2017-08-14T15:47:01-05:00 2016-09-30 BDO USA LLP 600 ANTON BLVD STE 500 COSTA MESA CA 92626 990 2015-10-01 952821104 Henry Mayo Newhall Memorial Hospital % ANNA BREWER HENR 6612001191 23845 McBean Parkway Valencia CA 91355 ROGER SEAVER PRESIDENT/CEO 6612001192 2017-08-14 true CINDY J JANIKOWSKI P00165179 7149573200 2015 2021-01-29 14:40:06Z ROGER SEAVER 23845 McBean Parkway Valencia CA 91355 414659261 false X WWW.HENRYMAYO.COM X 1972 CA TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF THE SANTA CLARITA VALLEY AND SURROUNDING AREAS, AND IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH COMPASSION AND EXCELLENCE. 15 9 2206 322 0 11273043 13465208 318459723 326806494 1264666 135703 3913070 4433821 334910502 344841226 6193229 4998257 0 0 132312648 148536391 0 0 0 169724035 166904495 308229912 320439143 26680590 24402083 357925667 387046616 221444365 221433815 136481302 165612801 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF THE SANTA CLARITA VALLEY AND SURROUNDING AREAS, AND IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH COMPASSION AND EXCELLENCE IN HEALTHCARE SERVICES. false false 253684253 4998257 330102217 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF THE SANTA CLARITA VALLEY AND SURROUNDING AREAS. THE HOSPITAL HAD 58,177 PATIENT DAYS DURING THE YEAR. WE ALSO PROVIDED SERVICES FOR 68,676 EMERGENCY VISITS. 77% of total hospital inpatient admits (excluding newborns) are admitted through the emergency room. 253684253 true true false true false false false false false false true false false false true true true false false false false false false false false false true true false true true true false false false false false false false true true true false false false false false true false false false true 292 0 true 2206 true false false false false false false false false false false X 15 9 false false false false false false false true true false false true true true true true true true true true true CA X X X ANNA BREWER 6612001191 23845 MCBEAN PARKWAY VALENCIA CA 91355 X ROGER E SEAVER PRESIDENT/CEO 40.0 0.5 X X 1053309 0 51782 Don Kimball Trustee 0.5 0.0 X 0 0 0 Judy Fish Trustee 0.5 0.0 X 0 0 0 John Barstis Trustee 0.5 0.0 X 0 0 0 Robert Benjamin Trustee 0.5 0.5 X 0 0 0 Mark Chamberlain Trustee 0.5 0.0 X 0 0 0 Richard Corlin Trustee 0.5 0.0 X 0 0 0 Lakhbinder Dhanda Trustee 0.5 0.0 X 0 0 0 Dale Donohoe Trustee 0.5 0.0 X 0 0 0 Cheri Fleming Trustee 0.5 0.0 X 0 0 0 Mark Liker Trustee 0.5 0.0 X 0 0 0 Chris Luechtefeld Trustee 0.5 0.0 X 0 0 0 Roscoe Marter Trustee 0.5 0.0 X 0 0 0 Craig Peters Trustee 0.5 0.0 X 0 0 0 Todd Stevens Trustee 0.5 0.0 X 0 0 0 CR BOB HUDSON SR VP/CFO 40.0 0.0 X 552082 0 51782 LARRY R KIDD SR VP/CCO 40.0 0.0 X 326658 0 37617 JONATHAN S MILLER VP-Facility/Support 40.0 0.0 X 239067 0 48145 CYNTHIA A PETERSON VP/CIO 40.0 0.0 X 237041 0 42726 MARK A PULEO VP/CHRO 40.0 0.0 X 227691 0 47639 PAIGE E HEAPHY VP-Performace Mgmt 40.0 0.0 X 223376 0 29083 DANITA DALEY VP-CNO 40.0 0.0 X 201514 0 21899 KINGMAN HO VP-CMO 40.0 0.0 X 102770 0 29834 JEAN MARIE STEWART SR DIR OF CATH LAB 40.0 0.0 X 318772 0 13000 BEATRICE V EDMONDSON DIR OF SURG 40.0 0.0 X 239250 0 26581 EVA A NOWLIN DIR OF QRM 40.0 0.0 X 224857 0 10474 HAROUTIOUN H SHAMAMIAN DIR OF PHARMACY 40.0 0.0 X 214095 0 20440 DONNA G FERGUSON DIR OF OP SURG 40.0 0.0 X 207390 0 30539 JOHN V SCHLEIF VP/COO 40.0 0.0 X 264857 0 9375 4632729 0 470916 326 true true false SODEXO INC AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 OTHER PRCHD SRVCS 8106570 INTERTEX GENERAL CONTRACTORS INC 28338 CONSTELLATION RD 900 VALENCIA CA 91355 CONSTRUCTION 3120812 BERNARDS BROS INC 555 FIRST ST SAN FERNANDO CA 91340 CONSTRUCTION 17455866 CALIFORNIA REHABILITATION SERVICES 333 E GLENOAKS BLVD SUITE 204 GLENDALE CA 91207 MEDICAL PRCHD SVCS 4906321 JACOBUS CONSULTING 15375 Barranca Pkwy Ste 202 IRVINE CA 92618 CONSULTING SVCS 2823985 85 4943136 670057 7852015 13465208 HEALTHCARE SERVICES 621110 326806494 326806494 326806494 1003118 1003118 0 0 1133000 1133000 0 1133000 1133000 68950620 69818035 -867415 -867415 -867415 0 0 0 JV INCOME 621110 753463 753463 NONPATIENT REVENUE 621110 2547358 1409260 1138098 3300821 344841226 330102217 1273801 X 0 4998257 4998257 0 0 3798246 3798246 0 0 0 108394282 108394282 3229008 3229008 24189361 24189361 8925494 8925494 6004251 6004251 838080 838080 508606 508606 15182 15182 0 0 57637393 39767976 17869417 432741 432741 44466069 44466069 2143861 2143861 0 7857026 7857026 380144 380144 0 0 6207105 6207105 0 14519150 14519150 1807870 1807870 REPAIR & MAINTENANCE 5914673 5914673 BAD DEBT 9790521 9790521 MISCELLANEOUS 8381823 8381823 320439143 253684253 66754890 0 54171507 42152465 8725105 2198635 1849671 1509872 48044915 51873513 0 0 0 0 0 0 5171106 5968258 3618076 3014519 375965571 186262756 152844179 189702815 69020924 73750620 0 0 0 0 0 0 14480184 16875919 357925667 387046616 55357829 60630413 0 0 2470656 2429433 155741486 151162869 0 0 0 0 0 0 0 0 7874394 7211100 221444365 221433815 X 133347935 160073124 3133367 5539677 0 0 136481302 165612801 357925667 387046616 24402083 4729416 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false true 15182 15182 false 990 SCH C POLITICAL CAMPAIGN AND LOBBYING ACTIVITIES 990 SCH C PART II-B QUESTION 1(I) FOR THE FISCAL YEAR ENDED 09/30/2016, THE ORGANIZATION PARTICIPATED WITH THE CALIFORNIA HOSPITAL ASSOCIATION TO ADVOCATE POSITIVE HEALTHCARE POLICY FOR HOSPITALS. 3226760 3226760 179976932 87218008 92758924 110293407 87228748 23064659 82468472 11816000 70652472 189702815 0 CAPITAL LEASES 6507381 DEFERRED RENT 703719 7211100 X 344572385 4729416 4729416 339842969 4998257 4998257 344841226 315440886 315440886 4998257 4998257 320439143 F990 SCH D PART XI RECON OF REVENUE PER AFS WITH REVENUE PER RETURN 990 SCH D PART XI QUESTION 4B CHARITY CARE 4,998,257. F990 SCH D PART XII RECON OF EXPENSES PER AFS WITH EXPENSES PER RETURN 990 SCH D PART XII QUESTION 4B CHARITY CARE 4,998,257. F990 SCH D PART X Line 2 FIN48(ASC 740) FOOTNOTE PART X LINE 2 THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC"). UNDER FASB ASC 740, UNCERTAINTY IN INCOME TAXES, INTEREST AND PENALTIES, IF ANY, ARE RECORDED TO INTEREST EXPENSE AND OTHER OPERATING COSTS, RESPECTIVELY. THERE WERE NO INTEREST OR PENALTIES RECORDED FOR THE YEARS, ENDED SEPTEMBER 30, 2016 AND 2015. THE TAX YEARS SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS INCLUDE THE YEARS 2012 AND FORWARD BY THE U.S. INTERNAL REVENUE SERVICE (IRS"). FOR CALIFORNIA, THE TAX YEARS SUBJECT TO EXAMINATION INCLUDE THE YEARS 2011 AND FORWARD. true true X true X true X true true true false true true 4998257 4998257 0.01560 17211933 17211933 0.05400 22210190 22210190 0.06960 6060389 6060389 0.01900 6060389 6060389 0.01900 28270579 28270579 0.08860 true 9790521 0 100447034 124429030 -23981996 X true true Tower Imaging Valenc Outpatient Radiology Services 0.5 0.0 0.5 1 1 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 23845 MCBEAN PKWY Valencia CA 91355 X X X 1 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 16 true false false true X SEE PART V X true 16 true SEE PART V false true X 200. 400. X X X X true true X X X true X SEE PART V X SEE PART V X SEE PART V X X X X X true false X X X X true X false false PART V, LINE 5 Henry Mayo Newhall Hospital completed a Community Health Needs Assessment (CHNA) in 2016 as required by state and federal law. Data Collection: This assessment incorporated components of primary data collection and secondary data analysis that focused on the health and social needs of the service area. The CHNA examined up-to-date data sources to present community demographics, social and economic factors, health care access, birth characteristics, leading causes of death, chronic disease, health behaviors, mental health and substance abuse, and preventive practices. These data are presented in the context of Los Angeles County and California State, framing the scope of an issue as it relates to the broader community. Input from Persons who Represent the Community: Targeted interviews were used to gather information and opinions from persons who represented the broad interests of the community served by the hospital. Twenty-two interviews were completed from June through September, 2016. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, and minority populations, or regional, state or local health or other departments or agencies that have current data or other information relevant to the health needs of the community served by the hospital facility. PART V, LINE 7A http://www.henrymayo.com/media/file/Henry%20Mayo%20CHNA%202016.pdf PART V, LINE 10A http://www.henrymayo.com/media/file/Henry%20Mayo%202017%20Implementation%2 0Strategy%20Final.pdf PART V, LINE 11 Needs the hospital will not address: Taking existing hospital and community resources into consideration, Henry Mayo will not directly address the remaining health needs identified in the CHNA including: asthma, dental care, mental health, overweight and obesity, and substance abuse. Knowing that there are not sufficient resources to address all the community health needs, Henry Mayo chose to concentrate on those health needs that can most effectively be addressed given the organizations areas of focus and available resources. Henry Mayo will continue to look for opportunities to address community needs where we can make a meaningful contribution. PART V, LINE 16A http://www.henrymayo.com/patients-and-visitors/patient-business-services/d iscount-payment-ab774 PART V, LINE 16B http://www.henrymayo.com/media/file/CHARITY%20CARE%20APPLICATION.pdf PART V, LINE 16C http://www.henrymayo.com/media/file/AB%20774_%20Summaryl%20For%20Patient%2 0(2).pdf PART III, LINES 2&4 The Hospital offers managed care-style discounts to most uninsured patients, which enables the Hospital to offer lower rates to those patients who historically have been charged standard gross charges. Under this method, the discount offered to uninsured patients is recognized as a contractual allowance instead of provision for bad debts, which reduces net patient revenues at the time the uninsured patient accounts are recorded and reduces provision for bad debts. The uninsured patient accounts, net of contractual allowances recorded, are further reduced to their net realizable value through provision for bad debts based on historical collection trends and other factors that affect the estimation process. For the years ended September 30, 2016 and 2015, provision for bad debts were approximately $9,790,521 and $8,622,426, respectively. PART III, LINE 8 COST METHODOLOGY IS COST ACCOUNTING SYSTEM. PART VI SUPPLEMENTAL INFORMATION FOR ITEMS 2-6 PAGE REFERENCES ARE TO THE COMMUNITY BENEFIT REPORT WHICH IS ATTACHED: 2. PAGE 2 - ASSESSING OUR COMMUNITY'S NEEDS 3. PAGE 7-11 - COMMUNITY BENEFIT SERVICES SUMMARY 4. PAGE 2 - ASSESSING OUR COMMUNITY'S NEEDS 5. PAGE 7-11 - COMMUNITY BENEFIT SERVICES SUMMARY 6. PAGE 7-11 COMMUNITY BENEFIT SERVICES SUMMARY PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA true CHARITY CARE - HENRY MAYO NEWHALL HOSPITAL 4940 4998257 COST OF SERV MED SERVICES SCH I GENERAL INFO ON GRANTS AND ASSISTANCE 990 SCH I PART I QUESTION 2 The hospital assists individuals who are uninsured or underinsured by providYng charity care. This is applied by following the hospitals charity care policy. This policy is administered through the Business Service Department of the hospital. SCH I GENERAL GRANTS AND OTHER ASSISTANCE TO INDIVIDUAL 990 SCH I PART III PATIENTS MEETING CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY MAY RECEIVE HEALTHCARE SERVICES AT NO CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES X X X true false false false false false false false false ROGER E SEAVER PRESIDENT/CEO 526694 0 504702 0 21913 0 13250 0 38532 0 1105091 0 0 0 CR BOB HUDSON SR VP/CFO 333029 0 206675 0 12378 0 13250 0 38532 0 603864 0 0 0 LARRY R KIDD SR VP/CCO 319883 0 714 0 6061 0 13250 0 24367 0 364275 0 0 0 JOHN V SCHLEIF VP/COO 59028 0 205320 0 509 0 923 0 8452 0 274232 0 0 0 JONATHAN S MILLER VP-Facility/Support 219511 0 17613 0 1943 0 12043 0 36102 0 287212 0 0 0 CYNTHIA A PETERSON VP/CIO 222469 0 11122 0 3450 0 11942 0 30784 0 279767 0 0 0 MARK A PULEO VP/CHRO 202130 0 24394 0 1167 0 11875 0 35764 0 275330 0 0 0 PAIGE E HEAPHY VP-Performace Mgmt 173615 0 49207 0 554 0 0 0 29083 0 252459 0 0 0 DANITA DALEY VP-CNO 188133 0 12393 0 988 0 0 0 21899 0 223413 0 0 0 JEAN MARIE STEWART SR DIR OF CATH LAB 293097 0 23973 0 1702 0 13000 0 0 0 331772 0 0 0 BEATRICE V EDMONDSON DIR OF SURG 154121 0 0 0 85129 0 7760 0 18821 0 265831 0 0 0 EVA A NOWLIN DIR OF QRM 123687 0 0 0 101170 0 6248 0 4226 0 235331 0 0 0 HAROUTIOUN H SHAMAMIAN DIR OF PHARMACY 202896 0 11016 0 183 0 0 0 20440 0 234535 0 0 0 DONNA G FERGUSON DIR OF OP SURG 192000 0 14008 0 1382 0 10007 0 20532 0 237929 0 0 0 SCH J, PART I, LINE 4A Two employees who left during the year received severance payments which are included on sch J, part II, column B(iii). the amounts were paid in accordance with the agreements. Additional information is available upon request. A CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-01 25000000 FINANCE AND REFINANCE FACILITY false false false B CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-01 35000000 FINANCE AND REFINANCE FACILITY false false false C CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-01 29550000 FINANCE AND REFINANCE FACILITY false false false D CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SCM4 2014-02-05 70000000 FINANCE AND REFINANCE FACILITY false false false A 0 41320000 25000000 0 0 0 277907 0 0 1113 0 0 2020 true true false true B 0 41690000 35000000 0 0 0 362268 0 0 2320 0 0 2020 true true false true C 0 27150000 29550000 0 0 0 332810 0 0 19084723 0 0 2020 true true false true D 0 0 70000000 0 0 0 2817884 0 0 29217383 0 0 2020 false true false true A false false false false 0 false false false false B false false false false 0 false false false false C false false false false 0 false false false false D false false false false 0 false false false false A false true false false 0 false 0 false false B false true false false 0 false 0 false false C false true false false 0 false 0 false false D false true false false 0 false 0 false false A false B false C false D false Intertex General DALE DONOHOE, trustee 3120812 CONSTRUCTION false Modern Diagnostic MARK LIKER, MD, trustee 235665 INTER NEURO MONITORING false FACEY MEDICAL FOUNDATION ROSCOE MARTER MD, TRUSTEE 2280925 PAY FOR HOSPITALISTS false KRYSTLE SEAVER FAMILY MEMBER OF OFFICER 58229 WAGES false KATHERINE DUNN FAMILY MEMBER OF OFFICER 82529 WAGES false F990 GOVERNANCE, MGMT AND DISCLOSURE 990 PART VI SECTION B QUESTION 11b THE CHAIRMAN OF THE FINANCE COMMITTEE, CHAIRMAN OF THE AUDIT AND COMPLIANCE COMMITTEE, THE BOARD OF DIRECTORS, CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND THE HOSPITAL'S FINANCE DEPARTMENT REVIEWED THE ENTIRE FORM 990 RETURN PRIOR TO FILING. F990 POLICIES 990 PART VI SECTION B QUESTION 15A The organization's CEO, executive director, or top management officials' compensation are determined through the use of a compensation committee, independent consulting, and board of directors approval. Other officers/key employees of the organization receive performance reviews annually and ratings are applied that suggest the percentage of salary increase. Percentages are determined through market surveys done by Human Resources and approved each year via the budget and aprroval process. F990 DISCLOSURE 990 PART VI SECTION C QUESTION 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. F990 POLICIES 990 PART VI SECTION B QUESTION 12C All board members are required to read the conflict of interest policy and complete a formal conflict of interest questionnaire annually and results of any conflict, if any, would be reported to the full board. Board members are aware and reminded of the hospital's fiduciary responsibility in reporting conflicts of interest. There have been circumstances where a conflict of interest exists and it has been disclosed to the board of directors. The conflict of interest forms are required to be updated on an annual basis. F990 GOVERNANCE, MGMT AND DISCLOSURE 990 PART VI SECTION A QUESTION 2 Dr. Dale Donohoe - Business Relationship with Intertex Dr. Mark Liker MD - Business Relationship with Modern Diagnostic Dr. Roscoe Marter - Business Relationship with Facey Medical Foundation Roger Seaver - Family relationship with Krystle Seaver Robert Benjamin - Family relationship with Katherine Dunn. F990 Compensation of Officers, Directors, Trustees, Key Employees, Highest 990 PART VII ALL KEY AND HIGHEST PAID PERSONNEL INCLUDE ONE WAGE INCREASE AND ONE PERFORMANCE BONUS PAYMENT. However, certain executives on the list had not received wage increases and performance bonuses in prior years which were paid in the current year. FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:9550433 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:19652933 FORM 990 PART IX LINE 11G DESCRIPTION:QUALITY ASSURANCE FEE TOTAL FEES:17869417 FORM 990 PART IX LINE 11G DESCRIPTION:REGISTRY TOTAL FEES:10564610 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUND 23845 MCBEAN PARKWAY VALENCIA CA 91355 953849903 RAISE FUNDS CA 501(C)(3) 7 Hospital false TOWER IMAGING VALENCIA 5455 WILSHIRE BLVD STE 1120 LOS ANGELES CA 90036 201345767 RADIOLOGY SER CA Hospital RELATED 893689 1070338 false 0 0.50000 false true true false false false false false false false false false false false true false false false false