2017-11-13T19:14:24-06:00 2016-12-31 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DR STE 500 SAN DIEGO CA 92122 990 2016-01-01 951683892 COMMUNITY MEMORIAL HEALTH SYSTEM % KATHRYN YAMADA COMM 8056525050 147 NORTH BRENT STREET VENTURA CA 93003 DAVID GLYER CFO 8056525012 2017-11-10 true JOCELYNE MILLER P00634378 8585357200 164.57.159.254 33577420173175000055 2017-11-13 P 766D71CAC641970255F07AED5FCBE6405FEC204C 81F9666D02272135E8BF02D72ABCCEB4470637ED 2016 2017-02-10 21:41:12Z GARY K WILDE 147 NORTH BRENT STREET VENTURA CA 93003 468880405 false X WWW.CMHSHEALTH.ORG X 1933 CA TO HEAL, COMFORT AND PROMOTE HEALTH FOR THE COMMUNITIES WE SERVE. 23 22 2569 352 15993 4827839 3760020 362047421 382269317 7330118 9013415 1367202 1509894 375572580 396552646 325896 331864 0 0 171249253 182428083 0 0 0 161927233 173685588 333502382 356445535 42070198 40107111 818166072 857554433 426677059 426152557 391489013 431401876 X SEE SCHEDULE O false false 309342261 0 382269317 PATIENT SERVICES TO INCLUDE 78,266 PATIENT DAYS, 186,542 OUTPATIENT VISITS, AND 237,347 VISITS TO THE CENTERS FOR FAMILY HEALTH (THE HEALTHCARE SYSTEM'S OUTPATIENT CARE CLINICS). SEE SCHEDULE O 1026267 331864 0 COMMUNITY OUTREACH PROGRAMS INCLUDE: FREE BREAST CANCER SCREENING FOR WOMEN AGES 35 TO 50 MEETING LOW INCOME GUIDELINES; FREE CERVICAL CANCER SCREENING FOR WOMEN AGES 25 TO 60 MEETING LOW INCOME GUIDELINES; FREE BLOOD PRESSURE CHECKS; CANCER RESOURCE CENTER AND SUPPORT GROUPS; HEART-AWARE PROGRAM THAT PROVIDES FREE RISK EVALUATION, PREVENTATIVE INFORMATION AND RESOURCES. SEE SCHEDULE O. 1132881 0 0 IT IS THE GOAL OF CMHS TO PROMOTE THE HEALTH OF THE COMMUNITY BY FOCUSING ON COMMUNITY EDUCATION OUTREACH, ACCESS TO CARE, UNCOMPENSATED AND UNDER-FUNDED CARE, AND SPONSORSHIP OF COMMUNITY RESOURCES. SEE SCHEDULE O. 311501409 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false true true false false false true true true true false false true 527 0 true 2569 true true true false false false false false false false false false X 23 22 true false false false false false false true true false false true true true true true true true true true false CA X X KATHRYN YAMADA 8056525012 2590 EAST MAIN STREET SUITE 200 VENTURA CA 93003 MICHAEL BRADBURY BOARD MEMBER 1.0 0.0 X 0 0 0 LAMAR BUSHNELL MD BOARD MEMBER 1.0 0.0 X 0 0 0 PHILIP DRESCHER BOARD MEMBER 1.0 0.0 X 0 0 0 EDIE MARSHALL BOARD MEMBER 1.0 17.0 X 0 0 0 DAVID FUKUTOMI BOARD MEMBER 1.0 0.0 X 0 0 0 TIMOTHY GALLAGHER BOARD MEMBER 1.0 0.0 X 0 0 0 THOMAS GOLDEN MD BOARD MEMBER 1.0 0.0 X 118290 0 0 JOHN HAMMER BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM HART MD BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN HILL MD BOARD MEMBER 1.0 0.0 X 0 0 0 LYDIA HOPPS BOARD MEMBER 1.0 1.0 X 0 0 0 FRITZ HUNTSINGER BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM KEARNEY BOARD MEMBER 1.0 1.0 X 0 0 0 HARRY MAYNARD BOARD MEMBER 1.0 0.0 X 0 0 0 F TED MUEGENBURG JR SECRETARY 1.0 0.0 X X 0 0 0 ELIZABETH PATTERSON MD BOARD MEMBER 1.0 0.0 X 0 0 0 JEFFREY PAUL CHAIR 1.0 0.0 X X 0 0 0 MARTIN POPS MD BOARD MEMBER 1.0 0.0 X 0 0 0 RICHARD RUSH PHD BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN RUSSELL BOARD MEMBER 1.0 0.0 X 0 0 0 ROY SCHNEIDER MD BOARD MEMBER 1.0 0.0 X 0 0 0 GREGORY SMITH VICE CHAIR 1.0 0.0 X X 0 0 0 GARY WOLFE TREASURER 1.0 0.0 X X 0 0 0 DAVID GLYER CFO 40.0 0.0 X 444642 0 108498 GARY K WILDE PRESIDENT AND CEO 32.0 8.0 X 1063145 0 538450 CYNTHIA FAHEY CNO 40.0 0.0 X 230791 0 47902 STANLEY FROCHTZWAJG CMO, INPATIENT 24.0 0.0 X 517199 0 96905 WILFRED GARAND VP PLANNING & MANAGED CARE 40.0 0.0 X 255427 0 72682 DIANY KLEIN VP HUMAN RESOURCES 40.0 0.0 X 889718 0 81235 HAADY LASHKARI CHF ADMIN OFFICER OJAI/VP CMH 40.0 0.0 X 229840 0 107453 EMILIE RAYMAN COMPLIANCE OFFICER 40.0 0.0 X 309983 0 43889 RICHARD REISMAN VP AMBULATORY MEDICINE 36.0 0.0 X 299422 0 5078 SAMUEL SMALL CHIEF OF MEDICAL EDUCATION 40.0 0.0 X 411852 0 4321 ADAM THUNELL VP OPERATIONS 40.0 0.0 X 383905 0 149935 RONALD SANDIFER CIO 40.0 0.0 X 432665 0 0 KIMBERLY BRIDGES ASSISTANT VP - CFH 40.0 0.0 X 205211 0 59310 CYNTHIA DEMOTTE VP QUALITY 40.0 0.0 X 214374 0 66209 MICHAEL ELLINGSON VP MARKETING & DEVELOPMENT 32.0 8.0 X 235115 0 70598 KEITH MCWILLIAMS DIRECTOR OF INFORMATION SYSTEM 40.0 0.0 X 224836 0 11286 CARLOS LIMON JR PHARMACIST 40.0 0.0 X 222964 0 16381 EUGENE DAY PHARMACIST 40.0 0.0 X 226845 0 16381 ANWAR ABBAS DIRECTOR OF INFORMATION SYSTEM 40.0 0.0 X 275810 0 868 MARY SCHMITZ DIRECTOR OF DEVELOPMENT 40.0 0.0 X 221935 0 11286 7413969 0 1508667 368 false true false KAUFMAN HALL ASSOCIATES LLC 5202 OLD ORCHARD RD 700 SKOKIE IL 60077 CONSULTING SERVICES 2469706 PB BUILDING MAINTENANCE 10454 TULSA CIR VENTURA CA 93301 MAINTENANCE SERVICES 1251413 VENTURA ANESTHESIA MEDICAL GROUP 1081 MONTAUK LANE UNIT B VENTURA CA 93301 MEDICAL SERVICES 1236410 DIVERSIFIED CLINICAL SERVICES INC 4500 SALISBURY ROAD STE 300 JACKSONVILLE FL 32216 MEDICAL SERVICES 1148638 VENTURA EMERGENCY PHYSICIANS 147 N BRENT STREET VENTURA CA 93001 MEDICAL SERVICES 1036621 76 0 247952 155419 3356649 300174 3760020 NET PATIENT SVC REVENUE 621500 376624713 376624713 0 0 CAFETERIA REVENUE 722210 1777312 1777312 0 0 HEALTHCARE SVC RENTAL INC 532000 1507444 1507444 0 0 BREAST/PROSTATE CENTER 900099 1247466 1247466 0 0 BILLING AND COLLECTION FEES 900099 487521 487521 0 0 624861 624861 0 0 382269317 4249363 4249363 0 0 116588 447016 -330428 0 -330428 -330428 76644795 71880743 4764052 4764052 4764052 0 0 0 0 0 0 0 0 0 REBATES/REFUNDS 900099 1024975 0 1024975 PHARMACY REVENUE 900099 260785 15993 244792 OTHER FOOD SALES 900099 258291 0 258291 296271 296271 1840322 396552646 382269317 15993 10507316 331864 331864 0 0 0 0 0 0 4510259 1151590 3358669 0 0 0 0 0 121762480 116678734 5083746 0 6695763 6695763 0 0 38552176 34909580 3642596 0 10907405 10252913 654492 0 2949163 1670336 1278827 0 713857 0 713857 0 508332 0 508332 0 0 0 0 0 0 0 0 0 0 0 21970478 18753171 3217307 0 472342 446493 25849 0 71978494 71243678 734816 0 11221161 10934816 286345 0 525968 172379 353589 0 5109152 5065089 44063 0 209738 209738 0 0 0 0 0 0 683410 304983 378427 0 9851 0 9851 0 0 0 0 0 11159302 11020846 138456 0 2557627 384951 2172676 0 PURCHASED SERVICES 23128043 18208570 4919473 0 HOSP QUALITY ASSURANCE FEE 15657798 0 15657798 RECRUITING 1777896 837368 940528 0 DUES & SUBSCRIPTIONS 1064032 464370 599662 0 1988944 1764177 224767 356445535 311501409 44944126 0 0 0 0 30152995 27489543 0 0 59044522 59315471 0 0 0 0 14029787 4814349 10157384 9910042 6098437 7515055 643173444 163405996 405603676 479767448 122043111 129078333 19339330 14507490 7327274 7736862 0 0 144369556 117419840 818166072 857554433 65172525 79325809 0 0 0 0 344805156 330932268 0 0 0 0 5229343 5470740 0 0 11470035 10423740 426677059 426152557 X 386247338 425943630 5241675 5458246 0 0 391489013 431401876 818166072 857554433 X 40107111 -232500 0 0 0 38252 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 65149 65149 false SCHEDULE C, PART II-B, LINE 1 LOBBYING ACTIVITIES THE ORGANIZATION IS A MEMBER OF THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA AND THE AMERICAN HOSPITAL ASSOCIATIONS. IN 2016, $209,237 WAS INCLUDED IN EXPENSES FOR ANNUAL MEMBERSHIP DUES, A PORTION OF WHICH IS DIRECTED BY THESE ORGANIZATIONS TO CONDUCT LOBBYING ACTIVITIES. 26949901 26949901 129609238 86636706 42972535 0 106583692 76769293 29814399 380030613 380030613 479767448 CONSTRUCTION FUNDS 77168296 OTHER ASSETS 22862959 ASSETS LIMITED TO USE 8339951 DEPOSITS WITH INSURANCE CO. 5462948 DUE FROM THIRD PARTIES 3585686 117419840 0 SELF-INSURANCE LIABILITIES 8007771 OTHER LIABILITIES 2415969 10423740 X SCHEDULE D, PART X, LINE 2 THE FOLLOWING FOOTNOTE IS FROM THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY MEMORIAL HEALTH SYSTEM: The System accounts for income taxes under the provisions of ASC 740, Income Taxes, which prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. Under ASC 740, the tax benefit from uncertain tax positions may be recognized only if it is more likely than not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period that the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers for tax positions that meet the more-likely-than-not recognition criteria. The System completed an analysis of its tax position, in accordance with ASC 740, and determined that there are no uncertain tax positions taken or expected to be taken. No significant tax liability for unrecognized tax benefits, interest, or penalties was accrued at December 31, 2016 or 2015. The System is subject to routine audits by the taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2008. true true X true X true X 700. true true false true true 1124498 1124498 0.00320 68713561 75623167 0 0.00000 69838059 75623167 1124498 0.00320 1545173 66098 1479075 0.00420 6937305 1637546 5299759 0.01490 14812812 11597118 3215694 0.00900 331864 331864 0.00090 23627154 13300762 10326392 0.02900 93465213 88923929 11450890 0.03220 1396330 1396330 0.00390 1396330 1396330 0.00390 true 12823555 72460830 88108694 -15647864 X true true SEE PART VI IMAGING CENTER 0.51 0.49 SEE PART VI REAL ESTATE 0.66 0.34 SEE PART VI MANAGEMENT SERVICES 0.5 0.5 2 1 COMMUNITY MEMORIAL HOSPITAL 147 NORTH BRENT STREET VENTURA CA 93003 WWW.CMHSHEALTH.ORG 050000026 X X X A 2 OJAI VALLEY COMMUNITY HOSPITAL 1306 MARICOPA HWY OJAI CA 93023 WWW.CMHSHEALTH.ORG 050000045 X X X A A 12 false false true X X X X X X X X X 16 true true true true X See Part V, Section C X true 16 true SEE PART V, SECTION C false true X 200. 700. X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C SEE PART V, SECTION C X X true X false X X true X false false PART V, SECTION B, LINE 5 IN CONDUCTING ITS MOST RECENT CHNA, THE SYSTEM COORDINATED ITS ASSESSMENT WITH THOSE OF THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH AND KAISER HEALTH PLAN, FOUNDATION HOSPITALS AND THE PERMANENTE MEDICAL GROUP. IN ADDITION, THE SYSTEM HELD FOCUS GROUPS WITH VARIOUS COMMUNITY ORGANIZATIONS TO INCLUDE HELP OF OJAI, LOS ROBLES HOME CARE, CLINICAS DEL CAMINO REAL, VENTURA COUNTY AREA AGENCY ON AGING, CALIFORNIA SENIOR LIVING, CAMARILLO HEALTHCARE DISTRICT, AND SEAVIEW IPA. PART V, SECTION B, LINE 6A & 6B IN CONDUCTING ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE SYSTEM COLLABORATED WITH AND UTILIZED THE WORK AND RESOURCES OF THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH AND KAISER HEALTH PLAN, FOUNDATION HOSPITALS AND THE PERMANENTE MEDICAL GROUP. FURTHER, FOCUS GROUPS WERE CONDUCTED TO GATHER DIRECT COMMUNITY INPUT. THE FOCUS GROUPS WERE HELD AT BOTH THE COMMUNITY MEMORIAL HOSPITAL AND OJAI VALLEY COMMUNITY HOSPITAL IN OCTOBER 2016 AND INCLUDED MEMBERS OF OTHER NON-PROFIT AND HEALTHCARE ORGANIZATIONS. PART V, SECTION B, LINE 7 CHNA WEBSITE http://www.cmhshealth.org/chna/pdfs/CHNA_2016.pdf PART V, SECTION B, LINE 10 IMPLEMENTATION STRATEGY http://www.cmhshealth.org/chna/pdfs/CHNA_Implementation_2016.pdf PART V, SECTION B, LINE 11 The Board of Trustees for Community Memorial Health System established a Community Benefit Committee for ongoing community benefit activities and the community health needs assessment. This committee reviewed information on the community needs for the Ojai Valley Community Hospital and Community Memorial Hospital service areas. Based on publicly reported health data and community input, the committee recommended the rank ordering of specific issues for each community and made its recommendations to the CMHS Board of Trustees. The CMHS Board of Trustees approved the CHNA and implementation strategies for the Systems hospitals. Substance abuse, mental health, and the treatment of chronic and acute health conditions (diabetes, heart disease, and cancer) were given priority focus. The System has addressed these areas by recruiting specialty and family physicians, implementing telemedicine services, offering free chronic disease detection and screening services, and through educational programs and support groups. In addition, physician residents in the Systems Graduate Medical Education program are providing free healthcare and health education in medically underserved areas of Ventura County. Oral health is an initiative that was identified in the most recent CHNA. Ojai Valley Community Hospital and Community Memorial Hospital do not provide dental care services. The System will continue to work closely with Clinicas del Camino Real to provide access to specialty physician care to address unmet dental care needs. Other initiatives that will not be addressed by the System include poverty and nutrition, senior adult day care, and child abuse domestic violence. CMHS plans to support the local school systems given the correlation between education level and poverty. CMHS will continue its ongoing participation in the home health alliance and association with home health providers to bring awareness and acceptance to seniors in using adult day care services. Progress will continue to be made to address unmet behavioral health needs in the Ojai community which should improve conditions for safe homes and families. PART V, SECTION B, LINE 15E COMMUNITY PUBLICITY MEASURES CMHS PUBLICIZES A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL IF INTERESTED. MOREOVER, CMHS HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THIS SIGNAGE DISPLAYED. PART V, SECTION B, LINE 16A FINANCIAL ASSISTANCE POLICY WEBSITE http://www.cmhshealth.org/cmh/pdfs/FinancialAssistance-CharityPolicy.pdf The system was made aware in August 2017 that the Financial Assistance Policy did not contain a list of providers, other than the hospital facility and its employees, that deliver emergency or other medically necessary care in the facility, and specify which providers are covered by the FAP and which are not, in order to meet the specific requirements of IRC 501(r). The System immediately worked on correcting the Finacial Assistance Policy and including the list of providers during 2017. The corrected Financial Assistance Policy is currently in use throughout the System in all ways required by IRC 501(r). PART V, SECTION B, LINE 16B FINANCIAL ASSISTANCE POLICY APPLICATION WEBSITE http://www.cmhshealth.org/cmh/pdfs/FinancialAssistance-CharityPolicy.pdf PART V, SECTION B, LINE 16C and 16F The System was made aware in August 2017 that the plain language summary was incomplete and did not meet the specific requirements of IRC 501(r). The System immediately worked on amending the PLS and completed the amendment in August 2017. The updated PLS is currently in use throughout the System in all ways required by IRC 501(r). PART V, SECTION B, LINE 16G INDIVIDUALS WERE NOTIFIED ABOUT THE FINANCIAL ASSISTANCE POLICY BY RECEIVING A CONSPICUOUS WRITTEN NOTICE ABOUT THE FINANCIAL ASSISTANCE POLICY ON THEIR BILLING STATEMENTS AND VIA CONSPICUOUS PUBLIC DISPLAYS. THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS COMPLETED AND MADE AVAILABLE DURING 2017. PART V, SECTION B, LINE 16I The System was made aware in August 2017 that the plain language summary and Financial Assistance Policy application needed to be translated to Spanish, Tagalog, Chinese, Persian, Vietnamese, Korean and Arabic in order to meet the specific requirements of IRC 501(r). We immediately worked on translating both documents and completed the translations prior to the filing of this return. The translated Financial Assistance Policy, Financial Assistance Policy application and Plain Language Summary are currently in use throughout the System in all ways required by IRC 501(r). The Systems electronic patient files contain the primary language spoken by each patient. The System will be reviewing its patient population every three years to determine whether there are additional limited English proficiency populations that require the translation of the Systems financial assistance policies and related documents in accordance with 501(r). 20 SAVIERS CENTER FOR FAMILY HEALTH 2921 S SAVIERS ROAD OXNARD CA 93033 OP CLINIC GROSSMAN IMAGING CENTER OF CMH LLC 2001 N SOLAR DRIVE SUITE 135 OXNARD CA 93030 IMAGING CENTER CAMARILLO CENTER FOR FAMILY HEALTH 422 B ARNEILL ROAD CAMARILLO CA 93010 OP CLINIC ASHWOOD CENTER FOR FAMILY HEALTH 116 ASHWOOD VENTURA CA 93003 OP CLINIC SANTA PAULA CENTER FOR FAMILY HEALTH 242 E HARVARD BLVD SANTA PAULA CA 93060 OP CLINIC VINEYARD CENTER FOR FAMILY HEALTH 2361 VINEYARD AVENUE OXNARD CA 93036 OP CLINIC SAN BUENAVENTURA UROLOGY CENTER 2705 LOMA VISTA ROAD SUITE 206 VENTURA CA 93003 OP CLINIC AIRPORT MARINA CENTER FOR FAMILY HEALTH 3641 W FIFTH STREET OXNARD CA 93035 OP CLINIC MAIN STREET CENTER FOR FAMILY HEALTH 138 W MAIN STREET VENTURA CA 93001 OP CLINIC MSO PACIFIC INPATIENT PHYSICIANS 147 N BRENT STREET VENTURA CA 93003 OP CLINIC FILLMORE CENTER FOR FAMILY HEALTH 852 VENTURA STREET FILLMORE CA 93015 OP CLINIC MIDTOWN MEDICAL GROUP CLINIC 2721 E MAIN STREET VENTURA CA 93003 OP CLINIC PORT HUENEME CENTER FOR FAMILY HEALTH 321 E PORT HUENEME ROAD PORT HUENEME CA 93041 OP CLINIC SANTA ROSA CENTER FOR FAMILY HEALTH 5800 SANTA ROSA ROAD CAMARILLO CA 93010 OP CLINIC MSO RAO CARDIOLOGY PRACTICE 100 N BRENT STREET VENTURA CA 93003 OP CLINIC MSO PATELSPEITEL FAMILY PRACTICE 124 N BRENT STREET VENTURA CA 93003 OP CLINIC OJAI CENTER FOR FAMILY HEALTH 655 N VENTURA AVENUE OAK VIEW CA 93022 OP CLINIC OAK VIEW CENTER FOR FAMILY HEALTH 655 N VENTURA AVENUE OAK VIEW CA 93022 OP CLINIC OJAI MULTISPECIALTY CENTER 117 PIRIE ROAD OJAI CA 93023 OP CLINIC PREMIERE ENDOCRINOLOGY CENTER 3655 W FIFTH STREET OXNARD CA 93035 OP CLINIC PART I, LINE 3C IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO USED AN ALGORITHM TO DETERMINE QUALIFICATION OF CHARITY CARE FROM INFORMATION PROVIDED BY PATIENTS AT INTAKE AS WELL AS INFORMATION FROM CREDIT REPORTS. PART I, LINE 7 Costing Method used is cost-to-charge using worksheet 2. PART I, LINE 7B UNREIMBURSED MEDICAID THE CALIFORNIA HOPSITAL 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 (CMS) DURING THE APPROVAL PROCESS, WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE SEPTEMBER 8, 2010. THE PRIMARY LEGISLATION (AB 1383) AND AMENDING LEGISLATION (AB 1653) CONTAIN TWO COMPONENTS, THE QUALITY ASSURANCE FEE 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 CALIFORNIA HEALTH FOUNDATION AND TRUST ESTABLISHED A GRANT FUND TO SUPPORT CHARITABLE ACTIVITIES OF VARIOUS HOSPITAL AND HEALTH SYSTEMS IN CALIFORNIA, INCLUDING MEASURES TO ALLEVIATE LOSSES POTENTIALLY RESULTING FROM THE ADMINISTRATION OF THE PROGRAM. AB 1653, THE PROGRAM THAT COVERED THE PERIOD OF APRIL 1, 2009 THROUGH DECEMBER 31, 2010, WAS APPROVED BY CMS IN DECEMBER 2010. THE AMENDED LEGISLATION ALLOWED THE CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) TO BEGIN ASSESSING FEES AND MAKE SUPPLEMENTAL PAYMENTS TO HOSPITALS. THE SYSTEM MADE PAYMENTS TO THE DHCS FOR THE QA FEE IN THE AMOUNT OF $15,657,798 AND $12,980,865 IN 2016 AND 2015, RESPECTIVELY. THE SYSTEM MADE CALIFORNIA HEALTH FOUNDATION AND TRUST PAYMENTS IN THE AMOUNT OF $317,864 AND $293,396 IN 2016 AND 2015, RESPECTIVELY, AND THE PLEDGE PAYMENTS WERE RECORDED WITHIN QA FEE IN OPERATING EXPENSES WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE SYSTEM RECEIVED SUPPLEMENTAL PAYMENTS OF $35,585,271 AND $32,421,924 OVER THE COURSE OF THE PROGRAM IN 2016 AND 2015, RESPECTIVELY. THE SYSTEM RECORDED THE SUPPLEMENTAL PAYMENTS AS OPERATING REVENUE WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. PART I, LINE 7G NO AMOUNT ATTRIBUTABLE TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G. PART I, LINE 7, COLUMN F The organization included $37,216 of bad debt expense in part IX. The amount has been subtracted from the calculation of column F. PART II Community Building Activities The System regularly recruits family and specialty physicians to fill the needs at its outpatient clinics and hospitals. The System also assists affiliated medical groups with the recruitment of physicians where community need is demonstrated. The System determines market need by performing a market study of the number of physicians needed per practice area based on population size. PART III, LINE 2 BAD DEBT IS REPORTED IN THE SAME MANNER AS THE AUDITED FINANCIAL STATEMENTS. PLEASE SEE THE NARRATIVE FOR PART III, LINE 4, FOR FURTHER DETAIL. PART III, LINE 4 THE SYSTEM USED WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, TO DETERMINE THE COST OF ITS BAD DEBT EXPENSE. BAD DEBT FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: THE SYSTEM MANAGES PATIENT ACCOUNT RECEIVABLES BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR CONTRACTUAL DISCOUNTS AND UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE BASED ON MANAGEMENTS 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. ON THE BASIS OF HISTORIAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEMS UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM 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. SIGNIFICANT CHANGES IN PAYER MIX, BUSINESS OFFICE OPERATIONS, GENERAL ECONOMIC CONDITIONS, AND HEALTH CARE COVERAGE PROVIDED BY FEDERAL OR STATE GOVERNMENTS OR PRIVATE INSURERS MAY HAVE A SIGNIFICANT IMPACT ON THE SYSTEMS ESTIMATES AND SIGNIFICANTLY AFFECT THE SYSTEMS LIQUIDITY, RESULTS OF OPERATIONS, AND CASH FLOWS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEMS POLICIES. THE SYSTEM DISCOUNTS UNINSURED SELF-PAY PATIENT CHARGES BY 40% AND CLASSIFIES ACCOUNTS PENDING MEDI-CAL APPROVAL AS SELF-PAY ACCOUNTS IN ITS ACCOUNTS RECEIVABLE AGING REPORT AND APPLIES THE STANDARD UNINSURED DISCOUNT. THE NET ACCOUNT BALANCE IS FURTHER SUBJECT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RESERVE POLICY. SHOULD THE ACCOUNT QUALIFY FOR MEDI-CAL COVERAGE, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND RECLASSIFIED TO MEDI-CAL ACCOUNTS RECEIVABLE WITH THE APPROPRIATE CONTRACTUAL DISCOUNT RATE APPLIED. SHOULD THE ACCOUNT NOT QUALIFY FOR MEDI-CAL COVERAGE BUT QUALIFY AS CHARITY CARE UNDER THE SYSTEMS CHARITY CARE POLICY, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND THE ENTIRE ACCOUNT BALANCE IS RECORDED AS A CHARITY CARE DEDUCTION. THE SYSTEMS COMBINED ALLOWANCE FOR DOUBTFUL ACCOUNTS, UNINSURED DISCOUNTS, AND CHARITY CARE COVERED APPROXIMATELY 92% AND 93% OF THE SYSTEMS COMBINED UNINSURED AND SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2016 AND DECEMBER 31, 2015, RESPECTIVELY. THE SYSTEMS ALLOWANCE FOR BAD DEBT WAS $38,767,172 AND $36,239,750 AS OF DECEMBER 31, 2016 AND 2015, RESPECTIVELY. THE SYSTEMS PROVISION FOR PATIENT BAD DEBTS DECREASED TO $12,823,555 FROM $13,963,730 FOR THE YEARS ENDED DECEMBER 31, 2016 AND DECEMBER 31, 2015, RESPECTIVELY. PART III, LINE 8 THE ENTIRE SHORTFALL OF MEDICARE EXPENSES OVER MEDICARE REIMBURSEMENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE COSTS ATTRIBUTABLE TO SERVICE MEDICARE PATIENTS. THE SYSTEM IS REIMBURSED FOR SERVICES PROVIDED TO PATIENTS UNDER CERTAIN PROGRAMS ADMINISTERED BY GOVERNMENTAL AGENCIES, WHICH INCLUDES THE MEDICARE PROGRAM. THE MEDICARE PROGRAM CONSISTS OF 23.6% OF THE SYSTEMS NET REVENUE FOR 2016. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FROM THE MEDICARE PROGRAM, AND THE MEDICARE PROGRAM DOES NOT COVER THE COSTS OF TREATING THE SYSTEM'S MEDICARE PATIENTS, ALTHOUGH THE QUALITY OF CARE AND ACCESS TO CARE IS THE SAME FOR ALL PATIENTS, REGARDLESS OF PAYER SOURCE. UNREIMBURSED COST UNDER THE MEDICARE PROGRAM IS A TRUE LOSS TO THE SYSTEM AND THE LOSS IS REFLECTED IN THE SYSTEM'S FINANCIAL STATEMENTS. AS SUCH, MEDICARE LOSSES SHOULD BE CONSIDERED A COMMUNITY BENEFIT PROVIDED BY THE SYSTEM. PART III, LINE 9B THE PATIENT'S ABILITY TO PAY IS EVALUATED UPON ADMISSION. A PATIENT FINANCIAL SERVICES STAFF ASSISTS PATIENTS WITH APPLYING FOR LOCAL, STATE AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT. IN THE EVENT THAT NO THIRD PARTY PAYMENT SOURCE IS AVAILABLE, PATIENTS ARE PROVIDED WITH INFORMATION ON THE SYSTEM'S FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE AND CHARITY CARE IS BASED ON A SLIDING SCALE FEE SCHEDULE UTILIZING THE CURRENT UNITED STATES FEDERAL POVERTY GUIDELINES. INFORMATION FROM THE APPLICANT'S FINANCIAL APPLICATION AND SUPPORTING DOCUMENTATION IS USED TO DETERMINE THE AMOUNT OF THE QUALIFIED FINANCIAL ASSISTANCE TO BE GRANTED. THE SYSTEM HAS A WRITTEN COLLECTION POLICY TO PROVIDE FOR AN EQUITABLE PROCESS BY WHICH A PATIENT AND/OR RESPONSIBLE PARTY CAN MAKE A PAYMENT OR PAYMENT ARRANGEMENT PRIOR TO OR AT THE TIME OF SERVICE. THE SYSTEM WILL PROACTIVELY DETERMINE THE PATIENT'S ABILITY TO PAY. A DEPOSIT, BASED UPON SELF-PAY LIABILITY IS COLLECTED PRIOR TO ADMISSION OR AT THE TIME OF SERVICE. FOR PATIENTS WHO ARE UNABLE TO PAY THEIR ESTIMATED LIABILITY AT THE TIME OF SERVICE, THE SYSTEM WILL OFFER A FINANCING OPTION. PATIENTS WHO MEET CHARITY OR INDIGENT GUIDELINES WILL BE REFERRED TO A FINANCIAL ADVOCATE FOR FINANCIAL AID. PART VI, LINE 2 NEEDS ASSESSMENT THE SYSTEM UPDATED ITS COMMUNITY NEEDS ASSESSMENT IN 2016. THE SYSTEM COORDINATED ITS HEALTH NEEDS ASSESSMENT WITH THOSE OF THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH, AND KAISER HEALTH PLAN, FOUNDATION HOSPITALS AND THE PERMANENTE MEDICAL GROUP. THE AREA-WIDE STUDY AND HEALTHCARE SURVEY CONSISTED OF AN ANALYSIS OF THE SOCIO-ECONOMIC PROFILE OF VENTURA COUNTY, THE HEALTH CARE STATUS AND NEEDS OF VENTURA COUNTY, THE STATUS OF HEALTHCARE DELIVERY AND SERVICES, COMMUNITY REPORTED HEALTH NEEDS AND COMMUNITY PRIORITIZATION AND IMPLEMENTATION STRATEGIES. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE PROGRAM BROCHURES EXPLAINING THE SYSTEM'S POLICY IS POSTED AND MADE AVAILABLE TO PATIENTS AT THE TIME OF ADMITTANCE. SIGNS ALERTING PATIENTS TO THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE PROMINENTLY DISPLAYED. AN INSERT REGARDING FINANCIAL ASSISTANCE ACCOMPANIES EACH INVOICE OF HOSPITAL SERVICES SENT TO EACH PATIENT. PART VI, LINE 4 COMMUNITY INFORMATION THE HEALTH SYSTEM'S TWO HOSPITALS ARE LOCATED IN THE CITY OF VENTURA AND THE CITY OF OJAI. THE HEALTH SYSTEM PROVIDES SERVICES THROUGH ITS HOSPITALS AND CENTERS FOR FAMILY HEALTH TO ALL OF WESTERN VENTURA COUNTY WHICH INCLUDES THE CITIES AND UNINCORPORATED AREAS SURROUNDING VENTURA, OJAI, SANTA PAULA, FILLMORE, OXNARD, PORT HUENEME AND CAMARILLO. THE POPULATION OF VENTURA COUNTY IS APPROXIMATELY 860,000 THOUSAND AND MADE OF UP 66.4% WHITE AND 33.6% OTHER RESIDENTS. THE COUNTY OF VENTURA PROVIDES COMMUNITY DATA THROUGH ITS WEBSITE "HEALTH MATTERS IN VCCAN BE ACCESSED AT HTTP://WWW.HEALTHMATTERSINVC.ORG/INDEX.PHP FOR FURTHER INFORMATION. DEMOGRAPHIC VARIABLES SUCH AS AGE, RACE AND ETHNICITY ARE MEANINGFUL WHEN PLANNING FOR BOTH INPATIENT AND OUTPATIENT CARE IN ORDER TO ENSURE THAT PATIENT CARE SERVICES ARE SENSITIVE TO THE PROGRAM PLANNING NEEDS OF THE SERVICE AREA POPULATION. IT HAS LONG BEEN ESTABLISHED THAT THERE ARE SIGNIFICANT VARIANCES IN PHYSICAL AND BEHAVIORAL HEALTH PROBLEMS BETWEEN GROUPS BASED ON ETHNICITY, INCOME AND RESIDENCE. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH CMHS 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. CMHS HAS AN OPEN MEDICAL STAFF, EXTENDING STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL AREAS AND DEPARTMENTS OF ITS FACILITY. THE EMERGENCY DEPARTMENT AT BOTH COMMUNITY MEMORIAL HOSPITAL AND THE OJAI COMMUNITY HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HEALTH SYSTEM PROVIDES EMERGENCY SERVICES TO ALL PATIENTS, WITH OR WITHOUT INSURANCE, AND CONTRACTS WITH PHYSICIANS TO PROVIDE SPECIALTY EMERGENCY COVERAGE. THIS 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 AND LIFESAVING MEDICAL SERVICES. THROUGH ITS HEALTHY WOMEN'S PROGRAM, CMHS PROVIDES FOR FREE BREAST AND CERVICAL CANCER SCREENING FOR UNINSURED AND UNDER-INSURED PATIENTS WHO LACK THE RESOURCES TO PAY FOR THESE SERVICES. THROUGH THIS PROGRAM, CMHS IS ABLE TO OFFER BREAST CANCER SCREENING AND TREATMENT, AND CERVICAL CANCER SCREENING AND VACCINATIONS TO WOMEN IN THE COMMUNITY WHO LACK ACCESS TO THESE EARLY DETECTION AND LIFE SAVING EXAMS. THE SYSTEM OFFERS FREE EDUCATIONAL SEMINARS TO THE PUBLIC COVERING A WIDE VARIETY OF HEALTH RELATED TOPICS SUCH AS DIABETES, CANCER, AND VASCULAR HEALTH. THE SYSTEM ALSO OFFERS A LARGE VARIETY OF CLASSES AND SUPPORT GROUPS THROUGH ITS CANCER RESOURCE CENTER, MATERNAL CHILD HEALTH, AND HEART AND VASCULAR HEALTH DEPARTMENTS. PART VI, LINE 6 N/A PART VI, LINE 7 State filing of community benefit report California 501(R) COMPLIANCE The hospital identified and corrected certain gaps in its 501(r) compliance. For more information, see disclosures in Part V, Section C, corresponding to Part V, Section B, Lines 16A, 16C, 16F, 16G, and 16I. false AMERICAN CANCER SOCIETY 2816 KNOLL DRIVE SUITE A VENTURA CA 93003 941170350 501(c)(3) 7500 0 GENERAL SUPPORT CA HOSPITAL FEE PROGRAM CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST SUITE 800 SACRAMENTO CA 95814 941498697 501(c)(3) 317864 0 GENERAL SUPPORT 2 SCHEDULE I, PART I, LINE 2 DESCRIPTION OF PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE GRANTS MADE BY COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) ARE ONLY GIVEN TO 501(C)(3) AND GOVERNMENT ORGANIZATIONS. ONCE THE GRANT IS GIVEN, IT IS NOT MONITORED BY CMHS AND IS LEFT UP TO THE DISCRETION OF THE GRANTEE. X true false X X X X X true true false false false false false true false CYNTHIA FAHEY CNO 224848 0 282 0 5661 0 47756 0 146 0 278693 0 0 0 STANLEY FROCHTZWAJG CMO, INPATIENT 358472 0 2932 0 155795 0 94377 0 2528 0 614104 0 92258 0 WILFRED GARAND VP PLANNING & MANAGED CARE 247668 0 2932 0 4827 0 72682 0 0 0 328109 0 0 0 DAVID GLYER CFO 344922 0 2932 0 96788 0 103420 0 5078 0 553140 0 72682 0 DIANY KLEIN VP HUMAN RESOURCES 250000 0 2932 0 636786 0 81235 0 0 0 970953 0 601844 0 HAADY LASHKARI CHF ADMIN OFFICER OJAI/VP CMH 213598 0 2932 0 13310 0 96051 0 11402 0 337293 0 0 0 EMILIE RAYMAN COMPLIANCE OFFICER 214592 0 2932 0 92459 0 41361 0 2528 0 353872 0 70464 0 RICHARD REISMAN VP AMBULATORY MEDICINE 288692 0 2876 0 7854 0 0 0 5078 0 304500 0 0 0 SAMUEL SMALL CHIEF OF MEDICAL EDUCATION 404679 0 2932 0 4241 0 0 0 4321 0 416173 0 0 0 ADAM THUNELL VP OPERATIONS 360598 0 2932 0 20375 0 143533 0 6402 0 533840 0 0 0 GARY K WILDE PRESIDENT AND CEO 644648 0 2932 0 415565 0 533098 0 5352 0 1601595 0 372198 0 RONALD SANDIFER CIO 432665 0 0 0 0 0 0 0 0 0 432665 0 0 0 KEITH MCWILLIAMS DIRECTOR OF INFORMATION SYSTEM 224836 0 0 0 0 0 0 0 11286 0 236122 0 0 0 CARLOS LIMON JR PHARMACIST 222964 0 0 0 0 0 0 0 16381 0 239345 0 0 0 EUGENE DAY PHARMACIST 226845 0 0 0 0 0 0 0 16381 0 243226 0 0 0 ANWAR ABBAS DIRECTOR OF INFORMATION SYSTEM 126501 0 0 0 149309 0 0 0 868 0 276678 0 0 0 MARY SCHMITZ DIRECTOR OF DEVELOPMENT 221935 0 0 0 0 0 0 0 11286 0 233221 0 0 0 KIMBERLY BRIDGES ASSISTANT VP - CFH 190472 0 2721 0 12018 0 56782 0 2528 0 264521 0 0 0 CYNTHIA DEMOTTE VP QUALITY 198105 0 2808 0 13461 0 64693 0 1516 0 280583 0 0 0 MICHAEL ELLINGSON VP MARKETING & DEVELOPMENT 217684 0 2900 0 14531 0 70282 0 316 0 305713 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 1A The Systems CEO receives an automobile allowance. The allowance is included in taxable wages and reported on his W-2. FORM 990, SCHEDULE J, PART I, LINE 4A The following individual received a severance payment: Anwar Abbas - $149,309 FORM 990, SCHEDULE J, PART I, LINE 4B On April 1, 2002, a Supplemental Executive Retirement Plan (the 2002 SERP) was established to cover senior staff members of CMHS. For the 2002 SERP, the monthly benefit at normal retirement date (age 65) is equal to the average monthly compensation for the three-year period during which compensation was the highest, including periods before April 1, 2002, at the following rates: (i) 4% for the CEO and 2% for other participants through April 4, 2004, and (ii) 5% for the CEO, which includes a catch up provision for a SERP benefit forfeited from a prior employer as a condition of his employment at CMH, and 2% for other participants after April 4, 2004. Participants vest after ten years of service and the attainment of age 60, including service prior to the effective date, or attainment of age 65, whichever is earlier. Together, the 1990 SERP and the 2002 SERP are referred to as SERPs. The SERPs are funded based on an annual valuation of the liability. The Board of Directors has designated assets to be segregated to fund the SERPs. However, the assets are not held in trust or otherwise legally restricted to fund the plans. The following individuals received a SERP payout during the year (as noted on Schedule J, Part II, Column F, all of these payouts, excluding accruals for the 2016 year, were previously reported annually on Schedule J, Part II, Column C, in prior years 990s): Diany Klein - $601,844 Gary K. Wilde - $372,198 Stanley Frochtzwajg - $92,258 David Glyer - $72,682 Emilie Rayman - $70,464 FORM 990, SCHEDULE J, PART I, LINE 7 BONUSES ARE AWARDED TO EXECUTIVES BASED UPON THEIR CONTRIBUTION TO THE OVERALL GOALS OF THE SYSTEM, THEIR ACHIEVEMENT OF INDIVIDUAL GOALS AND WITH REGARD TO REASONABLE COMPENSATION PRACTICES FOR COMPARABLE POSITIONS IN LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS THE BONUSES AND MOVES FOR APPROVAL BY THE BOARD OF TRUSTEES. A CITY OF SAN BUENAVENTURA 956000807 797049AJ2 2011-08-17 350000000 REPLACEMENT FACILITIES false false false A 0 0 349865548 77168296 136307293 0 0 0 0 136389959 0 0 2017 false false false true A false false false false 0 false false false false A false true false false 0 false 0 false false A false SCHEDULE K, PART II, LINE 3 ORIGINAL ISSUE DISCOUNT OF $134,452 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 664929 MEDICAL SUPPLIES false SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 497044 STORAGE RENTAL false X 6 300174 FMV false true false SCHEDULE M, PART I, COLUMN B THE NUMBER REPORTED IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 1 TO ESTABLISH, EQUIP AND MAINTAIN ONE OR MORE NONPROFIT HOSPITALS, MEDICAL CENTERS, INSTITUTIONS, CLINICS OR OTHER PLACES FOR THE RECEPTION AND CARE OF THE SICK, INJURED AND DISABLED, WITH PERMANENT FACILITIES THAT INCLUDE INPATIENT BED AND MEDICAL SERVICES; TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTS; AND TO PROVIDE ASSOCIATED SERVICES, OUTPATIENT CARE AND HOME CARE IN FURTHERANCE OF THIS CORPORATION'S CHARITABLE PURPOSES; TO PROMOTE AND CARRY ON EDUCATION ACTIVITIES RELATED TO THE CARE OF SICK, INJURED AND DISABLED, TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY OUT SCIENTIFIC AND MEDICAL RESEARCH RELATED TO THE CARE OF THE SICK, INJURED AND DISABLED; AND TO PROMOTE OR CARRY OUT SUCH OTHER ACTIVITIES AS MAY BE DEEMED ADVISABLE FOR THE BETTERMENT OF THE GENERAL HEALTH OF THE COMMUNITIES SERVED. FORM 990, PART III, LINES 4A-4C COMMUNITY BENEFIT PLAN IT IS THE GOAL OF CMHS TO PROMOTE THE HEALTH OF THE COMMUNITY BY FOCUSING ON THE FOLLOWING FOUR AREAS: COMMUNITY EDUCATION OUTREACH 1. CONTINUE TO SPONSOR AND PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PUBLIC EXPOS AND OTHER MECHANISMS TO PROMOTE HEALTH SERVICES, HEALTH EDUCATION, AND PREVENTION THROUGHOUT THE COMMUNITY. HEALTH RELATED EDUCATION AND PREVENTION WILL BE FOCUSED AROUND DIABETES, OBESITY, PRENATAL CARE, HEART HEALTH, AND HEALTHY LIVING AND NUTRITION. 2. PROVIDE INDIVIDUALS AND EMPLOYEES OF LOCAL BUSINESSES WITH THE HEARTAWARE HEART DISEASE DETECTION AND SCREENING PROGRAM. 3. CONTINUE TO PARTICIPATE IN THE STATE CPSP PROGRAM TO PROVIDE EDUCATIONAL RESOURCES TO LOW INCOME CHILDREN AND PREGNANT WOMEN. 4. PROVIDE COMMUNITY FORUMS IN VENTURA AND OJAI HIGHLIGHTING THE STATUS OF OUR HEALTH SYSTEM (THE HOSPITALS AND THE CENTERS FOR FAMILY HEALTH), NEW SERVICES AVAILABLE TO BENEFIT RESIDENTS OF THE COMMUNITY, AND COMMUNITY BENEFITS PROVIDED BY THE HEALTH SYSTEM. 5. DISTRIBUTE A HEALTH INFORMATION CARD TO INDIVIDUALS IN THE COMMUNITY TO ASSIST THEM IN KEEPING TRACK OF PERSONAL HEALTH INFORMATION THAT MAY BE VITAL WHEN ACCESSING THE HOSPITAL, AND, IN PARTICULAR, THE EMERGENCY DEPARTMENT. 6. ADD NEW DISEASE DETECTION AND SCREENING SERVICES FOCUSING ON DIFFERENT DISEASE CONDITIONS OF IMPORTANCE (MAJOR CHRONIC DISEASES). 7. CONTINUE TO PROVIDE AT LEAST 3,000 BLOOD PRESSURE CHECKS PER MONTH AT THE KIOSK IN THE PACIFIC VIEW MALL IN VENTURA. ACCESS TO CARE INCREASE ACCESS OF THE UNDERSERVED AND VULNERABLE POPULATION TO PRIMARY AND SECONDARY MEDICAL CARE IN VARIOUS GEOGRAPHIC LOCATIONS THROUGH THE CMHS SERVICE AREA. 1. CONTINUE TO OFFER A FREE PHYSICIAN REFERRAL SERVICE FOR MEMBERS OF THE PUBLIC PROVIDING AT LEAST 1,000 REFERRALS PER YEAR TO LOCAL PHYSICIANS AND OTHER HEALTH SERVICES. 2. CONTINUE EXPANSION OF EXISTING CENTERS FOR FAMILY HEALTH CLINICS AS WARRANTED BY THE GROWTH OF PATIENT VISITS. 3. CONTINUE TO PROVIDE ACCESS THROUGH THE CENTERS FOR FAMILY HEALTH CLINICS TO SIGNIFICANT NUMBERS OF MEDI-CAL AND UNINSURED INDIVIDUALS THROUGHOUT WESTERN VENTURA COUNTY. 4. CONTINUE TO PROVIDE GENERAL MEDICAL, SURGICAL, AND SPECIALTY PROFESSIONAL COVERAGE OF ER PATIENTS THROUGH THE "ER FUND". PROVIDE STIPENDS TO PHYSICIANS, AS NECESSARY, TO INSURE COVERAGE, ESPECIALLY FOR MEDICAL AND UNINSURED PATIENTS, BY ALL MEDICAL SPECIALTIES. 5. CONTINUE TO PROVIDE FREE PROSTATE CENTER SCREENINGS REGARDLESS OF ABILITY TO PAY. 6. PROVIDE FREE BREAST CANCER SCREENING AND TREATMENT TO WOMEN THROUGHOUT THE SERVICE AREA REGARDLESS OF ABILITY TO PAY. 7. THROUGH THE CENTERS FOR FAMILY HEALTH, CONTINUE TO PROVIDE AN EXTENSIVE CHILDHOOD IMMUNIZATION PROGRAM. 8. ENGAGE SENIOR POPULATION IN DIALOGUE SURROUNDING HEALTH CARE OBJECTIVES AND ASSIST WITH CARE COORDINATION . 9. ENHANCE OUT-OF-AREA TRANSPORTATION SERVICES TO IMPROVE ACCESS TO CARE. 10. CONTINUE TO TRAIN RESIDENT PHYSICIANS THROUGH THE SYSTEMS GRADUATE MEDICAL EDUCATION PROGRAM WITH FOCUS ON FAMILY AND INTERNAL MEDICINE. RESIDENTS WITH THE GME PROGRAM ARE PROVIDING FREE HEALTHCARE AND HEALTH EDUCATION IN MEDICALLY UNDERSERVED AREAS OF VENTURA COUNTY. UNCOMPENSATED AND UNDER FUNDED CARE; 1. CONTINUE TO PROVIDE ACCESS TO A SIGNIFICANT NUMBER OF MEDI-CAL BENEFICIARIES ACROSS A BROAD RANGE OF MEDICAL SERVICES (MEASURED AS A PERCENTAGE OF GROSS REVENUE AND TOTALING AT LEAST 9%). 2. CONTINUE TO PROVIDE A SIGNIFICANT LEVEL OF SUBSIDIZED CARE THROUGH THE CENTERS FOR FAMILY HEALTH. SPONSORSHIP OF COMMUNITY RESOURCES 1. CONTINUE TO SUPPORT THE INTERIM PERMIT NURSING PROGRAM, WITH THE OBJECTIVE OF TRAINING AT LEAST TWENTY (20) RECENTLY GRADUATED NURSES TO BECOME COMPETENT CLINICAL NURSES. 2. CONTINUE TO ASSIST THE VENTURA COUNTY DISTRICT ATTORNEY'S OFFICE IN SUPPORTING VICTIMS OF DOMESTIC ABUSE THROUGH THE "PROJECT SAFE HARBOR" PROGRAM. 3. PROVIDE A ROTATION FOR TRAINING OB/GYN, ORTHOPEDIC SURGERY, INTERNAL MEDICINE, AND FAMILY MEDICINE PHYSICIAN RESIDENTS. 4. CONTINUE TO PROVIDE CHILDREN'S TOURS OF THE HOSPITALS. 5. CONTINUE TO PROVIDE DATA TO A NATIONAL TUMOR REGISTRY THAT SUPPORTS A KNOWLEDGE BASE THAT ENHANCES THE CARE OF CANCER PATIENTS IN OUR COMMUNITY. 6. CONTINUE TO PROVIDE A CANCER CENTER THAT INCLUDES SUPPORT GROUPS TO HELP PATIENTS AND THEIR FAMILIES DEAL WITH THEIR CONDITION AT NO COST. SCHEDULE O, PART VI, LINE 2 BUSINESS RELATIONSHIPS JOHN RUSSELL AND MARTIN POPS HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, QUESTION 11B FORM 990 WAS PREPARED BY ERNST & YOUNG LLP AND COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) FINANCE WITH INPUT FROM THE SYSTEM'S PLANNING AND MANAGED CARE OFFICE. FORM 990 WAS REVIEWED BY THE CEO, CFO, CORPORATE COMPLIANCE OFFICER AND AUDIT COMMITTEE. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING THE FORM 990 WITH THE IRS. FORM 990, PART VI, QUESTION 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY AND COLLECTED FROM DIRECTORS, OFFICERS AND KEY EMPLOYEES ON AN ANNUAL BASIS. SUCH STATEMENTS PROVIDE DISCLOSURE OF FINANCIAL INTERESTS AND TRANSACTIONS WHERE CONFLICT OF INTEREST IS A POSSIBILITY, AND SHALL ASSIST IN THE AVOIDANCE OF POTENTIAL CONFLICT OF INTEREST IN CHOOSING NEW DIRECTORS, AND OTHER MATTERS INVOLVING OFFICERS, DIRECTORS, AND KEY EMPLOYEES. IT IS THE POLICY OF CMHS THAT REQUIRES DIRECTORS TO DISQUALIFY HIMSELF/HERSELF FROM MAKING A DECISION WHERE HE/SHE HAS A CONFLICT OF INTEREST. The Systems Chief Corporate Officer has oversight of this process and determines whether a conflict of interest is present. FORM 990, PART VI, QUESTIONS 15A AND 15B PROCESS FOR DETERMINING COMPENSATION IN 2015 AND 2016, THE ORGANIZATION USED AN INDEPENDENT CONSULTANT TO SURVEY EXECUTIVE COMPENSATION. NATIONWIDE SURVEYS WERE USED TO COMPARE THE COMPENSATION OF THE HEALTH SYSTEM'S EXECUTIVE STAFF TO THE 50TH PERCENTILE OF THOSE SURVEYED AND BY ORGANIZATIONAL SIZE AND SCOPE. THE BOARD COMPENSATION COMMITTEE IS RESPONSIBLE FOR ENGAGING THE INDEPENDENT COMPENSATION CONSULTANT AND FOR DETERMINING THE COMPENSATION OF THE CEO. THE COMPENSATION FOR ALL OTHER EXECUTIVES IS DETERMINED BY THE CEO AND SUBJECT TO THE APPROVAL BY THE BOARD COMPENSATION COMMITTEE. THE RECOMMENDATION OF THE BOARD COMPENSATION COMMITTEE IS THEN APPROVED BY THE BOARD OF DIRECTORS. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. The process was last completed in August 2016. FORM 990, PART VI, QUESTIONS 16A AND 16B JOINT VENTURES CMHS HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS. FORM 990, PART VI, QUESTION 19 PUBLIC DISCLOSURE OF CERTAIN DOCUMENTS THE AUDITED FINANCIAL STATEMENTS, FORM 990 TAX RETURNS, GOVERNING AND ORGANIZATIONAL DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE THROUGH THE ADMINISTRATIVE OFFICES AND ARE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSSETS CHANGE IN PENSION OBLIGATION $(262,205) CHANGE IN PLEDGE RECEIVABLE RESERVE $(136,934) CHANGE IN CONTRIBUTED CAPITAL $ 437,397 ROUNDING $( 6) ---------- TOTAL $ 38,252 ACCOUNTABLE CARE ALLIANCE OF VENTURA LLC 147 N BRENT STREET VENTURA CA 93003 462843182 MGMT SVCS CA 2400 2425 CMHS COMMUNITY MEMORIAL PHYSICIANS SVCS LLC 147 N BRENT STREET VENTURA CA 93003 463142917 MGMT SVCS CA 165447 89196 CMHS VENTURA ORTHOPEDIC CO-MANAGEMENT COMPANY 147 N BRENT STREET VENTURA CA 93003 453483342 MGMT SVCS CA 0 0 CMHS COMMUNITY MEMORIAL HEALTHCARE FOUNDATION 147 N BRENT STREET VENTURA CA 93003 953847251 FUNDRAISING CA 501(c)(3) 7 CMHS true GROSSMAN IMAGING CENTER OF CMH LLC 2001 N SOLAR DRIVE SUITE 135 OXNARD CA 93030 371512002 IMAGING CENTER CA NA Related 107364 665691 false 0 false 0.51000 VENTURA CARDIOVASCULAR CO-MANAGEMENT CO 147 N BRENT STREET VENTURA CA 93003 273227049 MANAGEMENT SVCS CA NA Related 222989 246188 false 0 false 0.50000 BUENAVISTA MEDICAL PROPERTIES LTD 168 NORTH BRENT STREET VENTURA CA 93003 770275364 RENTAL CA NA BUENAVISTA MEDICAL PROPERTIES INC 147 N BRENT STREET VENTURA CA 93003 770298516 REAL ESTATE CA NA C Corp 72286 264510 1.00000 true CALIFORNIA HEART INSTITUTE 147 N BRENT STREET VENTURA CA 93003 770276145 BILLING SERVICES CA NA C Corp 268640 152976 1.00000 true true false true true false false false false false true false false true true true false true false true GROSSMAN IMAGING CENTER a 139574 ACCRUAL METHOD GROSSMAN IMAGING CENTER d 3922076 ACCRUAL METHOD GROSSMAN IMAGING CENTER j 153516 ACCRUAL METHOD COMMUNITY MEMORIAL HEALTHCARE FDN c 185349 ACCRUAL METHOD COMMUNITY MEMORIAL HEALTHCARE FDN q 236578 ACCRUAL METHOD FORM 990, SCHEDULE R, PART III INFORMATION FOR RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS ORGANIZATION NAME: GROSSMAN IMAGING CENTER OF CMH, LLC ORGANIZATION EIN: 37-1512002 U.S. ADDRESS: 2001 N. SOLAR DR., SUITE 135, OXNARD, CA 93030 ORGANIZATION NAME: VENTURA CARDIOVASCULAR CO-MANAGEMENT CO. LLC ORGANIZATION EIN: 27-3227049 U.S. ADDRESS: 147 NORTH BRENT STREET, VENTURA, CA 93003 ORGANIZATION NAME: BUENAVISTA MEDICAL PROPERTIES, LTD. ORGANIZATION EIN: 77-0275364 U.S. ADDRESS: 168 NORTH BRENT STREET, VENTURA, CA 93003