2015-08-17T17:14:31-05:00 2014-09-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2013-10-01 941502014 SOUTHERN MONTEREY COUNTY MEMORIAL HOSP DBA GEORGE L MEE MEMORIAL HOSPITAL SOUT 8313856000 300 CANAL STREET KING CITY CA 93930 SUSAN M CHILDERS CFO 8313856000 2015-08-17 1 RENIE BURBANK P00159653 4159561500 2013 2016-02-25 16:41:14Z SUSAN M CHILDERS 300 CANAL STREET KING CITY CA 93930 64854346 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. 8 5 561 40 0 0 137746 219008 77968534 61990404 -494935 8881 7257324 2613957 84868669 64832250 82672 84450 0 0 36042245 36661266 0 0 0 37432262 31322514 73557179 68068230 11311490 -3235980 41786045 37354947 40714218 39508949 1071827 -2154002 THE HOSPITAL PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. 0 0 56607286 84450 61990404 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 23,869, AND TOTAL PATIENTS TREATED EXCEEDS 45,000. 56607286 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 201 0 1 561 1 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CA X MICHAEL FRENCH 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 START 113 TRUSTEE 2.00 X 0 0 0 NASH SARAH TRUSTEE 2.00 X 0 0 0 ZARO MD CHRISTINA THRU 514 CHIEF OF STAFF 2.00 X 0 0 12000 UKATU MD CHIDI 514-1214 CHIEF OF STAFF 2.00 X 0 0 0 SMITH LEX CEO 50.00 X X 306426 0 35319 CHILDERS SUSAN CFO 50.00 X 226886 0 34633 HRITZ KEN COO 50.00 X 189796 0 31494 WONG KAREN CHRO 50.00 X 165637 0 14358 SALAMACHA RENA CIO 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 CNO 40.00 X 147857 0 1542 ROBEY LAURA NURSE PRACTITIONER 40.00 X 141842 0 31494 2039428 0 265820 54 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 UKATU CHIDI MD 10521 RUTHELEN STREET LOS ANGELES CA 90047 MEDICAL SERVICES 815165 BRADFORD LETITIA MD 7485 RUSH RIVER SUITE 710-323 SACRAMENTO CA 95831 MEDICAL SERVICES 546805 FEJES JOHN M MD 25685 MORSE DR CARMEL CA 93923 MEDICAL SERVICES 418604 33 18000 201008 219008 PATIENT SERVICE REV. 621400 61990404 61990404 61990404 8881 8881 49410 22096 27314 27314 27314 WRITE-OFF LIABILITY 900099 1670440 1670440 OTHER OPERATING INCOME 900099 833205 833205 REBATES/REFUNDS 900099 82998 82998 2586643 64832250 61990404 0 2622838 X 84450 84450 1288584 52719 1235865 23055528 22230852 824676 274869 263871 10998 9979368 8689932 1289436 2062917 1925092 137825 127771 105213 22558 191628 191628 54024 10000 44024 101980 101980 14622577 11886161 2736416 83246 83246 1517160 1494327 22833 161792 142248 19544 79393 73696 5697 1406662 1406662 2030449 2030449 524611 481532 43079 MEDICAL SUPPLIES 5288474 5239213 49261 BAD DEBT EXPENSE 4572233 4572233 560514 407623 152891 68068230 56607286 11460944 0 972570 175927 11566094 9696863 787837 938779 589309 460409 47953089 24227791 22629548 23725298 12518 22669 5228169 2335002 41786045 37354947 9027500 8688291 389297 9878302 9523500 15354067 15095899 922031 751616 5532318 5060346 40714218 39508949 X 1071827 -2154002 1071827 -2154002 41786045 37354947 -3235980 10151 0 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 101980 101980 0 PART II-B, LINE 1: CA HOSPITAL ASSOC COMMITTEE ON ISSUES DUES (A000419), PER INVOICE #ES14115 ON 2/5/14: TO SUPPORT THE MEDI-CAL FUNDING & ACCOUNTABILITY ACT OF 2014. FOR MEDICARE COST REPORTING & FORM 990 COMPLIANCE REPORTING, 100% OF THE CONTRIBUTION IS FOR LOBBYING EXPENSE. CONTACT LOIS SUDER AT LSUDER @CALHOSPITAL.ORG OR 916.552.7622 FOR MORE INFO. THE FPPC ID # FOR CHCI IS 880212. 512182 512182 27039418 11666656 15372762 15689165 11924958 3764207 4712324 636177 4076147 23725298 OTHER RECEIVABLES 514114 ASSETS LIMITED AS TO USE 515 OTHER ASSETS 42082 THIRD PARTY SETTLEMENTS 1658496 DEPOSITS 119795 2335002 ACCRUED INTEREST PAYABLE 321506 SELF INSURED HEALTH CARE CLAIMS 533086 LITIGATION RESERVE 1014354 ASSEMBLY BILL 97 CLAWBACK LIAB 2185539 PROFESSIONAL FEES 62700 INCURRED CLAIMS PAYABLE 459400 CAPITAL LEASES 483761 5060346 X 60292264 10515 -4572233 -4561718 64853982 -21732 -21732 64832250 63518093 22096 22096 63495997 4572233 4572233 68068230 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, 2014 AND 2013, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF BAD DEBT EXPENSE FROM NET PATIENT REVENUE -4,572,233. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF RENTAL EXPENSES TO REVENUE -22,096. AUDITED FINANCIAL STATEMENT ROUNDING 364. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF RENTAL EXPENSES TO STATEMENT OF REVENUE 22,096. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF BAD DEBT EXPENSE FROM NET PATIENT REVENUE 4,572,233. 1 1 X 1 X 1 X 100.000000000000 1 1 0 1 1 1794560 1794560 0.02640 27 67000 30842417 23957242 6885175 0.10120 27 67000 32636977 23957242 8679735 0.12760 5 8629 97253 71763 25490 0.00040 5 8629 97253 71763 25490 0.00040 32 75629 32734230 24029005 8705225 0.12800 1 8629 84450 71763 12687 0.00020 4 12803 12803 0.00020 1 117801 117801 0.00170 6 8629 215054 71763 143291 0.00210 1 4572233 3999139 6915262 14543849 -7628587 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 X X X X X 12 1 0 0 0 1 0 1 1 100.000000000000 1 100.000000000000 1 X X X X X X X 1 1 X X X X X 1 X X 1 X X X X X 1 X 0 0 GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: 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 7: - 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 HOSPITALSPART V, SECTION B, LINE 8A: 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 IRS REGULATION SECTION 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 IRS REGULATION SECTION 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 2015. GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: 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. 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.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 OFFERING MULTIPLE HEALTH FAIRS AND PROVIDES MEALS TO ELIGIBLE ADULTS THROUGH THE COUNTY SENIOR NUTRITION PROGRAM. 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 INCREASED FROM 31% OF GROSS PATIENT ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2013, TO 20% OF GROSS PATIENT ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2014. THE HOSPITAL HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2014 OR 2013. 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: THE ORGANIZATION ENGAGED CAROL DAVIS WITH STRATEGY CONNECTIONS TO CONDUCT A THOROUGH COMMUNITY NEEDS ASSESSMENT THAT HAS ALSO PROVIDED ANNUAL MARKET & BUSINESS PLAN UPDATES FOR OUR STRATEGIC PLANS.CAROL CONDUCTED IN-DEPTH INTERVIEWS WITH CARE PROVIDERS, COMMUNITY STAKEHOLDERS AND REVIEW/ANALYSIS OF MARKET DEMOGRAPHICS ALONG WITH HISTORIC SERVICES PROVIDED. MMH ALSO REVIEWS SERVICES PROVIDED BY OTHER FACILITIES OUTSIDE OF THE IMMEDIATE MARKET SERVICE AREA. 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. WE ALSO MAKE THESE AVAILABLE TO THE GENERAL PUBLIC THROUGH OUR WEBSITE: HTTP://MEEMEMORIAL.COM/FOR-OUR-PATIENTS/PATIENT-RIGHTS 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 7, REPORTS FILED WITH STATES CA 0 COUNTY OF MONTEREY 1000 SOUTH MAIN ST SUITE 301 SALINAS CA 93901 946000524 84450 CASH VALUE NUTRITIONAL PROGRAM FOR THE ELDERLY 1 PART I, LINE 2: THE HOSPITAL MAINTAINS SEPARATE GENERAL LEDGER COST CENTER CODES TO TRACK & REPORT ALL GRANT ACTIVITIES. ALL ACTIVITY IS BASED ON GRANT INVOICING TO THE COUNTY. THE COUNTY AUDITS THE HOSPITAL'S BOOK ANNUALLY. THE HOSPITAL PROVIDES AN AUDITED REPORT TO THE COUNTY EACH YEAR. X X 0 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 CEO 292439 0 13987 0 0 0 3825 0 31494 0 341745 0 0 0 CHILDERS SUSAN CFO 215963 0 10923 0 0 0 3139 0 31494 0 261519 0 0 0 HRITZ KEN COO 189796 0 0 0 0 0 0 0 31494 0 221290 0 0 0 WONG KAREN CHRO 165637 0 0 0 0 0 0 0 14358 0 179995 0 0 0 SALAMACHA RENA CIO 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 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 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 WILL 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 USE EVALUATIONS. THE BOARD APPROVES ALL COMPENSATION AGREEMENTS. 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. CHRISTINA ZARO, MD, CHIEF OF STAFF, DEVOTES 2 HOUR PER WEEK FOR HER SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS. SHE DOES NOT RECEIVE COMPENSATION OR BENEFITS AS A BOARD MEMBER. DR. ZARO, PROVIDES SERVICES AS A PHYSICIAN TO THE HOSPITAL. SHE DEVOTES 20 HOURS PER WEEK AND THE COMPENSATION AND BENEFITS ARE FOR HER SERVICES AS A PHYSICIAN. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 11,886,161. MANAGEMENT AND GENERAL EXPENSES 2,736,416. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,622,577. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES INCLUDES: PROFESSIONAL FEES - MEDICAL THERAPIST & OTHER: $8,464,539 PURCHASED SERVICES - MEDICAL, MGMT SRVCS & OTHER: 5,279,110 CONTRACT LABOR - MEDICAL THERAPIST & OTHER: 878,928 FORM 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT: THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.