2016-08-15T16:00:41-05:00 2015-09-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-10-01 941502014 SOUTHERN MONTEREY COUNTY MEMORIAL HOSP DBA GEORGE L MEE MEMORIAL HOSPITAL SOUT 8313856000 300 CANAL STREET KING CITY CA 93930 SUSAN M CHILDERS CEO 8313856000 2016-08-15 1 RENIE BURBANK P00159653 4159561500 2014 2016-09-27 15:27:22Z MEE MEMORIAL HOSPITAL SUSAN M CHILDERS 300 CANAL STREET KING CITY CA 93930 67036410 0 X WWW.MEEMEMORIAL.COM X 1964 CA THE HOSPITAL PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. 6 4 579 40 0 0 219008 269549 61990404 65319619 8881 15752 2613957 1403304 64832250 67008224 84450 0 0 0 36661266 36275641 0 0 0 31322514 27792318 68068230 64067959 -3235980 2940265 37354947 38099910 39508949 37313633 -2154002 786277 THE HOSPITAL PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. 0 0 55627964 THE HOSPITAL, IS A 119-BED LICENSED FACILITY THAT PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. TYPES OF CARE OFFERED ARE ACUTE, LONG-TERM, AND RURAL HEALTH CLINIC SERVICES. OVER THE FISCAL YEAR, TOTAL PATIENT DAYS WERE 22,036. THE EMERGENCY SERVICE HAD OVER 13,000 VISITS AND OTHER SERVICES HAD OVER 30,000 OTHER OUTPATIENT VISITS DURING THE FISCAL YEAR. 55627964 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 224 0 1 579 1 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CA X STEPHEN OMTA 8313857162 300 CANAL STREET KING CITY CA 93930 X BUTTGEREIT JANET CHAIRMAN 2.00 X X 0 0 0 SCHINDELHEIM MD ROY VICE-CHAIRMAN 2.00 X X 251992 0 43494 BORZINI ROGER SECRETARY/TREASURER 2.00 X X 0 0 0 BUMBALOUGH PAULETTE TRUSTEE 2.00 X 0 0 0 EDDINGTON ROBERT TRUSTEE 2.00 X 0 0 0 NASH SARAH TRUSTEE 2.00 X 0 0 0 UKATU MD CHIDI CHIEF OF STAFF 2.00 X 0 0 0 SMITH LEX THRU 2014 CHIEF EXECUTIVE OFFICER 50.00 X X 306426 0 35319 CHILDERS SUSAN CHIEF EXECUTIVE OFFICER 50.00 X X 226886 0 34633 HRITZ KEN CHIEF OPERATING OFFICER 50.00 X 189796 0 31494 WONG KAREN CHF HUMAN RESOURSE OFF'R 50.00 X 165637 0 14358 SALAMACHA RENA CHIEF INFORMATION OFFICER 50.00 X 157696 0 42997 SILVA NANCY STAFF NURSE II OB 40.00 X 151586 0 928 GRASSO LAURIE STAFF NURSE II ER 40.00 X 150117 0 1435 FARRELL IAN PHYSICIAN ASSISTANT 40.00 X 149593 0 16126 MCKINNEY SHERRIE CHIEF NURSING OFFICER 40.00 X 147857 0 1542 ROBEY LAURA NURSE PRACTITIONER 40.00 X 141842 0 31494 2039428 0 253820 74 0 1 0 XTEND HEALTHCARE PO BOX 1709 HENDERSONVILLE TN 37077 PATIENT AR BILLING & COLLECTIONS AGENCY 1547157 MONTEREY ANESTHESIA PROFESSIONALS 1522 CONSTITUTION BLVD 123 SALINAS CA 93905 MEDICAL SERVICES 1350529 CHIDI UKATU MD INC 10521 RUTHELEN STREET LOS ANGELES CA 90047 MEDICAL SERVICES 815165 LETITIA BRADFORD MD 7485 RUSH RIVER SUITE 710-323 SACRAMENTO CA 95831 MEDICAL SERVICES 546805 JOHN FEJES MD 25685 MORSE DR CARMEL CA 93923 MEDICAL SERVICES 418604 39 161356 71062 37131 269549 PATIENT SERVICE REV. 621400 65319619 65319619 65319619 15752 15752 49834 28186 21648 21648 21648 OTHER OPERATING INCOME 900099 1322016 1322016 REBATES/REFUNDS 900099 59640 59640 1381656 67008224 65319619 0 1419056 X 1269622 41319 1228303 22135580 21309041 826539 264549 241323 23226 10120693 9232155 888538 2485197 2267011 218186 50891 50891 157812 157812 92237 92237 3280 3280 13791602 11963608 1827994 25349 25349 84577 72918 11659 604554 604554 1080891 1036644 44247 109277 103220 6057 139854 133797 6057 1345736 1345736 2086868 2086868 515511 515511 MEDICAL SUPPLIES 3873411 3869966 3445 OTHER EXPENSES 3830468 2754583 1075885 64067959 55627964 8439995 0 175927 1978354 9696863 9248004 938779 832275 460409 373963 49246299 26303530 23725298 22942769 22669 22683 2335002 2701862 37354947 38099910 8688291 8014246 389297 9523500 9152661 15095899 14863390 751616 694765 5060346 4588571 39508949 37313633 X -2154002 786277 -2154002 786277 37354947 38099910 2940265 14 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3280 3280 0 PART II-B, LINE 1: CA HOSPITAL ASSOC ADVOCACY PARTICIPATION. LOBBYING EXPENDITURE OF $3,280 WAS BASED ON 2015 DUES. TOTAL AMOUNT OF DUES WAS $23,246 OF WHICH 14.11% IS IDENTIFIED FOR DIRECT LOBBYING EXPENSES. 512182 512182 27288382 12491382 14797000 15943878 13172955 2770923 5501857 639193 4862664 22942769 OTHER RECEIVABLES 1643918 ASSETS LIMITED AS TO USE 365 OTHER ASSETS 30955 THIRD PARTY SETTLEMENTS 922494 DEPOSITS 104130 2701862 ACCRUED INTEREST PAYABLE 367572 SELF INSURED HEALTH CARE CLAIMS 452368 LITIGATION RESERVE 1014354 ASSEMBLY BILL 97 CLAWBACK LIAB 2185539 PROFESSIONAL FEES 57700 INCURRED CLAIMS PAYABLE 243200 CAPITAL LEASES 267838 4588571 X 67036424 14 14 67036410 -28186 -28186 67008224 64096145 28186 28186 64067959 0 64067959 PART X, LINE 2: THE HOSPITAL ASSESSES UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE PROVISIONS OF THE FASB ACCOUNTING STANDARD CODIFICATION ("ASC") TOPIC 740-10, INCOME TAXES. THE HOSPITAL RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE THAN 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. THE HOSPITAL RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2015 AND 2014, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF RENTAL EXPENSES TO REVENUE -28,186. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF RENTAL EXPENSES TO STATEMENT OF REVENUE 28,186. 1 1 X 1 X 1 X 100.000000000000 1 1 0 1 1 1228135 1228135 0.01920 27 13579 7385172 7315574 69598 0.00110 25675542 19244109 6431433 0.10040 27 13579 34288849 26559683 7729166 0.12070 1 9467 118211 79394 38817 0.00060 1 9467 118211 79394 38817 0.00060 28 23046 34407060 26639077 7767983 0.12130 1 137688 137688 0.00210 1 137688 137688 0.00210 1 4810827 1950000 7038193 7652535 -614342 X 1 1 1 1 GEORGE L MEE MEMORIAL HOSPITAL 300 CANAL STREET KING CITY CA 93930 HTTP://MEEMEMORIAL.COM/ 070000047 X X X GEORGE L MEE MEMORIAL HOSPITAL 1 1 0 0 1 0 1 X 100.000000000000 100.000000000000 X X X X 1 1 X X X 1 X WWW.MEEMEMORIAL.COM X 1 X 1 X X X X X X 1 X 0 1 GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: SURVEY QUESTIONNAIRES & DIRECT INTERVIEWS WITH CLERGY COUNCIL, CHAMBER OF COMMERCE, ROTARY CLUB, CITY COUNCIL AND COMMUNITY FOCUS GROUPS. GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: MMH IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AS FOLLOWS:- INVASIVE CARDIOLOGY - REFERRED TO OTHER HOSPITALS- GASTROENTEROLOGY - WORKING ON IMPLEMENTATION OF GI SERVICES- MENTAL HEALTH - WORKING WITH COUNTY BEHAVIORAL HEALTH SERVICES- KIDNEY, LIVER & HEART TRANSPLANTS - REFERRED TO OTHER HOSPITALS- CANCER/ONCOLOGY - REFERRED TO OTHER HOSPITALS GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: MEANS USED TO DETERMINE THE AMOUNTS BILLED TO UNINSURED INDIVIDUALS FOR EMERGENCY CARE:FOR ALL UNINSURED PATIENTS ABOVE 100% OF THE CURRENT FEDERAL POVERTY LEVEL, SEVERAL PAYMENT OPTIONS WILL BE PRESENTED, AS FOLLOWS:A. PROMPT PAY DISCOUNT: OFFER A 25% DISCOUNT IF THE ACCOUNT IS PAID IN FULL AT TIME OF SERVICE.B. PAYMENT PLAN: OFFER A 15% DISCOUNT IF THE PATIENT SIGNS AN AGREEMENT REPRESENTING THAT HE/SHE WILL MEET A PAYMENT PLAN THAT WILL PAY THE BALANCE IN FULL WITHIN 6 MONTHS AT NO INTEREST.C. CCS EARLY-OUT: IF THE PATIENT REJECTS EACH OF THE ABOVE OPTIONS, THE ACCOUNT WILL BE SENT TO CCS FOR "EARLY-OUT" COLLECTIONS FOR 90 DAYS. THIS "EARLY-OUT" PROCESS DOES NOT INCLUDE REPORTS TO CREDIT BUREAUS. AT THE END OF THE 90 DAYS, THE ACCOUNT WILL BE RETURNED TO THE HOSPITAL TO BE REVIEWED FOR POTENTIAL BAD DEBT WRITE-OFF AND COLLECTIONS REPORTING. GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: HOSPITAL PREPARED A BILLING WITH GROSS CHARGES AS ALL PATIENTS WOULD RECEIVE. ANY GROSS CHARGES WOULD THEN BE CREDITED TO CHARITY WHEN A PATIENT WAS DETERMINED TO BE ELIGIBLE. THAT PROCESS IS CONSISTENT WITH HFMA STATEMENT 15 PART V, SECTION B, LINE 12A MEE MEMORIAL HOSPITAL (MMH) CONDUCTED CHNA DURING 2012 WHICH IS REFLECTED IN ANNUAL REPORT, COMMUNITY BENEFIT REPORT, AND MARKET UPDATE/STRATEGY CONNECTIONS REPORT. THE DATA INCLUDES THE COMMUNITY SERVED, DEMOGRAPHICS, INTERVIEWS THE VARIOUS ORGANIZATION AND FOCUS GROUPS, ETC. MMH HAS FAILED TO ADOPT A CHNA REPORT THAT CONTAINS ALL OF THE ELEMENTS REQUIRED BY 1.501(R)-3. THEY HAVE ENGAGED A FIRM TO CORRECT THE FAILURE BY PREPARING AND ADOPTING A CHNA REPORT CONTAINING ALL OF THE REQUIRED ELEMENTS AND MAKING THE CORRECTED CHNA REPORT MADE WIDELY AVAILABLE TO THE PUBLIC (I.E., POSTED A WRITTEN REPORT OF THE CHNA AT THE FACILITY AND ON THEIR WEBSITE) WITHIN THE MEANING OF 1.501(R)-1(C)(4). MMH HAS FAILED TO ADOPT AND IMPLEMENT A CHNA WAS NEITHER WILLFUL NOR EGREGIOUS AND HAVE TAKEN MEASURES TO MEET THE REQUIREMENTS BEFORE THE END OF THEIR FISCAL YEAR 2016. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.MEEMEMORIAL.COM 5 KING CITY CLINIC 210 CANAL STREET KING CITY CA 93930 OUTPATIENT CLINIC SPECIALTY CLINIC 400 CANAL STREET SUITE B KING CITY CA 93930 OUTPATIENT CLINIC FAMILY MEDICAL CENTER 400 CANAL STREET SUITE A KING CITY CA 93930 OUTPATIENT CLINIC THE WOMEN'S CENTER 400 CANAL STREET SUITE C KING CITY CA 93930 OUTPATIENT CLINIC GREENFIELD CLINIC 467 S EL CAMINO REAL GREENFIELD CA 93927 OUTPATIENT CLINIC PART I, LINE 7: COST TO CHARGE RATIO WAS USED TO CALCULATE THE COMMUNITY BENEFIT EXPENSE ON PART I, LINE 7B. PART II, COMMUNITY BUILDING ACTIVITIES: ONLY HOSPITAL IN THE SOUTHERN PART OF THE COUNTY FOR A 50 MILE RADIUS SERVING A LARGE AGRICULTURAL AREA WITH MANY MEDICALLY INDIGENT AND UNDOCUMENTED RESIDENTS.THE HOSPITAL PROVIDES MANY SERVICES FOR THE COMMUNITY: ED, ICU, OR, OBSTETRICAL & DELIVERY, DIALYSIS, IMAGING, LAB, PHARMACY & PHYSICAL/REHAB. THE ONLY SNF TO DP/SNF IN THE AREA. PROVIDES TWO RURAL HEALTH CLINICS FOR THE PSA. MMH HAS AN OPEN MEDICAL STAFF. THE BOARD IS PRIMARILY COMPRISED ON COMMUNITY MEMBERS. MMH PROMOTES COMMUNITY HEALTH BY CONTRACTING WITH THE COUNTY OF MONTEREY TO PROVIDE CONGREGATE MEALS TO THE ELIGIBLE ADULTS IN THE SOUTH MONTEREY COUNTY UNDER THE MONTEREY COUNTY ELDERLY NUTRITION PROGRAM. WORKFORCE DEVELOPMENT COMMUNITY BUILDING ACTIVITY OF WORKFORCE DEVELOPMENT PROMOTED THE HEALTH OF THE COMMUNITY WITH PHYSICIAN RECRUITMENT. PART III, LINE 4: METHODOLOGY USED: BASED ON COST TO CHARGE RATIO.RATIONALE: THAT PORTION OF GROSS CHARGES THAT WOULD NORMALLY BE ADJUSTED FOR CONTRACTUAL ALLOWANCES IF THIS UNINSURED OR UNDER-INSURED GROUP COULD ACCESS CONTRACTUAL DISCOUNTS & THEN APPLYING A COST TO CHARGE RATIO TO ARRIVE AT THE HOSPITAL'S COST OF PROVIDING THAT CARE.NET PATIENT ACCOUNTS RECEIVABLE/BAD DEBTS EXPENSE FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: PATIENT ACCOUNTS RECEIVABLE CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES, AND PRIVATE PATIENTS. THE HOSPITAL'S PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCES FOR BOTH CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THESE ALLOWANCES.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PAYMENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. 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 ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS DECREASED FROM 6.8 MILLION DOLLARS AT SEPTEMBER 30, 2014 TO 5.3 MILLION DOLLARS AT SEPTEMBER 30, 2015. THE HOSPITAL HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2015 OR 2014. PART III, LINE 8: SHORTFALL EXPLANATION: UNFUNDED COSTS FOR DIRECT PATIENT CARE.COSTING METHODOLOGY: CALCULATED COST TO CHARGE RATIO APPLIED UNIFORMILY TO ALL PAYERS. PART III, LINE 9B: COLLECTION PRACTICES FOR QUALIFIED PATIENTS:IT IS THE POLICY OF GEORGE L. MEE MEMORIAL HOSPITAL TO PROVIDE EXCELLENT CUSTOMER SERVICE TO ALL PATIENTS, AND ASSIST ALL UNINSURED PATIENTS WITH OBTAINING COVERAGE FROM GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICARE, MEDI-CAL, AND CENTRAL COAST ALLIANCE FOR HEALTH, AND HEALTHY FAMILIES. IF SUCH COVERAGE IS NOT AVAILABLE TO THE PATIENT, THE HOSPITAL WILL PROVIDE APPROPRIATE HEALTHCARE TO THE PATIENT, AND THE HOSPITAL WILL PROVIDE FINANCIAL ASSISTANCE BASED ON THE CURRENT FEDERAL POVERTY LEVEL, AND PER THE HOSPITAL'S POLICY, IN ACCORDANCE WITH CALIFORNIA STATE LAW, EMTALA, AND MEDICARE REGULATIONS. FURTHER, SELF-PAY PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BASED ON INCOME WILL BE PROVIDED WITH SEVERAL OPTIONS FOR PAYMENT OF THEIR BILLS. IT IS THE HOSPITAL'S POLICY TO:- ASSIST ALL UNINSURED PATIENT WITH OBTAINING COVERAGE FROM GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICARE, MEDI-CAL, CENTRAL COAST ALLIANCE FOR HEALTH, AND HEALTHY FAMILIES.- PROVIDE ALL MEDICALLY NECESSARY HEALTH CARE SERVICES AT NO COST TO ELIGIBLE PATIENTS WHOSE FAMILY'S INCOME IS BELOW 100% OF THE CURRENT FEDERAL POVERTY LEVEL.- PROVIDE ALL MEDICALLY NECESSARY HEALTH CARE SERVICES AT A 50% DISCOUNT TO ELIGIBLE PATIENTS WHOSE FAMILY'S INCOME IS BETWEEN 101% AND 133% OF THE CURRENT FEDERAL POVERTY LEVEL. FOR THE SERVICES PROVIDED TO A PATIENT MEETING THESE CRITERIA, EXPECTED PAYMENT SHALL NOT EXCEED THE GREATER OF THE AMOUNT THAT WOULD BE EXPECTED FROM MEDICARE, MEDI-CAL, CENTRAL COAST ALLIANCE FOR HEALTH, OR HEALTHY FAMILIES FOR THE SAME SERVICES.- PROVIDE ALL MEDICALLY NECESSARY HEALTH CARE SERVICES AT A 35% DISCOUNT TO ELIGIBLE PATIENTS BETWEEN 133% AND 200% OF THE CURRENT FEDERAL POVERTY LEVEL. FOR THE SERVICES PROVIDED TO A PATIENT MEETING THESE CRITERIA, EXPECTED PAYMENT SHALL NOT EXCEED THE GREATER OF THE AMOUNT THAT WOULD BE EXPECTED FROM MEDICARE, MEDI-CAL, CENTRAL COAST ALLIANCE FOR HEALTH, OR HEALTHY FAMILIES FOR THE SAME SERVICES.- PROVIDE INTEREST-FREE PAYMENT PLANS FOR ELIGIBLE PATIENTS UNDER THIS POLICY.- FORGO REPORTS TO CREDIT BUREAUS, REFERRAL OF ACCOUNTS TO COLLECTION AGENCIES, LIENS AGAINST PROPERTY OR WAGE GARNISHMENTS FOR ELIGIBLE PATIENTS WHO ARE MEETING AN AGREED-UPON PAYMENT PLAN.- PROVIDE ADEQUATE NOTICE OF THIS POLICY IN ALL ADMITTING AND RECEPTION AREAS.- OFFER FREE FINANCIAL COUNSELING TO ALL UNINSURED PATIENTS FOR FINANCIAL MATTERS RELATED TO THEIR HOSPITAL BILLS.- FOR ALL UNINSURED PATIENTS ABOVE 100% OF THE CURRENT FEDERAL POVERTY LEVEL, SEVERAL PAYMENT OPTIONS WILL BE PRESENTED, AS FOLLOWS:A. PROMPT PAY DISCOUNT: OFFER A 25% DISCOUNT IF THE ACCOUNT IS PAID IN FULL AT TIME OF SERVICE.B. PAYMENT PLAN: OFFER A 15% DISCOUNT IF THE PATIENT SIGNS AN AGREEMENT REPRESENTING THAT HE/SHE WILL MEET A PAYMENT PLAN THAT WILL PAY THE BALANCE IN FULL WITHIN 6 MONTHS AT NO INTEREST.C. CCS EARLY-OUT: IF THE PATIENT REJECTS EACH OF THE ABOVE OPTIONS, THE ACCOUNT WILL BE SENT TO CCS FOR "EARLY-OUT" COLLECTIONS FOR 90 DAYS. THIS "EARLY-OUT" PROCESS DOES NOT INCLUDE REPORTS TO CREDIT BUREAUS. AT THE END OF THE 90 DAYS, THE ACCOUNT WILL BE RETURNED TO THE HOSPITAL TO BE REVIEWED FOR POTENTIAL BAD DEBT WRITE-OFF AND COLLECTIONS REPORTING. PART VI, LINE 2: NEEDS ASSESSMENT: MEE MEMORIAL WORKED WITH AN OUTSIDE CONSULTING FIRM, MOSS ADAMS, LLP (MOSS ADAMS) TO DEVELOP BOTH THE CHNA AND IMPLEMENTATION PLAN. MEE MEMORIAL WORKED WITH MOSS ADAMS TO COLLECT DEMOGRAPHIC AND MARKET AREA INFORMATION, INTERVIEW COMMUNITY MEMBERS AND PRIORITIZE KEY COMMUNITY HEALTH NEEDS. THE PROCESS BEGAN BY REVIEWING PRIOR MARKET ASSESSMENT REPORTS AND VARIOUS OTHER STUDIES/REPORTS PRODUCED BY OR FOR MEE MEMORIAL WITHIN THE PAST TWO YEARS. MOSS ADAMS THEN WORKED TO ANALYZE CURRENT DEMOGRAPHIC DATA FOR THE SERVICE AREA POPULATION, INCLUDING POPULATION SIZE AND GROWTH PROJECTIONS, AGE DISTRIBUTION, RACIAL AND ETHNIC DIVERSITY, SOCIOECONOMIC FACTORS AND HEALTH STATUS INDICATORS. IN CONJUNCTION WITH MOSS ADAMS, MEE MEMORIAL UTILIZED THESE KEY FINDINGS TO DEVELOP A PRIORITIZED LIST OF COMMUNITY HEALTH NEEDS AND CREATE THE CHNA AND RESPECTIVE IMPLEMENTATION PLAN. MOSS ADAMS UTILIZED THE FOLLOWING DATA SOURCES TO COMPLETE THE REPORT.MEE MEMORIAL MARKET DATAPREVIOUSLY CONDUCTED MEE MEMORIAL STRATEGIC PLANSCOMMUNITY MEMBER INTERVIEWS CONDUCTED BY MEE MEMORIAL HOSPITALTHE NIELSEN COMPANYBUREAU OF LABOR STATISTICSCENTERS FOR DISEASE CONTROL AND PREVENTIONU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCOUNTY HEALTH RANKINGSOFFICE OF STATEWIDE HEALTH PLANNING (OSHPD)THE MEE MEMORIAL IMPLEMENTATION PLAN WAS DEVELOPED BASED ON IDENTIFIED NEEDS AND SHORT-TERM AND LONG-TERM STRATEGIC GOALS FOR MEE MEMORIAL. THE IMPLEMENTATION PLAN ALIGNS WITH AND EXPANDS UPON CURRENT ORGANIZATIONAL STRATEGIES AND PROGRAMS. THE IMPLEMENTATION PLAN WILL BE FILED WITH THE INTERNAL REVENUE SERVICE USING FORM 990 SCHEDULE H. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UPON PRESENTATION TO OUR ADMITTING PROCESS, ONCE THE PATIENT IDENTIFIES THEY ARE WITHOUT INSURANCE, WE INFORM/EDUCATE THEM ABOUT THEIR OPTIONS WITH GOVERNMENT PROGRAMS AND PROVIDE CONTACT INFORMATION TO ACCESS THOSE PROGRAMS. ADDITIONALLY, WE PROVIDE THE PATIENT WITH OUR POLICIES RELATED TO CHARITY AND A CHARITY APPLICATION SHOULD THEY WISH TO PURSUE THAT ASSISTANCE. PART VI, LINE 4: COMMUNITY INFORMATION: THE PRIMARY SERVICE AREA (PSA) IS SOUTHERN MONTEREY COUNTY AND THE SALINAS VALLEY COMPRISED OF THE FOLLOWING COMMUNITIES: KING CITY, GREENFIELD, SAN ARDO, LOCKWOOD, JOLON, SAN LUCAS & BRADLEY. THE SERVICE AREA IS SOUTH OF SALINAS, CA BY 45 MILES AND NORTH OF PASO ROBLES BY 45 MILES.THE POPULATION SIZE OF THE PSA IS ROUGHLY 40,000 WITH THE MEDIAN AGE OF 28.5 (32.5% OF 0-17 OF THE AGE GROUP, 41.6% FOR 18-44, 18.9% FOR 45-64 & 7.1% OF THE POPULATION OVER 65 YEARS OF AGE). MEDIAN HOUSEHOLD INCOME (2014) IS $51,773. RACIAL & ETHNIC DISTRIBUTION IS AS FOLLOWS: 81.2% HISPANIC OR LATINO, 14.9% WHITE & 3.9% FROM OTHER RACES. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL OWNS AND OPERATES THE FAMILY HEALTH CENTER. A GOAL OF THE CENTER IS TO PROVIDE HIGH-QUALITY, LOW-COST HEALTH CARE SERVICES TO PEOPLE WHO DO NOT OTHERWISE HAVE ACCESS WHICH MAY BE DUE TO FINANCIAL, CULTURAL, LIFESTYLE, OR PSYCHOLOGICAL BARRIERS. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES CA X X 1 0 0 0 0 0 0 1 0 SCHINDELHEIM MD ROY VICE-CHAIRMAN 226992 0 25000 0 0 0 0 0 43494 0 295486 0 0 0 SMITH LEX THRU 2014 CHIEF EXECUTIVE OFFICER 149260 0 13987 0 143179 0 3825 0 31494 0 341745 0 0 0 CHILDERS SUSAN CHIEF EXECUTIVE OFFICER 215963 0 10923 0 0 0 3139 0 31494 0 261519 0 0 0 HRITZ KEN CHIEF OPERATING OFFICER 189796 0 0 0 0 0 0 0 31494 0 221290 0 0 0 WONG KAREN CHF HUMAN RESOURSE OFF'R 165637 0 0 0 0 0 0 0 14358 0 179995 0 0 0 SALAMACHA RENA CHIEF INFORMATION OFFICER 157696 0 0 0 0 0 0 0 42997 0 200693 0 0 0 SILVA NANCY STAFF NURSE II OB 151586 0 0 0 0 0 928 0 0 0 152514 0 0 0 GRASSO LAURIE STAFF NURSE II ER 150117 0 0 0 0 0 1435 0 0 0 151552 0 0 0 FARRELL IAN PHYSICIAN ASSISTANT 149593 0 0 0 0 0 1768 0 14358 0 165719 0 0 0 ROBEY LAURA NURSE PRACTITIONER 141842 0 0 0 0 0 0 0 31494 0 173336 0 0 0 PART I, LINE 4A LEX SMITH RECEIVED A PAYMENT OF $143,179 AND THE AMOUNT WAS INCLUDED IN HIS FORM W-2. PART I, LINE 7 MEE MEMORIAL HOSPITAL'S BONUSES ARE BASED ON BOARD CRITERIA, REVIEW & APPROVAL OF THE FOLLOWING FACTORS: FINANCIAL PERFORMANCE ENHANCED PROGRAM & SERVICES PHYSICIAN RECRUITMENT & RETENTION PERFORMANCE IMPROVEMENT/QUALITY STANDARDS REGULATORY & ACCREDITATION COMPLIANCE CHIDI UKATU MD INC CHIEF OF STAFF 620602 MEDICAL SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11 INTERNAL STAFF GATHERED, REVIEWED & COMPILED INFORMATION PROVIDED TO THE TAX PREPARER. TAX PREPARER GUIDED AND ADVISED CLIENT ON ANY ISSUE IN QUESTION. TAX PREPARER SUBMITS A COMPLETED FORM 990 FOR FINAL REVIEW AND APPROVAL. MMH PROVIDED AN ELECTRONIC COPY OF THE FINAL FORM 990 (INCLUDING ALL REQUIRED SCHEDULES) TO EACH VOTING MEMBER OF THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MONTEREY COUNTY MEMORIAL HOSPITAL HAS A CORPORATE POLICY ON CONFLICT OF INTEREST. THIS POLICY APPLIES TO ALL INTERESTED PERSONS WHO ARE AS FOLLOWS: A. TRUSTEES B. MEMBER OF SENIOR MANAGEMENT THE BOARD OF TRUSTEES, THE CEO, AND CFO CONTINUOUSLY MONITOR AND EVALUATE ANY AND ALL TRANSACTIONS OF INTERESTED PARTIES WITH THE HOSPITAL. IF THE CURRENT OR PAST TRANSACTION POSE A POTENTIAL RISK OF BEING A CONFLICT OF INTEREST TO THE HOSPITAL, THESE ITEM(S) WILL BE BROUGHT TO THE ATTENTION OF THE CEO, BOARD CHAIRMAN, AND OR FULL BOARD OF TRUSTEES. AFTER DISCLOSURE OF A POTENTIAL CONFLICT OF INTEREST TO THE BOARD, THE INTERESTED OFFICER OR BOARD MEMBER WOULD LEAVE THE BOARD MEETING WHILE THE CONFLICT OF INTEREST IS DISCUSSED AND/OR VOTED ON. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. PROVIDED, HOWEVER, IF THE INTERESTED PERSON IS AN ADMINISTRATIVE STAFF EMPLOYEE AND THE CONTEMPLATED TRANSACTION IS AT THE ADMINISTRATIVE LEVEL, THE DECISION SHALL BE MADE BY THE HOSPITAL CEO. ANY OFFICER OR BOARD MEMBER HAVING A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER MUST DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT. OFFICER OR BOARD MEMBERS SHOULD ALWAYS ABSTAIN FROM VOTING ON ANY ISSUES OF A POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS ESTABLISHED THROUGH COMPARISON TO REGIONAL SALARY SURVEY INFORMATION AND PERFORMANCE EVALUATIONS. THERE IS A PHYSICIAN COMPENSATION COMMITTEE TO SPECIFICALLY REVIEW ALL PHYSICIAN COMP. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A ROY SCHINDELHEIM, MD, DEVOTES 2 HOUR PER WEEK FOR HIS SERVICES AS A VICE CHAIRMAN OF THE BOARD OF DIRECTORS. HE DOES NOT RECEIVE COMPENSATION OR BENEFITS AS A BOARD MEMBER. DR. SCHINDELHEIM PROVIDES SERVICES AS A PHYSICIAN TO THE HOSPITAL. HE DEVOTES 40 HOURS PER WEEK AND THE COMPENSATION AND BENEFITS ARE FOR HIS SERVICES AS A PHYSICIAN. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 11,963,608. MANAGEMENT AND GENERAL EXPENSES 1,827,994. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,791,602. FORM 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT: THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.