2017-04-28T15:01:55-05:00 2016-06-30 ERNST & YOUNG US LLP 18101 VON KARMAN AVENUE SUITE 1700 IRVINE CA 92612 990 2015-07-01 941156596 ST JOSEPH HOSPITAL OF EUREKA % JONI MURPHY STJO 7074458121 2700 DOLBEER STREET EUREKA CA 95501 MICH RICCIONI CFO 7074458121 2017-04-28 true KARA ADAMS P00023315 9497942300 2015 2021-01-29 14:40:06Z DR DAVID O'BRIEN 2700 DOLBEER ST EUREKA CA 95501 268618814 false 0928 X HTTP://WWW.STJOEHUMBOLDT.ORG/ X 1942 CA TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING HEALTH & QUALITY OF LIFE OF THE PEOPLE IN THE COMM WE SERVE. 15 10 1417 144 0 3457585 2593911 251308497 265757322 -15606 161176 95863 85849 254846339 268598258 2198530 3521350 0 0 88088392 93195469 0 0 655154 128802678 129644659 219089600 226361478 35756739 42236780 252378253 271280496 117817695 121077388 134560558 150203108 X ST. JOSEPH HOSPITAL OF EUREKA IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IN THE COMMUNITIES WE SERVE. false false 215475349 3521350 265771014 SEE SCHEDULE O 215475349 true true false true false false false false false false true false false false true true false true false false false false false false true false true true true false true false false false false false false false true true true false false false true true true false false true X 0 0 true 1417 true false false false false false true true false false false false X 15 10 false false false false true true true true true false false true true true true true true false true false CA X JONI MURPHY 7074458121 2700 DOLBER ST EUREKA CA 95501 PATRICK CLEARY BOARD MEMBER 2.0 2.0 X 0 0 0 SISTER KAREN CLOCK BOARD MEMBER 2.0 2.0 X 0 0 0 BECKY GIACOMINI BOARD MEMBER 2.0 2.0 X 0 0 0 JOHN GIEREK JR BOARD CHAIRMAN 4.0 5.0 X 0 0 0 SISTER PAT HAYHURST CSJ BOARD MEMBER 2.0 2.0 X 0 0 0 RON JONES MD BOARD MEMBER 2.0 2.0 X 0 0 0 DENNIS LEONARDI VICE CHAIR 4.0 6.0 X 0 0 0 ELLEN MAHONEY MD BOARD MEMBER 2.0 2.0 X 0 0 0 JEFF NELSON BOARD MEMBER 2.0 2.0 X 0 0 0 DAVID O'BRIEN MD PRESIDENT 43.0 14.0 X X 0 692274 42772 SCOTT SAGEMAN MD BOARD MEMBER/CHIEF OF STAFF 2.0 2.0 X 37500 0 0 MEGAN SMITH-ZAGONE MD BOARD MEMBER 2.0 2.0 X 0 0 0 SR MARY THERESE SWEENEY CSJ BOARD MEMBER 2.0 2.0 X 0 0 0 EVAN BUXBAUM MD BOARD MEMBER 2.0 2.0 X 0 0 0 PAUL OHTA BOARD MEMBER 2.0 52.0 X 0 343958 25876 DONALD BAIRD MD BOARD MEMBER (PART YEAR) 2.0 2.0 X 0 0 0 RONALD DILUIGI BOARD MEMBER (PART YEAR) 2.0 52.0 X 0 285861 24072 SISTER LISA TURAY CSJ BOARD MEMBER (PART YEAR) 2.0 2.0 X 0 0 0 MICHEL RICCIONI CFO 12.0 44.0 X 0 752852 46110 OLUYEMI ADEYANJU SECRETARY 2.0 52.0 X 0 166281 2087 JOSHUA ALLEE VP, MISSION INTEGRATION 43.0 9.0 X 251449 0 17956 KEVIN KLOCKENGA REGIONAL CEO 10.0 40.0 X 0 1021111 33602 JAYNIE BOREN N. CA REG VP-STRATEGIC SVCS 10.0 49.0 X 0 427709 32872 ROBERT EISEN REGIONAL VP OF HUMAN RESOURCES 12.0 38.0 X 0 338361 38083 DAVID SOUTHERLAND VP, COO 43.0 7.0 X 374871 0 12054 LAURIE WATSON-STONE VP, ANCILIARY & SUPPORT SVCS 43.0 7.0 X 293034 0 44933 TAMMY BARK VP, CNO 43.0 7.0 X 218923 0 5993 WILLIAM PARKS VP MEDICAL AFFAIRS/CMO 43.0 7.0 X 215955 0 17933 TERRY LERMA DIRECTOR OF PHARMACY 40.0 0.0 X 249311 0 32345 KATE CRUZ MANAGER PHARMACY OPERATIONS 40.0 0.0 X 224445 0 48320 NIKKI COLLIER MANAGER PHARMACY OPERATIONS 40.0 0.0 X 222846 0 31133 HENRY BOOK RN FIRST ASSIST-CHARGE 36.0 0.0 X 221275 0 48044 PHILIP SAMS CLINICAL PHARMACIST 40.0 0.0 X 216432 0 43744 Robynn Van Patten FORMER SEC. (FORMER OFFICER) 0.0 0.0 X 0 320681 21760 CAROL REEDER VP, CNO 43.0 7.0 X 209741 0 0 2735782 4349088 569689 189 true true false MEDICAL STAFFING NETWORK HEALTHCARE PO BOX 840292 DALLAS TX 75284 REGISTRY 6106498 SOYRING CONSULTING PO BOX 732520 DALLAS TX 75373 CONSULTING 955206 QUEST DIAGNOSTIC INCORPORATED 3924 COLLECTION CENTER DR CHICAGO IL 60693 MEDICAL SERVICES 613852 NORTH COAST SURGICAL SPECIALISTS 2321 HARRISON AVE EUREKA CA 95501 PHYSICIAN SERVICES 550470 JOHN POSTEL MD 2321 HARRISON AVE EUREKA CA 95501 PHYSICIAN SERVICES 531667 35 45317 751000 115562 1682032 45317 2593911 NET PATIENT REVENUE 622110 264078781 264078781 EHR REVENUE 622110 947529 947529 CAFETERIA REVENUE 722514 624321 624321 MOB REVENUE 531120 68563 68563 ALL OTHER PROGRAM REVENUE 900099 38128 38128 265757322 161176 161176 0 0 0 0 0 0 92713 45317 20556 72157 72157 0 0 REBATES AND REFUNDS 900099 13692 13692 13692 268598258 265771014 233333 X 3521350 3521350 0 0 0 1653613 234459 1419154 0 61804136 59034160 2493955 276021 3648750 3305541 301228 41981 20677785 19462972 1069131 145682 5411185 5063470 302867 44848 15079262 14760364 318898 0 710833 0 710833 0 36620 0 36620 0 21659 21659 0 0 0 0 27522208 25548241 1905305 68662 122491 122406 85 0 6724969 6604012 110066 10891 3263862 3104092 150155 9615 0 3038230 3029703 8279 248 478916 201672 245922 31322 0 136006 134074 1932 3598527 3598527 0 9063526 9057511 6015 1209132 1209132 MEDICAL SUPPLIES 39875410 39875410 CA HOSPITAL FEE 9795636 9795636 REPAIRS AND MAINTENANCE 4022762 3888872 132425 1465 TAX AND LICENSES 520620 407942 112654 24 4423990 3494144 907383 22463 226361478 215475349 10230975 655154 0 0 7585289 15963523 4634780 4333780 18496299 21435977 0 0 0 0 242440 165133 5427279 5837201 1501864 1870356 323584080 126393814 201636989 197190266 610323 9626809 0 0 2130602 2111396 0 0 10112388 12746055 252378253 271280496 18255154 19729074 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99562541 101348314 117817695 121077388 X 116945360 131876737 17615198 18326371 0 0 134560558 150203108 252378253 271280496 X 42236780 107209 -26701439 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 21659 21659 false SCHEDULE C, PART II-B, LINE 1I LOBBYING ACTIVITIES DURING THE YEAR, ST. JOSEPH HEALTH SYSTEM CONDUCTED ADVOCACY EFFORTS WHICH INCLUDED SOME LOBBYING ACTIVITIES. THESE ACTIVITIES INCLUDED MEETING WITH LOCAL, STATE AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS, AS WELL AS COMMUNICATION TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION. THE LOBBYING EXPENDITURES REPORTED REPRESENTS THE PORTION OF DUES ALLOCATED TO ST. JOSEPH HOSPITAL EUREKA. 4663736 4663736 209181404 53610309 155571095 1094644 792154 302490 89566136 71991351 17574785 19078160 19078160 197190266 0 INTERCO. WITH HEALTH SYSTEM-BONDS 60924047 PAYABLE TO THIRD PARTIES 6315883 INTERCOMPANY PAYABLES 28093183 OTHER LIABILITIES 1250682 ACCRUED LIABILITIES 2315610 MANAGED CARE EXPENSES 2448909 101348314 X SCHEDULE D, PART X, LINE 2 CONSOLIDATED AUDIT FOOTNOTE FOR FIN 48 (ASC 740) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2016 OR 2015. DINNER&AUCTION 133701 45317 88384 20556 0 133701 45317 88384 20556 20556 67828 true true X true X true X 500. true true false true true 1350131 1350131 0.00600 63657897 69803012 0 103574 9824 93750 0.00040 65111602 69812836 1443881 0.00640 1864597 134825 1729772 0.00770 437968 0 437968 0.00190 544511 87891 456620 0.00200 0 0 0 1534536 53295 1481241 0.00660 4381612 276011 4105601 0.01820 69493214 70088847 5549482 0.02460 7753 7753 32603 1500 31103 0.00010 26884 26884 0.00010 20728 20728 0.00010 4147 450 3697 3278 3278 95393 1950 93443 0.00030 false 3173852 100506158 82843118 17663040 X true true 1 1 ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA CA 95501 WWW.STJOSEPHEUREKA.ORG D-0189726 X X X ST JOSEPH HOSPITAL OF EUREKA 1 false false true X X X X X X X X X 13 true true true true X SEE SCHEDULE H, PART V, SECTION C X true 13 true SEE SCHEDULE H, PART V, SECTION C false false true X 200. 500. 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 SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT WAS PROVIDED IN A MULTITUDE OF WAYS, INCLUDING SIX REGIONAL COMMUNITY FORUMS DONE IN COLLABORATION WITH PUBLIC HEALTH DURING SEPTEMBER AND OCTOBER 2013. AN ADJUNCT FORUM WAS DONE WITH THE PROMOTORES DE SALUD GROUP TO LEARN ABOUT HEALTH NEEDS SPECIFIC TO THE LATINO POPULATION IN HUMBOLDT COUNTY. ALSO AT THIS TIME, FIRST 5 HUMBOLDT WAS CONDUCTING THEIR ANNUAL SURVEY OF PROGRAM PARTICIPANTS AND AGREED TO INCLUDE QUESTIONS ON NUTRITION AND FOOD SECURITY. MORE THAN FORTY COMMUNITY NEEDS ASSESSMENTS, REPORTS, AND DOCUMENTS WERE USED FOR THIS META-ANALYSIS OF COMMUNITY NEED. NEARLY ALL OF THESE REPORTS INCLUDED COMMUNITY INPUT IN THE FORM OF QUESTIONNAIRES, INTERVIEWS, FOCUS GROUPS AND TOWN HALL MEETINGS. CONSULTING ORGANIZATIONS INCLUDED: THE HUMBOLDT COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, PUBLIC HEALTH BRANCH REPRESENTING ALL PEOPLE IN HUMBOLDT COUNTY BUT BEING A COUNTY WITH HIGH POVERTY RATES, SPECIAL EMPHASIS IS ON THE ECONOMICALLY POOR AND VULNERABLE. FIRST 5 HUMBOLDT REPRESENTING CHILDREN BIRTH TO AGE FIVE AND THEIR CAREGIVERS, ESPECIALLY LOW INCOME. PROMOTORES DE SALUD REPRESENTING MINORITY LATINO POPULATION. COMMUNITY AND FAMILY RESOURCE CENTERS ACROSS THE COUNTY REPRESENTING LOW AND VERY-LOW INCOME INDIVIDUALS, FAMILIES, DISABLED AND SENIORS. WE ALSO REVIEWED WHITE PAPERS FROM MULTIPLE AGENCIES REPRESENTING VULNERABLE POPULATIONS SUCH AS: HUMBOLDT SENIOR RESOURCE CENTER REPRESENTING FRAIL AND HOMEBOUND SENIORS, FOOD FOR PEOPLE REPRESENTING FOOD INSECURE PEOPLE AND CALIFORNIA CENTER FOR RURAL POLICY REPRESENTING THOSE LIVING IN POVERTY AND EXPERIENCING HEALTH DISPARITIES. SCHEDULE H, PART V, SECTION B, LINE 6A CHNA HOSPITAL FACILITIES: REDWOOD MEMORIAL HOSPITAL SCHEDULE H, PART V, SECTION B, LINE 6B CHNA OTHER ORGANIZATIONS: COUNTY OF HUMBOLDT DEPARTMENT OF HEALTH & HUMAN SERVICES - PUBLIC HEALTH BRANCH FIRST 5 HUMBOLDT NORTHERN CALIFORNIA ASSOCIATION OF NON-PROFITS SCHEDULE H, PART V, SECTION B, LINE 7A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: http://www.stjoehumboldt.org/documents/Community-Benefit/2014-Community-He alth-Needs-Assessment-Report.pdf SCHEDULE H, PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: http://www.stjoehumboldt.org/documents/Community-Benefit/FY15-17-SJE-CB-Pl an-and-IS-Report.pdf SCHEDULE H, PART V, SECTION B, LINE 11 IN FY15-FY17 ST. JOSEPH HOSPITAL OF EUREKA (SJE) PRIORITIZED THREE AREAS OF SIGNIFICANT HEALTH NEED AS WE HEARD IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THEY ARE 1) NUTRITION, HEALTHY FOOD AND FOOD SECURITY; 2) MENTAL AND BEHAVIORAL HEALTH SERVICES; AND 3) CARE COORDINATION AND REFERRAL. ST. JOSEPH HOSPITAL OF EUREKA IS ADDRESSING THESE IDENTIFIED NEEDS IN THE FOLLOWING WAYS: NUTRITION, HEALTHY FOOD AND FOOD SECURITY: GRANTED $121,000 TO 13 ORGANIZATIONS THAT PROVIDE HEALTHY FOOD TO INDIVIDUALS FACING FOOD SECURITY (IN PARTNERSHIP WITH REDWOOD MEMORIAL HOSPITAL). PARTICIPATED IN COUNTY-WIDE CAL-FRESH OUTREACH, ENROLLMENT AND RETENTION EFFORTS RESULTING IN A 4.4% INCREASE IN CAL-FRESH BENEFICIARIES SINCE JUNE 2015. HOSTED 29 FREE COMMUNITY DINNERS OR EVENTS FEATURING FRESH PRODUCE AND NUTRITIOUS FOODS. MENTAL AND BEHAVIORAL HEALTH SERVICES: INCREASED PARTICIPATION IN MAY IS MENTAL HEALTH AWARENESS MONTH WITH THE GOAL OF INCREASING AWARENESS OF AND REDUCING STIGMA ASSOCIATED WITH MENTAL ILLNESS. CONTRACTED WITH A BI-LINGUAL LICENSED MARRIAGE AND FAMILY THERAPIST TO PROVIDE FREE COUNSELING SERVICES TO SPANISH-SPEAKING FAMILIES AND INDIVIDUALS. GRANTED $82,600 TO SIX ORGANIZATIONS OFFERING MENTAL/BEHAVIORAL HEALTH SERVICES OR RESOURCES (IN PARTNERSHIP WITH REDWOOD MEMORIAL HOSPITAL). CARE COORDINATION AND REFERRAL: IMPROVED COMMUNICATION BETWEEN EMERGENCY DEPARTMENT AND PRIMARY CARE AROUND NOTIFICATION OF OVERDOSE. TALLIED 945 AVOIDABLE HOSPITAL BED DAYS IN MEDICAL RESPITE AT OUR HEALING RING AND SERENITY INN LOCATIONS SUPPORTED BY THE CARE TRANSITIONS PROGRAM. EXPANDED MEDICAL RESPITE SERVICES BY PARTNERING WITH THE BETTY KWAN CHINN HOMELESS FOUNDATION TO OPEN TEN ADDITIONAL RESPITE BEDS IN A NEW LOCATION. 3.3% 30-DAY READMISSION RATE FOR PATIENTS SERVED BY THE BEHAVIORAL HEALTH OUTREACH RN WHO SUPPORTS HIGH ACUITY BEHAVIORAL HEALTH DISCHARGES TO SKILLED NURSING FACILITIES. ALTHOUGH NO HEALTHCARE FACILITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY, WE ARE COMMITTED TO CONTINUE OUR MISSION THROUGH COMMUNITY BENEFIT EFFORTS AND BY FUNDING OTHER NON-PROFITS THROUGH THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE ST. JOSEPH HOSPITAL CHNA WILL NOT BE DIRECTLY ADDRESSED THROUGH PROGRAMMING OR FUNDING AND AN EXPLANATION IS PROVIDED BELOW: MOTOR VEHICLE SAFETY: ST. JOSEPH HOSPITAL OF EUREKA DOES NOT DIRECTLY ADDRESS MOTOR VEHICLE AND PEDESTRIAN SAFETY; HOWEVER WE PARTNER WITH SEVERAL ORGANIZATIONS THAT DO ADDRESS THIS ISSUE INCLUDING THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, REDWOOD COMMUNITY ACTION AGENCY AND LOCAL MUNICIPALITIES. LOW INCOME/ AFFORDABLE HOUSING: AFFORDABLE HOUSING IS A BIG NEED IN THE ST. JOSEPH HOSPITAL OF EUREKA SERVICE AREA AND WE RECOGNIZE HOUSING AS BEING A KEY SOCIAL DETERMINANT OF HEALTH, BUT ST. JOSEPH HOSPITAL OF EUREKA HAS HISTORICALLY FELT THAT THIS NEED IS BEYOND OUR SCOPE AND ABILITY TO IMPACT. HOWEVER, WE HAVE RECENTLY STARTED TO LOOK INTO BARRIERS TO HOUSING FOR HOMELESS FAMILIES AND EXPLORE OPPORTUNITIES FOR US TO WORK COLLABORATIVELY, ACROSS SECTORS, WITH THIS SIGNIFICANT NEED IN OUR COMMUNITY. FOR FURTHER INFORMATION PLEASE VISIT: HTTP://WWW.STJOSEPHEUREKA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/FY15-17-SJE-CB-P LAN-AND-IS-REPORT.PDF SCHEDULE H, PART V, SECTION B, LINE 13H THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT. SCHEDULE H, PART V, SECTION B, LINE 16A THE WEB ADDRESS IS: HTTP://WWW.STJOEHUMBOLDT.ORG/DOCUMENTS/FINANCIAL-ASSISTANCE-POLICY-ENGLISH .PDF SCHEDULE H, PART V, SECTION B, LINE 16B THE WEB ADDRESS IS: HTTP://WWW.STJOEHUMBOLDT.ORG/DOCUMENTS/PATIENT-FINANCIAL-ASSISTANCE/FINANC IAL-ASSISTANCE-APPLICATION-HUMBOLDT-ENGLISH_3.8.16.PDF SCHEDULE H, PART V, SECTION B, LINE 16C THE WEB ADDRESS IS: HTTP://WWW.STJOEHUMBOLDT.ORG/DOCUMENTS/PATIENTFINANCIALBROCHENG.PDF SCHEDULE H, PART V, SECTION B, LINE 16I THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S SERVICE AREA. SCHEDULE H, PART V, SECTION B, LINE 22D FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USED MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE HOSPITAL FACILITY USED THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED. 5 NORTHCOAST SURGERY CENTER 2705 HARRIS AVENUE EUREKA CA 95501 SURGERY CENTER OUTPATIENT IMAGING CENTER 2330 BUHNE STREET EUREKA CA 95501 IMAGING CENTER HUMBOLDT HOME INFUSION PROGRAM 2612 HARRISON AVENUE EUREKA CA 95501 AMBULATORY HOME INFUSION CTR. INPATIENT REHABILITATION CENTER 2200 HARRISON AVENUE EUREKA CA 95501 REHABILITATION CENTER OUTPATIENT REHABILITATION CENTER 2024 HARRISON AVENUE EUREKA CA 95501 REHABILITATION CENTER SCHEDULE H, PART I, LINE 3C IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES, INCLUDING BUT NOT LIMITED TO DISABILITY AND HOMELESSNESS ARE CONSIDERED WHEN DETERMINING ELIGIBILITY. SCHEDULE H, PART I, LINE 6A ST. JOSEPH HOSPITAL OF EUREKA PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT WWW.STJOEHUMBOLDT.ORG SCHEDULE H, PART I, LINE 7A-I THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS. SCHEDULE H, PART I, LINE 7G NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES THE ST. JOSEPH HOSPITAL OF EUREKA COMMUNITY BUILDING ACTIVITIES IN FY16 FOCUS ON THE UNDERLYING OR ROOT CAUSES OF POOR INDIVIDUAL AND COMMUNITY HEALTH INDICATORS. FOR EXAMPLE, OUR CEO PARTICIPATED IN A COMMUNITY-WIDE COALITION THAT SEEKS TO TRANSFORM OUR LOCAL HEALTH SYSTEM TO AN ACCOUNTABLE COMMUNITY FOR HEALTH AS WELL AS INVESTIGATE ROOT CAUSES OF WORKFORCE RELATED ISSUES AND PLAN FOR THE FUTURE OF HEALTHCARE WORKFORCE DEVELOPMENT. ALL OF THESE ACTIVITIES WERE UNDERTAKEN TO ASSURE EQUAL ACCESS TO A ROBUST HEALTHCARE SYSTEM FOR FUTURE GENERATIONS. ST. JOSEPH HOSPITAL OF EUREKA ALSO PROVIDING FUNDING TO SUPPORT INCREASED PURCHASING OF LOCAL FOODS. LOCAL FOOD SOURCING CONTRIBUTES TO THE HEALTH OF THE COMMUNITY BY DECREASING FOSSIL FUEL EMISSIONS RESULTING FROM TRANSPORTING FOOD FROM DIFFERENT PARTS OF THE COUNTY OR WORLD. THERE IS ALSO A MULTIPLIER EFFECT FOR EVERY DOLLAR SPENT IN THE LOCAL COMMUNITY THAT DOLLAR HELPS GENERATE A POSITIVE ECONOMIC IMPACT FOR OUR RURAL COMMUNITY. ST. JOSEPH HOSPITAL OF EUREKA SUPPORTED A RESIDENT-LED COMMUNITY BUILDING PROJECT ON THE SAMOA PENINSULA. THIS UNDERSERVED AND LOWER INCOME COMMUNITY EXPERIENCES MANY SOCIAL AND HEALTH PROBLEMS; THIS PROJECT WILL ENGAGE RESIDENTS TO MAKE DECISIONS ABOUT WHAT THEIR COMMUNITY NEEDS MOST IN ORDER TO IMPROVE HEALTH. SCHEDULE H, PART III, SECTION A, LINE 2 THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 3 THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS WERE GRANTED 100 PERCENT FINANCIAL ASSISTANCE (FREE CARE). AFTER THE RECLASSIFICATION THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART III, SECTION A, LINE 4 FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT CREDIT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED PAYORS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION REGULARLY ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING CMS STANDARD COSTING METHODS. THIS INCLUDES STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS. SCHEDULE H, PART III, SECTION C, LINE 9B PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT ST. JOSEPH HOSPITAL OF EUREKA ASSESSED THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION ST. JOSEPH HOSPITAL OF EUREKA PROVIDES NORTH COAST COMMUNITIES WITH ACCESS TO ADVANCED CARE AND ADVANCED CARING. THE HOSPITAL IS LOCATED ON THE FAR NORTH COAST IN HUMBOLDT COUNTY - ONE OF THE LARGEST COUNTIES IN CALIFORNIA BY GEOGRAPHY, COVERING 3,568 SQUARE MILES. THE COUNTY IS DENSELY FORESTED, MOUNTAINOUS AND RURAL WITH NEARLY 1.5 MILLION ACRES OF COMBINED PUBLIC AND PRIVATE FORESTS. A LARGE PORTION - 680,000 ACRES - OF REDWOOD FORESTS ARE PROTECTED OR STRICTLY CONSERVED. THE COUNTY IS THE SOUTHERN GATEWAY TO THE PACIFIC NORTHWEST AND IS SURROUNDED BY DEL NORTE COUNTY TO THE NORTH, TRINITY COUNTY TO THE EAST, MENDOCINO COUNTY TO THE SOUTH AND THE PACIFIC OCEAN ON THE WEST. THE COUNTY WAS ESTABLISHED IN MAY OF 1853 AND DERIVES ITS NAME FROM HUMBOLDT BAY, DISCOVERED BY A SEA OTTER HUNTING PARTY IN 1806 AND REDISCOVERED IN 1849, AND THE STATE'S SECOND LARGEST NATURAL BAY. PRIOR TO BEING DISCOVERED BY EURO-AMERICANS, THIS REGION HAS BEEN HOME TO INDIGENOUS PEOPLE FOR CENTURIES. THE INDIGENOUS PEOPLE OCCUPIED SPECIFIC TERRITORIES AND SPOKE SEVERAL DIFFERENT LANGUAGES. THE WIYOT, YUROK, HUPA, KAROK AND CHILULA ARE SOME OF THE NATIVE TRIBES TO THIS REGION AND HAVE MADE AND CONTINUE TO MAKE SIGNIFICANT CONTRIBUTIONS TO THE HISTORY AND DEVELOPMENT OF THIS REGION. THE COUNTY HAS A POPULATION OF 136,375 OR 38.2 PEOPLE PER SQUARE MILE. NEIGHBORING, TRINITY COUNTY, POPULATION 13,526 HAS ONLY 4.3 PEOPLE PER SQUARE MILE (COVERING 3,179 SQUARE MILES). CALIFORNIA AVERAGES 239.1 RESIDENTS PER SQUARE MILE AND CLASSIFIES RURAL COUNTIES AS UP TO 52 RESIDENTS PER SQUARE MILE. HUMBOLDT COUNTY IS CLASSIFIED AS A RURAL COUNTY AND TRINITY COUNTY IS CONSIDERED FRONTIER, BASED ON THIS PEOPLE PER SQUARE MILE AVERAGE. SEVEN PERCENT OF HUMBOLDT COUNTY HOUSEHOLDS ARE LIVING BELOW THE FEDERAL POVERTY LEVEL, WHICH IS HIGHER THAN BOTH THE STATE AND NATIONAL LEVEL. IN SOME POCKETS OF HUMBOLDT COUNTY, MORE THAN A QUARTER OF HOUSEHOLDS ARE LIVING IN POVERTY. THE REGIONS ECONOMICALLY POOR RESIDENTS HAVE BEEN SEVERELY IMPACTED BY THE GREAT RECESSION AND THE ELIMINATION OF PROGRAMS AND SERVICES THAT LOCAL GOVERNMENTS ARE NO LONGER ABLE TO FUND. THE GROWING GAP IN NEEDED SERVICES HAS PLACED AT RISK THE HEALTH OF THOUSANDS OF UNDERSERVED INDIVIDUALS AND FAMILIES. HEALTH INSURANCE OPTIONS FOR LOCAL RESIDENTS HAVE INCREASED WITH MEDICAID EXPANSION AND OPENING OF THE STATE HEALTH INSURANCE EXCHANGE, COVERED CALIFORNIA. HOWEVER, THE COUNTY LACKS PROVIDERS TO CARE FOR THE REGIONS NEWLY INSURED. HUMBOLDT COUNTY IS DESIGNATED AS A HEALTH PROFESSIONS SHORTAGE AREA AND AREAS ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS (GARBERVILLE/REDWAY, NORTH COASTAL, MCKINLEYVILLE, ARCATA, FERNDALE, WILLOW CREEK AND HOOPA). ATTRACTING AND RETAINING PRIMARY CARE AND SPECIALTY PHYSICIANS AS WELL AS OTHER HEALTH PROFESSIONALS IS AN ONGOING CHALLENGE FOR THIS RURAL COMMUNITY. ACCESS TO AFFORDABLE HEALTHCARE AND BASIC NEEDS HAS ELEVATED TO A CRITICAL LEVEL FOR PEOPLE LIVING IN HUMBOLDT COUNTY. TO RESPOND EFFECTIVELY REQUIRES COLLABORATIVE PROBLEM SOLVING AT THE COMMUNITY LEVEL. GOVERNMENT AND NONPROFIT HEALTH PROVIDERS LARGE AND SMALL MUST WORK TOGETHER TO LEVERAGE RESOURCES AND MAXIMIZE HEALTH ASSETS IN INNOVATIVE WAYS TO RESTORE WHAT HAS BEEN LOST, ENHANCE WHAT STILL EXISTS AND ENSURE SUSTAINABLE HEALTH PROGRAMS AND SERVICES ARE AVAILABLE OVER THE LONG-TERM TO POPULATIONS THAT NEED THEM THE MOST. COMMUNITY-BASED COLLABORATION HAS BEEN A PRIORITY FOR HUMBOLDT COUNTY NONPROFIT ORGANIZATIONS, AND WILL CONTINUE TO DRIVE THIS HOSPITALS COMMUNITY BENEFIT EFFORTS IN THE FUTURE. OTHER HOSPITALS IN THE COMMUNITY INCLUDE: JEROLD PHELPS COMMUNITY HOSPITAL MAD RIVER COMMUNITY HOSPITAL REDWOOD MEMORIAL HOSPITAL SEMPERVIRENS PSYCHIATRIC HOSPITAL SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH REALIZING OUR MISSION ST. JOSEPH HOSPITAL OF EUREKA IS AN ACUTE-CARE HOSPITAL FOUNDED IN 1920, LOCATED IN EUREKA, CA SERVING THE NORTH COAST REGION OF NORTHERN CALIFORNIA. ST. JOSEPH HOSPITAL OF EUREKA PROVIDES VITAL HOSPITAL AND COMMUNITY SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERSINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE (TRADITIONAL CHARITY CARE) AND DISCOUNTED CARE. ST. JOSEPH HOSPITAL OF EUREKA IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE OF ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: 1) A COMMUNITY BENEFIT COMMITTEE THAT IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES, 2) AN OPEN MEDICAL STAFF AND 3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ARE IN PART FUNDED BY CARE FOR THE POOR DOLLARS. LOCAL COMMUNITY BENEFIT COMMITTEE: THE ROLE OF THE ST. JOSEPH HOSPITAL OF EUREKA'S COMMUNITY BENEFIT COMMITTEE IS TO SUPPORT THE BOARD OF TRUSTEES IN OVERSEEING COMMUNITY BENEFIT EFFORTS. THE COMMITTEE ACTS IN ACCORDANCE WITH A BOARD-APPROVED CHARTER. THE COMMUNITY BENEFIT COMMITTEE IS CHARGED WITH DEVELOPING POLICIES AND PROGRAMS THAT ADDRESS IDENTIFIED NEEDS IN THE SERVICE AREA PARTICULARLY FOR UNDERSERVED POPULATIONS, OVERSEEING DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORTS, AND PROVIDING DIRECTION OF COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY BENEFIT COMMITTEE HAS A MINIMUM OF EIGHT MEMBERS INCLUDING THREE MEMBERS OF THE BOARD OF TRUSTEES. CURRENT MEMBERSHIP INCLUDES THREE MEMBERS OF THE BOARD OF TRUSTEES AND EIGHT COMMUNITY MEMBERS. A MAJORITY OF MEMBERS HAVE KNOWLEDGE AND EXPERIENCE WITH THE POPULATIONS MOST LIKELY TO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE COMMUNITY BENEFIT COMMITTEE GENERALLY MEETS BI-MONTHLY. ST. JOSEPH HOSPITAL OF EUREKAS FY15-FY17 COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORT FOCUSES ON THREE PRIORITY AREAS. THEY ARE 1) NUTRITION, HEALTHY FOOD AND FOOD SECURITY; 2) MENTAL AND BEHAVIORAL HEALTH SERVICES; AND 3) CARE COORDINATION AND REFERRAL. ST. JOSEPH HOSPITAL OF EUREKA IS ADDRESSING THESE IDENTIFIED NEEDS IN THE FOLLOWING WAYS DURING FY16: NUTRITION, HEALTHY FOOD AND FOOD SECURITY: GRANTED $121,000 TO 13 ORGANIZATIONS THAT PROVIDE HEALTHY FOOD TO INDIVIDUALS FACING FOOD SECURITY (IN PARTNERSHIP WITH REDWOOD MEMORIAL HOSPITAL). PARTICIPATED IN COUNTY-WIDE CALFRESH OUTREACH, ENROLLMENT AND RETENTION EFFORTS RESULTING IN A 4.4% INCREASE IN CALFRESH BENEFICIARIES SINCE JUNE 2015. HOSTED 29 FREE COMMUNITY DINNERS OR EVENTS FEATURING FRESH PRODUCE AND NUTRITIOUS FOODS. MENTAL AND BEHAVIORAL HEALTH SERVICES: INCREASED PARTICIPATION IN MAY IS MENTAL HEALTH AWARENESS MONTH WITH THE GOAL OF INCREASING AWARENESS OF AND REDUCING STIGMA ASSOCIATED WITH MENTAL ILLNESS. CONTRACTED WITH A BI-LINGUAL LICENSED MARRIAGE AND FAMILY THERAPIST TO PROVIDE FREE COUNSELING SERVICES TO SPANISH-SPEAKING FAMILIES AND INDIVIDUALS. GRANTED $82,600 TO SIX ORGANIZATIONS OFFERING MENTAL/BEHAVIORAL HEALTH SERVICES OR RESOURCES (IN PARTNERSHIP WITH REDWOOD MEMORIAL HOSPITAL). CARE COORDINATION AND REFERRAL: IMPROVED COMMUNICATION BETWEEN EMERGENCY DEPARTMENT AND PRIMARY CARE AROUND NOTIFICATION OF OVERDOSE. TALLIED 945 AVOIDABLE HOSPITAL BED DAYS IN MEDICAL RESPITE AT OUR HEALING RING AND SERENITY INN LOCATIONS SUPPORTED BY THE CARE TRANSITIONS PROGRAM. EXPANDED MEDICAL RESPITE SERVICES BY PARTNERING WITH THE BETTY KWAN CHINN HOMELESS FOUNDATION TO OPEN TEN ADDITIONAL RESPITE BEDS IN A NEW LOCATION. 3.3% 30-DAY READMISSION RATE FOR PATIENTS SERVED BY THE BEHAVIORAL HEALTH OUTREACH RN WHO SUPPORTS HIGH ACUITY BEHAVIORAL HEALTH DISCHARGES TO SKILLED NURSING FACILITIES. PATIENT FINANCIAL ASSISTANCE PROGRAM ST. JOSEPH HOSPITAL OF EUREKA BELIEVES THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY ST. JOSEPH HOSPITAL OF EUREKA HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM (FAP) THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. IN FY16, REDWOOD MEMORIAL HOSPITAL PROVIDED $1,350,131 IN FREE AND DISCOUNTED CARE. MEDICAID PROGRAM ST. JOSEPH HOSPITAL OF EUREKA PROVIDED ACCESS TO UNINSURED AND UNDERINSURED PERSONS BY PARTICIPATING IN THE FEDERAL AND STATE SPONSORED MEDICAID PROGRAM. IN FY16, ST. JOSEPH HOSPITAL OF EUREKA PROVIDED $5,628,404 IN MEDICAID SHORTFALL; HOWEVER TOTAL MEDICAID SHORTFALL WAS ($6,145,115) AFTER ACCOUNTING FOR MEDICAID REIMBURSEMENT FROM THE CALIFORNIA HOSPITAL QUALITY ASSURANCE FEE. PROGRAM SERVICE ACCOMPLISHMENTS CASH DONATIONS OR SPONSORSHIP FOR THE POOR THROUGHOUT FY16, ST. JOSEPH HOSPITAL EUREKA MADE SEVERAL CASH DONATIONS TOWARD COMMUNITY BENEFIT TO SUPPORT ORGANIZATIONS, PROGRAMS OR ACTIVITIES TARGETED FOR POOR AND VULNERABLE PERSONS LIVING IN HUMBOLDT AND THE SURROUNDING COUNTIES. A FEW EXAMPLES OF DONATIONS INCLUDE SUPPORTING SUMMER CAMP SCHOLARSHIPS FOR LOW-INCOME YOUTH AND PROGRAM DEVELOPMENT BY THE BOYS AND GIRLS CLUB, FOOD FOR PEOPLES FREE SUMMER LUNCH PROGRAM, HOMELESS SHELTERS AND SERVICES FOR THE HOMELESS INCLUDING OUR COUNTYS POINT IN TIME COUNT OF HOMELESS INDIVIDUALS, STABLE HOUSING FOR FOSTER YOUTH WHO HAVE AGED OUT OF THE SYSTEM BUT STILL NEED SUPPORT AND THE LIFE SAVING ANTI-OVERDOSE DRUG, NALOXONE, TO COMBAT THE LOCAL OPIOID EPIDEMIC. WE ALSO MADE A CASH DONATION TO THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND TO SUPPORT GRANT INITIATIVES TARGETED AT IMPROVING THE HEALTH CONDITION OF LOW-INCOME AND UNDER SERVED RESIDENTS LIVING IN THE COMMUNITIES WE SERVE. CARE TRANSITIONS PROGRAM THE CARE TRANSITIONS PROGRAM AT ST. JOSEPH HOSPITAL OF EUREKA, HOUSED WITHIN THE ST. JOSEPH HOSPITAL COMMUNITY BENEFIT DEPARTMENT, FOCUSES ON COMMUNITY-BASED INTERVENTIONS FOR HIGH-RISK PATIENTS RECENTLY DISCHARGED FROM AN IN-PATIENT SETTING. THE EMERGENCY DEPARTMENT IS NOT A SETTING TO REECEIVE TIMELY AND EFFECTIVE PRIMARY MEDICAL CARE AND/OR SOCIAL SERVICES. THE MULTI-DISCIPLINARY TEAM OF NURSE, SOCIAL WORKER AND HEALTH COACH PROVIDE TRANSITIONAL SUPPORT TO HOMELESS PATIENTS RECOVERING IN ONE OF OUR RESPITE BEDS AT HEALING RING, A CLEAN AND SOBER HOUSE. A SECOND NURSE WORKS WITH FREQUENT UTILIZERS OF THE EMERGENCY DEPARTMENT TO CONNECT THEM WITH PRIMARY CARE AND THE SUPPORT SERVICES THEY NEED WHILE TRYING TO DETERMINE THE ROOT CAUSE OF THEIR EMERGENCY DEPARTMENT OVERUSE. IN FY16 CARE TRANSITIONS PARTNERED WITH THE BETTY KWAN CHINN HOMELESS FOUNDATION TO OPEN A NEW MEDICAL RESPITE FACILITY TO EXPAND OUR CURRENT RESPITE SERVICES. TEN ADDITIONAL BEDS WILL BE AVAILABLE TO HOMELESS PATIENTS NEEDING EXTRA TIME TO RECOVER AFTER A HOSPITAL STAY. BEHAVIORAL HEALTH RESPONSE TEAM THE BEHAVIORAL HEALTH RESPONSE TEAM (BHRT), IS AN INNOVATIVE PROGRAM HOUSED WITHIN THE CARE MANAGEMENT DEPARTMENT OF ST. JOSEPH HOSPITAL OF EUREKA THAT WAS STARTED IN RESPONSE TO THE HIGH MENTAL HEALTH AND ADDICTION NEEDS OF PATIENTS IN OUR SERVICE AREA. THIS TEAM IS COMPRISED OF TWO PSYCH NURSES AND A BEHAVIORAL HEALTH SPECIALIST THAT PROVIDE IN-PATIENT BEHAVIORAL HEALTH ASSESSMENTS AND CARE PLANS. THE OUTREACH RN ALSO SUPPORTS HIGH RISK DISCHARGES TO LOCAL SKILLED NURSING FACILITIES, WHO OTHERWISE, WOULD NOT BE ABLE TO TAKE THESE COMPLEX PATIENTS. THE BEHAVIORAL HEALTH SPECIALIST RESPONDS TO CALLS FROM THE EMERGENCY DEPARTMENT TO HELP DE-ESCALATE PATIENTS WITH CO-OCCURRING MENTAL ILLNESS AND ADDICTION. FOR MORE INFORMATION ABOUT ST. JOSEPH HOSPITAL EUREKA, PLEASE WWW.STJOEHUMBOLDT.ORG. FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG. WWW.STJHS.ORG. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM ST. JOSEPH HOSPITAL, EUREKA IS A HEALING MINISTRY OF ST. JOSEPH HEALTH, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND (FORMERLY KNOWN AS THE ST. JOSEPH HEALTH SYSTEM FOUNDATION) TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. EVERY YEAR, EACH ST. JOSEPH HEALTH HOSPITAL CONTRIBUTES 10% OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND TO SUPPORT OUTREACH EFFORTS FOR THE ECONOMICALLY POOR. IN FY16 THIS AMOUNT TOTALED $3,257,000 FOR ST. JOSEPH HOSPITAL OF EUREKA. 75% OF THE CONTRIBUTIONS ARE USED TO SUPPORT CARE FOR POOR PROGRAMS BY EACH HOSPITAL. 17.5% OF FUNDS ARE USED TO SUPPORT ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND INITIATIVES. THE REMAINING 7.5% ARE DESIGNATED TOWARD AN ENDOWMENT WHICH HELPS ENSURE THE FUNDS ABILITY TO SUSTAIN PROGRAMS INTO THE FUTURE THAT ASSIST LOW-INCOME AND UNDERSERVED POPULATIONS. ST. JOSEPH HEALTH FURTHERMORE RECOGNIZES THAT THE HEALTH OF ANY COMMUINTY DEPENDS ON THE MAINTENANCE AND CREATION OF STRONG STRUCTURES- BOTH PHYSICAL AND SOCIAL- THAT CONTRIBUTE TO THE LONG-TERM WELL-BEING OF PEOPLE. THAT PHILOSOPHY INSPIRED THE INITIATION OF THE ST. JOSEPH HEALTH COMMUNITY INVESTMENT FUND- AN EFFORT TO ENABLE NON PROFIT 501(C)3 ORGANIZATIONS TO ACHIEVE THEIR FULL POTENTIAL AND PLAY A MAJOR ROLE IN THE GROWTH OF THEIR COMMUNITIES. THE SJH COMMUNITY INVESTMENT FUND PROVIDES CAPITAL IN THE FORM OF LOANS, DEPOSITS AND OTHER FORMS OF SUPPORT TO NON-PROFITS TO ENABLE THEM TO PROMOTE SOCIAL GOOD THROUGH THE DEVELOPMENT OF HEALTHIER COMMUNITIES. IN FY16, A TOTAL OF $11,200,000 WAS INVESTED INTO THE COMMUNITY THROUGH LOANS AND LINES OF CREDIT. TO LEARN MORE ABOUT ST. JOSEPH HEALTH GO TO WWW.STJHS.ORG SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA true HUMBOLDT AREA FOUNDATION 363 INDIANOLA ROAD BAYSIDE CA 95524 237310660 501(c)(3) 28320 PROGRAM SUPPORT HUMBOLDT SENIOR RESOURCE CENTER 1910 CALIFORNIA ST EUREKA CA 95501 942261434 501(c)(3) 20000 PROGRAM SUPPORT EUREKA RESCUE MISSION 1031 BROADWAY EUREKA CA 95501 946135983 501(c)(3) 15600 PROGRAM SUPPORT REDWOOD COMMUNITY ACTION AGENCY 904 G STREET EUREKA CA 95501 942646370 501(c)(3) 16250 PROGRAM SUPPORT ST VINCENT DE PAUL PO BOX 1386 EUREKA CA 95501 941573587 501(c)(3) 15000 PROGRAM SUPPORT REDWOOD TEEN CHALLENGE 2212 2ND STREET EUREKA CA 95501 680358004 501(c)(3) 15000 PROGRAM SUPPORT ARCATA HOUSE PARTNERSHIP 1005 11TH STREET ARCATA CA 95521 943163269 501(c)(3) 10000 PROGRAM SUPPORT BETTY KWAN CHINN HOMELESS FOUNDATION PO BOX 736 EUREKA CA 95502 461413135 501(c)(3) 10000 PROGRAM SUPPORT CASA OF HUMBOLDT 2356 MYRTLE AVENUE EUREKA CA 95501 680477682 501(c)(3) 10000 PROGRAM SUPPORT 2-1-1 HUMBOLDT 1707 E STREET STE 4 EUREKA CA 95503 946107605 501(c)(3) 10000 PROGRAM SUPPORT FOOD FOR PEOPLE INC 307 W 14TH STREET EUREKA CA 95501 942772549 501(c)(3) 27145 PROGRAM SUPPORT NORTH COAST GROWERS ASSOCIATION PO BOX 4232 ARCATA CA 95521 770212408 501(c)(3) 10000 PROGRAM SUPPORT KLAMATH TRINITY RES CONSERVATION DISTRICT PO BOX 279 HOOPA CA 95546 261992669 501(c)(3) 15000 PROGRAM SUPPORT HEALY SENIOR CENTER OF SOUTHERN HUMBOLDT PO BOX 1849 REDWAY CA 95560 942762224 501(c)(3) 10000 PROGRAM SUPPORT BOY & GIRLS CLUB OF THE REDWOODS 3117 PROSPECT AVENUE EUREKA CA 95503 942184464 501(c)(3) 5500 PROGRAM SUPPORT HUMBOLDT NETWORK OF FAMILY RES CENTERS PO BOX 2668 MCKINLEYVILLE CA 95519 680445130 501(c)(3) 14000 PROGRAM SUPPORT ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DR STE 100 IRVINE CA 92612 330143024 501(c)(3) 3257000 CARE FOR THE POOR 17 SCHEDULE I, PART I, LINE 2 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING USE OF GRANTS EACH GRANTEE REPORTS ON THE PROGRESS OF THE FUNDED PROGRAM ON A BIANNUAL BASIS EVERY 6 MONTHS TO THE COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE REVIEWS DOCUMENTATION TO CONFIRM THAT THE GRANTEE IS COMPATIBLE WITH THE MISSION, VISION, AND VALUES OF ST. JOSEPH HEALTH SYSTEM. ALSO THE GRANTEE MUST DEMONSTRATE COLLABORATION, FLEXIBILITY, AND RESPECT FOR DIVERSE CULTURES WHILE UTILIZING EFFECTIVE STRATEGIES AND OUTCOME MEASURES. THE GRANTEE MUST HAVE AN EXISTING GOVERNING AND/OR ADVISORY BOARD WITH SUFFICIENT EXPERTISE AND FAMILIARITY WITH THE PROPOSED PROGRAM/PROJECT. THE GRANTEE MUST BE A NONPROFIT ORGANIZATION IN CALIFORNIA THAT IS TAX EXEMPT. FUNDS THAT ARE TRANSFERRED TO ST. JOSEPH HEALTH SYSTEM FOUNDATION (CARE FOR THE POOR) ARE MONITORED AND DISTRIBUTED BY THE ST. JOSEPH HEALTH SYSTEM, AND ARE NOT MONITORED ON A HOSPITAL LEVEL ONCE THE FUNDS ARE TRANSFERRED. X true true true true false false false false false true false DAVID O'BRIEN MD PRESIDENT 0 425145 0 200374 0 66755 0 16228 0 26544 0 735046 0 0 PAUL OHTA BOARD MEMBER 0 231173 0 85294 0 27491 0 18587 0 7289 0 369834 0 0 RONALD DILUIGI BOARD MEMBER (PART YEAR) 0 150984 0 108146 0 26731 0 12365 0 11707 0 309933 0 0 MICHEL RICCIONI CFO 0 374936 0 141096 0 236820 0 18347 0 27763 0 798962 0 181755 OLUYEMI ADEYANJU SECRETARY 0 124704 0 30000 0 11577 0 0 0 2087 0 168368 0 0 KEVIN KLOCKENGA REGIONAL CEO 0 626686 0 314627 0 79798 0 13250 0 20352 0 1054713 0 0 JAYNIE BOREN N. CA REG VP-STRATEGIC SVCS 0 289266 0 110871 0 27572 0 10600 0 22272 0 460581 0 0 ROBERT EISEN REGIONAL VP OF HUMAN RESOURCES 0 233095 0 85863 0 19403 0 8793 0 29290 0 376444 0 0 CAROL REEDER VP, CNO 0 0 0 0 209741 0 0 0 0 0 209741 0 0 0 DAVID SOUTHERLAND VP, COO 270169 0 77838 0 26864 0 2475 0 9579 0 386925 0 0 0 LAURIE WATSON-STONE VP, ANCILIARY & SUPPORT SVCS 200667 0 68102 0 24265 0 16152 0 28781 0 337967 0 0 0 JOSHUA ALLEE VP, MISSION INTEGRATION 179495 0 56784 0 15170 0 7232 0 10724 0 269405 0 0 0 TAMMY BARK VP, CNO 164363 0 38440 0 16120 0 0 0 5993 0 224916 0 0 0 WILLIAM PARKS VP MEDICAL AFFAIRS/CMO 181051 0 14416 0 20488 0 0 0 17933 0 233888 0 0 0 TERRY LERMA DIRECTOR OF PHARMACY 220331 0 10737 0 18243 0 4741 0 27604 0 281656 0 0 0 KATE CRUZ MANAGER PHARMACY OPERATIONS 220445 0 4000 0 0 0 16212 0 32108 0 272765 0 0 0 NIKKI COLLIER MANAGER PHARMACY OPERATIONS 222346 0 500 0 0 0 20107 0 11026 0 253979 0 0 0 HENRY BOOK RN FIRST ASSIST-CHARGE 221275 0 0 0 0 0 8549 0 39495 0 269319 0 0 0 PHILIP SAMS CLINICAL PHARMACIST 210510 0 0 0 5922 0 19546 0 24198 0 260176 0 0 0 Robynn Van Patten FORMER SEC. (FORMER OFFICER) 0 112168 0 0 0 208513 0 4522 0 17238 0 342441 0 0 SCHEDULE J, PART I, LINE 1A SUPPLEMENTAL COMPENSATION INFORMATION TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: ST. JOSEPH HOSPITAL OF EUREKA GROSSES UP PAYMENTS FOR LIMITED APPROVED EXPENDITURES. SCHEDULE J, PART I, LINE 3 THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O, PART VI, LINE 15A FOR THE PROCESS USED BY ST. JOSEPH HEALTH SYSTEM. SCHEDULE J, PART I, LINE 4A THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING FY16: CAROL REEDER: $ 209,741 ROBYNN VAN PATTEN: $ 208,513 SCHEDULE J, PART I, LINE 4B BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NON QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE YEAR OR AGE 65 VESTING SCHEDULE. EXECUTIVES PREVIOUSLY PARTICIPATED IN ANOTHER NON-QUALIFIED DEFERRED COMPENSATION PLAN THAT WAS FROZEN EFFECTIVE DECEMBER 2007. AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED. THIS FROZEN PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN. THE FOLLOWING INDIVIDUAL RECEIVED 457(F) PAYMENTS DURING THE YEAR: MICHEL RICCIONI - $181,755 SCHEDULE J, PART I, LINE 7 A PORTION OF EXECUTIVES SALARIES ARE PLACED 'AT RISKARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT RISK PAY. ELLEN MAHONEY MD SEE PART V 125498 MEDICAL SERVICES false JOHN GIEREK JR SEE PART V 202231 STORAGE false SCHEDULE L, PART IV, COLUMN (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION 1. ELLEN MAHONEY, M.D., IS A BOARD TRUSTEE OF SJHE AND MORE THAN 35% OWNER OF M ELLEN MAHONEY MEDICAL CORPORATION. 2. JOHN GIEREK, JR IS A BOARD TRUSTEE OF SJHE AND PRESIDENT AND MORE THAN 35% OWNER OF HUMBOLDT MOVING AND STORAGE. X GENERAL MERCHANDISE 50 43125 COST X JEWELRY 1 255 COST X MEALS/FOOD 5 1937 COST false true false SCHEDULE M, PART I, COLUMN (B) THE AMOUNTS IN COLUMN (B) REPRESENT THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 4A REALIZING OUR MISSION ST. JOSEPH HOSPITAL HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 96 YEARS. SERVING THE COMMUNITIES OF HUMBOLDT COUNTY, PARTS OF DEL NORTE, TRINITY AND MENDOCINO COUNTIES, ST. JOSEPH HOSPITAL EUREKA IS AN ACUTE CARE HOSPITAL THAT PROVIDES QUALITY CARE IN THE AREAS OF CARDIAC CARE, CRITICAL CARE, DIAGNOSTIC IMAGING, EMERGENCY MEDICINE, CANCER PROGRAM, REHABILITATION SERVICES, AND OBSTETRICS INCLUDING A LEVEL II NEONATAL INTENSIVE CARE UNIT, AS WELL AS COMMUNITY-BASED PROGRAMS FOCUSED ON PREVENTION, OUTREACH, CARE COORDINATION AND COMMUNITY BUILDING. WITH OVER 1300 EMPLOYEES COMMITTED TO REALIZING THE MISSION, ST. JOSEPH HOSPITAL EUREKA IS ONE OF THE LARGEST EMPLOYERS IN THE HUMBOLDT REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, ST. JOSEPH HOSPITAL EUREKA IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORSMINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBLITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. PATIENT FINANCIAL ASSISTANCE PROGRAM ST. JOSEPH HOSPITAL BELIEVES THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY ST. JOSEPH HOSPITAL HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM (FAP) THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. IN FY16, ST. JOSEPH HOSPITAL PROVIDED $1,350,131 IN FREE AND DISCOUNTED CARE. MEDICAID PROGRAM ST. JOSEPH HOSPITAL OF EUREKA PROVIDED ACCESS TO UNINSURED AND UNDERINSURED PERSONS BY PARTICIPATING IN THE FEDERAL AND STATE SPONSORED MEDICAID PROGRAM. IN FY16, ST. JOSEPH HOSPITAL OF EUREKA PROVIDED $5,628,404 IN MEDICAID SHORTFALL; HOWEVER TOTAL MEDICAID SHORTFALL WAS ($6,145,115) AFTER ACCOUNTING FOR MEDICAID REIMBURSEMENT FROM THE CALIFORNIA HOSPITAL QUALITY ASSURANCE FEE. PROGRAM SERVICE ACCOMPLISHMENTS CASH DONATIONS OR SPONSORSHIP FOR THE POOR THROUGHOUT FY16, ST. JOSEPH HOSPITAL EUREKA MADE SEVERAL CASH DONATIONS TOWARD COMMUNITY BENEFIT TO SUPPORT ORGANIZATIONS, PROGRAMS OR ACTIVITIES TARGETED FOR POOR AND VULNERABLE PERSONS LIVING IN HUMBOLDT AND THE SURROUNDING COUNTIES. A FEW EXAMPLES OF DONATIONS INCLUDE SUPPORTING SUMMER CAMP SCHOLARSHIPS FOR LOW-INCOME YOUTH AND PROGRAM DEVELOPMENT BY THE BOYS AND GIRLS CLUB, FOOD FOR PEOPLES FREE SUMMER LUNCH PROGRAM, HOMELESS SHELTERS AND SERVICES FOR THE HOMELESS INCLUDING OUR COUNTYS POINT IN TIME COUNT OF HOMELESS INDIVIDUALS, STABLE HOUSING FOR FOSTER YOUTH WHO HAVE AGED OUT OF THE SYSTEM BUT STILL NEED SUPPORT AND THE LIFE SAVING ANTI-OVERDOSE DRUG, NALOXONE, TO COMBAT THE LOCAL OPIOID EPIDEMIC. WE ALSO MADE A CASH DONATION TO THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND TO SUPPORT GRANT INITIATIVES TARGETED AT IMPROVING THE HEALTH CONDITION OF LOW-INCOME AND UNDER SERVED RESIDENTS LIVING IN THE COMMUNITIES WE SERVE. CARE TRANSITIONS PROGRAM THE CARE TRANSITIONS PROGRAM AT ST. JOSEPH HOSPITAL OF EUREKA, HOUSED WITHIN THE ST. JOSEPH HOSPITAL OF EUREKA COMMUNITY BENEFIT DEPARTMENT, FOCUSES ON COMMUNITY-BASED INTERVENTIONS FOR HIGH-RISK PATIENTS RECENTLY DISCHARGED FROM AN IN-PATIENT SETTING. THE EMERGENCY DEPARTMENT IS NOT A SETTING TO RECEIVE TIMELY AND EFFECTIVE PRIMARY MEDICAL CARE AND/OR SOCIAL SERVICES. THE MULTI-DISCIPLINARY TEAM OF NURSE, SOCIAL WORKER AND HEALTH COACH PROVIDE TRANSITIONAL SUPPORT TO HOMELESS PATIENTS RECOVERING IN ONE OF OUR RESPITE BEDS AT HEALING RING, A CLEAN AND SOBER HOUSE. A SECOND NURSE WORKS WITH FREQUENT UTILIZERS OF THE EMERGENCY DEPARTMENT TO CONNECT THEM WITH PRIMARY CARE AND THE SUPPORT SERVICES THEY NEED WHILE TRYING TO DETERMINE THE ROOT CAUSE OF THEIR EMERGENCY DEPARTMENT OVERUSE. IN FY16 CARE TRANSITIONS PARTNERED WITH THE BETTY KWAN CHINN HOMELESS FOUNDATION TO OPEN A NEW MEDICAL RESPITE FACILITY TO EXPAND OUR CURRENT RESPITE SERVICES. TEN ADDITIONAL BEDS WILL BE AVAILABLE TO HOMELESS PATIENTS NEEDING EXTRA TIME TO RECOVER AFTER A HOSPITAL STAY. BEHAVIORAL HEALTH RESPONSE TEAM THE BEHAVIORAL HEALTH RESPONSE TEAM (BHRT), IS AN INNOVATIVE PROGRAM HOUSED WITHIN THE CARE MANAGEMENT DEPARTMENT OF ST. JOSEPH HOSPITAL OF EUREKA THAT WAS STARTED IN RESPONSE TO THE HIGH MENTAL HEALTH AND ADDICTION NEEDS OF PATIENTS IN OUR SERVICE AREA. THIS TEAM IS COMPRISED OF TWO PSYCH NURSES AND A BEHAVIORAL HEALTH SPECIALIST THAT PROVIDE IN-PATIENT BEHAVIORAL HEALTH ASSESSMENTS AND CARE PLANS. THE OUTREACH RN ALSO SUPPORTS HIGH RISK DISCHARGES TO LOCAL SKILLED NURSING FACILITIES, WHO OTHERWISE, WOULD NOT BE ABLE TO TAKE THESE COMPLEX PATIENTS. THE BEHAVIORAL HEALTH SPECIALIST RESPONDS TO CALLS FROM THE EMERGENCY DEPARTMENT TO HELP DE-ESCALATE PATIENTS WITH CO-OCCURRING MENTAL ILLNESS AND ADDICTION. FOR MORE INFORMATION ABOUT ST. JOSEPH HOSPITAL EUREKA, PLEASE VISIT WWW.STJOEHUMBOLDT.ORG. FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG. FORM 990, PART V, LINE 1 ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR SJH ENTITIES UNDER SJH AP SHARED SERVICES. THEREFORE, SJHS ISSUES FORM 1099-MISC UNDER ITS TAX ID. SJHS COMPLIES WITH BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS. FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS ST. JOSEPH HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF ST. JOSEPH HOSPITAL EUREKA. FORM 990, PART VI, LINE 7A ST. JOSEPH HOSPITAL OF EUREKA HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE ST. JOSEPH HOSPITAL OF EUREKA BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE ST. JOSEPH HOSPITAL OF EUREKA BOARD AS NOMINATIONS MUST BE APPROVED BY THE ST. JOSEPH HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND THE ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR. FORM 990, PART VI, LINE 7B THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS. FORM 990, PART VI, LINE 11B THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AND WAS REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD AT THE MARCH 2017 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING. FORM 990, PART VI, LINE 12C OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE. FORM 990, PART VI, LINES 15A & 15B THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS APPROVED BY THE TOTAL REWARDS CENTER FOR EXCELLENCE COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF FOR PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2016. DURING THE YEAR, TOTAL REWARDS CENTER FOR EXCELLENCE COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTNG FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING. FORM 990, PART VI, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC THE ORGANIZATION MAKES ITS GOVERINING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES (NON-EMPLOYEES) PHYSICIAN FEES - $10,073,505 PURCHASED SERVICES - $ 8,244,806 REGISTRY/TEMP HELP - $ 9,203,897 ------------- TOTAL $27,522,208 FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCE EQUITY TRANSFERS - ($26,701,439) COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE STE 100 IRVINE CA 92612 461259908 HEALTHCARE CA 501(C)(3) 11,III SJHS true COVENANT ACO 3615 19TH STREET LUBBOCK TX 79410 611573313 HEALTHCARE TX 501(C)(3) 11,I CHS true COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK TX 79410 752765566 HEALTHCARE TX 501(C)(3) 3 SJHS true COVENANT HEALTH SYSTEM FOUNDATION 3623 22ND PLACE LUBBOCK TX 79410 752897026 HEALTHCARE TX 501(C)(3) 7 CHS true COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK TX 79410 752743883 HEALTHCARE TX 501(C)(3) 3 CHS true COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK TX 79410 463516417 HEALTHCARE TX 501(C)(3) 11,I CHS true HMTS INC 1 HOAG DRIVE NEWPORT BEACH CA 92658 453583707 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