE POLICY. OTHER OVERPAYMENTS FROM PATIENTS WILL BE PROCESSED IN ACCORDANCE WITH THE REFUND REQUEST POLICY. SCHEDULE H, PART VI, LINE 2 Needs Assesment In 2015, a Community Needs Assessment was completed. The assessment is intended to be a resource for PVHMC to become involved with developing and maintaining activities and programs that can help improve the health and well-being of the residents of Pomona Valley. The Community Needs Assessment process included primary and secondary data collection, including valuable community, stakeholder, and public health input that was examined to prioritize the most critical needs of our community and serve as the basis for our community benefit plan initiatives and implementation strategy. PVHMC partnered with California State university San Bernardinos Institute of Applied Research to acquire input from 333 residents via telephone survey- including low income, medically-underserved and minority members- within eleven communities that we serve. Telephone surveys were conducted between January 7 and January 10, 2015. The Principal Investigator was Barbara Sirotnik, PhD and the Project Coordinator was Lori Aldana, MBA. Additional primary data was obtained through a PVHMCs independent community health needs interview with Christin Mondy, Los Angeles County SPA 3 and SPA 4 Health Officer, and also through three focus group meetings with organizations who represent the broad interests of the communities we serve. The research objectives were to look at the demographic profile of the community, health insurance coverage, health access barriers, utilization of health care services for routine primary/preventative care, utilization of urgent care services, need for specialty health care and experience with PVHMC including classes, support groups, and the emergency department, as well as identify groups within our community that are experiencing health disparities and identify areas for potential collaboration with other community-based organizations. The Community Needs Assessment has been made widely available to the public at https://www.pvhmc.org/About-Us/Community-Services.aspx The following is a summary of findings from surveying 333 members of our community. When respondents were asked would you say that in general your health is excellent, very good, fair or poor, most of the respondents (68.8%) said excellent or very good. Only 3.3% said their health is poor. These figures are not a significant shift from 2009 and 2012 needs assessment values. The majority of respondents (80.5%) said that all of the adults in the household are covered by insurance, with another 14.0% saying that some of the adults are covered. Only 5.5% of them said that none of the adults are covered by health insurance. This is a significant improvement from previous years needs assessments when only 76.6% of respondents said that all of the adults in the household were covered by insurance. The health insurance trend found in the 2015 assessment is as follows: Younger people are less likely to have all adults covered than older people, Hispanics are less likely to have all adults covered than non-Hispanics, People with higher incomes are more likely to have all adults covered than those with lower incomes, and Those people with more education are most likely to report that all adults are covered. When examining barriers to health care, 11.6% of respondents reported they or anyone in their family had needed any health services within the past year that they could not get. As might be expected, income was strongly related to the this question: 24% of those making $35,000 a year or less reported that they had needed services that they couldnt get, as opposed to 11% of those making $35,000 up to $80,000, and 5% of those making $80,000 or more. When asked what kept them from getting needed services (Question 8a), cost was the number one factor, with 27.0% (10 people) saying they are worried about the cost of services and/or co-payments, and 13.5% (5 people) indicating a concern about the cost of needed prescriptions. Another 9 said they do not have health insurance and 3 said their provider wouldnt accept their insurance coverage. What services were those people unable to get in the last year? The answers from the 37 people who responded were quite varied: 7 mentioned dental care, 4 mentioned some type of surgery, three mentioned vision, and another 3 indicated that they couldnt get prescriptions filled. The 2015 Community Needs Assessment also examined community utilization of primary and preventative care services as well as barriers to receiving needed care. In the survey findings, most respondents reported that they keep up with regular doctor visits. That is, 80.3% of them said they had visited their doctor for a general physical exam (as opposed to an exam for a specific injury, illness or condition) within the past year and 83.2% said that all of their children had a preventative health care check-up within the past year; another 0.8% said that some of the children had a check-up. On the other hand, that still means that 16.0% said their children did NOT have a health-care check-up within the past year. It is unknown why the 16% (20 families) did not seek that service since almost all of them (19 of the 20) had earlier indicated that all of the children are covered by insurance. This question was noted for consideration in future needs assessment surveys. Furthermore, considering that these screening tests have proven over time to be invaluable in detecting medical problems early, we examined why these members of our community chose not to get them. The predominant reasons cited in an open ended multiple response question included being too old or too young to need the test (47.5%), not thinking the test is important or necessary (21.0%), the perception that healthy people dont need it (11.5%), and not having insurance (9.0%). Very few people (2.5%) indicated that a fear or dislike of the test kept them from getting the screening. PVHMC works to meet these needs of our community members who are unable to get needed resources to socioeconomic and environmental barriers, providing free, low-cost, or reduced-cost health services such as immunizations, mammograms, medications, and medical devices, among others. We can continue to do more to make use of our primary care and urgent care services to meet the needs of our community and offload a large proportion of the pressure on our Emergency Department. As a private community safety net hospital, also with the designation as a disproportionate share hospital (DSH), we care for a greater population of low-income, medically vulnerable patients. They often require an increased need of accessible, high quality, and cost-effective health care services. We deliver care to all patients in our ED, with or without insurance. The necessity to improve and build upon the efficiency of our ED is critical for PVHMC in order for us to keep up with the growing demands being placed upon our system every day. The 2015 community needs assessment further revealed the need for specialty healthcare. Respondents were given a list of various chronic or ongoing health conditions and asked if they or any member of their family have any of the conditions. in total, 59.0% of respondents answered yes to having chronic or ongoing high blood pressure conditions, 31.5% with diabetes, 19.0% with asthma, 14.5% with cancer, 14.0% with obesity, 14.0% with osteoporosis, 5.5 % with chronic heart failure, and 16.0% stated they have other ongoing health conditions. Understanding the need for community health status improvement, a focus of our 2016 community benefit plan is in making the community more aware of the programs, classes and support groups offered by the hospital to help prevent, manage, or improve health outcomes for those at risk or living with chronic disease or illness. Nutrition (8.7%), Diabetes (7.3%), Obesity and Weight Loss (6.4%), High Blood Pressure (5.5%) and Cancer Care (5.5%) were the most requested health classes during our needs assessment. The hospital currently provides many of the classes the respondents were interested in; therefore we are dedicated to providing greater communication about the availability of these existing resources. SCHEDULE H, PART VI, LINE 3 THE HOSPITAL MAKES EVERY EFFORT TO INFORM ITS PATIENTS OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. SPECIFICALLY: - EVERY REGISTERED PATIENT RECEIVES A WRITTEN NOTICE OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY WRITTEN IN PLAIN LANGUAGE PER IRC 501(R); - UPON REQUEST, PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ARE MADE AVAILABLE FREE OF CHARGE. THESE DOCUMENTS ARE ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE; - WHENEVER POSSIBLE, DURING THE REGISTRATION PROCESS, UNINSURED PATIENTS ARE SCREENED FOR ELIGIBILITY WITH GOVERNMENT; -SPONSORED PROGRAMS INCLUDING MEDI-CAL HOSPITAL PRESUMPTIVE ELIGIBILITY AND/OR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM; - PUBLIC NOTICES ARE POSTED THROUGHOUT THE HOSPITAL NOTIFYING THE PUBLIC OF FINANCIAL ASSISTANCE FOR THOSE WHO QUALIFY SUCH NOTICES ARE POSTED IN HIGH VOLUME INPATIENT, AREAS AND IN OUTPATIENT SERVICE AREAS OF THE HOSPITAL, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, INPATIENT ADMISSION AND OUTPATIENT REGISTRATION AREAS, OR OTHER COMMON PATIENT WAITING AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED AT ALL LOCATIONS WHERE A PATIENT MAY PAY THEIR BILL. NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE. THESE NOTICES ARE WRITTEN IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT ARE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. - GUARANTOR BILLING STATEMENTS CONTAIN INFORMATION TO ASSIST PATIENTS IN OBTAINING GOVERNMENT SPONSORED COVERAGE AND/OR FINANCIAL ASSISTANCE PROVIDED BY THE HOSPITAL. CONSISTENT WITH HEALTH AND SAFETY CODE SECTION 127420, THE HOSPITAL WILL INCLUDE THE FOLLOWING CLEAR AND CONSPICUOUS INFORMATION ON A PATIENT'S BILL: (1) A STATEMENT OF CHARGES FOR SERVICES RENDERED BY THE HOSPITAL (2) A REQUEST THAT THE PATIENT INFORM THE HOSPITAL IF THE PATIENT HAS HEALTH INSURANCE COVERAGE, MEDICARE, MEDI-CAL, OR OTHER COVERAGE (3) A STATEMENT THAT IF THE CONSUMER DOES NOT HAVE HEALTH INSURANCE COVERAGE, THE CONSUMER MAY BE ELIGIBLE FOR COVERAGE OFFERED THROUGH THE CALIFORNIA HEALTH BENEFIT EXCHANGE (COVERED CA), MEDICARE, MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES PROGRAM, OR CHARITY CARE (4) A STATEMENT INDICATING HOW PATIENTS MAY OBTAIN AN APPLICATION FOR THE MEDI-CAL PROGRAM, COVERAGE OFFERED THROUGH THE CALIFORNIA HEALTH BENEFIT EXCHANGE, OR OTHER STATE- OR COUNTY-FUNDED HEALTH COVERAGE PROGRAMS AND THAT THE HOSPITAL WILL PROVIDE THESE APPLICATIONS. IF THE PATIENT DOES NOT INDICATE COVERAGE BY A THIRD-PARTY PAYER OR REQUESTS A DISCOUNTED PRICE OR CHARITY CARE, THEN THE HOSPITAL SHALL PROVIDE AN APPLICATION FOR THE MEDI-CAL PROGRAM, OR OTHER STATE- OR COUNTY-FUNDED PROGRAMS TO THE PATIENT. THIS APPLICATION SHALL BE PROVIDED PRIOR TO DISCHARGE IF THE PATIENT HAS BEEN ADMITTED OR TO PATIENTS RECEIVING EMERGENCY OR OUTPATIENT CARE. THE HOSPITAL SHALL ALSO PROVIDE PATIENTS WITH A REFERRAL TO A LOCAL CONSUMER ASSISTANCE CENTER HOUSED AT LEGAL SERVICES OFFICES (5) INFORMATION REGARDING THE FINANCIALLY QUALIFIED PATIENT AND CHARITY CARE APPLICATION, INCLUDING THE FOLLOWING: (A) A STATEMENT THAT INDICATES THAT IF THE PATIENT LACKS, OR HAS INADEQUATE INSURANCE, AND MEETS CERTAIN LOW- AND MODERATE-INCOME REQUIREMENTS, THE PATIENT MAY QUALIFY FOR DISCOUNTED PAYMENT OR CHARITY CARE. (B) THE NAME AND TELEPHONE NUMBER OF A HOSPITAL EMPLOYEE OR OFFICE FROM WHOM THE PATIENT MAY OBTAIN INFORMATION ABOUT THE HOSPITAL'S DISCOUNT PAYMENT AND CHARITY CARE POLICIES, AND HOW TO APPLY FOR THAT ASSISTANCE. (C) IF A PATIENT APPLIES, OR HAS A PENDING APPLICATION, FOR ANOTHER HEALTH COVERAGE PROGRAM AT THE SAME TIME THAT HE OR SHE APPLIES FOR A HOSPITAL CHARITY CARE OR DISCOUNT PAYMENT PROGRAM, NEITHER APPLICATION SHALL PRECLUDE ELIGIBILITY FOR THE OTHER PROGRAM. THE HOSPITAL WILL PROVIDE PATIENTS WITH A REFERRAL TO A LOCAL CONSUMER ASSISTANCE CENTER HOUSED IN A LEGAL SERVICES OFFICE. SCHEDULE H, PART VI, LINE 4 Community Information Our Mission - PVHMC is a not-for-profit regional Medical Center dedicated to providing high quality, cost effective health care services to residents of the greater Pomona Valley. The Medical Center offers a full range of services from local primary acute care to highly specialized regional service. Selection of all services is based on community need, availability of financing and the organizations technical ability to provide high quality results. Basic to our mission is our commitment to strive continuously to improve the status of health by reaching out and serving the needs of our diverse ethnic, religious and cultural community. Our Community PVHMC is dedicated to meeting the health care demands of the growing populations of Los Angeles and San Bernardino counties. Our Primary Service Area is defined as the cities of Pomona, Claremont, Chino, Chino Hills, La Verne, Montclair, Ontario, Rancho Cucamonga, Alta Loma, Upland and San Dimas and make up a population of 840,789 according to the 2010 United States Census. According to the Office of Statewide Health and Planning 2012 data, Pomona East and South are designated as a Medically Underserved Area, specifically as an area with a Primary Care shortage. As a private community safety net hospital, also with the designation as a disproportionate share hospital (DSH), we care for a greater population of low-income, medically vulnerable patients. They often require an increased need of accessible, high quality, and cost-effective health care services. We deliver care to all patients in our ED, with or without insurance. Based on the 2010 Census, the ethnic diversity of Pomona is such that 48.0% are White, 70.5% are Hispanic or Latino, 7.3% are Black or African American, 1.2% are American Indian, 8.5% are Asian, 0.2% are Hawaiian or Pacific Islander, 30.3% identify as Other, and 4.5% identify as two or more races. Among this population, According to the 2006-2010 American Community Survey 5 year estimates, retrieved from the California Department of Finance, Pomonas Median household income is $50,497, with 17.2% of families living below the Federal Poverty Level. Educational attainment data was also retrieved from the 2006-2010 ACS Survey, showing 21.1% of Pomona residents over the age of 25 have less than a 9th grade education level, 15.7% have completed less than 12th grade, 26.0% have a high school diploma, 6.1% have an Associates degree, 10.2% have a Bachelors degree, and 4.0% have earned a Graduate or Professional degree. Market Share- Several other hospitals serve our community. These hospitals are Kaiser Foundation Hospital of Fontana, San Antonio Community Hospital, Chino Valley Medical Center, Arrowhead Regional Medical Center, Montclair Hospital Medical Center, Loma Linda University Medical Center, Canyon Ridge Hospital, Kaiser Foundation Hospital of Baldwin Park, Community Hospital of San Bernardino, San Dimas Community Hospital, and Citrus Valley Health Partners-Queen of the Valley Campus. SCHEDULE H, PART VI, LINE 5 Other Information on Promoting Community Health Improvements Pomona Valley Hospital Medical Center is governed by a Board of Directors whose members are representative of the community, hospital and medical staff leadership. Consistent with the IRS community benefit standard a majority of the Board of Directors are neither employees, contractors nor family members of the organization. Pomona Valley Hospital Medical Center is a community based disproportionate share hospital. In addition, we participate in Medicare, MediCal, CHAMPUS, Tricare. Pomona Valley Hospital Medical Center is an open medical staff, extending staff privileges to all qualified physicians for all areas and departments of our facility. Pomona Valley Hospital Medical Center is home to the only 24-hours-a-day, full service Emergency Department (ED) and Level II Trauma Center in Pomona. Our ED treats all patients regardless of their ability to pay; Pomona Valley Hospital Medical Center provides Emergency Services to all patients with our without insurance. The Emergency Department's dedicated staff is experienced in providing prompt, accurate diagnosis and skillful medical treatment. This expert team includes board-certified emergency physicians, physician assistants; board certified nurses, emergency medical technicians, respiratory therapists and other highly trained emergency care professionals. All are dedicated to providing technologically advanced, lifesaving medical services with compassionate, culturally appropriate care. A part of PVHMCs mission is our dedication to continuously strive to improve the status of health by reaching out and serving the needs of our diverse ethnic, religious and cultural community. SCHEDULE H, PART VI, LINE 6 Pomona Valley Hospital Medical Center is a stand alone hospital, not part of a health care system. SCHEDULE H, PART VI, LINE 7 CALIFORNIA false CASA COLINA 255 E BONITA AVENUE POMONA CA 91769 953655255 501(c)(3) 6000 0 PROGRAM SUPPORT COMMUNITY SENIOR SERVICE 141 SPRING STREET CLAREMONT CA 91711 953100466 501(c)(3) 10416 0 PROGRAM SUPPORT KECK GRADUATE INSTITUTE 535 WATSON DRIVE CLAREMONT CA 91711 954625327 501(c)(3) 100000 0 PROGRAM SUPPORT PILGRIM PLACE 721 W HARRISON AVENUE CLAREMONT CA 91711 951691301 501(c)(3) 7500 0 PROGRAM SUPPORT SHOES THAT FIT 1420 N CLAREMONT BLVD CLAREMONT CA 91711 954425565 501(c)(3) 15000 0 PROGRAM SUPPORT WOODS HEALTH SERVICES 2705 MOUNTAIN VIEW LA VERNE CA 917504313 951809564 501(c)(3) 25000 0 PROGRAM SUPPORT CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST STE 8000 SACRAMENTO CA 95814 941498697 501(c)(3) 1104375 7 FORM 990, SCHEDULE I, PART I, LINE 2 THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE ON JANUARY 1, 2010. THE HOSPITAL MADE PLEDGE PAYMENTS (GRANT) TO THE CALIFORNIA HEALTH FOUNDATION & TRUST TOTALING $1,104,375 IN CONJUNCTION WITH THIS PROGRAM, NO MONITORING IS COMPLETED AFTER THE GRANT IS MADE. POMONA VALLEY HOSPITAL MEDICAL CENTER CONFIRMED THAT THE ORGANIZATIONS RECEIVING GRANTS ARE 501(C)(3) ORGANIZATIONS AND IS CONFIDENT THAT THE GRANTS ARE BEING USED FOR PROPER PURPOSES AND TO FURTHER THE CHARITABLE PURPOSE OF THOSE ORGANIZATIONS ALTHOUGH NO FORMAL MONITORING IS DONE. X X X X X false true false false false false false false false RICHARD YOCHUM PRESIDENT/CEO 731611 0 219606 0 1947664 0 391803 0 16520 0 3307204 0 1731404 0 MICHAEL NELSON ASST. TREASURER/SECRETARY 514952 0 122004 0 9288 0 354683 0 16328 0 1017255 0 0 0 CHRIS ALDWORTH ASST SECRETARY 245915 0 60778 0 8840 0 19448 0 8392 0 343373 0 0 0 JULI HESTER TREASURER/CFO 308774 0 69576 0 2253 0 21600 0 22358 0 424561 0 0 0 DARLENE SCAFFIDDI VP OF NURSING 316000 0 79000 0 17312 0 21600 0 22358 0 456270 0 0 0 KENNETH K NAKAMOTO VP MED STAFF AFF 338962 0 64102 0 10374 0 16200 0 17447 0 447085 0 0 0 KENT HOYOS CIO 351042 0 65508 0 5303 0 21600 0 23311 0 466764 0 0 0 RAY INGE VP HUMAN RESOURCES & PAYROLL 301619 0 54080 0 7577 0 16200 0 23007 0 402483 0 0 0 MICHAEL VESTINO VP, SUPPORT SERVICES 255797 0 47792 0 11586 0 7169 0 22111 0 344455 0 0 0 JOSEPH BAUMGARTNER DIRECTOR OF PHYSICAL THERAPY 283333 0 17269 0 11248 0 18389 0 15382 0 345621 0 0 0 SCHEDULE J, PART I, LINE 4B THE HOSPITAL HAS EMPLOYMENT CONTRACTS WITH MR. YOCHUM AND MR. NELSON. THE CONTRACTS PROVIDE FOR A PAYMENT OF 6.00 FOR MR. NELSON AND 6.16 FOR MR. YOCHUM TIMES ANNUAL CASH COMPENSATION IF THE EXECUTIVE REMAINS EMPLOYED UNTIL THE END OF THE CONTRACT. EMPLOYMENT REQUIREMENTS ARE 40 YEARS FOR MR. YOCHUM AND 39 YEARS FOR MR. NELSON. IN THE EVENT OF VOLUNTARY TERMINATION OR TERMINATION FOR CAUSE, ALL BENEFITS UNDER THE CONTRACT ARE FORFEITED. IN THE EVENT OF EARLY TERMINATION BECAUSE OF DEATH OR DISABILITY, A PRORATED BENEFIT WOULD BE PAID. THE CONTRACT AFFIRMS THE THE BOARD OF DIRECTORS HAS THE RIGHT TO TERMINATE THE CONTRACT, WITH OR WITHOUT CAUSE, AT ITS DISCRETION, AND PROVIDES A FORMULA FOR CALCULATING THE SEVERANCE PAYMENT IN THE EVENT OF INVOLUNTARY TERMINATION. ONCE THE EMPLOYEE HAS MET ALL VESTING REQUIREMENTS, AND THE AMOUNT IS NOT SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, THE AMOUNT IS INCLUDED IN OTHER REPORTABLE COMPENSATION (SCHEDULE J, PART II, B(III)). SCHEDULE J, PART II, COLUMN C INCLUDES DEFERRED COMPENSATION OF $370,203 FOR MR. YOCHUM AND $333,083 FOR MR. NELSON. RICHARD YOCHUM RECEIVED A DEFERRED COMPENSATION PAYOUT OF $1,930,990 IN 2017 OF WHICH $1,731,404 WAS REPORTED ON PRIOR YEAR'S FORM 990. Gregory Daly SEE PART V 143620 Compensation for services false Schedule L, Part IV BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS GREGORY DALY IS THE BROTHER OF DARLENE SCAFFIDDI, KEY EMPLOYEE OF THE ORGANIZATION. FORM 990, PART I, LINE 1 POMONA VALLEY HOSPITAL MEDICAL CENTER IS A NOT-FOR-PROFIT, REGIONAL MEDICAL CENTER DEDICATED TO PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE SERVICES TO RESIDENTS OF THE GREATER POMONA VALLEY. FORM 990, PART III, LINE 1 OUR MISSION - PVHMC IS A NOT-FOR-PROFIT REGIONAL MEDICAL CENTER DEDICATED TO PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE SERVICES TO RESIDENTS OF THE GREATER POMONA VALLEY. THE MEDICAL CENTER OFFERS A FULL RANGE OF SERVICES FROM LOCAL PRIMARY ACUTE CARE TO HIGHLY SPECIALIZED REGIONAL SERVICE. SELECTION OF ALL SERVICES IS BASED ON COMMUNITY NEED, AVAILABILITY OF FINANCING AND THE ORGANIZATIONS TECHNICAL ABILITY TO PROVIDE HIGH QUALITY RESULTS. BASIC TO OUR MISSION IS OUR COMMITMENT TO STRIVE CONTINUOUSLY TO IMPROVE THE STATUS OF HEALTH BY REACHING OUT AND SERVING THE NEEDS OF OUR DIVERSE ETHNIC, RELIGIOUS AND CULTURAL COMMUNITY. OUR VISION - PVHMCS VISION IS TO BE THE REGIONS MOST RESPECTED AND RECOGNIZED MEDICAL CENTER AND MARKET LEADER IN THE DELIVERY OF QUALITY HEALTH CARE SERVICES; BE THE MEDICAL CENTER OF CHOICE FOR PATIENTS AND FAMILIES BECAUSE THEY KNOW THEY WILL RECEIVE THE HIGHEST QUALITY CARE AND SERVICES AVAILABLE ANYWHERE; BE THE MEDICAL CENTER WHERE PHYSICIANS PREFER TO PRACTICE BECAUSE THEY ARE VALUED CUSTOMERS AND TEAM MEMBERS SUPPORTED BY EXPERT HEALTH CARE PROFESSIONALS, THE MOST ADVANCED SYSTEMS AND STATE-OF-THE-ART TECHNOLOGY; BE THE MEDICAL CENTER WHERE HEALTH CARE WORKERS CHOOSE TO WORK BECAUSE PVHMC IS RECOGNIZED FOR EXCELLENCE, INITIATIVE IS REWARDED, SELF-DEVELOPMENT IS ENCOURAGED, AND PRIDE AND ENTHUSIASM IN SERVING CUSTOMERS ABOUNDS; BE THE MEDICAL CENTER BUYERS DEMAND (EMPLOYERS, PAYORS, ETC.) FOR THEIR HEALTH CARE SERVICES BECAUSE THEY KNOW WE ARE THE PROVIDER OF CHOICE FOR THEIR BENEFICIARIES AND THEY WILL RECEIVE THE HIGHEST VALUE FOR THE BENEFIT DOLLAR; AND, BE THE MEDICAL CENTER THAT COMMUNITY LEADERS, VOLUNTEERS AND BENEFACTORS CHOOSE TO SUPPORT BECAUSE THEY GAIN SATISFACTION FROM PROMOTING AN INSTITUTION THAT CONTINUOUSLY STRIVES TO MEET THE HEALTH NEEDS OF OUR COMMUNITIES, NOW AND IN THE FUTURE. OUR COMMUNITY PVHMC IS LOCATED IN LOS ANGELES COUNTY SERVICE PLANNING AREA 3 (SPA3) AND IS DEDICATED TO MEETING THE HEALTH CARE DEMANDS OF THE GROWING POPULATIONS OF BOTH LOS ANGELES AND SAN BERNARDINO COUNTIES. OUR PRIMARY SERVICE AREA IS DEFINED AS THE CITIES OF POMONA, CLAREMONT, CHINO, CHINO HILLS, LA VERNE, MONTCLAIR, ONTARIO, RANCHO CUCAMONGA, ALTA LOMA, UPLAND AND SAN DIMAS AND MAKE UP A POPULATION OF 840,789. OUR SECONDARY SERVICE AREA INCLUDES ADDITIONAL SURROUNDING CITIES IN SAN GABRIEL VALLEY AND WESTERN SAN BERNARDINO COUNTY. IN 2010 AS DERIVED FROM THE STATISTICS REPORTED BY THE U.S. CENSUS BUREAU, THE ETHNIC DIVERSITY REPRESENTED BY THE DEMOGRAPHICS OF THE CITY OF POMONA WAS SUCH THAT 33.6% IS HISPANIC OR LATINO, 14.4% IS WHITE, 7.3% IS BLACK/AFRICAN-AMERICAN, 8.5% IS ASIAN, 1.2% IS AMERICAN INDIAN, 0.2% HAWAIIAN/PACIFIC ISLANDER, 30.3% IS OTHER, AND 4.5% IS TWO OR MORE RACES. FORM 990, PART III, LINE 4A EXECUTIVE SUMMARY - POMONA VALLEY HOSPITAL MEDICAL CENTER (PVHMC) IS A 412-BED, FULLY ACCREDITED, ACUTE CARE HOSPITAL SERVING EASTERN LOS ANGELES AND WESTERN SAN BERNARDINO COUNTIES. FOR OVER A CENTURY, PVHMC HAS BEEN COMMITTED TO SERVING OUR COMMUNITY AND PLAYS AN ESSENTIAL ROLE AS A SAFETY-NET PROVIDER AND TERTIARY REFERRAL FACILITY FOR THE REGION. A NATIONALLY RECOGNIZED, NOT-FOR-PROFIT FACILITY, THE HOSPITALS SERVICES INCLUDE CENTERS OF EXCELLENCE IN CANCER CARE, CARDIAC AND VASCULAR CARE, WOMENS AND CHILDRENS SERVICES, AND TRAUMA CARE. SPECIALIZED SERVICES INCLUDE CENTERS FOR BREAST HEALTH, SLEEP DISORDERS, A NEONATAL ICU, A PERINATAL CENTER, PHYSICAL THERAPY/SPORTS MEDICINE, A LEVEL II TRAUMA CENTER AND EMERGENCY DEPARTMENT WHICH INCLUDES OUR LOS ANGELES COUNTY AND SAN BERNARDINO COUNTY STEMI RECEIVING CENTER DESIGNATION, ROBOTIC SURGERY, AND THE FAMILY MEDICINE RESIDENCY PROGRAM AFFILIATED WITH UCLA. SATELLITE CENTERS IN CHINO HILLS, CLAREMONT, COVINA, LA VERNE AND POMONA PROVIDE A WIDE RANGE OF OUTPATIENT SERVICES INCLUDING PHYSICAL THERAPY, URGENT CARE, PRIMARY CARE, RADIOLOGY AND OCCUPATIONAL HEALTH. ALONG WITH BEING NAMED ONE OF HEALTHGRADES 100 BEST HOSPITALS FOR CARDIAC CARE, 2014-2018 (ONLY ONE OF THREE IN CALIFORNIA TO RECEIVE ALL 3 TOP 100 RECOGNITIONS IN 2014-2015) AND RECEIVING HEALTHGRADES 2017 PATIENT SAFETY AWARD, THE JOINT COMMISSION HAS GIVEN PVHMC THE GOLD SEAL OF APPROVAL FOR ORTHOPEDIC JOINT REPLACEMENT, PALLIATIVE CARE, DIABETES, AND THE GOAL SEAL OF APPROVAL FOR CERTIFICATION AS A PRIMARY STROKE CENTER FOR LOS ANGELES COUNTY, DEMONSTRATING WHAT WE HAVE BEEN DOING ALL ALONG - PROVIDING QUALITY CARE AND SERVICES IN THE HEART OF OUR COMUNITY. AS A COMMUNITY HOSPITAL, WE CONTINUOUSLY REFLECT UPON OUR RESPONSIBILITY TO PROVIDE HIGH-QUALITY HEALTHCARE SERVICES, ESPECIALLY TO OUR MOST VULNERABLE POPULATIONS IN NEED, AND TO RENEW OUR COMMITMENT WHILE FINDING NEW WAYS TO FULFILL OUR CHARITABLE PURPOSE. PART OF THAT COMMITMENT IS SUPPORTING ADVANCED LEVELS OF TECHNOLOGY AND PROVIDING APPROPRIATE STAFFING, TRAINING, EQUIPMENT, AND FACILITIES. PVHMC WORKS VIGOROUSLY TO MEET OUR ROLE IN MAINTAINING A HEALTHY COMMUNITY BY IDENTIFYING HEALTH-RELATED PROBLEMS AND DEVELOPING WAYS TO ADDRESS THEM. IN 2015, IN COMPLIANCE WITH SECTION 501(R)(3) OF THE INTERNAL REVENUE CODE, CREATED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (2010), A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED. THIS ASSESSMENT IS INTENDED TO BE A RESOURCE FOR PVHMC IN THE DEVELOPMENT OF ACTIVITIES AND PROGRAMS THAT CAN HELP IMPROVE AND ENHANCE THE HEALTH AND WELL-BEING OF THE RESIDENTS OF POMONA VALLEY. IN RESPONSE TO THE ASSESSMENTS FINDINGS, FY 2015-2017 COMMUNITY BENEFIT IMPLEMENTATION STRATEGY WAS DEVELOPED TO OPERATIONALIZE THE INTENT OF PVHMCS COMMUNITY BENEFIT PLAN INITIATIVES THROUGH DOCUMENTED GOALS, PERFORMANCE MEASURES, AND STRATEGIES. PVHMC DEMONSTRATES ITS PROFOUND COMMITMENT TO ITS LOCAL COMMUNITY AND HAS WELCOMED THIS OCCASION TO FORMALIZE OUR COMMUNITY BENEFIT PLAN AND IMPLEMENTATION STRATEGY. OUR COMMUNITY IS CENTRAL TO US AND IT IS REPRESENTED IN ALL OF THE WORK WE DO. PVHMC HAS SERVED THE POMONA VALLEY FOR 110 YEARS, AND WE VALUE MAINTAINING THE HEALTH OF OUR COMMUNITY. COMMUNITY NEEDS ASSESSMENT- IN 2015, A COMMUNITY NEEDS ASSESSMENT WAS COMPLETED. THE ASSESSMENT IS INTENDED TO BE A RESOURCE FOR PVHMC TO BECOME INVOLVED WITH DEVELOPING AND MAINTAINING ACTIVITIES AND PROGRAMS THAT CAN HELP IMPROVE THE HEALTH AND WELL-BEING OF THE RESIDENTS OF POMONA VALLEY. THE COMMUNITY NEEDS ASSESSMENT PROCESS INCLUDED PRIMARY AND SECONDARY DATA COLLECTION, INCUDING VALUABLE COMMUNITY, STAKEHOLDER, AND PUBLIC HEALTH INPUT THAT WAS EXAMINED TO PRIORITIZE THE MOST CRITICAL NEEDS OF OUR COMMUNITY AND SERVE AS THE BASIS FOR OUR COMMUNITY BENEFIT PLAN INITIATIVES AND IMPLEMENTATION STRATEGY. PVHMC PARTNERED WITH CALIFORNIA STATE UNIVERSITY SAN BERNARDINOS INSTITUDE OF APPLIED REASEARCH TO CONDUCT 333 COMMUNITY MEMBER SURVEYS, CONDUCTED A TOTAL OF 3 COMMUNITY FOCUS GROUPS, AND SOUGHT INPUT FROM CHRISTIN MONDY, PUBLIC HEALTH DEPARTMENT OFFICER FOR LOS ANGELES SERVICE PLANNING AREAS 3 AND 4. THE RESEARCH OBJECTIVES WERE TO LOOK AT THE DEMOGRAPHIC PROFILE OF THE COMMUNITY, HEALTH INSURANCE COVERAGE, HEALTH ACCESS BARRIERS, UTILIZATION OF HEALTH CARE SERVICES FOR ROUTINE PRIMARY/PREVENTATIVE CARE, UTILIZATION OF URGENT CARE SERVICES, NEED FOR SPECIALTY HEALTH CARE AND EXPERIENCE WITH PVHMC INCLUDING CLASSES, SUPPORT GROUPS, AND THE EMERGENCY DEPARTMENT. IMPLEMENTATION STRATEGY FY 2015-2017 - THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT AND OUR COMMUNITY BENEFIT PLAN AND IMPLEMENTATION STRATEGY, ADOPTED BY OUR GOVERNING BOARD OF DIRECTORS REFLECTS OUR COMMITMENT TO MEET THE NEEDS OF OUR COMMUNITY, AS THE MAJORITY OF OUR SERVICES ARE TIED INTO PROVIDING INFORMATION AND EDUCATION TO THE COMMUNITY REGARDING AVAILABILITY AND ACCESSIBILITY TO HEALTH AND SOCIAL SERVICES. BY FOSTERING GREATER COORDINATION AND COLLABORATION AMONG LOCAL SERVICE PROVIDERS, WE ARE ABLE TO CONTINUE TO OFFER COMPREHENSIVE MEDICAL SERVICES AND PROGRAMS TO A LARGE COMMUNITY. OUR SERVICES SHOW HOW THE COMMUNITYS NEEDS DRIVE THE CONCEPTION AND ESTABLISHMENT OF THE SERVICES WE PROVIDE AND CONTRIBUTE TO ITS GROWTH AND IMPROVEMENT. EVERY ACTIVITY AND PROGRAM IS BUDGETED TO MANAGE THE USE OF AVAILABLE RESOURCES. OUR COMMITMENT TO THESE VITAL SERVICES IS DEMONSTRATED THROUGH THE CONCERTED EFFORTS OF EACH DEPARTMENT TO ENSURE THAT ESSENTIAL SERVICES CONTINUE TO BE PROVIDED TO THE COMMUNITY. COMMUNITY BENEFIT PLAN AND IMPLEMENTATION STRATEGY FOCUS STUDY UPDATE, 2018 (FY 2017) PVHMCS 2018 REPORT AND FOCUS STUDY (FOR FY 2017) UPDATE HIGHLIGHTS SOME OF OUR MANY EFFORTS TO PROMOTE AN IMPROVED QUALITY OF LIFE AND EVALUATES OUR CURRENT STRATEGIES AND THE ANTICIPATED IMPACT THOSE STRATEGIES AND PROGRAMS HAVE IN ADDRESSING PRIORITY HEALTH NEEDS IDENTIFIED IN OUR NEEDS ASSESSMENT. ACTIONS AND UPDATES FROM FISCAL YEAR 2017 THAT PVHMC HAS CHOSEN TO HIGHLIGHT ARE: - TRAUMA SERVICES PRIORITY HEALTH NEED AREA 3 (ACCESS TO CARE) - STROKE PROGRAM PRIORITY HEALTH NEED AREAS 1, 2 & 3 (CHRONIC DISEASE, HEALTH EDUCATION & ACCESS TO CARE) - DIABETES PROGRAM PRIORITY HEALTH NEED AREAS 1 & 2 (CHRONIC DISEASE MANAGEMENT AND HEALTH EDUCATION) DIABETES CARE UPDATE FY 2017 COMMUNITY-BASED PROGRAM TYPE 2 DIABETES (T2D) IS A GROWING PROBLEM. IT HAS TRIPLED OVER THE LAST DECADE AND IT IS ANTICIPATED TO TRIPLE OVER THE NEXT SEVERAL DECADES (CDC, 2015). APPROXIMATELY 9.3% OF AMERICANS HAVE DIABETES; 90-95% OF WHICH IS T2D. THIS EQUATES TO 21 MILLION INDIVIDUALS DIAGNOSED WITH DIABETES (CDC 2014 REPORT CARD ON DM). MORE SO, IT IS ESTIMATED THAT 8.1 MILLION INDIVIDUALS ARE UNDIAGNOSED (CDC 2014 REPORT CARD ON DM). THIS IS A STAGGERING NUMBER, AND PREDIABETES DIAGNOSES ARE ALSO ON THE RAPID RISE. FURTHERMORE, IN PVHMCS 2015 COMMUNITY HEALTH NEEDS ASSESSMENT, APPROXIMATELY 25.9% SAID THAT THEY OR A FAMILY MEMBER WERE LIVING WITH A DIAGNOSIS OF EITHER TYPE 1 OR TYPE II DIABETES. THIS PERCENTAGE IS IN ALIGNMENT WITH ESTIMATES OF THE PREVALENCE OF DIABETES WITHIN THE PATIENTS DISCHARGED FROM PVHMC WITH AN EXISTING OR NEW DIAGNOSIS OF DIABETES (AVERAGE OF 25% OF PATIENTS DISCHARGED FROM PVHMC). WE KNOW, HOWEVER, THIS IS LIKELY TO BE AN UNDERESTIMATE GIVEN THAT UNTIL NOW THERE HAS BEEN NO ROUTINE SCREENING FOR DIABETES ACROSS HOSPITAL SERVICES. MOST OF KNOWN T2D CASES ALSO SUFFER FROM COMORBIDITIES, ESPECIALLY CARDIOVASCULAR DISEASE. THE INCIDENCE OF HIGH BLOOD PRESSURE (42%), OBESITY (21%, LIKELY A LOW ESTIMATE), AND ARTERIOSCLEROSIS (32%), WERE ALSO SIGNIFICANT IN OUR COMMUNITY RESPONSES. SUCH DATA PAINTS A POOR PROGNOSIS FOR THE RESIDENTS OF POMONA AND THE SURROUNDING COMMUNITIES. IT IS FOR THE REASONS ABOVE THAT PVHMC IDENTIFIED DIABETES AS A PRIORITY AREA TO ADDRESS IN THE COMMUNITY. 2016 SCREENING FINDINGS THE HOSPITAL A1C REPORTS FROM JAN. 1 DEC. 10, 2016 HAD TOTAL A1C READINGS FOR 11,292. FROM THESE PATIENTS, 31.8% WERE PREDIABETIC (A1C=5.7-6.4%) AND 24.6% WERE DIABETIC (A1C>6.4%). FROM THE PREDIABETIC PATIENTS, 100 OF THEM CONSENTED TO PARTICIPATE IN THE STUDY. PARTICIPANTS MEASUREMENTS WERE COLLECTED FROM THEIR MEDICAL CHART, AND WERE SURVEYED. MAJORITY OF THESE PARTICIPANTS WERE MALE (56%), WHILE 46% WERE FEMALE. THE MEAN AGE WAS 56.8 (STD. DEV.=14.1), WITH AGES RANGING FROM 24 -88 YEARS OLD. THIS POPULATION OF PARTICIPANTS CONSISTED MOSTLY OF LATINO OR HISPANIC PEOPLE (54%), WHILE 31% WERE WHITE. MAJORITY OF PARTICIPANTS WERE MARRIED (35%), AND HAD A HIGH SCHOOL DEGREE (33%). THE ADA RISK SCORE AND A 10-ITEM SURVEY WERE ADMINISTERED. EIGHTY THREE PERCENT OF PARTICIPANTS SCORED EQUAL OR HIGHER THAN 5; WHICH INDICATES A HIGHER RISK FOR TYPE-2 DIABETES. FROM THE 10-ITEM SURVEY, 35% DID NOT ENGAGE IN MODERATE PHYSICAL ACTIVITIES, AND 20% CURRENTLY SMOKE. FROM THE PHYSICAL MEASUREMENTS, CALCULATED BODY MASS INDEX (BMI) AMONG OUR PARTICIPANTS SHOWED THAT 26% WERE OVERWEIGHT (BMI=25-29.9), AND 49% WERE OBESE (BMI=30) AND 22% WE FORM 990, PART VI, LINE 11B A COPY OF THE TAX RETURN ALONG WITH A PRESENTATION FROM EY, THE HOSPITAL'S EXTERNAL ACCOUNTING FIRM, IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING IN NOVEMBER 2018. REPRESENTATIVES FROM EY REVIEW THE RETURN DIRECTLY WITH THE DIRECTORS AND ANSWER ANY QUESTIONS THEY MAY HAVE. THE INTERNAL PROCESS INCLUDES (A) PREPARATION OF THE FINANCIAL DATA BY HOSPITAL PERSONNEL, AND (B) SURVEYS OF DIRECTORS, OFFICERS AND KEY EMPLOYEES REGARDING INFORMATION IN RESPONSE TO QUESTIONS IN PART VI. THIS INFORMATION IS DISCLOSED IN SCHEDULE L. THE COMPLETED 990 IS REVIEWED FOR OVERALL COMPLETENESS AND ACCURACY BY THE CEO AND CFO. FORM 990, PART VI, LINE 12C EACH YEAR OFFICERS, DIRECTORS, AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS PURSUANT TO HOSPITAL POLICY. THE STATEMENTS ARE THEN REVIEWED BY THE OFFICERS OF THE BOARD (THE CHAIRMAN AND THE TWO VICE CHAIRMEN) BEFORE PRESENTED TO THE FULL BOARD AT THE ANNUAL ORGANIZATIONAL MEETING OF THE BOARD. ANY CONFLICTS OF CONCERN ARE ADDRESSED BY THE OFFICERS AND DISCUSSED BY THE FULL BOARD AT THE ORGANIZATIONAL MEETING. THEREAFTER, IT IS THE RESPONSIBILITY OF EACH MEMBER TO RAISE AN ISSUE OF POTENTIAL CONFLICT TO THE BOARD AND/OR ITS OFFICERS FOR DISPOSITION. IF A CONFLICT IS DEEMED TO EXIST, THE MEMBER IS EXCUSED FROM THE MEETING AND/OR TOPIC WHERE THE CONFLICT EXISTS. FORM 990, PART VI, LINE 15A & 15B The Board of Directors has a Compensation Committee which annually reviews and determines the compensation for the CEO. Its determination of the CEOs Compensation is based upon a tri-annual review and report of the CEOs and other senior executives compensation compared to industry practice. In 2017 the Compensation Committee relied on this report for their annual review. The Compensation Review Process is documented in the minutes of the Compensation Committee. FORM 990, PART VI, LINE 18 THE HOSPITAL IS NOT REQUIRED TO MAKE ITS FORM 1023 AVAILABLE AS IT FILED FOR TAX EXEMPT STATUS PRIOR TO JULY 15, 1987. THE HOSPITAL MAKES ITS 990 AND 990T AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THIS FORM 990, IN ACCORDANCE WITH THE IRS INSTRUCTIONS. FORM 990, PART XI, LINE 9 EFFECT OF ADOPTION OF FASB STATEMENT 158 $(154,625) LOSS FROM SUBSIDIARIES $(808,896) ------------ TOTAL $(963,521) Pomona Valley Medical Center Foundation 1798 N Garey Avenue Pomnona CA 91767 953403287 Support PVHMC CA 501(c)(3) 7 NA false The Auxiliary of PVHMC 1798 N Garey Avenue Pomona CA 91767 956053224 SUPPORT PVHMC CA 501(c)(3) 12c PVHMC true Pomona Valley Medical Plaza 1798 N Garey Avenue Pomona CA 91767 954175295 Leasing CA PVHMC RELATED -456343 3263307 false 0 false 0.90000 Pomona Valley Health Facilities 1798 N Garey Avenue Pomona CA 91767 954104554 R.E. Operations CA PVHMC C Corp 1.00000 true true false true false false false false false true true false false false true true true false false false Pomona Valley Medical Plaza i 472654 Accrual The Auxiliary of PVHMC B 55305 Accrual PVHMC Foundation c 189569 Accrual SCHEDULE R, PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP POMONA VALLEY MEDICAL PLAZA 1798 NORTH GAREY AVENUE POMONA, CA 91767 EIN: 95-4175295