2017-09-14T10:47:48-05:00 2016-10-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2015-11-01 951945832 Valley Presbyterian Hospital VALL 8187826600 15107 Vanowen Street Van Nuys CA 91405 Janice Klostermeier SVP Fin/CFO 8187826600 2017-09-13 1 Renie Burbank P00159653 4159561500 2015 2017-02-10 21:41:12Z Gustavo Valdespino 15107 Vanowen Street Van Nuys CA 91405 383741687 0 X www.valleypres.org X 1948 CA VALLEY PRESBYTERIAN HOSPITAL EXISTS TO IMPROVE THE QUALITY OF HEALTH IN OUR COMMUNITY. 17 16 1957 354 0 0 2787759 2800344 379393965 341098672 3110398 2491727 7472529 7750299 392764651 354141042 1716942 593415 0 0 138148669 146247050 0 0 781136 200001959 186027623 339867570 332868088 52897081 21272954 285456877 309304159 101152022 100256842 184304855 209047317 X VALLEY PRESBYTERIAN HOSPITAL EXISTS TO IMPROVE THE QUALITY OF HEALTH IN OUR COMMUNITY. 0 0 276036797 593415 343895548 SEE SCHEDULE O 276036797 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 385 0 1 1957 1 0 0 0 0 0 1 1 0 0 0 0 X 17 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Janice Klostermeier 8187826600 15107 Vanowen St Van Nuys CA 91405 X Greg Kay MD Chairman 1.30 X X 0 0 0 David Adelman Secretary 0.50 X X 0 0 0 Alex Guerrero Treasurer 0.60 X X 0 0 0 William C Allen Secretary (Dec 2015) 0.40 X X 0 0 0 David Chandler Director 0.40 X 0 0 0 David Fleming Chairman Emeritus 0.40 X 0 0 0 Ruth Garcia-Corrales Director 0.40 X 0 0 0 Dianne F Harrison PhD Director 0.50 X 0 0 0 Luca Jacobellis Director 0.40 X 0 0 0 Richard Katz Director (Dec 2015) 0.40 X 0 0 0 Peter Koetters MD Chief of Staff (Jan 2016) 0.80 X 5000 0 0 Matthew Mischel MD Director 0.40 X 0 0 0 Todd Moldawer MD Director 0.40 X 0 0 0 Ganesa Pandian MD Director 0.40 X 0 0 0 Tracy Rafter Director (Dec 2015) 0.40 X 0 0 0 Kevin Rice MD Director 0.40 X 0 0 0 Joshua Rokaw MD Director (Dec 2015) 0.40 X 0 0 0 Barbara Romero Director 0.40 X 0 0 0 Munaf Shamji MD Director 0.40 X 0 0 0 Sukshma Sreepathi MD Chief of Staff/Director 0.80 X 23464 0 0 Tony Tartaglia Director 0.40 X 0 0 0 Francisco Uribe Director (Dec 2015) 0.40 X 0 0 0 Vladimir Victorio Director 0.40 X 0 0 0 Gustavo Valdespino President and CEO 40.00 X 1662026 0 186783 Lori Cardle SVP and CFO 40.00 X 470685 0 92369 Jean O'Keefe Rico SVP-Chief Quality Officer 40.00 X 760530 0 95646 Gayathri Jith SVP Strategy & Ambulatory 40.00 X 631091 0 86806 Pegi Matsuda President-Foundation 40.00 X 318157 0 64119 Jeffrey L Allport VP/Chf Information Officer 40.00 X 275741 0 50011 Timothy Elder VP Ancillary/Support Serv. 40.00 X 234905 0 1422 Lori L Burnell SVP/Chief Nursing Officer 40.00 X 302342 0 53007 Jonathan Wu VP-Human Resources 40.00 X 263235 0 33647 Somasundaram Devadason Pharmacist 40.00 X 241333 0 16689 Jeremy Redin Former Assistant CFO 40.00 X 238176 0 24768 Starr K Williams III Pharmacist 40.00 X 208055 0 14982 Darryl Toy Director, Pharmacy 40.00 X 203320 0 10500 Dena L Decker Director, Qlty & Ptnt Sfty 40.00 X 192051 0 12920 6030111 0 743669 333 0 1 0 Preferred IPA 1025 N Brand Blvd 100 Glendale CA 91202 Medical Services 9013226 Community Family Care 19210 S Vermont Ave Los Angeles CA 90048 Medical Services 2792975 Rehabcare Group of California Inc PO Box 502096 St Louis MO 63150 Healthcare Management 2524082 St Vincent Anesthesia Medical Group PO Box 50045 Pasadena CA 91115 Anesthesia Services 1587500 Dell Computer Corporation PO Box 677654 Dallas TX 75267 Consulting Services 1574692 82 332875 1393851 1073618 2800344 Net Patient Service Revenue 541900 340384517 340384517 Program Related Rental Revenue 541900 714155 714155 341098672 3561489 3561489 286784 15826 270958 270958 270958 28334347 29402702 1407 -1068355 -1407 -1069762 -1069762 119505 332875 180710 -61205 -61205 ANCILLARY & OTHER REV 900099 6197706 2796876 3400830 FOOD Service Revenue 722210 1159936 1159936 GIFT SHOP REVENUE 453220 182904 182904 7540546 354141042 343895548 0 7445150 X 593415 593415 3821493 924053 2897440 115804910 103308319 12000135 496456 3264171 3264171 14620920 168546 14449840 2534 8735556 7558524 1144273 32759 789573 788723 850 189040 189040 82825 82825 124030 124030 34017619 27917377 5999102 101140 203908 203908 8309704 5718371 2534975 56358 3405116 2976072 414743 14301 4135720 390548 3745172 575137 232659 324225 18253 138011 52471 83885 1655 1119258 1119258 8923274 7798941 1086855 37478 3169398 2770054 386033 13311 Capitation expenses 52408892 52408892 medical supplies 34628253 34628253 Provider Program fees 25243733 25243733 Other Controllable Exp 8564132 3346569 5211522 6041 332868088 276036797 56050155 781136 3371697 8289186 34784763 14277503 868380 904380 33219315 31367490 3837499 3962736 2760757 3010460 282631119 187850316 89312963 94780803 99186497 134061307 18115006 18650294 285456877 309304159 63754216 63104015 18965060 16819712 18432746 20333115 101152022 100256842 X 178984669 203242980 5320186 5804337 184304855 209047317 285456877 309304159 X 21272954 2829945 639563 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 82825 82825 0 Part II-B, Line 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE CALIFORNIA HOSPITAL ASSOCIATION (CHA), HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC), AND PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS, INC. (PEACH). A PORTION OF THE DUES PAID ARE USED FOR LOBBYING ACTIVITIES BY CHA, HASC AND PEACH ON BEHALF OF THEIR MEMBERS. 1587222 1587222 150207657 95365547 54842110 2030062 1853889 176173 116523212 90630880 25892332 12282966 12282966 94780803 SELF INSURANCE RESERVES 81520 OTHER RECEIVABLES 1682924 Due from third-party payors 8611857 HOSPITAL PROVIDER FEE Receivable 6891342 Trustee Held Funds Related to Long-Term Debt 1382651 18650294 SELF INSURANCE RESERVES 14841249 Annuity and Trust Liabilities 1683110 Asset Retirement Obligation 3093005 Capital Lease Obligation 715751 20333115 357683056 2829945 639563 3469508 354213548 124030 -196536 -72506 354141042 332940594 196536 196536 332744058 124030 124030 332868088 Part XI, Line 2d - Other Adjustments: Change in Value of Split-Interest Agreements 639,563. Part XI, Line 4b - Other Adjustments: Reclassification of Rental Expenses -15,826. Reclassification of Fundraising Expenses -180,710. Part XII, Line 2d - Other Adjustments: Reclassification of Rental Expenses 15,826. Reclassification of Fundraising Expenses 180,710. Part X, Line 2: THE HOSPITAL RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF OCTOBER 31, 2016 OR 2015. golf Tournament 191230 145975 45255 679 17324 15835 15038 30383 DINNER 261150 186900 74250 5500 50412 3600 41939 452380 332875 119505 679 17324 21335 65450 3600 72322 180710 -61205 1 1 X 1 X 350.000000000000 1 X 1 1 1 0 1 1 579977 579977 0.00170 153073072 147804969 5268103 0.01580 3455472 3455472 0.01040 157108521 147804969 9303552 0.02790 1177549 1177549 0.00350 1464764 1464764 0.00440 486161 486161 0.00150 3128474 3128474 0.00940 160236995 147804969 12432026 0.03730 1 5494699 2913230 65148297 80352718 -15204421 X 1 1 1 1 VALLEY PRESBYTERIAN HOSPITAL 15107 VANOWEN STREET VAN NUYS CA 91405 WWW.VALLEYPRES.ORG 930000170 X X X VALLEY PRESBYTERIAN HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://www.valleypres.org/For-Community/Community-Benefit.aspx X 1 15 1 http://www.valleypres.org/For-Community/Community-Benefit.aspx 0 0 1 X 350.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X X X X X 1 X X 1 X X X X X X 1 X 0 0 VALLEY PRESBYTERIAN HOSPITAL Part V, Section B, Line 5: VALLEY PRESBYTERIAN HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2016. VALLEY PRESBYTERIAN HOSPITAL CONTRACTED WITH VALLEY CARE COMMUNITY CONSORTIUM (VCCC) TO CONDUCT A CHNA THAT WAS COMPLIANT WITH STATE AND FEDERAL REGULATIONS. TO BETTER UNDERSTAND THE HEALTH NEEDS IN THE HOSPITAL SERVICE AREA, VCCC REVIEWED NUMEROUS STATE AND COUNTY SOURCES, COLLECTED PRIMARY DATA, CONDUCTED A LOCAL LITERATURE REVIEW, AND DOCUMENTED COMMUNITY ASSETS AND RESOURCES. THE CHNA MAY BE ACCESSED AT WWW.VALLEYPRES.ORG/FORCOMMUNITY/COMMUNITYBENEFIT.ASPX.The CHNA incorporated components of primary data collection and secondary data analysis that focus on the health and social needs of the service area. Secondary data were collected from a wide range of local, county, and state sources. Four key informant interviews were conducted. Five focus groups were convened to obtain information and opinions from 50 persons who represented the broad interests of the community served by the hospital. A total of 187 paper and electronic surveys were also administered to health professionals, community residents, elected official representatives, and seniors. The surveys were offered in English and Spanish. VALLEY PRESBYTERIAN HOSPITAL Part V, Section B, Line 11: VPH PLANS TO MEET THE IDENTIFIED PRIORITY HEALTH NEEDS THROUGH A COMMITMENT OF RESOURCES WITH THE FOLLOWING PROGRAMS AND SERVICES. CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH EDUCATION, ONE OF THE TEN COMMUNITY NEEDS IDENTIFIED FROM THE CHNA, WILL BE ADDRESSED BROADLY THROUGHOUT ALL OF VPH'S COMMUNITY EDUCATION EFFORTS. THE REMAINING NINE IDENTIFIED PRIORITY HEALTH NEEDS WILL BE INTERWOVEN INTO THE FOLLOWING COMMUNITY EDUCATION PROGRAM THEMES: DIABETES AWARENESS AND SCREENING (BLOOD GLUCOSE, ETC.); PREVENTIVE HEALTH SCREENINGS (BLOODPRESSURE, CAROTID ARTERY, CHOLESTEROL, BMI, FOOT SCREENINGS, ETC.); CHRONIC DISEASE CARE MANAGEMENT; MENTAL HEALTH; NUTRITION; STROKE AWARENESS AND EDUCATION; CHILDHOOD OBESITY AWARENESS AND EDUCATION; WOMEN'S SERVICES AND PRENATAL AWARENESS AND EDUCATION; HEALTHY AGING. VALLEY PRESBYTERIAN HOSPITAL Part V, Section B, Line 16i: OTHER MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED IS THROUGH FINANCIAL COUNSELING IF IDENTIFIED AS UNDERINSURED. VALLEY PRESBYTERIAN HOSPITAL Part V, Section B, Line 22d: THE HOSPITAL FACILITY BILLED 110% OF MEDICARE RATE TO INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. Part III, Line 4: The organization's audited financial statements do not contain a bad debt footnote. The footnote from the audited financial statements that addresses Allowance for Doubtful Accounts is as follows:Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts.The Hospital's allowance for doubtful accounts for self-pay patients was 90.0 percent of self-pay accounts receivable at both October 31, 2016 and 2015. In addition, the Hospital's write-offs totaled approximately $1,708,000 and $2,554,000 for the years ended October 31, 2016 and 2015, respectively. Decreased write-offs were the result of a lower number of self-pay accounts primarily related to the Affordable Care Act (ACA) and Medicaid expansion, resulting in less uninsured patients. The Hospital maintained allowances for doubtful accounts from third-party payors of approximately $3,636,000 and $4,719,000 as of October 31, 2016 and 2015, respectively.The Hospital has not changed its charity care or uninsured discount policies during the years ended October 31, 2016 or 2015. Part III, Line 8: THE COSTING METHODOLOGY WAS BASED ON THE 2016 MEDICARE COST REPORT COST TO CHARGE RATIO. Part III, Line 9b: PAYMENT PLANS: BALANCES ARE DUE UPON DISCHARGE FROM THE HOSPITAL. IF THE PATIENT DOES NOT QUALIFY FOR STATE ASSISTANCE OR VPH's FINANCIAL ASSISTANCE PROGRAM, PAYMENT ARRANGEMENTS MAY BE ESTABLISHED WITH VPH's FINANCIAL COUNSELOR. PAYMENT ARRANGEMENTS MAY BE MADE WITH NO INTEREST PENALTIES. DEFAULTING ON A PAYMENT PLAN WILL RESULT IN DISQUALIFICATION OF THIS OPTION. Part VI, Line 2: COMMUNITY NEEDS ASSESSMENT AND PLANNING PROCESS:AS AN INDEPENDENT, NONPROFIT COMMUNITY HOSPITAL, VPH IS DEDICATED TO IMPROVING THE QUALITY OF HEALTH IN THE SAN FERNANDO VALLEY. WE ARE A VALUES-BASED ORGANIZATION THAT STRIVES TO UPHOLD OUR CORE VALUES OF DIGNITY, RESPECT, COMPASSION, TRANSPERENCY, AND COLLABORATION. WE ARE COMMITTED TO SUPPORTING ACTIVITIES AND PROGRAMS THAT ADDRESS THE IDENTIFIED UNMET HEALTH NEEDS IN OUR SERVICE AREA.VPH FOLLOWS A FOUR-STEP PROCESS TO DEVELOP THE COMMUNITY BENEFIT PLAN. THE FOUR STEPS INCLUDE:1. REVIEW THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND OTHER INFORMATION FROM COMMUNITY-BASED ORGANIZATIONS, PUBLIC SOURCES, ETC.2. CREATE NEW PROGRAMS BASED ON INFORMATIon FROM THE NEEDS ASSESSMENT, DISCUSSIONS WITH OTHER HEALTH CARE PROFESSIONALS, AND REVIEWING AND ADDRESSING COMMUNITY PROGRAM INFORMATION FROM OTHER LOCAL HOSPITALS.3. REFERENCE THE VPH STRATEGIC PLAN TO ALIGN COMMUNITY BENEFIT PROGRAMS WITH OVERALL VPH GOALS, OBJECTIVES, AND STRATEGIES.4. ANALYZE EXISTING COMMUNITY BENEFIT PROGRAM RESULTS TO ENHANCE AND/OR MODIFY ACTIVITIES TO BE IMPLEMENTED OR CONTINUED IN FISCAL YEAR 2016. Part VI, Line 3: PATIENT EDUCATION: A PACKET IS GIVEN TO ANY PATIENT IDENTIFIED AS SELF PAY OR UNDER INSURED.FINANCIAL ASSISTANCE PROGRAM: UNINSURED OR UNDERINSURED PATIENTS WHO ARE UNABLE TO PAY THEIR BILL MAY BE ELIGIBLE FOR 100% FINANCIAL ASSISTANCE, LEAVING NO FINANCIAL OBLIGATION TO THE HOSPITAL FOR THE BILL. QUALIFICATIONS ARE BASED UPON VERIFIABLE INCOME, FAMILY SIZE AND CURRENT FEDERAL POVERTY GUIDELINES. TO QUALIFY FOR VALLEY PRESBYTERIAN HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, REQUIRED DOCUMENTATION MUST BE SUBMITTED WITHIN 15 DAYS OF DISCHARGE FROM THE HOSPITAL. UNINSURED DISCOUNT RATE: VALLEY PRESBYTERIAN HOSPITAL OFFERS DAILY RATES FOR INPATIENT SERVICES AND A SIGNIFICANTLY REDUCED CHARGE RATE FOR OUTPATIENT SERVICES. THE DISCOUNT IS SIMILAR TO RATES PAID BY MEDICARE AND IS OFFERED UNDER THE UNINSURED DISCOUNT PROGRAM.PAYMENT PLANS: BALANCES ARE DUE UPON DISCHARGE FROM THE HOSPITAL. IF THE PATIENT DOES NOT QUALIFY FOR STATE ASSISTANCE OR VALLEY PRESBYTERIAN HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, PAYMENT ARRANGEMENTS MAY BE ESTABLISHED WITH VALLEY PRESBYTERIAN HOSPITAL'S FINANCIAL COUNSELOR. PAYMENT ARRANGEMENTS MAY BE MADE WITH NO INTEREST PENALTIES. DEFAULTING ON A PAYMENT PLAN WILL RESULT IN DISQUALIFICATION OF THIS OPTION. MEDI-CAL AND GOVERNMENT PROGRAMS: PATIENTS MAY QUALIFY FOR GOVERNMENT PROGRAMS TO ASSIST WITH ALL OR PART OF THE HOSPITAL EXPENSES. VALLEY PRESBYTERIAN HOSPITAL HAS AN INTERNAL MEDI-CAL ELIGIBILITY UNIT TO ASSIST PATIENTS WITH THE MEDI-CAL APPLICATION PROCESS. PATIENTS MAY RECEIVE BILLS FROM OTHER BILLING COMPANIES FOR ITEMS SUCH AS PHYSICIAN CHARGES, RADIOLOGY, AND AMBULANCE. Part VI, Line 4: COMMUNITY INFORMATION: The catchment area served by Valley Presbyterian Hospital is bordered to the north by the Santa Susana Mountains, the Santa Clarita Valley, and the city of Lancaster and Palmdale and rural communities in the Antelope Valley; to the east by the communities of Sylmar, Sun Valley, and Studio City; to the south by the communities of Van Nuys, Sherman Oaks, Encino, Tarzana, and the Santa Monica mountains; and to the west by the communities of Woodland Hills, Calabasas, Canoga Park, in Los Angeles County and Simi Valley of Ventura County. The hospital service includes higher income and middle-class households adjacent to pockets of extreme poverty and ethnic diversity.Valley Presbyterian Hospital's service area includes the towns of Calabasas, Canoga Park, Canyon Country, Castaic, Chatsworth, Encino, Granada Hills, Lancaster, Mission Hills, Newhall, North Hills, North Hollywood, Northridge, Pacoima, Palmdale, Panorama City, Reseda, San Fernando, Santa Clarita, Sherman Oaks, Studio City, Sun Valley, Sunland, Sylmar, Tarzana, Tujunga, Valencia, Valley Village, Van Nuys, West Hills, Winnetka, and Woodland Hills in Los Angeles County, and a portion of Simi Valley in Ventura County. The communities that Valley Presbyterian Hospital serves have diverse geography and topography, vary across levels of socio-economic status and educational attainment levels, and experience differences in physical environment and overall access to required health services.In the VPH service area, racial/ethnic diversity has increased substantially due to immigration from countries including Mexico, El Salvador, Iran, Israel, Armenia, Vietnam, Korea, India, and China. A nearly equal percentage of the region's residents are Latino and non-Hispanic white at close to 40% each, with a significant yet smaller percentage of Asian/Pacific Islanders and African Americans/Blacks. Although the county and the state have begun to experience a slight increase in employment, the recovery has been slow following the global recession of 2009. While area residents are more educated, and higher proportions hold of graduate and professional degrees compared to the rest of the county, poverty remains a significant barrier for families in several communities. Part VI, Line 7, Reports Filed With States CA 1 Los Angeles Valley College 5800 Fulton Ave Van Nuys CA 91401 952587353 501(c)(3) 55000 General Support American Diabetes Association PO Box 930850 Atlanta GA 311930850 131623888 501(c)(3) 40000 Promatoras Program & Latino Initative Program El Nido Family Centers 10200 Sepulveda Boulevard Suite 350 350 Mission Hills CA 91345 953186429 501(c)(3) 20000 Payment for teen family services Social and Environmental Entreprenuers 23532 Calabasas Rd Suite A Calabasas CA 91302 954116679 501(c)(3) 18000 General Support YMCA of Metropolitan Los Angeles 6901 Lennox Ave Van Nuys CA 91405 951644052 501(c)(3) 15580 General Support Ovarian Cancer Coalition of CA PO Box 40035 Studio City CA 91614 954840165 501(c)(3) 15000 General Support San Fernando Valley Mental Health Center 16360 Roscoe Blvd 2nd Floor Van Nuys CA 91406 956194487 501(c)(3) 15000 Hygiene kits and beds Valley Care Community Consortium 7515 Van nuys Blvd 5th floor Van Nuys CA 91405 205569606 501(c)(3) 13000 Mental Health Symposium Los Angeles County Economic Development Corporation 444 S Flower St 37th Floor Los Angeles CA 90071 953643339 501(c)(3) 10000 General Support MEND 10641 N San Fernando Rd Pacoima CA 91331 237306337 501(c)(3) 10000 Healthy Nutrition Program National Health Foundation 515 S Figueroa St Ste 1200 Los Angeles CA 90071 237314808 501(c)(3) 9500 General Support Valley Economic Development Center 5121 Van Nuys Blvd 3rd Floor Sherman Oaks CA 91403 953139419 501(c)(3) 7500 General Support Woodbury University 7500 N Glenoaks Blvd Burbank CA 91510 952786163 501(c)(3) 7500 General Support California State University Northridge 18111 Nordhoff St Northridge CA 91330 956196006 501(c)(3) 7250 General Support Tierra Del Sol Foundation 9919 Sunland Blvd Sunland CA 91040 952671260 501(c)(3) 5500 General Support BARLOW FOUNDATION 2000 Stadium Way Los Angeles CA 90026 954560787 501(c)(3) 5000 General Support FOUNDATION EXCELLENCE IN EDUCATION 14702 Sylvan St Van Nuys CA 91411 953901313 501(c)(3) 5000 Shower Truck San Fernando Valley Rescue Mission Alliance 8756 Canby Ave Northridge CA 91325 237278002 501(c)(3) 5000 General Support Los Angeles County Business Federation 1000 Alameda St 240 Los Angeles CA 90012 260295348 501(c)(3) 5000 Health Fair California Health Foundation and Trust 1215 K Street Ste 800 Sacramento CA 95814 943186429 501(c)(3) 238980 CA Hospital Provider Program Northeast Valley Health Corporation 1172 North Maclay Ave San Fernando CA 91340 237120632 501(c)(3) 60000 Propeller Health & Diabetes Care Coordinator 21 0 Part I, Line 2: 1) once a grant is received, grant covenants are identified, reviewed and communicated as appropriate, 2) covenants are calendared by month to ensure timely response and completion, 3A) if a grant is for capital equipment, the benefitting VALLEY PRESBYTERIAN HOSPITAL department notifies the development department that a project has been completed and/or equipment has been purchased; a purchase order is completed; THE development department notifies accounting that funds may be released, 3B) if the grant is for training, all steps in 3A apply, but instead of completing a purchase order, documentation of training details is attached including who attended training, how many hours and hourly rates, 4) once the grant is expended, the grantor is notified. X X X X X 1 1 0 0 0 1 0 0 0 Gustavo Valdespino President and CEO 665870 0 174925 0 821231 0 164557 0 22226 0 1848809 0 810457 0 Lori Cardle SVP and CFO 400005 0 63000 0 7680 0 76412 0 15957 0 563054 0 0 0 Jean O'Keefe Rico SVP-Chief Quality Officer 344802 0 60255 0 355473 0 73618 0 22028 0 856176 0 342611 0 Gayathri Jith SVP Strategy & Ambulatory 324002 0 54000 0 253089 0 65476 0 21330 0 717897 0 245694 0 Pegi Matsuda President-Foundation 262038 0 45794 0 10325 0 56211 0 7908 0 382276 0 0 0 Jeffrey L Allport VP/Chf Information Officer 231754 0 33750 0 10237 0 34259 0 15752 0 325752 0 0 0 Timothy Elder VP Ancillary/Support Serv. 195472 0 8984 0 30449 0 0 0 1422 0 236327 0 0 0 Lori L Burnell SVP/Chief Nursing Officer 262662 0 30601 0 9079 0 37162 0 15845 0 355349 0 0 0 Jonathan Wu VP-Human Resources 222789 0 32445 0 8001 0 32639 0 1008 0 296882 0 0 0 Somasundaram Devadason Pharmacist 241333 0 0 0 0 0 10594 0 6095 0 258022 0 0 0 Jeremy Redin Former Assistant CFO 210435 0 18000 0 9741 0 6223 0 18545 0 262944 0 0 0 Starr K Williams III Pharmacist 195447 0 0 0 12608 0 8157 0 6825 0 223037 0 0 0 Darryl Toy Director, Pharmacy 185647 0 16222 0 1451 0 9901 0 599 0 213820 0 0 0 Dena L Decker Director, Qlty & Ptnt Sfty 176147 0 15391 0 513 0 6522 0 6398 0 204971 0 0 0 Part I, Lines 4a-b DURING CALENDAR YEAR 2015, VALLEY PRESBYTERIAN HOSPITAL HAD A 457(F) PLAN. THE FOLLOWING ARE OFFICERS AND KEY EMPLOYEES THAT PARTICIPATED IN THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: GUSTAVO VALDESPINO - $184,975 JEAN O'KEEFE RICO - $76,961 LORI CARDLE - $78,711 GAYATHRI JITH - $71,820 PEGI MATSUDA - $52,331 JONATHON WU - $35,860 JEFFREY ALLPORT - $37,171 LORI BURNELL - $49,855 Jeremy redin - $9,667 During Calendar Year 2015, Valley Presbyterian Hospital had a key employee, Timothy Elder, who received a severence payment of $19,823. This amount was reported on his W-2. Part I, Line 6 VALLEY PRESBYTERIAN HOSPITAL has an Incentive (Bonus) plan for Executive Team members and HOSPITAL DEPARTMENT Directors. Payment of any bonus is contingent on several criteria, EBIDA, QUALITY, AND PATIENT SATISFACTION OF WHICH ARE BENCHMARKED BY ACHIEVING SPECIFIC METRICS ON AN ANNUAL BASIS. FORM 990, PART III, LINE 4A: In FY16, VPH provided community benefit activities and programs within its service area. A summary of these activities follows. Community Health Improvement Services: The hospital's community education programs are designed to meet the significant community health needs. During the fiscal year, 5,056 people participated in one or more of the hospital's free community education programs. Community Health Education/Community-Based Clinical Services: Women's Services - VPH offered a number of free community education programs to women and to their families to help them experience a safe pregnancy and childbirth. During the past year, more than 2,234 women and their families attended community classes on: 1) childbirth preparation, 2) caring for a new baby, and 3) breastfeeding support. A majority of women's services classes are held in English and in Spanish. Chronic Disease Education - VPH held workshops on diabetes awareness and heart health in English and Spanish. Heartsaver CPR classes were also offered. More than 65 community residents attended these free community workshops during the fiscal year. Healthy Aging - The hospital offered low-impact exercise classes for seniors living with chronic pain. The senior exercise classes were held twice a week and had 2,687 class visitors. As a result of the Healthy Maturity classes, participants identified changes they would make to their lives to include, increasing their physical activity, and stretching and reducing their stress levels. Community Health Fairs - The hospital hosted its annual Health and Wellness Community Fair on October 8, 2016. There were 975 attendees and 160 employee volunteers. The participants received 1,650 free screenings and 200 children participated in a health education activity. Over 1,200 pieces of fresh produce were distributed to attendees plus each attendee was offered a healthy luncheon meal. During the community health fair, there was a health cooking demonstration from the hospital's Dietary Director. Presentations were offered on diabetes awareness and the signs and prevention of stroke. VPH also participated in the Children's Community School Fair, Los Angeles Valley College Health Fair, Latino Expo, Successful Aging Expo, and Health Screenings at Curacao at the Panorama Mall. At these community events, more than 700 persons received free health screenings. VPH Cares - This community magazine was distributed twice during the fiscal year and included stories and educational information on living a healthy lifestyle, healthy cooking and eating, physical activity, heart health, first aid, cancer prevention and other important health education topics. The magazine was mailed to more than 31,269 homes within a five-mile radius of the hospital. Health Care Support Services: Patient Transportation - Transportation assistance (bus tokens and taxi vouchers) was provided to over 1,439 patients and families with limited resources to support access to care. VPH launched transportation van service available free of charge to community residents needing a ride to and from the hospital and to and from a community clinic. Insurance Enrollment - These services were provided to assist patients with government sponsored health insurance coverage programs. The hospital employed enroller assisted patients primarily with Medi-Cal coverage. During the fiscal year, the hospital enrolled more than 2,963 persons in one or more government-sponsored insurance coverage programs. Psychiatric Care - VPH financed inpatient mental health care services at a trusted community partner. In FY16, VPH supported inpatient mental health care for 146 vulnerable patients who needed intensive psychiatric care. Health Professions Education: Education programs for physicians, nurses, nursing students, and other health professionals were offered by the hospital throughout the fiscal year. Continuing Education for Physicians and Other Health Providers - Valley Presbyterian Hospital hosted medical education events made available to physicians and health providers among the hospital staff and the provider community. More than 879 health care providers attended medical education events hosted by the hospital. Nursing Education - The hospital provided preceptors for nursing students this past year. One Clinical Nurse Specialist student from California State University, Dominguez Hills participated in a clinical rotation. Student nurses in the leadership and management tracks from California State University, Dominguez Hills and California State University, Northridge worked with hospital preceptors. Valley Simulation Laboratory - The Valley Simulation Laboratory at Valley Presbyterian Hospital provides high-fidelity mannequins that are designed to simulate patient situations and responses. The Laboratory is designed to model Labor & Delivery and the Intensive Care Unit. VPH partnered with local nursing programs to provide nursing students with a link from classroom learning to hands-on medical applications in a no-risk environment. The Simulation Laboratory was used 80 times in the past year. Other Health Professions Education - The hospital also provided preceptors for 111 students in various health care disciplines: -17 Respiratory Therapy students from Concorde Career College and Los Angeles Valley College completed clinical internships. -1 student dietician from California State University Northridge completed a clinical internship. -1 public health student from California State University Northridge participated in a precepted clinical rotation. -28 podiatric medical students from Western University of Health Sciences College of Podiatric Medicine, participated in clinical rotations. -35 Radiology Technician students from Casa Loma College, California State University Northridge, and Kaplan College completed clinical internships. -2 Health Administration students from California State University Northridge and USC completed internships. -2 Medical Laboratory Technician students from College of the Canyons completed a clinical rotation. -4 Surgical Technician students from Concorde Career College and Simi Valley Surgical Technicians School completed a clinical rotation. -2 Health Information Management students from Santa Barbara Community College obtained precepted training. Cash and In-Kind Contributions: Funds and in-kind services were donated to community groups and not for profit organizations. The support of these organizations furthered the hospital's mission and/or aligned with the ten community health needs identified through the Community Health Needs Assessment. Donated Space - The hospital donated meeting space within its facility for 23 not profit organizations and/or community forums during the fiscal year. Compassion in Action - The hospital sponsored an employee volunteer program throughout the fiscal year. Through this program, 81 employees contributed 670 hours in programs to benefit the community. Activities included feeding the homeless, conducting free community health screenings, collecting food and clothing for the homeless and donating toys to children during the holiday season, and many other activities. Although the hospital supports employee involvement, some of these activities are conducted by employees on their own time. Cash Donations - During FY16, 34 community organizations were supported by the hospital. These community organizations were partners with the hospital in the furtherance of its mission and/or alignment with needs identified through the Community Health Needs Assessment. The hospital also participated with local economic development activities in the community by participating in a number of organizations that assist small business development in neighborhoods with vulnerable populations and create new employment opportunities in areas with high rates of joblessness. In addition to supporting economic development through a commitment of leadership time, the hospital donated funds to support economic initiatives. Hospital executives also participated on a number of coalitions, committees and networks of agencies addressing common community issues. FORM 990, PART III, LINE 4A: Community Building Activities: These are activities that support community assets by offering the expertise and resources of the hospital. These activities may address the root causes of health problems, such as homelessness, poverty, and environmental concerns. Economic Development: In FY16, the hospital provided support to the Women's Entrepreneur Center and the future Young Adult Entrepreneur Center through a partnership with the Valley Economic Development Center (VEDC). The VEDC has assisted more than 104,000 businesses in creating and retaining over 19,400 jobs. Over 3,100 individuals have graduated from the Entrepreneurial Training Program at the Women's Business Center and entered the Los Angeles Form 990, Part VI, Section B, line 11 THE CFO and ASSISTANT CFO review the draft 990. Once the 990 is completed, it is reviewed with the CEO, the Board Finance committee, and board of directors prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c VPH's Board members are required to sign a conflict of interest statement. Each officer, director, and key employee of VPH is required to complete an annual conflict of interest disclosure attestation. VPH's Compliance Officer and CEO review these attestations to identify any/all conflicts that the organization must be aware of so the appropriate mitigations can be put in place. Should a Board member, officer, director, and/or key employee have a conflict with any issues being discussed or voted on at the Board of Directors, they would be asked to recuse themselves from the discussion and/or vote on the issue. Form 990, Part VI, Section B, line 15 Executive compensation is reviewed and pay actions are recommended by the compensation committee, which consists of Board and non-Board members with compensation experience, and approved by the VPH Board of Directors. The Compensation committee retains an independent consulting firm and maintains an objective decision-making process, ensuring consistency of VPH's executive programs with the organization's executive pay philosophy and overall mission and values. VPH's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to fulfill its mission of improving the quality of health in the San Fernando Valley and to ensure its financial stability. Total compensation offered to our executives includes base salary, incentive bonus, and benefits. The incentive bonus is based on key measurable success indicators approved in advance by the compensation committee. These indicators include quality, financial and patient satisfaction goals. In order to retain our key employees, we offer a deferred compensation plan which provides an annual benefit (based on a percentage of compensation) to be paid on a future date upon vesting in the plan. In determining each individual's compensation, the committee relies on comparability data provided by our independent consultant and obtained from several data sources including: Forms 990 of select comparator organizations (28 California-based, similarly-sized nonprofit hospitals) and a number of well-regarded national healthcare surveys. Form 990, Part VI, Section C, line 19 Upon request at the hospital location. FORM 990, PART VII, SECTION A: BUSINESS TRANSACTIONS WITH INTERESTED PERSONS: Peter Koetters, MD and Sukshma Sreepathi, MD are both members of the board, each devoting an average of 0.80 hours per week relating to their activities associated with serving on the Board of Directors. The reportable compensation related to professional medical administrative services provided to the hospital is unrelated to the average number of hours per week reported on Form 990, Part VII, Section A. Form 990, Part IX, line 11g Other fees for Services: Program service expenses 17,238,157. Management and general expenses 3,842,360. Fundraising expenses 0. Total expenses 21,080,517. Physician Fees: Program service expenses 9,195,795. Management and general expenses 46,250. Fundraising expenses 0. Total expenses 9,242,045. Consulting Fees: Program service expenses 1,483,425. Management and general expenses 2,110,492. Fundraising expenses 101,140. Total expenses 3,695,057. Form 990, Part XI, line 9: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 639,563. VALLEY PRESBYTERIAN HOSPITAL FOUNDATION 15107 Vanowen Street Van Nuys CA 91405 901119606 To support VPH CA 501(c)(3) Line 11a, I VALLEY PRESBYTERIAN HOSPITAL 1 CHARITABLE REMAINDER TRUST (4) Charitable Giving CA Valley Presbyterian Hospital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0