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THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. 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X X true true X X X true X X true X X X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 - ENCINO & SHERMAN OAKS THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE LOCAL COMMUNITY. SUCH INPUT WAS RECEIVED FROM HOSPITALS, COMMUNITY HEALTH CARE LEADERS AND BUSINESS LEADERS. THE HOSPITAL FACILITY ALSO SOUGHT INPUT FROM COMMUNITY BASED ORGANIZATIONS SUCH AS THE VALLEY ECONOMIC ALLIANCE AND VARIOUS PUBLIC ENTITIES. THE HOSPITAL FACILITY CONSULTED THE "PERSONS" THROUGH IN PERSON INTERVIEWS, BY TELEPHONE AND OTHER MEANS. SCHEDULE H, PART V, SECTION B, LINE 6A - ENCINO & SHERMAN OAKS PARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESMENT SURVEYS INCLUDE GLENDALE ADVENTIST HOSPITAL, HENRY MAYO NEWHALL MEMORIAL HOSPITAL, KAISER PERMANENTE PANORAMA CITY, KASIER PERMANENTE WOODLAND HILLS, MISSION CITY COMMUNITY HOSPITAL, VALLEY PRESBYTERIAN HOSPITAL, NORTHRIDGE HOSPITAL MEDICAL CENTER, PROVIDENCE HOLY CROSS, PROVIDENCE SAINT JOSEPH MEDICAL CENTER, AND PROVIDENCE TARZANA. SCHEDULE H, PART V, SECTION B, LINE 16I - ENCINO & SHERMAN OAKS OTHER MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED IS THROUGH FINANCIAL COUNSELING IF IDENTIFIED AS UNDERINSURED. SCHEDULE H, PART V, SECTION B, LINE 22D - ENCINO & SHERMAN OAKS THE HOSPITAL FACILITY APPLIES PRIME CHARITY CARE AND DISCOUNT POLICIES TO INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. SCHEDULE H, PART V, SECTION B, LINE 2 - HUNTINGTON BEACH PRIME HEALTHCARE SERVICES, INC. CONTRIBUTED PRIME HEALTHCARE HUNTINGTON BEACH, LLC, DBA HUNTINGTON BEACH HOSPITAL ("HBH"), TO PRIME HEALTHCARE FOUNDATION, INC. (THE "FOUNDATION") ON DECEMBER 31, 2012, AND THE FOUNDATION EFFECTIVELY TOOK OWNERSHIP OF HBH ON JANUARY 1, 2013. AS A RESULT, THE LAST DAY OF THE FOUNDATION'S SECOND TAXABLE YEAR OF OWNERSHIP BEGINNING AFTER SUCH DATE IS DECEMBER 31, 2015, AND HBH EXPECTS TO HAVE COMPLETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT BY THAT DATE. SCHEDULE H, PART V, SECTION B, LINE 2 - PAMPA PRIME HEALTHCARE SERVICES, INC. CONTRIBUTED PRIME HEALTHCARE SERVICES - PAMPA LLC, DBA PAMPA REGIONAL MEDICAL CENTER (PRMC), TO PRIME HEALTHCARE FOUNDATION, INC. (THE "FOUNDATION") ON DECEMBER 31, 2013, AND THE FOUNDATION EFFECTIVELY TOOK OWNERSHIP OF PRMC ON JANUARY 1, 2014. AS A RESULT, THE LAST DAY OF THE FOUNDATION'S SECOND TAXABLE YEAR OF OWNERSHIP BEGINNING AFTER SUCH DATE IS DECEMBER 31, 2016 AND PRMC EXPECTS TO HAVE COMPLETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT BY THAT DATE. SCHEDULE H, PART V, SECTION B, LINE 5 - MONTCLAIR A SURVEY WAS DISSEMINATED TO THE COMMUNITY VIA ONLINE ACCESS THROUGH THE HOSPITAL'S WEBSITE AS WELL AS BEING DISTRIBUTED BY THE ADVISORY COMMITTEE MEMBERS ACROSS THE COMMUNITY, IN BOTH ENGLISH AND SPANISH VERSIONS. THE SURVEY REACHED PATIENTS AND COMMUNITY MEMBERS OF ALL AGES AND BACKGROUNDS. A TOTAL OF 38 SURVEYS WERE COLLECTED. EXTENSIVE INTERVIEWS WITH COMMUNITY LEADERS THAT WOULD BE ABLE TO ADDRESS AND FURTHER DESCRIBE THE NEEDS OF THE COMMUNITY WERE CONDUCTED. A FOCUS GROUP OF SPANISH-SPEAKING HEALTH PROVIDERS WAS ALSO CONDUCTED. THE GROUP CONSISTED OF SIX MEMBERS OF THE POR LA VIDA "CONSEJERA" STAFF. THESE WOMEN ACT AS HEALTH EDUCATORS, PROVIDING EDUCATIONAL AND ADVOCACY SERVICES. SEVERAL COMMUNITY REPRESENTATIVES WERE INTERVIEWED EITHER IN PERSON OR BY TELEPHONE, INCLUDING THE MAYOR PRO TEM OF MONTCLAIR, AND A LOCAL NON-PROFIT BOARD MEMBER. SCHEDULE H, PART V, SECTION B, LINE 11 - MONTCLAIR THE PRIORITIZATION PROCESS PRODUCED TWO ISSUES WITH VERY HIGH SCORES: CARE COORDINATION AND EDUCATION, WITH ANOTHER GROUP OF HIGH-PRIORITY ISSUES CLOSELY GROUPED SLIGHTLY LOWER. The Care Coordination issue is an important item to address both as a basic issue, and as a factor being emphasized by portion of the Affordable Care Act. MHMC has the opportunity to work with the Community Vital Signs Initiative to address this need in cooperation with community groups identified in the interview and focus group process. Additional coordination efforts on the part of hospitals and local medical groups are also area for study and process development. The hospital will coordinate with local providers and act as a referral source to its patients requiring follow-on care after hospitalization. To the extent resources are available in the community to monitor discharged patients, they should be utilized to avoid relapses or other conditions that might lead to re-hospitalization. Education of all types is crucial to implementation of the Affordable Care Act, since much of the growth in insured populations in the area will be driven by newly insured residents entering the realm of health insurance for the first time. While it will not be possible to get walk-in clients insured under the California Connect program after March 1, 2014, a window of opportunity exists between the current period and that deadline, as well as a chance to educate residents who miss the enrollment window about future enrollment opportunities. Also, residents who may not qualify for insurance under the ACA may have other opportunities that will need to be publicized. This is another area of opportunity for implementation of new strategies designed to bring more residents under the insurance umbrella, and hospital staff will need to monitor upcoming legislation and regulations that may provide opportunities to educate community residents regarding their insurance options. The hospital is already developing educational programs focused on specific diseases that will provide residents with methods of coping and/or curing those diseases. It should be noted that this issue resurfaced again under the label Health Information, and the issues to be addressed are similar. Heart disease was the lowest priority of the top ten issues. Since the Community Vital Signs Initiative has adopted this issue as its primary focus, MHMC should work with members of the CVSI group to coordinate efforts to address the disease. But given the greater focus on diabetes and associated issues by community members in the Montclair area, it is considered more appropriate for MHMC to focus its efforts on addressing this issue. SCHEDULE H, PART V, SECTION B, LINE 11 - ENCINO & SHERMAN OAKS ALL STRATEGIC INITIATIVES AND RECOMMENDATIONS NOTED IN THE IMPLEMENTATION STRATEGY SECTION OF THE CHNA ARE BEING ADOPTED, PROVIDED AVAILABLE RESOURCES EXIST. SCHEDULE H, PART III, SECTION A, LINE 4 SEE PAGES 9 AND 11 OF PRIME HEALTHCARE FOUNDATION, INC.'S AUDITED FINANCIAL STATEMENTS FOR DISCUSSION OF BAD DEBT EXPENSE WITHIN NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES FOR NET PATIENT SERVICE REVENUE AND ALLOWANCE FOR CONTRACTURAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS RESPECTIVELY. SCHEDULE H, PART III, SECTION C, LINE 9B - ENCINO & SHERMAN OAKS PAYMENT PLANS - BALANCES ARE DUE UPON DISCHARGE FROM THE HOSPITAL IF THE PATIENT DOES NOT QUALIFY FOR STATE ASSISTANCE OR PRIME HEALTHCARE'S FINANCIAL ASSISTANCE PROGRAM. PAYMENT ARRANGEMENTS MAY BE ESTABLISHED WITH HOSPITAL'S FINANCIAL COUNSELOR AND MAY BE MADE WITH NO INTEREST OR PENALTIES. DEFAULTING ON A PAYMENT PLAN WILL RESULT IN DISQUALIFICATION OF THIS OPTION. SCHEDULE H, PART VI, LINE 2 - ENCINO & SHERMAN OAKS NEEDS ASSESSMENT HOSPITALS PARTICIPATE IN THE TRIENNIAL SAN FERNANDO/SANTA CLARITA VALLEY COMMNUNITY NEEDS ASSESSMENT PROCESS THAT BEGAN IN 1997 AND FORMED THE PLATFORM FOR COMMUNITY PROGRAMS IMPLEMENTED IN FY 2013/2014. THE COPY OF THE 2013 COMMUNITY NEEDS ASSESSMENT PAGES 158 & 159 CONTAIN THE NAMES OF THE PARTICIPANT ORGANIZATIONS AND A DESCRIPTION OF THE COLLABORATION PROCESS, THE SURVEY'S FINDINGS, ALONG WITH VARIOUS INTERNAL AND EXTERNAL ANALYSES THAT ARE USED TO ASSIST HOSPITALS IN DETERMINING THE TYPES OF SERVICE MODIFICATIONS AND PROGRAMS THAT IT SHOULD CONSIDER TO ADDRESS THE NEEDS OF ITS COMMUNITY. BUILDING ON THAT BACKGROUND, A STRATEGIC PLAN IS CREATED AND PRESENTED TO THE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. CONSEQUENTLY, HOSPITALS PROVIDED FUNDS FOR VARIOUS LOCAL COMMUNITY ORGANIZATIONS AND CHARITIES INCLUDING THE LOCAL ALZHEIMER'S ASSOCIATION, THE SHERMAN OAKS LITTLE LEAGUE AND THE VALLEY ECONOMIC ALLIANCE. IN ADDITION, HOSPITALS PROVIDED COMMUNITY AND MEDICAL EDUCATION FREE OF CHARGE AND OPEN TO ALL PUBLIC ON THE FOLLOWING HEALTH RELATED TOPICS: BLOOD MANAGEMENT, PALLIATIVE CARE, PAIN MANAGEMENT, RENAL DISEASES. FURTHERMORE FOCUSING ON THE PUBLIC HEALTH, PREVENTION AND HOLISTIC WELL-BEING OF COMMUNITY MEMBERS, HOSPITALS INVITED NUMEROUS GROUPS AND ORGANIZATIONS TO CONDUCT FORUMS AND PUBLIC MEETINGS AT THE HOSPITALS, FREE OF CHARGE, INCLUDING: LUPUS LA, OVEREATERS ANONYMOUS, ALCOHOLICS ANONYMOUS, NEIGHBORHOOD COUNCIL, SHERMAN OAKS CHAMBER OF COMMERCE, DEBTOR'S ANONYMOUS, SUICIDE PREVENTION AND BEREAVEMENT SERVICES, LOCAL CHAPTER PF PHARMACY ASSOCIATION, NATIONAL ALLIANCE OF MENTAL ILLNESS AND OTHERS. CURRENT COMMUNITY PROGRAMS ARE CONSTANTLY REVIEWED OR ENHANCED AND IF NECESSARY, NEW COMMUNITY OUTREACH PROGRAMS ARE CREATED AND IMPLEMENTED. SCHEDULE H,PART VI,LINE 3-ENCINO,SHERMAN OAKS,HUNTINGTON BEACH & MONTCLAIR PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE A PATIENT EDUCATION PACKET IS GIVEN TO ANY PATIENT IDENTIFIED AS SELF PAY OR 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 HOSPITALS' FINANCIAL ASSISTANCE PROGRAM, REQUIRED DOCUMENTATION MUST BE SUBMITTED WITHIN 15 DAYS OF DISCHARGE FROM THE HOSPITAL. UNINSURED DISCOUNT RATE: HOSPITALS OFFER DAILY RATES FOR INPATIENT SERVICES AND A SIGNIFICANTLY REDUCED CHARGE RATE FOR OUTPATIENT SERVICES. THE DISCOUNT IS SIMILAR TO THE RATES PAID BY MEDICARE AND IS OFFERED UNDER THE UNINSURED DISCOUNT PROGRAM PAYMENT PLANS - BALANCES ARE DUE UPON DISCHARGE FROM HOSPITAL. IF THE PATIENT DOES NOT QUALIFY FOR STATE ASSISTANCE OR HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM, PAYMENT ARRANGEMENTS MAY BE ESTABLISHED WITH HOSPITAL'S FINANCIAL COUNSELOR. PAYMENT ARRANGEMENTS MAY BE MADE WITH NO INTEREST OR 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. HOSPITALS RETAIN THE SERVICES OF A VENDOR FOR DETERMINING MEDI-CAL AND COVERED CALIFORNIA ELIGIBILITY TO ASSIST PATIENTS WITH THE MEDI-CAL AND CALIFORNIA CONNECT APPLICATION PROCESS. PATIENTS MAY RECEIVE BILLS FROM OTHER BILLING COMPANIES FOR ITEMS SUCH AS PHYSICIAN CHARGES, RADIOLOGY, AND AMBULANCE SERVICES. SCHEDULE H, PART VI, LINE 4 - ENCINO & SHERMAN OAKS COMMUNITY INFORMATION HOSPITALS' TOTAL SERVICE AREA IS COMPRISED OF APPROXIMATELY 1 MILLION PERSONS WITH A FORECASTED INCREASE OF 5% BY 2016. HOSPITALS' 2014 PRIMARY SERVICE AREA (PSA) INCLUDES THE COMMUNITIES OF ENCINO, WOODLAND HILLS, RESEDA, SUN VALLEY, CANOGA PARK, GRANADA HILLS, PANORAMA CITY, SAN FERNANDO, STUDIO CITY, NORTH HOLLYWOOD, SHERMAN OAKS AND WINNETKA. THE PSA IS PART OF THE CITY OF LOS ANGELES. SCHEDULE H, PART I, LINE 7, COLUMN (F) PERCENT OF TOTAL EXPENSE BAD DEBT EXPENSE OF $60,987,935. WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. SCHEDULE H, PART III, SECTION A, LINE 2 THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 - HUNTINGTON BEACH THE COSTING METHODOLOGY WAS BASED ON THE CMS COST REPORT COMPONENTS. SCHEDULE H, PART VI, LINE 2 - HUNTINGTON BEACH (HBH) NEEDS ASSESSMENT HBH IS IN THE PROCESS OF DEVELOPING A COMMUNITY HEALTH NEEDS ASSESSMENT, USING 4 METHODOLOGIES. THE PROCESS INCLUDES THE FOLLOWING: - FOCUS GROUPS INVOLVING COMMUNITY REPRESENTATIVES SUCH AS CITY REPRESENTATIVES, COMMUNITY SOCIAL SERVICE AGENCIES, OTHER HEALTHCARE PROVIDERS AND INTERESTED CITIZENS. - PRINTED COMMUNITY NEEDS SURVEYS DISTRIBUTED TO HOSPITAL VISITORS AND CLIENTS, COMMUNITY GROUP MEETINGS, AND VARIOUS CHURCH AND SOCIAL ORGANIZATIONS. THE SURVEYS ARE AVAILABLE IN FIVE DIFFERENT LANGUAGES. - INTERVIEWS WITH KEY REPRESENTATIVES OF GOVERNMENT AGENCIES AND ETHNIC/RELIGIOUS GROUPS TO GET THEIR OPINIONS OF NEEDED SERVICES AND AVAILABLE RESOURCES TO BE COORDINATED WITH HOSPITAL SERVICES. - REVIEW OF COUNTYWIDE HEALTHCARE NEEDS SURVEYS DONE BY VARIOUS COUTYWIDE AND NATIONAL ORGANIZATIONS, INCLUDING www.ochealthiertogether.org and www.healthindicators.gov. SCHEDULE H, PART VI, LINE 4 - HUNTINGTON BEACH COMMUNITY INFORMATION The communities being served are defined by Speedtrack data provided by the hospital. According to 2014 discharge data, 75% of all discharges come from nine Zip codes, Huntington Beach (4 zip codes) 92646,92647,92648,92649, Midway City 92655, Westminster 92683, Fountain Valley 92708, Anaheim 92804, Fullerton 92832. The area contains multiple ethnic and racial communities, each with differing health and social welfare needs. It also includes many organizations providing various health and social services, which the hospital supports with financial and staff time assistance. SCHEDULE H, PART III, SECTION B, LINE 8 - PAMPA THE COSTING METHODOLOGY WAS BASED ON A CONTRACTUAL MODEL DEVELOPED BY PRIME CORPORATE WHERE ALLOWABLE COSTS ARE CALCULATED USING COSTS ACCOUNTING METHODS. SCHEDULE H, PART VI, LINE 2 - PAMPA NEEDS ASSESSMENT THE HEALTH CARE NEEDS TO THE COMMUNITIES SERVED BY PRIME HEALTHCARE SERVICES - PAMPA LLC ARE ASSESSED IN A VARIETY OF WAYS INCLUDING Questionnaires THAT are mailed out to the entire community and handed out at the facility. SCHEDULE H, PART VI, LINE 3 - PAMPA PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE To ensure that the patients are aware of the existence of the Charity Care Program, the following actions ARE taken: a) Written notice to patients. b) Posting of notices within the Emergency Department, Billing Office, Admissions Office, and other outpatient settings. c) Notice to accompany bills to potentially eligible patients. SCHEDULE H, PART VI, LINE 4 - PAMPA COMMUNITY INFORMATION Pampa is considered a rural service area servicing all surrounding counties for 60+ miles. Pampa is the second largest city in the Texas Panhandle with Pampa alone having a population of over 18,000 people and a median age of 36. Pampa and its surrounding areas have a wide array of cultural diversity with many homes having 4+ household members. A majority of community members are middle to low income and even below poverty level. SCHEDULE H, PART III, SECTION B, LINE 9B - PAMPA Pampa Regional Medical Center may use the services of an external collection agency for the collection of patient debt. No debt shall be advanced for collection until the Director of the Hospital PFS or his/her designee has reviewed the account and approved the advancement of the debt to collection. Pampa Regional Medical Center shall obtain an agreement from each collection agency that it utilizes to collect patient debt that the agency will comply with the requirements of Texas Health & Safety Code section 311.031 to 311.048. Neither Pampa Regional Medical Center nor any collection agency utilized by Pampa Regional Medical Center shall report adverse information to a consumer credit reporting agency or commence civil action against the patient for nonpayment at any time prior to 150 days after the initial billing if the patient lacks third party coverage or for a patient that provides information that he or she may qualify for the Charity Care Program. In addition, if a patient is attempting to qualify for eligibility under Pampa Regional Medical Center Charity Care Program or the Discount Payment Policy and is attempting in good faith to settle an outstanding bill with the hospital by negotiating a reasonable payment plan or making regular partial payments of a reasonable amount, Pampa Regional Medical Center shall not send the unpaid bill to any collection agency unless that entity has agreed to comply with Texas Health & Safety Code section 311.031 to 311.048. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM PRIME HEALTHCARE FOUNDATION, INC. AND ITS SUBSIDIARIES ARE THEIR OWN HEALTH SYSTEM MANAGED BY PRIME HEALTHCARE MANAGEMENT II, INC. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT THIS IS NOT APPLICABLE TO PRIME HEALTHCARE FOUNDATION, INC. AND ITS SUBSIDIARIES. SCHEDULE H, PART III, SECTION A, LINE 3 - PAMPA THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY IS THE ACTUAL BAD DEBT, CHARITY, AND POLICY DISCOUNT DEDUCTIONS FROM REVENUE AS EACH HAVE A SEPARATE ACCOUNT. SCHEDULE H, PART III, SECTION A, LINE 3 - HUNTINGTON BEACH THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS DEEMED TO BE $0 SINCE THE ACTIVITY ASSOCIATED WITH THE PATIENTS THAT ARE ELIGIBLE FOR FA IS CAPTURED AS EITHER CHARITY OR POLICY ADJUSTMENT, WHICH ARE DISTINCT FROM BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION B, LINE 8 - ENCINO & SHERMAN OAKS THE COSTING METHODOLOGY WAS BASED ON THE 2014 AS FILED MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION B, LINE 9B - HUNTINGTON BEACH & MONTCLAIR THE HospitalS may use the services of an external collection agency for the collection of patient debt. No debt shall be advanced for collection until the Director of the Hospital PFS or his/her designee has reviewed the account and approved the advancement of the debt to collection. THE HospitalS shall obtain an agreement from each collection agency that THEY utilize to collect patient debt that the agency will comply with the requirements of AB 774 and SB1276. Neither THE HOSPITAlS nor any collection agency utilized by THE HOSPITALS' reporting agency or commence civil action against the patient for nonpayment at any time prior to 150 days after the initial billing if the patient lacks third party coverage or for a patient that provides information that he or she may qualify for the Charity Care Program. In addition, if a patient is attempting to qualify for eligibility under THE HospitalS' Charity Care Program or the Discount Payment Policy and is attempting in good faith to settle an outstanding bill with the hospital by negotiating a reasonable payment plan or making regular partial payments of a reasonable amount, THE HOSPITALS shall not send the unpaid bill to any collection agency unless that entity has agreed to comply with AB 774 and SB1276. Any collection agency shall comply with any payment plan entered into by a patient. THE HospitalS shall not, in dealing with patients eligible under the Charity Care Program or the Discount Payment Policy, use wage garnishments or liens on primary residences as a means of collecting unpaid hospital bills. SCHEDULE H, PART III, SECTION B, LINE 8 THE FOLLOWING HOSPITALS USED THE COST TO CHARGE RATIO TO REPORT THE MEDICARE ALLOWABLE COSTS ON LINE 6: PRIME HEALTHCARE SERVICES - SHERMAN OAKS LLC PRIME HEALTHCARE SERVICES - MONTCLAIR LLC PRIME HEALTHCARE SERVICES - ENCINO LLC THE FOLLOWING HOSPITALS USED OTHER COSTING METHODOLOGIES TO REPORT THE THE MEDICARE ALLOWABLE COSTS ON LINE 6: PRIME HEALTHCARE HUNTINGTON BEACH LLC PRIME HEALTHCARE SERVICES - PAMPA LLC SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH ALL OF THE HOSPITALS CONDUCT OUTREACH PROGRAMS AS FURTHER DISCUSSED IN CHNA REPORTS. SCHEDULE H, PART III, SECTION A, LINE 3 - ENCINO & SHERMAN OAKS THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART 1, LINE 5A THE FOLLOWING HOSPITALS BUDGETED AMOUNTS FOR FREE OR DISCOUNTED CARE PROVIDED UNDER THE FINANCIAL ASSISTANCE POLICY DURING THE TAX YEAR: PRIME HEALTHCARE SERVICES - SHERMAN OAKS LLC PRIME HEALTHCARE SERVICES - ENCINO LLC THE FOLLOWING ORGANIZATIONS DID NOT BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE PROVIDED UNDER THE FINANCIAL ASSISTANCE POLICY DURING THE TAX YEAR: PRIME HEALTHCARE HUNTINGTON BEACH LLC PRIME HEALTHCARE SERVICES - PAMPA LLC PRIME HEALTHCARE SERVICES - MONTCLAIR LLC SCHEDULE H, PART 1, LINE 6A THE FOLLOWING HOSPITALS PREPARED A COMMUNITY BENEFIT REPORT DURING THE TAX YEAR: PRIME HEALTHCARE SERVICES - SHERMAN OAKS LLC PRIME HEALTHCARE SERVICES - ENCINO LLC THE FOLLOWING ORGANIZATIONS DID NOT PREPARE A COMMUNITY BENEFIT REPORT DURING THE TAX YEAR: PRIME HEALTHCARE HUNTINGTON BEACH LLC PRIME HEALTHCARE SERVICES - PAMPA LLC PRIME HEALTHCARE SERVICES - MONTCLAIR LLC SCHEDULE H, PART III, SECTION A, LINE 3 - MONTCLAIR Patients who qualify, and are given financial assistance, are grouped and classified within THE patient accounting systems. These actual amounts, from the actual patients, were used to determine the amount of bad debt expense attributable to THE financial assistance policy. SCHEDULE H, PART III, SECTION B, LINE 8 - MONTCLAIR The costing methodology, and resulting allowable costs, was developed by using the cost-to-charge ratio as calculated in the latest Medicare cost report filing. SCHEDULE H, PART VI, LINE 2 - MONTCLAIR NEEDS ASSESSMENT The healthcare needs of the communities served by MONTCLAIR HOSPITAL MEDICAL CENTER are assessed in a variety of ways including direct input from the community during community events, community physicians during outreach opportunities, local police and fire department and city council representation on our board of directors and telephone surveys of patients and families. SCHEDULE H, PART VI, LINE 4 - MONTCLAIR COMMUNITY INFORMATION Montclair Hospital Medical Center service area covers a population of approximately 1.1 million in 2013. Montclair is located at the western edge of San Bernardino County, California. The overall population growth of the total service area is projected to increase by 4.4% by 2018. This is slightly less than overall growth in the County of San Bernardino which is projected to increase approximately 5% by 2018. The most significant growing age group is adults 45-64. The fastest growth of the population in this geographic area is ages of 65 and over. Though this age group represents only an average of 8.8% of the total population, the large increase of the older population is important to note as this segment of the population has health requirements unique to it, including ongoing medical conditions management as well as long term care needs. Approximately 67% of the population residing in the Primary Service Area are Latino/Hispanic. In the Secondary Service Area, the Latino/Hispanic community amounts to approximately 53% of the total population. This segment of the population is forecasted to remain the largest and is expected to grow moderately through 2018. true THE VALLEY ECONOMIC ALLIANCE 5121 VAN NUYS BOULEVARD 200 SHERMAN OAKS CA 91403 954524503 501(c)(3) 20000 GENERAL SUPPORT Anc Western Region 104 N Belmont STREET glendale CA 91206 953885801 501(c)(3) 10000 GENERAL SUPPORT CITY OF HUNTINGTON BEACH PO Box 711 HUNTINGTON BEACH CA 92648 956000723 GOV AGENCY 10000 GENERAL SUPPORT GREAT BALLS OF FIRE PO Box 6792 Huntington Beach CA 92615 205098860 501(c)(3) 10000 GENERAL SUPPORT 4 SCHEDULE I, PART I, LINE 2 ALL GRANTS MADE BY THE ORGANIZATION ARE TO 501(C)(3) ORGANIZATIONS AS DETERMINED BY THE INTERNAL REVENUE SERVICE AND PUBLISHED IN PUBLICATION 78 OR GOVERNMENTAL AGENCIES. RECIPIENTS ARE ALL PUBLIC CHARITIES OR GOVERNMENTAL AGENCIES THAT THE ORGANIZATION HAS DONE A CONSIDERABLE AMOUNT OF DUE DILIGENCE REVIEW OF IN ADVANCE OF MAKING THE GRANT. THE ORGANIZATION'S BOARD HAS DETERMINED THAT NO ADDITIONAL POST-GRANT FOLLOW-UP IS NECESSARY AS THEY ARE RELYING ON THE INTERNAL REVENUE SERVICE AND ATTORNEY GENERAL TO OVERSEE THESE ORGANIZATIONS. false false false false false false false false false Brad Morse CEO - PAMPA 238209 0 0 0 0 0 0 0 0 0 238209 0 0 0 Bockhi Park VICE CHAIR/CEO-ENCINO & SOH 390000 0 0 0 0 0 11700 0 14797 0 416497 0 0 0 Kanner Tillman CFO - ENCINO & SHERMAN OAKS 225000 0 0 0 0 0 6000 0 13133 0 244133 0 0 0 EM V Garcia Hospital Administrator 225000 0 0 0 0 0 6750 0 5174 0 236924 0 0 0 Keith SINN DIRECTOR OF PHARMACY 219118 0 0 0 0 0 8765 0 4548 0 232431 0 0 0 VISITACION PERALTA NURSE CHARGE 202444 0 0 0 0 0 6073 0 1213 0 209730 0 0 0 ROLAND SANTOS CHIEF NURSING OFFICER 191488 0 0 0 0 0 5745 0 6356 0 203589 0 0 0 ANDRIAN GARCIA NURSE 174468 0 0 0 0 0 5234 0 10052 0 189754 0 0 0 SCHEDULE J, PART 1, LINE 3 The corporation's Human Resources Department takes into account each person's experience, education, background, and other relevant factors, such as comparable market salaries for the relevant position, in determining that person's compensation. The CEO of Prime Healthcare Foundation, Inc. ("PHF") is not compensated by PHF. DESERT VALLEY INSURANCE LTD SEE PART V 3398590 INSURANCE false PRIME HEALTHCARE MANAGEMENT IIINC SEE PART V 15973054 MANAGEMENT FEES true BIO-MED SERVICES INC SEE PART V 2710216 ASSET MANAGEMENT SERVICES false HOSPITAL BUSINESS SERVICES INC SEE PART V 288000 BUSINESS OFFICE SERVICES false PART IV, LINE (1), COLUMN (B) ENTITY IS OWNED BY FAMILY MEMBERS OF PRESIDENT/DIRECTOR, ONE OF WHOM IS ALSO A DIRECTOR OF PRIME HEALTHCARE FOUNDATION, INC. PART IV, LINE (2), COLUMN (B) ENTITY IS OWNED BY PRESIDENT/DIRECTOR. PART IV, LINE (3), COLUMN (B) ENTITY IS OWNED BY FAMILY MEMBERS OF PRESIDENT/DIRECTOR, ONE OF WHOM IS ALSO A DIRECTOR OF PRIME HEALTHCARE FOUNDATION, INC. PART IV, LINE (4), COLUMN (B) ENTITY IS CONTRUCTIVELY OWNED BY PRESIDENT/DIRECTOR. X 1 59901912 FMV X 1 715000 FMV 3 false false false SCHEDULE M, PART I, COLUMN (B) THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS RECEIVED IN COLUMN (B) OF PART I. FORM 990, PART VI, SECTION A, LINE 2 PREM REDDY, M.D. AND KAVITHA BHATIA, M.D. HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B BEFORE FILING, FORM 990 AND SUPPLEMENTAL INFORMATION TO FORM 990 IS SENT TO ALL BOARD MEMBERS FOR THEIR REVIEW, QUESTIONS AND COMMENTS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 6 DR. PREM REDDY IS THE SOLE MEMBER OF PRIME HEALTHCARE FOUNDATION, INC. FORM 990, PART IV, LINE 20B THE AUDITED FINANCIAL STATEMENTS THAT ARE ATTACHED TO THIS RETURN INCLUDE KNAPP MEDICAL CENTER AND ITS SUBSIDIARIES: KNAPP MEDICAL GROUP, MID-VALLEY PHYSICIANS ASSOCIATION, INC, AND KNAPP MEDICAL CENTER ASC, LLC. HOWEVER, THESE ENTITIES ARE NOT INCLUDED IN THIS RETURN AS THEY ARE SEPARATE ENTITIES FOR TAX PURPOSES THAT FILE THEIR OWN TAX RETURNS. THE AUDITED FINANCIAL STATEMENTS THAT ARE ATTACHED TO THIS RETURN ALSO INCLUDE SIGNATURE PAMPA MEDICAL GROUP. THIS ENTITY IS NOT INCLUDED IN THIS RETURN AS IT IS A SEPARATE ENTITY FOR TAX PURPOSES THAT FILES ITS OWN TAX RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE REVIEW OF QUESTIONNAIRES THAT ARE COMPLETED ANNUALLY. FORM 990, PART VI, SECTION B, LINES 15A AND 15B The corporation's Human Resources Department takes into account each person's experience, education, background, and other relevant factors, such as comparable market salaries for the relevant position, in determining that person's compensation. The CEO of Prime Healthcare Foundation, Inc. ("PHF") is not compensated by PHF. FORM 9909, PART VI, SECTION A, LINES 7A AND 7B THE SOLE MEMBER HAS THE RIGHT TO APPOINT THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. CERTAIN GOVERNANCE DECISIONS OF THE ORGANIZATION ARE RESERVED TO ITS SOLE MEMBER. FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:UTILITIES & TELEPHONE TOTAL EXPENSES:5152443 PROGRAM SERVICES:5135225 MANAGEMENT AND GENERAL:17218 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:LICENSES AND PERMITS TOTAL EXPENSES:1264 MANAGEMENT AND GENERAL:1264 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:FOOD TOTAL EXPENSES:1901541 PROGRAM SERVICES:1901541 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:LINEN/BEDDING TOTAL EXPENSES:41935 PROGRAM SERVICES:41935 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:CLEANING TOTAL EXPENSES:494120 PROGRAM SERVICES:494120 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:MINOR MEDICAL EQUIPMENT TOTAL EXPENSES:773991 PROGRAM SERVICES:773991 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:OTHER SUPPLIES TOTAL EXPENSES:5363036 PROGRAM SERVICES:5363036 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:TRAINING TOTAL EXPENSES:288895 PROGRAM SERVICES:288895 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:DUES AND SUBSCRIPTION TOTAL EXPENSES:669243 PROGRAM SERVICES:658247 MANAGEMENT AND GENERAL:10996 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:OTHER EXPENSES TOTAL EXPENSES:645911 PROGRAM SERVICES:637258 MANAGEMENT AND GENERAL:8653 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:STATE TAXES TOTAL EXPENSES:51170 MANAGEMENT AND GENERAL:51170 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:TAXES AND LICENSES TOTAL EXPENSES:24102182 PROGRAM SERVICES:24102182 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:RECRUITING TOTAL EXPENSES:266685 PROGRAM SERVICES:266685 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:PROPERTY TAXES TOTAL EXPENSES:453017 MANAGEMENT AND GENERAL:453017 FORM 990 PART IX LINE 24 - OTHER EXPENSES DESCRIPTION:FOREIGN TAXES TOTAL EXPENSES:43054 MANAGEMENT AND GENERAL:43054 PRIME HEALTHCARE SERVICES - ENCINO LLC 16850 BEAR VALLEY RD STE 200 VICTORVILLE CA 92395 262128507 HOSPITAL CA -4672845 30487451 PHF PRIME HEALTHCARE SERVICES - MONTCLAIR LL 16850 BEAR VALLEY RD STE 200 VICTORVILLE CA 92395 202898771 HOSPITAL CA -2546595 54482452 PHF PRIME HEALTHCARE SERVICES - SHERMAN OAKS 16850 BEAR VALLEY RD STE 200 VICTORVILLE CA 92395 202546649 HOSPITAL DE 14095654 75382619 PHF PRIME HEALTHCARE HUNTINGTON BEACH LLC 16850 BEAR VALLEY RD STE 200 VICTORVILLE CA 92395 205252882 HOSPITAL DE -2113262 81478967 PHF PHSF VICTOR VALLEY LLC 16850 BEAR VALLEY ROAD STE 200 VICTORVILLE CA 92395 273455658 HOLDING CO. 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