2015-02-13T18:40:30-07:00 2014-06-30 990 2013-07-01 237429117 MADERA COMMUNITY HOSPITAL MADE 5596755555 1250 E Almond Avenue Madera CA 93637 Diane Neff Accounting Manager 5596752823 2015-02-12 2013 2016-02-25 16:41:14Z Evan Rayner 1250 E Almond Avenue Madera CA 93637 75937035 0 X www.maderahospital.org X 1971 CA Madera Community Hospital is dedicated to actively promoting and maintaining the health and well being of residents throughout the Central Valley of California. 16 13 1013 80 0 0 1270935 3086512 82691293 69568112 34090 18269 2365085 3264142 86361403 75937035 0 0 0 0 46519011 45378803 0 0 0 37150762 33875076 83669773 79253879 2691630 -3316844 83346055 75905063 28267279 24143131 55078776 51761932 Madera Community Hospital provides Inpatient and Outpatient healthcare services to the citizens of Madera and its surrounding communities. 0 0 52391670 0 69568112 Delivery and Management of General Inpatient and Outpatient Healthcare Services were provided to the citizens of Madera and its surrounding communities. 0 0 0 52391670 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 1 134 0 1 1013 1 0 0 0 0 0 0 X 16 13 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X X Mark J Foote 5596755505 1250 E Almond Avenue Madera CA 93637 Steve Barsotti Board Member 1 0 X 0 0 0 Anna DaSilva Board Member 1 0 X 0 0 0 Margaret Diebert Board Member 1 0 X 0 0 0 Michael Diebert Board Member 1 0 X 0 0 0 William Driggs Board Member 1 0 X 0 0 0 Duane Furman Board Member 1 0 X 0 0 0 Anita Eden Board Member 1 0 X 0 0 0 Stell Manfredi Board Member 1 0 X 0 0 0 Aftab Naz Board Member 1 0 X 11500 0 0 Wally Nishimoto Board Member 1 0 X 0 0 0 Monte Pistoresi Board Member 1 0 X 0 0 0 Robert Poythress Board Member 1 0 X 0 0 0 Kanwal Singh Board Member 1 0 X 53912 0 0 Don Warnock Board Member 1 0 X 0 0 0 Victor Yanez MD Board Member 1 0 X 33000 0 0 Jan Zitek Board Member 1 0 X 0 0 0 John W Frye Exec Director/CEO 40 0 X 310746 0 2255 Mary C Farrell VP - Patient Care 40 0 X 178032 0 3105 Mark J Foote VP - Finance 40 0 X 171713 0 3785 Karen Paolinelli Director of Family Health Services 40 0 X 186987 0 1171 Dale Costantino Director of Pharmacy 40 0 X 158306 0 876 Angelica Malagon Pharmacist II 40 0 X 144209 0 459 Matthew Kobzeff Pharmacist II 40 0 X 138285 0 7122 Meri Combs Director of Med/Surg 40 0 X 136404 0 3485 Donna Aldrich Director of L&D and Obstetrics 40 0 X 135089 0 0 1658183 0 22258 39 0 1 0 Navin Haffty and Associates 1900 West Park Drive Suite 180 Westborough MA 01581 Consulting Services 796636 Galen Inpatient Physicians 2100 Powell Street Suite 920 Emeryville CA 94608 Hospital Physician Services 759132 Madera Anesthesia Consultants PO Box 7096 Stockton CA 95267 Anesthesia Services 660000 CEP America 2100 Powell Street Suite 920 Emerville CA 94608 Emergency Room Physicians Services 521250 Zaks 1906 Howard Road Madera CA 93637 Security Services 452852 24 0 0 0 150000 51590 2884922 2829922 3086512 Medicare 622000 21774469 21774469 0 0 Medicaid 622000 29676350 29676350 0 0 CMSP 622000 1761185 1761185 0 0 Other 3rd Parties 622000 14925670 14925670 0 0 Other Payers 622000 1430438 1430438 0 0 0 0 0 0 69568112 18269 18269 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 EMR Incentive Payments 622000 1689881 1689881 0 0 Non-Patient Food Sales 722212 822930 822930 0 0 Rebates & Refunds 622000 283834 283834 0 0 467497 467497 0 0 3264142 75937035 72850523 0 0 0 0 0 0 0 0 0 0 870712 327630 543082 0 0 0 0 0 32300124 26193040 6107084 0 0 0 0 0 9391814 7010430 2381384 0 2816153 2251946 564207 0 0 0 0 0 117382 0 117382 0 40200 0 40200 0 0 0 0 0 0 0 0 0 818363 541805 276558 0 0 0 0 0 492481 131284 361197 0 0 0 0 0 0 0 0 0 197468 193808 3660 0 72602 55786 16816 0 0 0 0 0 34658 24888 9770 0 437699 0 437699 0 0 0 0 0 3484116 560623 2923493 0 1595910 0 1595910 0 Supplies 10004101 8009449 1994652 0 Quality Assurance Provider Fees 3636859 0 3636859 0 Other Purchased Services 6323469 2649090 3674379 0 Professional Fees 3346634 3322634 24000 0 3273134 1119257 2153877 0 79253879 52391670 26862209 0 2681168 1996772 16645423 14216461 0 0 17313621 18087920 0 0 0 0 6209803 3123492 1725634 1638922 340959 562388 80813502 44741810 38207039 36071692 0 0 0 0 0 0 0 0 222408 207416 83346055 75905063 3726366 3227997 0 0 0 0 0 0 0 0 0 0 16920334 15822980 0 0 7620579 5092154 28267279 24143131 X 55078776 51761932 0 0 0 0 55078776 51761932 83346055 75905063 -3316844 0 0 0 0 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 410000 84936 494936 0 44614798 18115089 26499709 0 1696 1696 0 0 34106346 25412755 8693591 0 1595726 1212270 383456 36071692 0 Accrued Payroll and Related Liabilities 4582638 Quality Assurance Fees Payable 509516 5092154 75937035 0 0 0 0 0 75937035 0 0 0 75937035 79253879 0 0 0 0 0 79253879 0 0 0 79253879 1 1 X 1 X 1 X 0 1 0 1 1 1904697 0 1904697 0.024 38829204 25541356 13287848 0.1677 26478599 15394408 11084191 0.1399 0 0 67212500 40935764 26276736 0.3316 206774 0 206774 0.0026 115587 0 115587 0.0015 0 0 0 0 0 0 0 0 54656 0 54656 0.0007 0 0 377017 0 377017 0.0048 0 0 67589517 40935764 26653753 0.3364 0 0 0 0 0 0 0 0 1858 62470 0 62470 0 0 0 0 0 0 0 0 0 989 0 989 0 5139 0 5139 0 37960 0 37960 0 0 0 0 0 0 1858 106558 0 106558 0 1 2032182 0 14480000 24604200 -10124200 X 1 1 5 1 Madera Community Hospital 1250 E Almond Avenue Madera CA 93637 www.maderahospital.org X X X A 2 Madera Community Hospital Family Health Services 1210 E Almond Avenue Madera CA 93637 www.maderahospital.org Provider-Based Rural Health Clinic A 3 Chowchilla Medical Center Clinic 205 Hospital Drive Chowchilla CA 93610 www.maderahospital.org Provider-Based Rural Health Clinic A 4 Madera Community Hospital Outpatient Center 1270 E Almond Avenue Madera CA 93637 www.maderahospital.org Provider-Based Outpatient Laboratory and Radiology Services A 5 Madera Community Hospital Home Health Agency 1270 E Almond Avenue Madera CA 93637 www.maderahospital.org Provider-Based Home Health Agency A A 1 X X X X X X X X X 13 1 1 1 X www.maderahospital.org X www.hospitalcouncil.net X X X 1 0 1 1 200 1 350 1 X X X 1 1 X X 1 X X X 0 X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-Group A Madera Community Hospital participated in the 4-County Community Needs Assessment that was completed in March 2013. There were 14 focus groups convened within the 4-county area. Participants in the interviews included the Madera County Director of Public Health, the Executive Director of First 5 of Madera County, Madera Community Hospital CEO and other local healthcare facilities executives. Schedule H, Part V, Section B, Line 4-Group A Adventist Health Central Valley Network, Kaweah Delta Medical Center, Sierra View District Hospital, Coalinga Regional Medical Center, Corcoran District Hospital, San Joaquin Valley Rehabilitation Hospital, Tulare Regional Medical Center, Community Medical Centers, Children's Hospital Central California, Kaiser Permanente, Saint Agnes Medical Center, Madera Community Hospital. Schedule H, Part I, Line 7 The amounts included in the table for Line 7 are based on amounts taken from the hospital's Medicare Cost Report and the Annual Community Benefits Report. Schedule H, Part II Madera Community Hospital's community building activities mainly consist of training local residents in careers in healthcare. As a result, this activity promotes health in the community by raising the awareness of local residents in our training programs about healthcare topics and these people also help promote good healthcare practices with the people they interact with. Schedule H, Part III, Section A, Line 4 Bad Debt Expense is recorded in the financial statements as the amount of charges written off for each account determined to be uncollectable. The amount on Line 2 is determined by the bad debt expense reported in the financial statements times a cost-to-charge ratio from this year's Medicare Cost Report. Schedule H, Part III, Section B, Line 8 All of the shortfall reported on Line 7 is included in the Community Benefit costs. The costs were calculated in the Medicare Cost Report for this period. The revenue was derived from actual and estimated collections on Medicare accounts. Schedule H, Part III, Section C, Line 9b The Bad Debt Collection policy contains procedures for contracted debt collection agencies to return accounts to the hospital if the debtor qualifies for the hospital's Charity Care program. Schedule H, Part VI, Line 2 Madera Community Hospital participated in a 4-county Community Needs Assessment that was published in March 2013. Various focus groups were formed from members of the local communities to discuss the health needs. Schedule H, Part VI, Line 3 There are notices on each billing statement that goes to the patient regarding information about the financial assistance policy. All self-pay patients are given a pamplet about the availability of the financial assistance program and their access to public benefit programs. There is information also displayed in all public registration areas. Schedule H, Part VI, Line 4 The direct service area of the hospital contains about 125,000 residents, mostly made up of western Madera County. The population is about 54% Hispanic, 30% White/Caucasian, with a mix of other ethnicities. The population has a high number of Medicaid and Medicare patients, many low income families and is generally an agriculture-based economy. Most of the County is part of a Health Professional Shortage Area (HPSA). Schedule H, Part VI, Line 5 Madera Community Hospital is the only local hospital in a wide geographic area. It is governed by a community-based, volunteer Board of Trustees. The Medical Staff is open to any qualified practitioner that meets credentialing criteria. The hospital is one of the largest employers in the area, tries to hire employees locally and sponsors programs for high school students and others to enter nursing and other medical fields. The hospital promotes a wide number of programs to support the better health of the residents it serves. All of the various community health and educational programs done by or sponsored by Madera Community Hospital are fully discussed in the Community Benefit Report for this year. Schedule H, Part VI, Line 6 The hospital is a free-standing, community-based, 501(c)(3) organization and is not affiliated with any health system. Schedule H, Part VI, Line 7 California X X 0 0 0 0 0 0 0 0 0 John W Frye Exec Director/CEO 294274 0 0 0 16472 0 40160 0 2255 0 353161 0 0 Mary C Farrell VP - Patient Care 162936 0 13562 0 1534 0 35865 0 3105 0 217002 0 0 0 Mark J Foote VP - Finance 157102 0 13132 0 1479 0 23000 0 3785 0 198498 0 0 0 Karen Paolinelli Director of Family Health Services 180194 0 6070 0 723 0 0 0 1171 0 188158 0 0 0 Dale Costantino Director of Pharmacy 142913 0 14670 0 723 0 20769 0 876 0 179951 0 0 0 Angelica Malagon Pharmacist II 144209 0 0 0 0 0 17500 0 459 0 162168 0 0 0 Matthew Kobzeff Pharmacist II 138285 0 0 0 0 0 0 0 7122 0 145407 0 0 0 Meri Combs Director of Med/Surg 130359 0 5412 0 633 0 1300 0 3455 0 141159 0 0 0 Donna Aldrich Director of L&D and Obstetrics 128217 0 5157 0 1715 0 22500 0 0 0 157589 0 0 0 Schedule J, Part I, Line 3 The Board of Trustees reviews and approves the salary for the CEO on an annual basis. The Board uses the California Hospital Association Executive Salary Survey when determining the salary for the CEO. Creative Copy Owner is Board Member 51297 Printing Services 0 Aftab Naz Board Member 11500 Physician Services 0 Pistoresi Ambulance Owner is Board Member 47699 Ambulance Services 0 Kanwal Singh Board Member 53912 Physician Services 0 Victor Yanez Board Member 33000 Physician Services 0 Madera Anesthesia Consultants Owner is Board Member 660000 Anesthesia Services 0 X 1 280000 appraisal X Notes Receivable 2 2549922 Amount Due on Notes 0 0 0 0 Form 990, Part VI, Section A, Line 2 Steve Barsotti is MCH Insurance Agent at Foster & Parker Insurance Company that does Business with MCH. Margaret Diebert and Mike Diebert are Stepmother & Stepson. Margaret Diebert and Don Warnock are Sister-in-Law & Brother-in-Law. Robert Poythress is Manager of Citizen's Business Bank that does Business with MCH Form 990, Part VI, Section B, Line 11b The Staff Accountant completes the draft of the Form 990 and Related Schedules and submits them to the Accounting Manager for review. The Chief Financial Officer completes Schedule H and assists in answering the questions related to the governance of the organization. All financial information is tied back to the Audited Financial Statements. The Accounting Manager submits the final draft of the Form 990 and Related Schedules to the Chief Financial Officer for review. The Chief Financial Officer reviews the final draft of the Form 990 and Related Schedules before it is filed. Form 990, Part VI, Section B, Line 12c For any conflicts of interest or complaints of such, an investigation is conducted by the Human Resources department. Depending upon the outcome of the investigation, employee re-education, training and counseling are conducted as necessary. Form 990, Part VI, Section B, Line 15 Each officer or key employee receives a written performance evaluation on an annual basis. All rate changes are made in accordance with the hospital's wage and salary plan. The hospital uses the California Hospital Association Executive Salary Survey in setting the annual compensation rates. The CEO was reviewed by a Board of Trustees Committee in October 2012. The VP-Finance, VP-Patient Care Services, the AVP-Human Resources were all reviewed by the CEO in February 2014. Form 990, Part VI, Section C, Line 19 The Audited Financial Statements are available upon request in the Administration office during normal business hours. They are also part of the information that is available to the public on the California Office of Statewide Health and Planning Department website. The Conflict of Interest policy and the Governing documents are currently not available for public inspection. Madera Community Hospital Foundation 1250 E Almond Avenue Madera CA 93637 942514197 Fundraising CA 501(c)(3) 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 Madera Community Hospital Foundation c 150000 Cash Madera Community Hospital Foundation o 47107 Payroll Records Madera Community Hospital Foundation p 582 Cash We received an approved Extension of Time to File an Exempt Organization Return on Notice Number CP211A dated December 1, 2014.