2017-11-10T16:10:30-06:00 2016-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2016-01-01 941201197 Dameron Hospital Association DAME 2099445550 525 West Acacia Street Stockton CA 95203 Lorraine Auerbach President/CEO 2099445550 2017-11-09 1 Joua V Lo P01225144 2099556100 2017-11-09 73.93.142.236 2017-11-09 17:31:48 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 189799C539B232A8D1FA5D0851A612580EB85C47 2016 2017-02-10 21:41:12Z Lorraine Auerbach 525 West Acacia Street Stockton CA 95203 285273148 0 X www.dameronhospital.org X 1912 CA We support physicians and our employees in providing quality care in a safe, caring environment. 8 6 1035 56 174435 0 210 406500 232844153 171039828 824947 -1015863 588070 391474 234257380 170821939 0 0 0 0 90704238 73988296 0 0 0 103808474 107813118 194512712 181801414 39744668 -10979475 193812310 184156739 30520788 27090592 163291522 157066147 X We support physicians and our employees in providing quality care in a safe, caring environment. 0 1 161806528 170929325 Dameron Hospital is a Joint Commission accredited, 202-bed, not-for-profit community hospital delivering excellent healthcare to generations of San Joaquin County residents for over 100 years and is a nationally recognized as a leader in quality and safety. Dameron Hospital strives to promote healing and wellness through compassionate, quality and cost-effective care to meet the identified needs of the community we serve. Dameron Hospital is proud of its past and is dedicated to its future in providing services to the community to meet their healthcare needs. In keeping with a healthier community, Dameron Hospital is a smoke-free, tobacco-free environment.Dameron Hospital exists solely to serve the healthcare needs of the greater Stockton area and San Joaquin County, providing the community with advanced technology and state-of-the-art diagnostic and therapeutic equipment, as well as facilities for Inpatient, Outpatient, Occupational Services and Ambulatory Care Center. Dameron Hospital offers a broad array of services for the health maintenance for all age groups.Comprehensive patient services include Bariatric, Cardiology, Orthopedics, Emergency/Urgent Care, and Imaging Specialties. In May of 2016 the Obstetrics, Pediatrics, and NICU departments were closed. Dameron Hospital no longer offers these services. 161806528 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 136 0 1 1035 1 1 1 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X Lorraine Travis-Brown 2099445550 525 W Acacia St Stockton CA 95203 Lorraine Auerbach President/CEO 40.00 1.00 X X 1075346 0 13090 William Trezza Chairman of the Board 10.00 X X 0 0 0 Dan Dixon Vice Chairman 10.00 X X 0 0 0 Brian Martucci Secretary 10.00 1.00 X X 0 0 0 Philip Ruhl Director 10.00 X 39000 0 0 Robert Lawrence Director 10.00 X 0 0 0 Hon Ron A Northup Director 10.00 X 0 0 0 Gary Giannini Director 10.00 X 0 0 0 Elizabeth Propp VP of Finance/CFO 40.00 1.00 X 395267 0 30683 Bradley Reinke VP of Medical Affairs/CMO 32.00 X 284088 0 0 Janine Hawkins VP Pt Care Svcs (Thru 12/2016) 40.00 X 496346 0 27148 Michael Glasberg VP of Operations/COO 40.00 X 472483 0 24347 Terrance Thomas Registered Nurse 40.00 X 218319 0 19796 Chad Davis Assistant Director of Surgery 40.00 X 215350 0 13540 Denise Hair Assistant CNO 40.00 X 196288 0 18113 Chris Peterson Cardiac Cath Supervisor 40.00 X 190578 0 17992 Tresha Moreland VP of HR (Thru 3/2016) 40.00 X 229254 0 1890 Christopher Arismendi Former CEO (Thru 10/2012) 0.00 X 253846 0 0 David Kerrins Former CIO (Thru 12/2015) 0.00 X 239185 0 0 4305350 0 166599 175 1 1 0 CPS LLC P O Box 638316 Cincinnati OH 45263 Pharmacy Services 4155396 Sound Physicians P O Box 742936 Los Angeles CA 90074 Hospitalist Services 3009197 Pacific Heart and Vascular Medical Group 1801 East March Lane Suite D400 Stockton CA 95210 Cardiovascular Services 1499747 Anesthesiology Consultants PO Box 13728 Sacramento CA 95853 Anesthesiology Services 1096419 Rehab Practice Management 9364 Ansley Avenue Brentwood TN 37027 Rehabilitation Services 897099 23 406500 406500 Patient Service Rev. 621110 74959144 74959144 Medical/Medicare Pymts 621110 58710735 58710735 Hospital Fee 621110 33978400 33978400 Cafeteria 722210 665230 665230 Rebates/Refunds 621110 245952 245952 2480367 2480367 171039828 1739141 1739141 238578 122949 115629 115629 115629 109397844 287007 112119070 320785 -2721226 -33778 -2755004 -2755004 1769254 1888405 -119151 -110503 -8648 Other Income 900099 211913 211913 Income from K-1 541900 183083 183083 394996 170821939 170929325 174435 -688321 X 2857799 2857799 493031 493031 49324652 47575096 1749556 1631217 1579866 51351 14376850 12876041 1500809 5304747 5053353 251394 4098592 1875365 2223227 1712733 1712733 225943 225943 112873 112873 28861911 21981273 6880638 25109123 24945123 164000 8542748 8542748 1819360 1537796 281564 22915 17575 5340 79554 75312 4242 225 225 8554028 8554028 1307306 1307306 Medi-cal Hospital Fee E 18146400 18146400 Bad Debts Provision 8996581 8996581 Dues & Subscriptions 222826 49746 173080 181801414 161806528 19994886 0 3900 3900 61227265 12154218 27986653 19810737 617553 551998 3538329 3710377 1583795 1551203 199568931 136577140 53647711 62991791 32477331 61218932 4130792 7074220 8598981 15089363 193812310 184156739 19179131 16673472 11341657 10417120 30520788 27090592 X 162587284 157058310 704238 7837 163291522 157066147 193812310 184156739 -10979475 4754100 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5273787 5273787 1995756 88337028 52125254 38207530 1560764 1161853 398911 93974424 78500778 15473646 8427172 4789255 3637917 62991791 Other Receivables 1196456 Cost Report Settlement Receivable 13521823 Deferred Compensation Fund 194859 Due from Medical Group 176225 15089363 Risk Management Programs 6852432 Retiree Medical Liability 3564688 10417120 1 1 1 X 350.000000000000 1 X 150.000000000000 1 1 0 1 1 68640 68640 0.00040 54691035 31203166 23487869 0.13590 54759675 31203166 23556509 0.13630 46516 46516 0.00030 12200 12200 0.00010 77510 77510 0.00040 136226 136226 0.00080 54895901 31203166 23692735 0.13710 2 29597 29597 0.00020 1 250 250 0.00000 1 250 250 0.00000 2 8197 8197 0.00000 3 8472 8472 0.00000 3 77510 77510 0.00040 12 124276 124276 0.00060 1 8996581 899658 44237005 58760720 -14523715 X 1 1 1 1 Dameron Hospital Association 525 West Acacia Street Stockton CA 95203 www.dameronhospital.org 030000024 X X X Dameron Hospital Association 1 0 0 1 X X X X X X 16 1 1 0 1 X www.dameronhospital.org X www.healthiersanjoaquin.org 1 16 1 www.dameronhospital.org 0 0 1 X 350.000000000000 150.000000000000 X 1 1 X X X X 1 X www.dameronhospital.org X www.dameronhospital.org X www.dameronhospital.org X X X 1 X X 0 X 1 X 0 0 Dameron Hospital Association Part V, Section B, Line 5: The robust and comprehensive assessment included both primary and secondary data. Primary data included input from more than 180 members of the Hospital Service Area (HSA), expert interviews with 45 key informants, focus group interviews with 137 community members and more than 300 community health assessnent surveys were collected. Secondary data included health outcome data, socio-demographic data, behavioral, and environmental data at the ZIP code or census tract level. Analysis of both primary and secondary data revealed 10 specific Communities of Concern, living with a high burden of disease in San Joaquin County. These 10 communities had consistently high rates of negative health outcomes that frequently exceeded county, state, and Healthy People 2020 benchmarks. The primary goals of the assessment are:- Engage local stakeholders- Generate knowledge that will lead to collaborative action- Identify data that would be useful for policy and advocacy work- Establish a "Call to Action" for community members- Assess community needs and assets- Develop a community dissemination plan- Provide ongoing tracking and monitoringRanking of the seven health needs are shown below:1. Lack of access to primary and preventative care services2. Lack of or limited access to health education3. Lack of or limited access to dental care4. Limited cultural competence in health and related systems5. Limited or no nutrition literacy/access to healthy and nutritious foods, food security6. Limited transportation options7. Lack of safe and affordable places to be active Dameron Hospital Association Part V, Section B, Line 6a: - St. Joseph's Medical Center- Lodi Memorial Hospital- Sutter Tracy Community Hospital- Kaiser Permanente Dameron Hospital Association Part V, Section B, Line 11: The implementation plan was developed following a distinct three step strategic planning process. First, the health needs identified in the CHNA were prioritized by members of the SJC2HAC. Second, Dameron Hospital selected four of the prioritized health needs as a primary focus for the purposes of meeting the health needs of the Community. Those chosen most closely aligned with the hospital's Mission and organizational capabilities. The third, and final step was the development of an implementation plan.Step 1: Prioritizing Health NeedsThe SJC2HAC prioritized and ranked the identified community health needs. Each health need was ranked along two dimensions: 1) the significance or severity of the health need; and 2) the ability of a hospital to make a notable impact on the identified health need.Step 2: Identify Health Needs for Dameron Hospital's 2015 focusDameron Hospital identified four primary health needs, from the seven, that aligned with its Mission and organizational capabilities. Dameron Hospital's Mission is to support physicians and our employees in providing quality patient care in a safe and caring environment.Step 3: Strategic PlanningThis process followed two key steps. First, personnel in the hospital were recruited to participate and develop the implementation plan. Second, Dameron Hospital leadership evaluated the implementation plan and its alignment to the community needs assessment. The final Plan is depicted in Strategic Plan (pgs. 20-22 of the Community Benefit Report) This evaluation and prioritization results were used as the roadmap for our 2015 Community Benefit Plan. Dameron Hospital Association Part V, Section B, Line 20e: - Documented its determination of whether individuals were eligible for financial assistance under the hospital facility's financial assistance policy.- Notified individuals of the financial assistance policy in communications with the individuals regarding the individual's bills.- Notified individuals of the financial assistance policy on admission.- Notified individuals of the financial assistance policy prior to discharge. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 8,996,581. Part II, Community Building Activities: * Community support- Free Interpreter Services for patients and their designated support person.- Taxi/bus transportation to and from the Hospital/Clinic, if needed.* Leadership development and training for community membersLeadership Stockton is a program designed to inspire a new generation of men and women to assume leadership roles in the community. The nine-month program challenges and prepares individuals from diverse backgrounds to become influential in the region's future. To develop educated and motivated community leader participants are exposed to civic, civil, education, healthcare and non-profit entities. Participants heard from area healthcare leaders about the current and future state of healthcare. Brad Reinke, MD and Chief Medical Officer presented on behalf of Dameron Hospital. The roundtable discussion enabled participants to learn about hospital and healthcare facilities located throughout Greater Stockton community. A question and answer period concluded the forum.* Coalition buildingDameron Hospital is an active participant in the San Joaquin County Healthier Community Coalition. The purposes of the Coalition are: a) to provide leadership in the development and coordination of health status improvement efforts in San Joaquin County; b) to provide a forum for health services stakeholders to share ideas and information about projects and seek collaborative partners; and c) to work collaboratively and encourage the efforts of other collaborative attempting to respond to community health issues and problems. Dameron Hospital collaborated on creating an all-inclusive free and confidential service helpline for local resources. The 211 helpline, launched in 2015, is available 24 hours a day, seven days a week. Dameron staff has co-chaired this Coalition and participated in key leadership roles since 2011. Its purpose is to make it easy for people to find the help they need, when they need it. (http://www.211.org)Dameron Hospital participated in the recent Community Health Needs Assessment (CHNA), which is publicly available at http://healththiersanjoaquin.org. Additional detail about identified needs, data collected, community input obtained, and prioritization methods used can be found in the CHNA report. The significant community health needs identified are:1. Obesity/Diabetes2. Education3. Youth Development4. Economic Security5. Violence and Injury6. Substance Use7. Access to Housing8. Access to Care9. Mental Health10. Oral Health11. Asthma/Air Quallity* Community health improvement advocacyDameron has offered flu shot clinics in the community. In addition, Dameron's Linacia pharmacy has provided pharmaceuticals at no cost to a number of indigent patients.* Workforce developmentDecision Medicine:This two-week program, sponsored by San Joaquin Medical Society, is designed to introduce high school students to the field of medicine through personal mentoring opportunities and site visits with behind-the-scenes access to some of our regional hospitals, clinics and public health centers. Decision Medicine 2016 took place at various locations in Northern California, including hospitals, various clinics and inside actual private offices of participating physicians in San Joaquin County. Decision Medicine 2016 at Dameron Hospital was a full eight-hour day including student interactive tours into the Core Laboratory, the Pathology Laboratory, American Medical Response ambulance tour, and a tour of the Hospital Data Center; didactic lectures on Basic Hematology & Comparative Cellular Morphology and Forensic Pathology; and hands-on laboratory exercises for Phlebotomy, Blood Specimen Preparation, Blood Smear Technique, Differential Staining Technique, Blood Smear Examination by Light Microscopy, and Blood Typing. In addition, students were provided an individual Complete Blood Analysis (CBC), a preliminary ABO blood group determination, historical information about Dameron Hospital and career information in pathology and laboratory medicine. Dameron Hospital hosted twenty-four students that included lunch and refreshments throughout the day. The Director of Risk Management coordinates this Program for Dameron Hospital. Volunteers include a Board Member, Chief Information Officer, Hospital Executive Leadership Team Member, Laboratory Medical Director, Laboratory Manager, several Clinical Laboratory Scientists, Patient Relations Coordinator, and Health Educator.Health Careers Academy:The Health Careers Academy (HCA) was established in 2011 by the Stockton Unified School District to meet the growing community need for healthcare clinicians in Stockton and the greater San Joaquin County. HCA has a student population of 470 students with a senior class of 118. The goal of HCA is to produce students who have been challenged with a rigorous college prep curriculum, as well as teaching them health career technical skills. Students are provided with community service opportunities to gain better sense of community awareness and are exposed to various medical professions during their PRN rounds. Upon graduation, they leave prepared to join the workforce; pursue further health related vocational training; or attend a four-year college. Dameron Hospital staff is committed to offering speakers, mentors and participate in mock interview at the request of the HCA. Our Community Benefit Director serves on the HCA Community Committee to enhance the learning experiences of our future health care professions.Association of California Nurse Leaders (ACNL):This Association was created and is embraced by nurse leaders throughout California. Its mission is to develop nurse leaders; advance professional practice; influence health policy; and promote quality and patient safety. With health care reform, implementation of the IOM Future of Nursing initiatives, professional practice issues and regulatory mandates, challenges and opportunities for nurse leaders have never been greater. ACNL helps nurse leaders address these issues together. ACNL provides essential information, statewide networking with peers, progressive leadership development programs and timely educational activities. Dameron Hospital's Nursing Directors are members of the North Central Chapter that includes monthly chapter meetings, participation in ACNL projects and sponsoring annual ACNL conferences.Dameron Hospital continued its ACNL membership and active participation through 2016.* Other community building activityContinuing Medical Education:The Institute for Medical Quality/California Medical Association (IMQ/CMA) provides Continuing Medical Education (CME) for physicians accredited at Dameron Hospital. Classes are offered at noon on Fridays (excluding Holidays and the months of July and August) in the hospital's Annex building. The classes are open to all physicians throughout the community. Dameron provided 26 continuing medical education classes throughout 2016 and will continue to provide Continuing Medical Education Classes in 2017. A total of 476 medical professionals attended the classes in 2016 and 86 other healthcare professionals. Diabetes:Dameron Hospital offered a Diabetes Outpatient Education Program through April of 2016. The program was free to community residents who registered for the program. Dameron Hospital's staff of dieticians, registered nurses, certified diabetic educators, social workers and physicians administered the program and utilized the American Diabetes Association (ADA) certified U.S. Department of Health "Journey to Control Diabetes Conversation Maps." Dameron offered diabetes education and glucose screenings at numerous health fairs and public events throughout the community. More than 100 people were given diabetic education at these community events.Chronic Obesity:In 2014 Dameron Hospital initiated a comprehensive Bariatric Services Program. Chronic obesity is the largest health care problem in San Joaquin County, which in turns contributes to Hypertension, Diabetes, and associated orthopedic dysfunctions. Our dedicated Bariatric Services Coordinator facilitates all components of the Bariatric Program. Weight loss seminars and support groups are available to the entire community. Seminars attended by 703 educated interested individuals about the problems of obesity and the surgical options that are available. Dameron also offers a Healthy Lifestyles class that is available to anyone who has had a Bariatric procedure. The class provides reinforcement of concepts to enhance learning and provide a networking opportunity to over 287 Bariatric patients in 2016. Many areas of San Joaquin County have food deserts, no access to fresh fruit and vegetables, which contribute to obesity in the African-American and Hispanic populations. Part III, Line 4: The organization determines the amount that could be attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy based upon a query of the collections system (Golden State Collections) - 10% of estimated bad debt expense.Any discounts and/or payments applied to a patient's account are not reversed before writing the account off to bad debt. In other words, the net balance of the account is what's written off.Bad debt expense is not included as a community benefit in the hospital's community benefit report.Bad Debt expense footnote - See audited financial statements, page 9 & 10, footnote 1, Patient accounts receivable and Allowance for uncollectible accounts sections. Part III, Line 8: If Medicare does not reimburse our costs for patient care, the excess of cost over reimbursement should be considered a benefit to the community we serve.Medicare uses the Medicare cost report program in computing the cost in providing medical care services for Medicare beneficiaries. The Medicare cost report calculates routine costs using per diem methodolgy and the ancillary cost is calculated using cost to charge ratios. Part III, Line 9b: In accordance with the Hospital's Charity Care and Discounted Payment Policy, patients will be made aware of the availability of Charity Care and Discounted Payment options on the Hospital's website, at all points of registration in the Hospital, as well as in connection with billing statements issued by the Hospital.The Patient Accounting Department sends the responsible party a final bill at least 90 days from the date the Hospital provides the first post-discharge billing statement, informing the responsible party of the Hospital's Charity Care and Discounted Payment Policy, a plain language summary of that policy and the patient's rights, as required under California Health and Safety Code section 127430(a), the phone number the responsible party can call for more information if interested in applying, the collections actions that may be pursued in the event of nonpayment, and the deadline for when those actions may be commenced (such deadline to be at least 30 days from the date of the final bill is sent). The Patient Accounting Department will also attempt to call or otherwise orally inform the responsible party of the Hospital's Charity Care and Discounted Payment Policy and how the responsible party may obtain assistance with the application process. The responsible party is requested to forward any insurance information or to make payment or submit an application under the Charity Care and Discounted Payment Policy within the stated deadline or the account may be referred to collections. Collections actions may include engaging a collection agency to assist with obtaining payment, reporting the patient's account to a consumer credit reporting agency, deferring, denying or requiring a payment before providing elective, non-Medically Necessary Services because of the patient's nonpayment of one or more bills for previously provided care, commencing a civil action against the patient for nonpayment, wage garnishment, bank garnishment and abstract liens on real property as well as business garnishment if responsible party is the business owner. However, for a patient that lacks coverage, the Hospital, any assignee of the Hospital, or other owner of the patient debt, including a collection agency, will not report adverse information to a consumer credit reporting agency or commence civil action against the patient for nonpayment at any time prior to 150 days after the initial billing. This period shall be extended if the patient has a pending appeal for coverage of the services until a final determination of the appeal is made.If the responsible party requests financial assistance, the request is forwarded to the Credit and Collections Department and the patient is sent an application under the Charity Care and Discounted Payment Policy identifying the charity process and the documentation required for processing. The responsible party is given 30 days to complete and return the application and supporting documents. If the collections process has already begun, it shall be suspended during this time. If an incomplete application is received, the Hospital will provide written notice describing additional information needed and will provide the contact information, including the telephone number and office location, of a person who can provide information about the Hospital's Charity Care and Discounted Payment Policy and assistance with completing the application.Collections shall remain suspended until a determination of eligibility is made or the Hospital has determined, after a reasonable period of time, the patient has failed to respond to requests for additional information to complete the application. If a complete application is received, the Hospital will determine the patient's eligibility and will notify the patient in writing of the determination and the basis for the determination. If the patient is determined to be eligible for assistance under the Charity Care and Discounted Payment Policy, (1) if such assistance is in the form of a discount, the patient will receive a billing statement that indicates the amount owed, how that amount was determined, and states or describes how the patient can obtain information regarding the Amount Generally Billed ("AGB") for the care provided, and (2) the patient will be refunded any amounts paid over the amount for which the patient has been determined under the Charity Care and Discounted Payment Policy to be responsible. The Hospital shall further take all reasonably available measures to address any adverse information reported to credit reporting agencies. The Hospital will accept applications under the Charity Care and Discounted Payment Policy until 240 days from the date the Hospital provides the first post-discharge billing statement.Extended payment plans for the amount owed may be arranged for those unable to pay their account in full pursuant to the Hospital's Charity Care and Discounted Payment Policy. Requests for payment plans exceeding the Hospital's schedule may be referred to the Hospital's designee for handling. If the account is not paid or satisfactory payment arrangements made, the account is sent for pre-collection to the Credit and Collections Department or its designee, as described in the Charity Care and Discounted Payment Policy. The Hospital may declare an extended payment plan (including a Reasonable Payment Plan) inoperative if the patient fails to make all consecutive payments during a 90-day period. Before declaring an extended payment plan inoperative, the Hospital, collection agency or assignee shall make a reasonable attempt to contact the patient by telephone, give written notice that the extended payment plan may become inoperative, and inform the patient that s/he may renegotiate the terms of the payment plan. Part VI, Line 2: Dameron Hospital is a member of the San Joaquin County Community Health Assessment Collaborative (SJC2HAC), responsible for producing and releasing, every three years, the Healthier San Joaquin County Community Assessment, required by Federal and State laws. In accordance with these legislative requirements, Dameron Hospital, in collaboration with other members of SJC2HAC, conducted an assessment of the community they serve, which encompasses all of San Joaquin County. Based on the results of this assessment, an Implementation Plan was developed detailing how the community needs will be addressed. This Plan is submitted annually to The California Office of Statewide Health Planning and Development (OSHPD), The Internal Revenue Service, and the Dameron Hospital Board of Directors. The Community Assessment was conducted over eight-months and was led by Valley Vision, Inc., a non-profit community consulting organization dedicated to improving the quality of life for residents across Northern California. The most recent SJC2HAC assessment was released in March 2013. The assessment is used to: inform and engage local stakeholders and community members, promote collaborative efforts based on data, solicit community input and obtain group consensus in order to improve the health of our community. The Dameron Hospital Association 2016 Community Benefit Report reflects the 2013 SJC2HAC findings, our program, and activities to meet the identified needs of the community. Part VI, Line 3: The Hospital shall offer a paper copy of a plain language summary of the financial assistance policy to patients as part of the intake or discharge process, including for individuals who received emergency or outpatient care and were never admitted as inpatients. A conspicuous written notice on billing statements will notify and inform recipients about the availability of financial assistance under this Policy. Such notice shall provide the telephone number of the Hospital's department that can provide information about the Policy and the application process and the direct Website address where copies of the FAP, Financial Assistance Application form, and a plain language summary may be obtained. Signage regarding the Policy, how to obtain more information about the Policy and how to obtain copies of the Policy, the Financial Assistance Application form, and a plain language summary, is posted at all points of registration, including the emergency department, the billing office, the admissions office and other outpatient settings. Prior to commencing collection activities, the Hospital or its designee shall provide the patient with written notice containing a plain language summary of the patient's rights pursuant to California Health and Safety Code Section 127430(a), and a statement that nonprofit credit counseling services may be available in the area.The Hospital will, in addition to informing patients about this Policy, notify and inform members of the community about the availability of financial assistance under this Policy as well as how or where to obtain more information about the Policy and the Financial Assistance Application process and to obtain copies of the FAP, Financial Assistance Application form, and a plain language summary of the Policy. Part VI, Line 4: San Joaquin County is one of the original counties of California, created in 1850 and is located in the Central Valley of Northern California; home to approximately 730,000 residents. Stockton is the County seat, the largest incorporated city in the county and is home to almost half of the county's residents. San Joaquin County is one of the most agriculturally rich regions in California and known for its asparagus, strawberries, almonds, cherries, wine grapes and other abundant crops. The racial and ethnic makeup of county residents includes Whites (68.1%), African American (8.1%), and Native American (2.0%), Asian (15.9%), Pacific Islander (0.7%), and two or more races (4.9%). Hispanic or Latino origin includes (40.5%). According to the US Census (2010-2014v), almost 40% of all county residents speak a language other than English at home, and nearly one in four over the age of 25 does not have a high school diploma.San Joaquin County offers its residents affordable housing, abundant recreational facilities, excellent educational opportunities, and diverse cultural resources. As the northernmost county in the Central Valley, San Joaquin County includes the cities of Stockton, Lathrop, Lodi, Manteca, Ripon, Tracy, and Escalon, as well as numerous planned communities, census-designated areas, small towns and unincorporated areas.The U.S Census Bureau anticipates that San Joaquin County's population will reach 789,000 by 2020. Population change by ethnicity will also affect San Joaquin County; the largest increase over the next thirty years will come from an estimated 104.6% increase in the Hispanic/Latino population and the white population will decrease by 8.7%. This represents a significant shift in San Joaquin County demographics. In 2015, unemployment for the county was 8.9% compared to the state rate of 6.2%. San Joaquin County's population is slowly aging. The 2014 Census showed that people aged 60 and older now make up 11.8% of the population.According to the U.S. Census Bureau (2010-2015) San Joaquin County's median household income median is $53,274 household income, which aligns with the median income in the United States ($53,889), but lower California ($61,818). It is important to note that a 17.5% of the San Joaquin County population lives below federal poverty level compared to the 15.3% rate in the state of California. Poverty is highest among children. Part VI, Line 5: In addition to our medical services and programs, Dameron Hospital also offers the following Community Benefit and outreach services: - Complimentary use of classroom for various community education and support groups - Volunteer Program for community members willing to donate their time in a health care environment - Sponsorship of health-related community events and activities - Donations of materials, equipment and supplies to community groups - Employee volunteer time - Taxi/bus transportation to and from the Hospital/Clinic, if needed - Continuing Medical Education for community physicians - Community education classes - Referral service to community sub-specialties at tertiary centers, for population age 21 of under - Unreimbursed Medi-Cal, Medicare, Charity Care, and Uninsured patient discounts - Participation in the Decision Medicine program exposing high school students to health care careers to encourage youth to give back to the community and consider a career in medicine - On-site free wireless Internet access and Notary Services - Workforce development - Health professional education - Management participation in local leadership programs and local school mentoring programs - Online health center "FollowMyHealth" - Physician recruitment in a medical shortage area - Staff participation in conducting community health needs assessments - Multilingual education classes - Provide a clinical setting for undergraduate/vocational training to students enrolled in outside programs - Free Interpreter Services for patients and their designated support person Part VI, Line 6: (not part of affiliated healthcare system) Part VI, Line 7, Reports Filed With States CA X X X X X 1 1 0 0 0 0 0 1 0 Lorraine Auerbach President/CEO 729298 0 254340 0 91708 0 0 0 13090 0 1088436 0 0 0 Elizabeth Propp VP of Finance/CFO 330162 0 65105 0 0 0 19021 0 11662 0 425950 0 0 0 Bradley Reinke VP of Medical Affairs/CMO 246960 0 37128 0 0 0 0 0 0 0 284088 0 0 0 Janine Hawkins VP Pt Care Svcs (Thru 12/2016) 252873 0 49360 0 194113 0 15075 0 12073 0 523494 0 0 0 Michael Glasberg VP of Operations/COO 378733 0 93750 0 0 0 17763 0 6584 0 496830 0 0 0 Terrance Thomas Registered Nurse 218319 0 0 0 0 0 7681 0 12115 0 238115 0 0 0 Chad Davis Assistant Director of Surgery 215350 0 0 0 0 0 7936 0 5604 0 228890 0 0 0 Denise Hair Assistant CNO 178603 0 17685 0 0 0 10523 0 7590 0 214401 0 0 0 Chris Peterson Cardiac Cath Supervisor 190578 0 0 0 0 0 6334 0 11658 0 208570 0 0 0 Tresha Moreland VP of HR (Thru 3/2016) 55921 0 0 0 173333 0 0 0 1890 0 231144 0 0 0 Christopher Arismendi Former CEO (Thru 10/2012) 0 0 0 0 253846 0 0 0 0 0 253846 0 0 0 David Kerrins Former CIO (Thru 12/2015) 0 0 0 0 239185 0 0 0 0 0 239185 0 0 0 Part I, Lines 4a-b Dr. Christopher Arismendi terminated as CEO/President on 10/31/12. His severance agreement was for a total of $1,200,000 over 4 years, and during 2016 the remainder of $253,846 was paid to him. David Kerrins terminated as CIO on 12/8/2015. His severance agreement was for a total of $239,185, which was paid to him in full during 2016. Tresha Moreland terminated as VP of Human Resources on 3/22/16. Her severance agreement was for a total of $217,000 over 12 months, and during 2016 a total of $141,885 was paid to her. The 457(f) plan was opened up in 2014 to highly compensated executive or managerial personnel determined to be eligible by the plan committee. During 2016 there were two remaining participants, one of whom (William Chase) terminated in 2014 and one who terminated at the end of 2016. The latter participant received a distribution of a portion of her remaining prior year contributions of $156,382 during 2016. Part I, Line 7 Executive Incentive Compensation is set based on meeting a specific set of metrics established annually by the CEO and Executive Team and approved by the Board. Metrics generally include quality, finance, patient safety, patient experience, employee engagement and meaningful use goals. Each year, the Board appoints an Executive Compensation Committee to 1) review and approve an Annual Executive Compensation Plan; 2) to evaluate Executive performance against established goals as well as overall executive performance; and 3) to set the overall Executive Compensation Plan for the following year. The CEO provides recommendations concerning the performance and compensation of the Executives for Board approval. The Executive Compensation Committee and Chairman of the Board evaluate the CEO and approve the CEO's compensation. The Annual Executive Compensation Plan is developed and presented to the Board by an independent healthcare compensation expert who also advises and guides the board as to market and other factors affecting executive and CEO compensation. This includes but is not limited to base compensation, the Executive Incentive program and recommended performance and market compensation adjustments. Form 990, Part III, line 3 On May 1, 2016, Kaiser ended the long standing contract for Dameron Hospital to provide hospital services to its members. While Dameron negotiated a new patient care services contract with Kaiser effective May 1st, with Kaiser's purchase of a portion of St Joseph Medical Center, the Association no longer will be the major provider of hospital services to Kaiser members in the San Joaquin area. Under the previous agreement, Kaiser represented approximately 27% of the net patient revenue for Dameron for the years ended 2015 and 2014. As a result of the loss of the previous Kaiser contract and in particular due to the related loss of physician coverage in the Maternal Child Health (MCH) areas, Dameron announced effective April 27, 2016 that it discontinued its MCH service line. This eliminated 70 positions or approximately 8% of Dameron's workforce and placed MCH beds in licensing suspense while Dameron assesses both the future of MCH services and alternative revenue replacement strategies. Form 990, Part VI, Section B, line 11b Form 990 has been reviewed by the CEO and financial staff and mission and the revenue sources for the hospital have remained unchanged in 2016. Form 990, Part VI, Section B, line 12c Each individual Fiduciary must execute a Conflicts of Interest Disclosure Statement and Questionnaire at least annually and must promptly report all facts regarding any new transaction that might create a Conflict of Interest as soon as they become aware of any such transaction. It is each Fiduciary's duty to make a full disclosure as provided herein of all material facts regarding any possible conflict of interest, to describe the situation or transaction, and to disclose the details of the employee, medical staff officer, or Related Party's interest in the situation or transaction. All Fiduciaries shall report all possible conflicts of interest to the Chief Executive Officer, or her designee. The Chief Executive Officer, or designee, shall conduct such review as appropriate, and refer such information to the Board of Directors of the Hospital. The Board of Directors shall review such conflicts and disclosures. The Board of Directors may consult with legal counsel and such other authorities as may be desired, and may request any additional information deemed relevant, including the source and amount of any income or financial interest or other economic benefit to be derived by such person from the situation or transaction. It is the policy of the Board of Directors that the existence of ANY interest described within the Corporate Compliance & Regulatory Affairs policy shall be disclosed before any transaction is consummated. Each Fiduciary has a continuing responsibility to scrutinize any transaction in which the Fiduciary or a Related Party is directly or indirectly interested for potential conflict of interest and to make a full disclosure as provided herein. The Chief Executive Officer, or the Board of Directors shall as provided herein then determine whether a Conflict of Interest exists and shall take the appropriate action. All decisions regarding conflicts of interest rest in the sole discretion of the Board of Directors in the exercise of its ultimate judgment of the best interests of the Hospital. All officers who are employees, along with the rest of management and the Board are subject to an annual conflict of interest disclosure process. Form 990, Part VI, Section B, line 15 In 2013 the organization established an executive compensation committee, which sets the policy each year and creates the compensation document. An outside independent consultant, Romanoff & Associates, provides salary ranges and market value used in setting compensation. Process was last done on May 25, 2016. Form 990, Part VI, Section C, line 19 Financial statements are made available upon request. Governing documents and conflict of interest policy are not available to the public to view. Form 990, Part IX, line 11g Nurse Registry: Program service expenses 3,911,405. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,911,405. Other Contracted Services: Program service expenses 1,337,389. Management and general expenses 544,960. Fundraising expenses 0. Total expenses 1,882,349. Physicians Fees: Program service expenses 3,583,751. Management and general expenses 19,200. Fundraising expenses 0. Total expenses 3,602,951. Other Professional Fees: Program service expenses 2,372,463. Management and general expenses 1,040,761. Fundraising expenses 0. Total expenses 3,413,224. Pharmacy and Laboratory Outsourcing: Program service expenses 3,684,815. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,684,815. Maintenance: Program service expenses 2,797,376. Management and general expenses 1,930. Fundraising expenses 0. Total expenses 2,799,306. Medical records & Transcription services: Program service expenses 0. Management and general expenses 1,401,000. Fundraising expenses 0. Total expenses 1,401,000. Other Purchased Services: Program service expenses 4,294,074. Management and general expenses 3,872,787. Fundraising expenses 0. Total expenses 8,166,861. Dameron Hospital Foundation 525 West Acacia Street Stockton CA 95203 942811364 Support Dameron Hospital Association CA 501(c)(3) Line 7 Dameron Hospital Association 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Dameron Hospital Foundation C 406500 FMV