2013-11-06T16:45:02-06:00 2012-12-31 330155525 HBLA CERTIFIED PUBLIC ACCOUNTANTS INC 19600 FAIRCHILD STE 320 IRVINE CA 92612 990 2012-01-01 956006469 CITRUS VALLEY MEDICAL CENTER INC CITR 6263317331 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 RAJESH K SHARMA 6269387595 2013-10-23 1 EDWARD E BENOE P00032866 9498332815 2012 2016-03-07 17:11:31Z ROBERT H CURRY 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 417211401 0 X CVHP.ORG X 1959 CA OPERATION OF ACUTE CARE FACILITY. 21 18 2569 375 54190 53190 538776 694863 349371049 378875210 1806052 2307517 3025269 2873836 354741146 384751426 0 0 0 0 177140034 165121856 0 0 0 171788799 197271433 348928833 362393289 5812313 22358137 227217469 257479858 118782961 124632340 108434508 132847518 X OUR MISSION IS TO HELP PEOPLE KEEP WELL IN BODY, MIND AND SPIRIT BY PROVIDING QUALITY HEALTH CARE SERVICES IN A COMPASSIONATE ENVIRONMENT. 0 0 325059127 379887878 CVMC OPERATES TWO ACUTE CARE HOSPITALS, QUEEN OF THE VALLEY CAMPUS (QVC) AND INTER-COMMUNITY CAMPUS (ICC), IN THE EAST SAN GABRIEL VALLEY OF LOS ANGELES COUNTY. CVMC PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE FOR THE COMMUNITIES SURROUNDING THE TWO MEDICAL CAMPUSES. QVC & ICC PROVIDE CARE FOR AN AVERAGE OF 303 PATIENTS PER DAY. COMBINED ADJUSTED PATIENT DAYS WAS 153,664. EMERGENCY ROOM & OUTPATIENT VISITS TOTALED 156,791. CVMC PROVIDED CHARITY CARE AT COST TOTALING $3,887,000, UNREIMBURSED MEDI-CAL COST TOTALING $28,434,000, AND OTHER COMMUNITY BENEFIT COST TOTALING $4,388,000. DURING 2012, CVMC RECORDED A NET SUPPLEMENTAL MEDI-CAL PAYMENTS OF $25,084,000 FROM THE CALIFORNIA HOSPITAL FEE PROGRAM FOR THE HOSPITAL SERVICES TO MEDI-CAL PATIENTS COVERED FOR THE 18-MONTH PERIOD FROM JULY 1, 2011 TO DECEMBER 31, 2012. COMMUNITY WELLNESS SERVICES IS COMMITTED TO IMPROVING THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH STATUS OF OUR COMMUNITIES AND TO CONSERVE AND ENHANCE THE ORGANIZATIONS RESOURCES. THIS IS ACCOMPLISHED THROUGH A VARIETY OF CLASSES, COMMUNITY PROGRAMS, SUPPORT GROUPS, HEALTH FAIRS, SCREENINGS, EDUCATIONAL PROGRAMS WITHIN OUR SCHOOLS, CHURCHES, LIBRARIES, SENIOR CENTERS AS WELL AS THE USE OF TELEPHONE REFERRALS. MOST PROGRAMS ARE OFFERED AT NO CHARGE. ALL PROGRAMMING IS OPEN TO EVERY MEMBER OF OUR COMMUNITY AND SURROUNDING COMMUNITIES. 325059127 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 293 0 2569 1 1 1 0 0 0 0 0 0 0 0 0 X 21 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X RAJESH K SHARMA SR VP & CFO 6269387595 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 WALTER ALLEN III 3.00 X 0 0 0 SOHANJEET BASSI MD 3.00 X 0 0 0 ROBERT H CURRY 14.00 26.00 X X 0 858332 35097 ROBERT DUNCAN 3.00 X 0 0 0 HUMBERTO GALLENO MD 3.00 X 0 0 0 RAYMOND MATTES IHM 3.00 X 0 0 0 BERNARD BOLLINGER JR ESQ 3.00 X 0 0 0 HAROLD BORAK SR 3.00 X 0 0 0 JACQUELINE BRACY MD 3.00 X 0 14297 0 CLIFFORD CHRIST 3.00 X 0 0 0 PATRICIA GOMER LCSW 3.00 X 0 0 0 PATSY GORRELL 3.00 X 0 0 0 J PAUL HOLLAND MD 3.00 X 0 0 0 ARTHUR LUDWICK 3.00 X 0 0 0 TERI MEISTER ESQ 3.00 X 0 0 0 BILL W TANG MD 3.00 X 23200 0 0 EARL WASHINGTON 3.00 X 0 0 0 PATRICIA HANES PHD 3.00 X 0 0 0 OJ RODRIGUEZ 3.00 X 0 0 0 GURJEET KALKAT MD 3.00 X 0 0 0 GORDON SHIPP 3.00 X 0 0 0 WILLIAM HANES MD 3.00 X 157200 0 0 KHAN HAMEED MD 3.00 X 0 0 0 MARY KIRCHEN IHM 3.00 X 0 0 0 EDWARD M TRONAAS EDD 3.00 X 0 0 0 CARL WILLIAMS 3.00 X 0 0 0 ELVIA FOULKE 20.00 20.00 X 0 321892 5389 RAJESH SHARMA 14.00 26.00 X 0 483824 16453 GREGORY LANDERS 40.00 X 0 262066 19102 CECILIA AGUDO 40.00 X 0 227700 16059 JODI B GALLI 40.00 X 0 223433 14995 MARY ZIMMER 40.00 X 0 223918 31127 KENT MARTYN 40.00 X 0 217381 14092 180400 2832843 152314 321 0 1 0 SAN GABRIEL VALLEY IMAGING PO BOX 635 WEST COVINA CA 91793 PURCHASED SERVICE MEDICAL 5611477 CITRUS VALLEY ANESTHESIOLOGISTS 13751 ROSEWELL AVE STE C CHINO CA 91710 PURCHASED SERVICE MEDICAL 1391500 SOUTHERN CALIFORNIA HOSPITALIST PO BOX 8206 ANAHEIM CA 92812 PURCHASED SERVICE MEDICAL 974121 MANAGED CARE SUPPORT SYSTEMS PO BOX 3900 SAN FRANCISCO CA 94139 PURCHASED SERVICE CONSULTING 965559 ANESTHESIA PRACTICE ASSOCIATES 5 HOLLANT ST STE 101 IRVINE CA 92618 PROFESSIONAL FEES 937500 106 681863 13000 694863 PATIENT REV/MEDICARE/MEDICAID PAY 900099 306820090 306820090 HOSPITAL FEE PROGRAM REVENUE 900099 65007697 65007697 ELECTRONIC HEALTH RECORDS PROGRAM 900099 5603726 5603726 PREMIUM REVENUE 900099 1443697 1443697 378875210 2108118 2108118 175471 9563 165908 165908 54190 111718 32628460 21351 32442206 8206 186254 13145 199399 199399 CAFETERIA SALES 722210 1125876 1125876 MISCELLANEOUS 900099 646151 646151 REBATES & REFUNDS 900099 516533 516533 419368 366517 52851 2707928 384751426 379887878 54190 4114495 X 831838 827020 4818 119317186 118626216 690970 3484408 3461890 22518 30661437 30526279 135158 10826987 10783453 43534 98574 91065 7509 312238 312238 7887168 7286318 600850 46024669 46005625 19044 260332 251640 8692 2593480 2593480 10852964 10852964 3358538 3131546 226992 UNRELATED BUSINESS INCO 32645 32645 PURCHASED SERVICES 58623952 23660410 34963542 HOSPITAL FEE - PROG EXP 39923828 39923828 PROVISION FOR BAD DEBT 18332866 18332866 8970179 8392289 577890 362393289 325059127 37334162 0 7247 7267 3757495 17673147 59857464 47988568 13431126 14207594 3841207 4253111 1618564 1708296 308640928 237193425 68647631 71447503 66725327 87573226 9331408 12621146 227217469 257479858 41585058 51397990 71263213 67967233 5934690 5267117 118782961 124632340 X 105188886 129678501 3245622 3169017 108434508 132847518 227217469 257479858 X 22358137 2169207 -114334 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 129028761 87321529 41707232 175590919 149871896 25719023 4021248 4021248 71447503 FIXED INCOME - RESTRICTED ASSETS - WORKERS COMP FUND 235000 F FIXED INCOME INVESTMENTS - LIMITED TO USE 62773246 F FIXED INCOME - WORKERS COMP FUNDS - TRAVELERS 3740723 F FIXED INCOME - BOND INVESTMENT FUND 11478683 F EQUITIES - INVESTMENTS - LIMITED TO USE 9345574 F 87573226 WORKERS COMP RESERVES 4901000 LONG-TERM CAPITAL LEASE 366117 5267117 X 367513000 2169207 270321 2439528 365073472 19677954 19677954 384751426 343681000 0 343681000 18712289 18712289 362393289 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT DECEMBER 31, 2012 OR 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: BENEFICIAL INTEREST IN CVHF'S OPERATING INCOME 269,882. ROUNDING DIFFERENCE 439. PART XI, LINE 4B - OTHER ADJUSTMENTS: BANK CHARGES 76,310. INVESTMENT FEES 312,238. TEMPORARILY RESTRICTED NET INCOME 263,543. BAD DEBT 18,332,866. TRANSFER FROM CITRUS VALLEY HEALTH FOUNDATION 681,863. PASSTHROUGH INCOME DIFFERENCE 20,697. RENTAL EXPENSES -9,563. PART XII, LINE 4B - OTHER ADJUSTMENTS: BANK CHARGES 76,310. INVESTMENT FEES 312,238. BAD DEBT 18,332,866. ROUNDING DIFFERENCE 438. RENTAL EXPENSES -9,563. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 3887000 3887000 0.01070 134596084 131245503 3350581 0.00920 138483084 131245503 7237581 0.01990 4094113 4094113 0.01130 275000 275000 0.00080 41600 22541 19059 0.00010 4410713 22541 4388172 0.01220 142893797 131268044 11625753 0.03210 1 18332866 0 93453229 82198597 11254632 X 1 1 1 1 CVMC - QVC AND ICC

140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108

X X X IP REHAB UNIT, IP MENTAL HEALTH UNIT, SNF UNIT CVMC - QVC AND ICC 1 1 X X X X X X X X X 10 1 1 1 X X X X X X X X X X 1 0 1 1 300.000000000000 1 350.000000000000 1 X X X X X X X 1 1 X 1 0 1 X 0 0 PART I, LINE 3C: N/APART I, LINES 6A: THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. CITRUS VALLEY HEALTH PARTNERS, INC. (CVHP), PREPARED AN ANNUAL WRITTEN COMMUNITY BENEFIT REPORT THAT DESCRIBES THE HOSPITAL'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY THE HOSPITAL. PART I, LINE 7: MANY GOVERNMENT PROGRAMS (MEDI-CAL, HEALTHY FAMILIES, AND MEDICARE) AND OTHER THIRD PARTY COVERAGE PROGRAMS HAVE BEEN ESTABLISHED TO PROVIDE FOR OR DEFRAY THE HEALTHCARE COSTS FOR THE INDIVIDUALS WHO ALSO MAY BE CONSIDERED NEEDY. IN THE CASE WHERE ARRANGEMENTS FOR PAYMENT TO THE HOSPITAL REQUIRE THE HOSPITAL TO ACCEPT THE PAYMENT AMOUNT AS PAYMENT IN FULL, THE BALANCES OF THESE ACCOUNTS WRITTEN OFF ARE ATTRIBUTABLE TO CONTRACTUAL ADJUSTMENTS AND WILL NOT BE CONSIDERED CHARITY CARE. IN CASES WHERE THESE PROGRAMS REQUIRE THE PATIENTS TO PAY CO-PAYMENTS OR DEDUCTIBLES AND THE PATIENTS DO NOT HAVE THE ABILITY TO PAY; THESE AMOUNTS WILL BE CONSIDERED CHARITY CARE.CHARITY DETERMINATION WILL BE GRANTED ON "ALL, PARTIAL, OR NOTHING BASIS". THERE IS A CATEGORY OF PATIENTS WHO QUALIFY FOR MEDI-CAL, BUT DO NOT RECEIVE PAYMENT FOR THEIR ENTIRE STAY. UNDER THE CHARITY POLICY DEFINITION, THESE PATIENTS ARE ELIGIBLE FOR CHARITY CARE WRITE-OFFS. IN ADDITION, THE HOSPITAL SPECIFICALLY INCLUDES AS CHARITY THE CHARGES RELATED TO DENIED STAYS, DENIED DAYS OF CARE, AND NON-COVERED SERVICES. THESE "TREATMENT AUTHORIZATION REQUEST" DENIALS AND ANY LACK OF PAYMENT FOR NON-COVERED SERVICES PROVIDED TO MEDI-CAL PATIENTS ARE TO BE CLASSIFIED AS CHARITY. THESE PATIENTS ARE RECEIVING THE SERVICES AND THEY DO NOT HAVE THE ABILITY TO PAY FOR IT. IN ADDITION, MEDICARE PATIENTS WHO HAVE MEDI-CAL COVERAGE FOR THEIR CO-INSURANCE/DEDUCTIBLES, FOR WHICH MEDI-CAL DOES NOT MAKE PAYMENT AND MEDICARE DOES NOT ULTIMATELY PROVIDE BAD DEBT REIMBURSEMENT WILL ALSO BE INCLUDED AS CHARITY. THESE INDIGENT PATIENTS ARE RECEIVING A SERVICE FOR WHICH A PORTION OF THE RESULTING BILL IS NOT BEING REIMBURSED.THE ABOVE CHARITY WRITE-OFFS ARE CONVERTED INTO CHARITY COST USING THE COST TO CHARGE RATIO WHICH WAS DERIVED FROM WORKSHEET 2 OF THE INSTRUCTIONS TO THE IRS SCHEDULE H, "RATIO OF PATIENT CARE COST-TO-CHARGES."INCLUDED IN PART I, LINE 7B ARE NET SUPPLEMENTAL FEE-FOR-SERVICE MEDI-CAL PAYMENTS OF $25,083,869 FROM THE CALIFORNIA HOSPITAL FEE PROGRAM ("PROGRAM") FOR THE SERVICES PROVIDED TO MEDI-CAL PATIENTS COVERED FOR THE 18-MONTH PERIOD JULY 1, 2011 TO DECEMBER 31, 2012.THE PROGRAM WAS SIGNED INTO LAW AND WAS APPROVED BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) IN JUNE 2012. UNDER THE PROGRAM, CALIFORNIA HOSPITALS WERE ASSESSED A FEE BASED ON THE NUMBER OF MEDI-CAL PATIENT DAYS EACH FACILITY PROVIDES. THE STATE WOULD USE THESE MONIES TO DRAW DOWN MATCHING FEDERAL FUNDS. THE FEES PAID BY HOSPITALS, COMBINED WITH THE FEDERAL MATCHING FUNDS, WERE DISTRIBUTED BACK TO THE HOSPITALS IN THE FORM OF SUPPLEMENTAL MEDI-CAL PAYMENTS. THE ACTUAL AMOUNT EACH HOSPITAL RECEIVED WAS BASED ON THE FACILITY'S VOLUME OF MEDI-CAL PATIENTS. CVMC PROVIDED APPROXIMATELY 64,754 DAYS OF QUALITY HEALTH CARE SERVICES TO MEDI-CAL BENEFICIARIES DURING THIS 18-MONTH PERIOD.CVMC IS ONE OF THE LARGEST PROVIDERS OF CARE TO MEDI-CAL ENROLLEES IN SOUTHERN CALIFORNIA. DUE TO DEEP FUNDING CUTS TO THE MEDI-CAL PROGRAM, AS WELL AS HISTORICAL LOW LEVELS OF REIMBURSEMENT AND HIGH RATE OF DENIALS, THE HOSPITAL FEE PROGRAM HAS BEEN CRITICAL IN HELPING CVMC TO CONTINUE PROVIDING QUALITY HEALTH CARE SERVICES TO THE POOREST AND MOST VULNERABLE POPULATION IN THE COMMUNITY. WITHOUT THE PROGRAM, A NUMBER OF HOSPITALS MAY BE FORCED TO RESTRICT OR END SERVICES TO MEDI-CAL PATIENTS AND OUR HOSPITAL MAY FACE SIMILAR DILEMMA.THE PROGRAM REMAINS CRUCIAL IN MAINTAINING MEDI-CAL SERVICES AND CHARITY PROVIDED BY OUR HOSPITAL TO THE COMMUNITY'S LOW INCOME POPULATION, AND IT IS VITAL TO CVMC THAT FUTURE SIMILAR PROGRAMS BE APPROVED AND IMPLEMENTED. PART I, LINE 7G: THE AMOUNT INCLUDED IN THIS LINE IS THE NET COST OF THE SUBSIDIZED HEALTH SERVICES PROGRAM CALLED "NEONATAL SLEEP APNEA" WHICH TREATMENT INCORPORATES STUDIES THAT FURTHER SCIENCE'S UNDERSTANDING OF THE APNEA ILLNESS IN NEWBORNS. PART III, LINE 4: TEXT OF THE FOOTNOTE TO THE CONSOLIDATED FINANCIAL STATEMENTS REGARDING BAD DEBT EXPENSE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS- CVHP RECOGNIZES BAD DEBT EXPENSE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON THE HISTORICAL EXPERIENCE OF EACH AFFILIATE.STATEMENT REGARDING COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III - REGARDING CARE OF THE POOR AND COMMUNITY BENEFIT REPORT - CVHP HAS A POLICY TO TREAT EMERGENCY PATIENTS REGARDLESS OF ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT IN ACCORDANCE WITH CERTAIN ESTABLISHED POLICIES OF THE CORPORATION. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED BECAUSE OF INABILITY TO PAY. CVHP PROVIDES PROGRAMS AND ACTIVITIES THAT CONTRIBUTE TO CHARITY CARE, CARE OF THE POOR, AND COMMUNITY BENEFIT. THESE PROGRAMS AND ACTIVITIES SERVE A MAJORITY OF PERSONS WHO ARE BENEFICIARIES OF MEDI-CAL AND COUNTY/STATE PROGRAMS FOR THE MEDICALLY INDIGENT. ALSO INCLUDED ARE ACTIVITIES THAT IMPROVE THE COMMUNITY'S HEALTH STATUS, AND EDUCATE OR PROVIDE SOCIAL SERVICES TO THE ELDERLY AND CHILDREN. THE CORPORATION USES 3 CATEGORIES TO CLASSIFY CARE OF THE POOR AND COMMUNITY BENEFIT: CATEGORY 1: TRADITIONAL CHARITY CARE - CARE OF THE POOR INCLUDES SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED. THIS WRITE-OFF IS ARRANGED BEFORE THE CARE IS GIVEN WHEN POSSIBLE. IF THERE IS ANY SUBSIDY DONATED FOR THESE SERVICES, THAT AMOUNT IS DEDUCTED FROM THE GROSS AMOUNT. CATEGORY 2: UNPAID COST OF PUBLIC PROGRAMS - THIS AMOUNT REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PATIENTS IN THE MEDI-CAL PROGRAM AND ENROLLED IN HMO AND PPO PLANS UNDER CONTRACT WITH THE MEDI-CAL PROGRAM. CATEGORY 3: COMMUNITY BENEFIT - SERVICES THAT ARE BENEFICIAL TO THE BROADER COMMUNITY, IE., OTHER NEEDY POPULATIONS THAT MAY NOT QUALIFY AS POOR BUT THAT NEED SPECIAL SERVICES AND SUPPORT. EXAMPLES INCLUDE THE ELDERLY, SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH AIDS. THEY ALSO INCLUDE THE COST OF HEALTH PROMOTION AND EDUCATION, AND HEALTH CLINICS AND SCREENINGS.STATEMENT REGARDING BAD DEBT EXPENSE:THE POLICY OF THE ORGANIZATION IS TO PROVIDE OUR UNINSURED AND UNDERINSURED PATIENTS THE SAME ALLOWANCES PROVIDED TO ITS MANAGED CARE CONTRACTORS. THAT IS, THOSE PATIENTS SHALL HAVE APPLIED TO THEIR ACCOUNTS APPROPRIATE ALLOWANCES AND PER DIEM RATES. THE ORGANIZATION IS TO FOLLOW UP ON AND COLLECT ALL SELF PAY ACCOUNT BALANCES, AS WELL AS, WHERE THIRD PARTY BENEFITS EXIST, ALL PATIENT CO-PAYS AND DEDUCTIBLES, EITHER AT THE TIME OF SERVICE, OR WHEN THEY BECOME DUE. THIS SHALL BE ACCOMPLISHED IN A FAIR, CARING AND COMPASSIONATE MANNER. THE RESULTING NET REALIZABLE BALANCE ON THESE ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL COLLECTION EFFORTS AND FOLLOW UP ATTEMPTS HAVE BEEN MADE. THE ORGANIZATION RECOGNIZES BAD DEBT EXPENSE BASED UPON ITS HISTORICAL EXPERIENCE. PART III, LINE 8: MEDICARE COST REPORT WAS USED TO REPORT THE MEDICARE REVENUE AND MEDICARE ALLOWABLE COSTS. THE MEDICARE RAC (RECOVERY AUDIT CONTRACTORS) AMOUNT RETRACTED BY MEDICARE IN THE CURRENT YEAR FOR THE SERVICES PROVIDED TO THE MEDICARE PATIENTS IN THE PRIOR YEARS WAS NOT OFFSET AGAINST THE MEDICARE REVENUE IN THE CURRENT YEAR. MEDICARE ALLOWABLE COSTS TEND TO UNDERSTATE THE ACTUAL COSTS WHICH INCLUDED CERTAIN COST DISALLOWANCES AND NON-REIMBURSABLE COST CENTERS SUCH AS NON-ALLOWABLE PHYSICIAN FEES, CAFETERIA COSTS, MANAGED CARE OUTSIDE MEDICAL CLAIMS, HOME OFFICE'S MANAGEMENT FEES ADJUSTMENT, MAMMOGRAPHY CLINIC, NON-ALLOWABLE MEALS, HOME OFFICE BUILDING COSTS, AND OTHER NON-ALLOWABLE EXPENSES. IF THE MEDICARE RAC AUDIT TAKEBACKS OF $1,797,575 AND THE ESTIMATED ADDITIONAL ALLOCATED DISALLOWABLE MEDICARE COSTS OF $5,144,089 WERE INCLUDED IN LINE 5 AND LINE 6 RESPECTIVELY, THE SURPLUS ON LINE 7 WOULD BE $4,312,967. PART III, LINE 9B: THE CORPORATION OFFERS THE FOLLOWING COVERAGE OPTIONS WHICH ARE ALWAYS EXPLORED IN ASSESSING PATIENTS' ABILITY TO PAY:A) LINKAGE TO AVAILABLE STATE AID SUCH AS: (I) MEDI-CAL, (II) CALIFORNIA CHILDREN SERVICES, (III) HEALTHY FAMILIES, (IV) OTHERB) PATIENTS UNDER AGE TWENTY ONE YEARS, WHO ARE SELF PAY, SHALL BE REFERRED TO THE ONSITE MEDI-CAL ELIGIBILITY WORKER OR TO EITHER OF OUR CONTRACTED VENDORS FOR COMPLETION OF A MEDI-CAL APPLICATION AND/OR THE ON SITE GEM (GET ELIGIBILITY MOVING) PROGRAM.C) ALL OBSTETRICAL PATIENTS WHO ARE SELF PAY AND UNABLE TO MEET THEIR FINANCIAL OBLIGATION SHALL BE REFERRED TO THE ONSITE MEDI-CAL ELIGIBILITY WORKER OR TO EITHER OF OUR CONTRACTED VENDORS FOR COMPLETION OF A MEDI-CAL APPLICATION AND/OR THE ON SITE GEM PROGRAM.FOR THOSE PATIENTS WHO QUALIFY FOR CHARITY CARE ACCORDING TO THE ORGANIZATION'S CHARITY CARE POLICY, THE PATIENT ACCOUNTS WOULD BE WRITTEN OFF TO CHARITY AND THE PATIENTS WOULD NOT BE BILLED. PART V, SECTION A: CVMC OPERATES TWO ACUTE CARE HOSPITALS, QUEEN OF THE VALLEY CAMPUS (QVC) AND INTER-COMMUNITY CAMPUS (ICC). QVC IS LOCATED AT 1115 SOUTH SUNSET AVENUE, WEST COVINA, CA 91790. ICC IS LOCATED AT 210 W. SAN BERNARDINO ROAD, COVINA, CA 91723. CVMC - QVC AND ICC PART V, SECTION B, LINE 3: COMMUNITY HEALTH NEEDS ASSESSMENT - PRIMARY DATA WERE COLLECTED DIRECTLY FROM PEOPLE IN THE COMMUNITY. TWENTY-TWO PEOPLE REPRESENTING 20 COMMUNITY ORGANIZATIONS AND AGENCIES WERE INTERVIEWED. ADDITIONALLY, FOUR FOCUS GROUPS WERE CONDUCTED WITH: HEALTH CARE PROVIDERS, SOCIAL SERVICES PROVIDERS, PROMOTORAS AND SCHOOL LIAISONS, AND BUSINESS AND EDUCATION LEADERS. THREE GROUPS WERE CONDUCTED IN ENGLISH AND ONE IN SPANISH (THE PROMOTORAS/SCHOOL LIASONS GROUPS). FOR THE PROMOTORAS GROUP THAT SPOKE SPANISH, A BILINGUAL FACILITATOR CONDUCTED THE FOCUS GROUPS IN SPANISH. A TOTAL OF FORTY-NINE PEOPLE PARTICIPATED IN THE FOCUS GROUPS. CVMC - QVC AND ICC PART V, SECTION B, LINE 4: COMMUNITY HEALTH NEEDS ASSESSMENT - THE HOSPITAL FACILITY'S NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES: - FOOTHILL PRESBYTERIAN HOSPITAL - MORRIS L. JOHNSTON MEMORIAL - GLENDORA, CA - KAISER FOUNDATION HOSPITAL - BALDWIN PARK, CA CVMC - QVC AND ICC PART V, SECTION B, LINE 20D: INDIVIDUALS ELEGIBLE FOR FINANCIAL ASSISTANCE- THE HOSPITAL DETERMINED, DURING THE TAX YEAR, THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO (FINANCIAL ASSISTANCE POLICY) FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE AS FOLLOWS: - THE PREVAILING MANAGED CARE PER DIEM RATE SHALL BE APPLIED FOR ALL INPATIENT STAYS. ANY IMPLANTS AND OR PROSTHETIC DEVICES AND HIGH COST DRUGS ARE EXCLUDED FROM THE PER DIEM RATES AND ARE PAYABLE AT INVOICE PLUS A 5% PROCESSING FEE. - ALL NON-SURGICAL OUTPATIENT SERVICES SHALL BE REDUCED BY SIXTY FIVE PERCENT (65%) OF CHARGES AT THE TIME OF SERVICE. THIS DISCOUNT WILL BE CHANGED IN FUTURE YEARS TO APPROXIMATE THE AMOUNT EXPECTED TO BE RECEIVED FROM MANAGED CARE PLANS. - ALL OUTPATIENT SURGICAL PROCEDURE SHALL BE CHARGED AT BENCHMARK MANAGED CARE CASE RATES. IMPLANTS AND/OR PROSTHETIC DEVICES ARE EXCLUDED FROM THE CASE RATE AND ARE PAYABLE AT INVOICE PLUS A 5% PROCESSING FEE. PART VI, LINE 2: NEEDS ASSESSMENT: IN 2010, CITRUS VALLEY HEALTH PARTNERS (CVHP) CONDUCTED A STATE-MANDATED COMMUNITY HEALTH NEEDS ASSESSMENT. NEEDS ASSESSMENTS ARE THE PRIMARY TOOLS USED TO DETERMINE THE HOSPITAL'S "COMMUNITY BENEFIT" PLANS, THAT IS, HOW THE HOSPITAL WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY HEALTH SERVICES TO ADDRESS UNMET COMMUNITY NEEDS. THIS COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN PARTNERSHIP WITH KAISER FOUNDATION HOSPITAL - BALDWIN PARK.IN 1994, CALIFORNIA PASSED LEGISLATION (SB 697) THAT REQUIRED NON-PROFIT HOSPITALS TO REPORT ON COMMUNITY BENEFIT THEY PROVIDE. THIS LEGISLATION FURTHER REQUIRED HOSPITALS TO ASSESS THE HEALTH NEEDS OF THE COMMUNITIES THEY SERVE AND DEVELOP PLANS TO ADDRESS PRIORITY NEEDS. IN ADDITION TO CALIFORNIA'S REQUIREMENT FOR HEALTH NEEDS ASSESSMENTS, THE RECENT PASSAGE OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, HAS INSTITUTED FEDERAL REGULATIONS FOR TAX EXEMPT HOSPITALS TO CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS AND DEVELOP COMMUNITY BENEFIT PLANS EVERY THREE YEARS. CVHP IS IN THE PROCESS OF CONDUCTING A NEW COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013 IN ACCORDANCE WITH THE NEW IRC SECTION 501(R) CREATED BY THE AFFORDABLE CARE ACT.SERVICE AREA: CITRUS VALLEY HEALTH PARTNERS COMPRISES FOUR CAMPUSES: INTER-COMMUNITY IN COVINA, QUEEN OF THE VALLEY IN WEST COVINA, FOOTHILL PRESBYTERIAN IN GLENDORA, AND CITRUS VALLY HOSPICE IN WEST COVINA. THE SERVICE AREA FOR CITRUS VALLY HEALTH PARTNERS ENCOMPASSES 13 CITIES AND 4 CENSUS DESIGNATED PLACES (CDP'S).LIST OF CITIES AND CDP'S:AVOCADO HEIGHTS - CDP, AZUSA, BALDWIN PARK, COVINA, DIAMOND BAR, EL MONTE, GLENDORA, HACIENDA HEIGHTS - CDP, IRWINDALE, LA PUENTE, LA VERNE, ROWLAND HEIGHTS - CDP, SAN DIMAS, SOUTH EL MONTE, VALINDA - CDP, WALNUT, AND WEST COVINADATA COLLECTION:THIS COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES COLLECTION AND ANALYSES OF PRIMARY AND SECONDARY DATA.SERVICE AREA DESCRIPTION:THE SECONDARY DATA SELECTED FOR THIS REPORT EXAMINE UP-TO-DATE DATA SOURCES FOR THE SERVICE AREA TO PRESENT A COMMUNITY PROFILE, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACCESS TO HEALTH CARE, CHRONIC DISEASES, PREVENTIVE PRACTICES, HEALTH BEHAVIORS, SOCIAL ISSUES, AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN PERTINENT, THESE DATA SETS ARE PRESENTED IN THE CONTEXT OF LOS ANGELES COUNTY AND/OR THE STATE. DEMOGRAPHIC DATA ARE PRESENTED FOR ALL CITIES AND CDPS IN A SUPPLEMENTARY APPENDIX.THIS REPORT PRESENTS A SUMMARY THAT HIGHLIGHTS THE DATA FINDINGS, PRESENTS KEY NEEDS AND OPPORTUNITIES FOR ACTION. A DETAILED NARRATIVE EXAMINES EACH OF THE DATA SETS. THE REPORT INCLUDES BENCHMARK COMPARISON DATA (WHERE AVAILABLE), COMPARING CVHP COMMUNITY DATA FINDINGS WITH NEWLY RELEASED HEALTHY PEOPLE 2020 OBJECTIVES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY ASSISTANCE: THE HOSPITAL EMPLOYS A VARIETY OF METHODS TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY POSTING ITS CHARITY CARE POLICIES IN PUBLIC PLACES AND PROVIDING PATIENTS WITH WRITTEN NOTICE ABOUT THEIR FINANCIAL OPTIONS, INCLUDING THE AVAILABILITY OF DISCOUNTS, PAYMENT PLANS AND PUBLIC INSURANCE PROGRAMS SUCH AS MEDI-CAL, HEALTHY KIDS, HEALTHY FAMILIES, ACCESS FOR INFANTS AND MOTHERS PROGRAM AND OTHER OPTIONS. SINCE 1991, CVHP'S GEM (GET ENROLLMENT MOVING PROJECT) HAS BEEN A LEADER IN THE SAN GABRIEL VALLEY IN CONNECTING FAMILIES AND INDIVIDUALS WITH ACCESS TO FREE OR LOW-COST HEALTH INSURANCE, AS WELL AS REFERRALS TO OTHER HEALTH ACCESS PROGRAMS FOR THE UNINSURED. THE GEM PROJECT PARTNERS WITH PROMOTORAS (BILINGUAL HEALTH PROMOTERS), SCHOOLS, CHILD-CARE AGENCIES, CHURCHES, FAMILY RESOURCE CENTERS, CLINICS, COMMUNITY BASED ORGANIZATION, ETC. TO IDENTIFY UNINSURED CHILDREN AND ADULTS, AND PROVIDE INSURANCE ENROLLMENT SERVICES IN THE GEM OFFICE AND AT THE OFF-SITE COMMUNITY LOCATIONS. IN ADDITION, THE HOSPITAL HAS OUTREACH PROGRAMS TO LOW INCOME VULNERABLE POPULATIONS VIA DOOR-TO-DOOR, COMMUNITY SITES AND EVENTS. CVHP ALSO SUPPORTS ECHO (EVERY CHILD'S HEALTH OPTION) PROGRAM WHICH PROVIDES URGENT AND SPECIALTY CARE TO UNINSURED CHILDREN. PART VI, LINE 4: COMMUNITY INFORMATION: CITRUS VALLEY MEDICAL CENTER (CVMC) SERVES AN URBAN COMMUNITY OF NEARLY ONE MILLION PEOPLE IN THE SAN GABRIEL VALLEY AND HAS TWO HOSPITALS: CVMC - INTER-COMMUNITY CAMPUS IN COVINA AND CVMC - QUEEN OF THE VALLEY CAMPUS IN WEST COVINA. FOLLOWING IS A SUMMARY OF THE MAJOR DEMOGRAPHICS OF THE HOSPITAL'S SERVICE AREA -- POPULATION BY AGE: 7.9% AGE 0-4, 20.9% AGE 5-17, 62.2% AGE 18-64 AND 9% AGE 65+; MEDIAN HOUSEHOLD INCOME $65,912; POVERTY LEVEL: 33.7% OF THE RESIDENTS IN THE HOSPITAL SERVICE AREA LIVE UNDER 200% OF THE FEDERAL POVERTY LEVEL AND ARE CLASSIFIED AS LOW-INCOME. PAYER MIX BASED ON CVMC'S INPATIENT DAYS SERVED: MEDI-CAL AND MEDI-CAL MANAGED CARE 39.0%, MEDICARE AND MEDICARE MANAGED CARE 41.7%, MANAGED CARE 15.4%, AND SELF-PAY 3.9%. APPROXIMATELY 8 OTHER HOSPITALS ARE SERVICING THE AREAS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL PROVIDES A WIDE RANGE OF PATIENT CARE SERVICES THROUGH ITS TWO CAMPUSES AS FOLLOWS:CVMC - QUEEN OF THE VALLEY CAMPUS LOCATED IN WEST COVINA IS A 325-BED FULLY ACCREDITED NONPROFIT, CATHOLIC HEALTH CARE FACILITY FOUNDED IN 1962 BY THE IMMACULATE HEART COMMUNITY.KEY SERVICES: -FAMILY BIRTH & NEWBORN CENTER (A 40-BED PERINATAL SERVICES AND A 40-BED NICU) - MORE DELIVERIES ARE MADE AT THIS CAMPUS THAN ANY HEALTH CARE FACILITY IN THE EAST SAN GABRIEL VALLEY. MORE THAN 15,000 BABIES HAVE BEEN CARED FOR IN THE LEVEL IIIB NEWBORN INTENSIVE CARE UNIT SINCE THE NICU OPENED IN 1972. -THE GELERIS FAMILY CANCER CENTER - OFFERING COMPLETE EDUCATION, DIAGNOSIS, TREATMENT AND SUPPORT SERVICES. PATIENTS ARE KEPT APPRISED OF ONGOING CLINICAL CANCER TRIALS AND MAY PARTICIPATE, WHEN ELIGIBLE.-QUEEN'S MAMMOGRAPHY CENTER - PROVIDING LOW-COST MAMMOGRAPHY SCREENING AND BREAST HEALTH EDUCATION.-STATE-OF-THE-ART MRI, CAT SCAN AND LITHOTRIPSY SERVICES-12-BED INTENSIVE CARE UNIT.-6-BED CARDIAC CARE UNIT.-37-BED DEFINITIVE OBSERVATION UNIT.-12-BED REHABILITATION UNIT.-160-BED MEDICAL/SURGICAL SERVICES.-18-BED PEDIATRICS UNIT - A CERTIFIED CHILD LIFE SPECIALIST IS ON STAFF TO PROVIDE EDUCATION, SUPPORT AND THERAPEUTIC INTERVENTIONS THAT ADDRESS THE PSYCHOSOCIAL AND EMOTIONAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES.-CITRUS VALLEY CENTERS FOR REHABILITATION SERVICES - OFFERING SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY SERVICES FOR CHILDREN AND ADULTS-EMERGENCY DEPARTMENT IS ONE OF THE BUSIEST IN SOUTHERN CALIFORNIA, WITH NEARLY 56,000 VISITS ANNUALLY-ROBOTIC SURGERY PROGRAM FEATURING THE DA VINCI SI SURGICAL SYSTEM.CVMC - INTER-COMMUNITY CAMPUS HAS BEEN PROVIDING HEALTH CARE SERVICES TO THE COMMUNITY SINCE 1922. THE NONPROFIT 193-BED FACILITY IN COVINA PROVIDES HIGH-QUALITY HEALTH CARE TO THE EAST SAN GABRIEL VALLEY WITH A WIDE RANGE OF MEDICAL, SURGICAL AND SPECIALTY SERVICES. KEY SERVICES: -CITRUS VALLEY HEART CENTER - OFFERING THE ONLY OPEN HEART SURGERY PROGRAM IN THE EAST SAN GABRIEL VALLEY -CARDIAC CATH LAB - PROVIDING THE LATEST TREATMENTS AND ADVANCEMENTS FOR PATIENTS SUFFERING FROM CARDIAC DISEASE -DIAGNOSTIC CARDIOLOGY AND NUCLEAR MEDICINE DEPARTMENTS -CARDIAC REHABILITATION PROGRAM -14-BED CARDIAC CARE UNIT. -8-BED INTENSIVE CARE UNIT. -54-BED DEFINITIVE OBSERVATION UNIT. -24-BED ORTHO/SURG UNIT. -38-BED MEDICAL/SURGICAL SERVICES. -30-BED MENTAL HEALTH UNIT. -25-BED TRANSITIONAL CARE UNIT. -RADIATION ONCOLOGY AND INPATIENT CANCER UNIT. -MAMMOGRAPHY SCREENING CENTER. -WOUND CARE - COMPREHENSIVE CARE FOR PATIENTS WITH WOUNDS THAT WON'T HEAL, INCLUDING A STATE-OF-THE-ART HYPERBARIC CHAMBER -EMERGENCY DEPARTMENT -CHEST PAIN EMERGENCY UNIT -CITRUS VALLEY CENTERS FOR REHABILITATION SERVICES - OFFERING SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY SERVICES FOR CHILDREN AND ADULTS -INFORMATION CENTER FOR PHYSICIAN, HOSPITAL AND COMMUNITY OUTREACH REFERRALS -CANCER RESOURCE CENTER THE HOSPITAL IS GOVERNED BY A 21-MEMBER BOARD OF DIRECTORS COMPRISED OF PHYSICIANS, BUSINESS AND COMMUNITY LEADERS. THE BOARD HAS THE OVERALL RESPONSIBILITY FOR THE MANAGEMENT OF THE HOSPITAL. TO CARRY OUT THIS RESPONSIBILITY, THE GOVERNING BODY PROVIDES FOR THE EFFECTIVE FUNCTIONING OF ACTIVITIES RELATED TO: DELIVERY OF PATIENT CARE, PERFORMANCE IMPROVEMENT, PATIENT SAFETY, RISK MANAGEMENT, MEDICAL STAFF CREDENTIALING, FINANCIAL MANAGEMENT, STRATEGIC PLANNING AND COMMUNITY BENEFIT.THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITIES. THE HOSPITAL'S MEDICAL STAFF CONSISTED OF 611 PHYSICIANS, OF WHICH 370 ARE MEMBERS OF ITS ACTIVE STAFF (DEFINED AS ADMITTING MORE THAN TWELVE PATIENTS PER YEAR). THE TEN MOST ACTIVE ADMITTING PHYSICIANS ACCOUNTED FOR APPROXIMATELY 26% OF TOTAL ADMISSIONS. THESE PHYSICIANS HAD SPECIALTIES IN INTERNAL MEDICINE, PSYCHIATRY, OBSTETRIC/GYNECOLOGY AND CARDIOLOGY - 75.1% OF THE TOTAL MEDICAL STAFF MEMBERS AND 84.9% OF THE ACTIVE MEDICAL MEMBERS WERE BOARD-CERTIFIED IN THEIR RESPECTIVE SPECIALTIES.THE SURPLUS FUNDS HELD BY THE HOSPITAL ARE USED TO FULFILL ITS MISSION AS AN INTEGRATED HEALTH CARE ORGANIZATION COMMITTED TO PROVIDING QUALITY HEALTH CARE SERVICES IN A COMPASSIONATE ENVIRONMENT FOR THE PEOPLE IN THE SURROUNDING COMMUNITIES BY OFFERING OUTREACH EDUCATION AND CHARITY CARE, INVESTING IN ADVANCED MEDICAL TECHNOLOGY AND MODERNIZING HOSPITAL FACILITIES. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: CITRUS VALLEY HEALTH PARTNERS (CVHP), THE SOLE CORPORATE MEMBER OF CVMC, FOOTHILL PRESBYTERIAN HOSPITAL (FPH), CITRUS VALLEY HOSPICE (HOSPICE), AND CITRUS VALLEY HEALTH FOUNDATION (CVHF), PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT DESCRIBES SPECIFIC OUTREACH PROGRAMS AND SERVICES THAT SUPPORT AND PROVIDE CHARITY CARE AND EDUCATION AND PROMOTE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES SERVED BY CVMC AND ITS AFFILIATE ORGANIZATIONS.FPH OPERATES A GENERAL ACUTE CARE HOSPITAL WITH 105 LICENSED BEDS, LOCATED IN GLENDORA, CALIFORNIA, AND PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE SURROUNDING COMMUNITIES.HOSPICE, LOCATED IN WEST COVINA, CALIFORNIA, OPERATES A 10 LICENSED BED SKILLED NURSING FACILITY AND IN HOME SERVICES FOR TERMINALLY ILL PATIENTS AND A HOME HEALTH CARE AGENCY DOING BUSINESS AS CITRUS VALLEY HOME HEALTH. CVHF PERFORMS THE FUND-RAISING AND TRUST ADMINISTRATION ACTIVITIES RELATED TO CVHP AND ITS AFFILIATES.CVHP IS AN ORGANIZATION RECOGNIZED FOR OUR OUTSTANDING COMMUNITY OUTREACH EFFORTS AND ACCOMPLISHMENTS. AN ORGANIZATION DEDICATED TO CREATING INNOVATIVE PARTNERSHIPS AMONG THE NUMEROUS HEALTH AND SOCIAL SERVICE ORGANIZATIONS IN OUR VALLEY, WITH CLOSE TO 100 AGENCIES FORMING A COLLABORATIVE RELATIONSHIP DEVOTED TO PROMOTING COMMUNITY HEALTH AND WELL-BEING. FOR EXAMPLE, CVHP'S PARTNERSHIP NURSING PROGRAM IS BASED ON THE CONCEPT THAT THROUGH WORKING PARTNERSHIPS BETWEEN FAITH COMMUNITIES, COMMUNITY ORGANIZATIONS AND MEDICAL PROFESSIONALS, HEALTH AND WELLNESS ISSUES CAN BE SIGNIFICANTLY IMPROVED. EVERY CHILD'S HEALTHY OPTION (ECHO) IS A COLLABORATIVE EFFORT INVOLVING CVHP, LOCAL SCHOOL DISTRICTS AND HEALTH PROVIDERS THAT ENSURES THAT EVERY CHILD, REGARDLESS OF INCOME LEVEL, HAS ACCESS TO QUALITY HEALTH CARE. PROMOTERS OF HEALTH IS A PEER EDUCATION PROGRAM DESIGNED TO TEACH AND INSPIRE AT-RISK CHILDREN - AGES 12 TO 20 - TO MAKE HEALTHY DECISIONS. AND THROUGH THE GET ENROLLMENT MOVING PROGRAM, ALSO KNOWN AS GEM, VOLUNTEERS AND CVHP STAFF MEMBERS WORK TOGETHER TO RECRUIT ELIGIBLE FAMILIES AND ENROLL THEM IN MEDI-CAL, HEALTHY FAMILIES OR OTHER STATE PROGRAMS. FAMILIES MUST MEET CERTAIN CRITERIA TO QUALIFY AND COST VARIES DEPENDING ON INCOME, NUMBER OF CHILDREN AND OTHER FACTORS. THE PROGRAM IS FUNDED BY STATE AND COUNTY GRANTS AWARDED TO CVHP.FOR CVHP'S ACCOMPLISHMENTS AND OUTSTANDING EFFORTS TO IMPROVE THE COMMUNITY'S HEALTH AND WELL-BEING, WE WERE NAMED WINNER OF A 1999 VHA LEADERSHIP AWARD IN COMMUNITY HEALTH IMPROVEMENT. CVHP WAS ONE OF ONLY EIGHT HONOREES NATIONWIDE TO RECEIVE A VOLUNTARY HOSPITALS OF AMERICA, INC. (VHA) AWARD IN 1999 AND WAS THE ONLY CALIFORNIA-BASED ORGANIZATION TO BE RECOGNIZED. AS A TEAM OF THE FOUR FINEST HEALTH CARE INSTITUTIONS IN THE REGION, OUR COLLECTIVE STRENGTHS ENABLE US TO CONTINUE THE COMMITMENT TO EXCELLENCE THE SAN GABRIEL VALLEY HAS COME TO KNOW AND TRUST. REPORTS FILED WITH STATES PART VI, LINE 7 CA 1 0 0 0 0 0 0 0 0 ROBERT H CURRY 0 594693 0 154551 0 109088 0 13968 0 21129 0 893429 0 0 WILLIAM HANES MD 0 0 0 0 157200 0 0 0 0 0 157200 0 0 0 ELVIA FOULKE 0 204727 0 71527 0 45638 0 0 0 5389 0 327281 0 0 RAJESH SHARMA 0 315016 0 115624 0 53184 0 0 0 16453 0 500277 0 0 GREGORY LANDERS 0 164033 0 6909 0 91124 0 6942 0 12160 0 281168 0 0 CECILIA AGUDO 0 227643 0 0 0 57 0 3708 0 12351 0 243759 0 0 JODI B GALLI 0 165142 0 44630 0 13661 0 4926 0 10069 0 238428 0 0 MARY ZIMMER 0 204088 0 6552 0 13278 0 10095 0 21032 0 255045 0 0 KENT MARTYN 0 177692 0 6422 0 33267 0 8358 0 5734 0 231473 0 0 PART I, LINE 4A GREGORY LANDERS RECEIVED SEVERANCE PAYMENT OF $83,418 AND KENT MARTYN RECEIVED SEVERANCE PAYMENT OF $27,805. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, QUESTION 3 - ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR - CVHP USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. PLEASE SEE ADDITIONAL EXPLANATION AT SCHEDULE O FOR FORM 990, PART VI, SECTION B, LINE 15. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 2010-03-31 3700000 MEDICAL EQUIPMENT 0 0 1 A 3700000 3700000 2011 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THIS ORGANIZATION IS CITRUS VALLEY HEALTH PARTNERS, INC. THE MEMBER THROUGH THE BOARD OF DIRECTORS HAS THE RIGHT TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE ORGANIZATION'S SOLE MEMBER, CITRUS VALLEY HEALTH PARTNERS. FORM 990, PART VI, SECTION B, LINE 11 STAFF ACCOUNTANTS, ACCOUNTING MANAGER AND DIRECTOR OF CORPORATE FINANCE REVIEW FORM 990 FOR ACCURACY AND COMPLETENESS UPON RECEIVING IT FROM THE CPA TAX PREPARER. FORM 990 IS FORWARDED TO RAJESH SHARMA, SR. VP & CFO, FOR THE FINAL REVIEW. TAX PREPARER PRESENTS FORM 990 TO THE AUDIT AND COMPLIANCE COMMITTEE FOR APPROVAL. BOARD DELEGATED REVIEW AND APPROVAL TO THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, KEY EMPLOYEES, AND MANAGEMENT ARE COVERED BY THE CONFLICT OF INTEREST POLICY. DETERMINATIONS OF CONFLICT AND REVIEW OF CONFLICT ARE PERFORMED AT THESE VARIOUS LEVELS OF THE ORGANIZATION. APPROPRIATE ACTION DEPENDING ON THE CONFLICT IS TAKEN BY MANAGEMENT, KEY EMPLOYEES, AND THE BOARD. DISCLOSURE FORMS ARE REQUIRED ANNUALLY BY EACH MEMBER OF THE BOARD OF DIRECTORS, KEY EMPLOYEES, AND MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION UTILIZES THE FOLLOWING TO ESTABLISH REASONABLE COMPENSATION: COMPENSATION COMMITTEE; INDEPENDENT COMPENSATION CONSULTANT; WRITTEN EMPLOYMENT CONTRACT; COMPENSATION SURVEY/STUDIES; APPROVAL BY BOARD OR COMPENSATION COMMITTEE, WHICH APPROVAL IS DOCUMENTED IN CONTEMPORANEOUS WRITTEN MINUTES. EXECUTIVE PAY AT CITRUS VALLEY HEALTH PARTNERS FOLLOWS MARKET-BASED PAY PRACTICES FOR HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND TYPE IN THE SOUTHERN CALIFORNIA AREA. SALARY RANGES FOR EXECUTIVES WORKING AT CVHP FACILITIES FALL WITHIN THE MIDDLE OF THE MARKET, JUST AS THEY DO FOR ALL EMPLOYEES OF OUR ORGANIZATION. EVERY POSITION IN THE ORGANIZATION HAS A SALARY RANGE ATTACHED TO IT THAT REPRESENTS WHAT OTHERS DOING A SIMILAR JOB IN OTHER ORGANIZATIONS ARE LIKELY TO BE PAID. THE LONG-STANDING PAY PHILOSOPHY FOR CVHP HAS BEEN TO POSITION OUR SALARY RANGES IN THE MIDDLE OF OUR LOCAL LABOR MARKET WE DON'T WANT TO LAG THE LOCAL MARKET, NOR DO WE WANT TO LEAD THE MARKET, SINCE THAT IS NOT A STRATEGY WE CAN AFFORD TO SUSTAIN OVER TIME. WE RELY ON MARKET STUDIES TO DETERMINE WHERE OUR PAY PRACTICES ARE RELATIVE TO OTHER HOSPITALS IN SOUTHERN CALIFORNIA. FOR EXECUTIVE PAY, WE USE THE NATIONALLY-RECOGNIZED AND RESPECTED FIRM, HAYGROUP, TO ANALYZE OUR EXECUTIVE PAY PROGRAM AND DETERMINE WHERE IT FALLS IN OUR MARKET. THIS STUDY IS PERFORMED EVERY OTHER YEAR. THE MOST RECENT EXECUTIVE COMPENSATION DATA IS DATED OCTOBER 2012. AS PART OF THEIR EXECUTIVE COMPENSATION REVIEW, HAYGROUP ALSO ISSUES AN OPINION LETTER REGARDING THE REASONABLENESS OF THE PAY PROGRAM FOR A NOT-FOR-PROFIT ORGANIZATION LIKE OURS THAT IS SUBJECT TO THE REQUIREMENTS OF SECTION 4958 OF THE INTERNAL REVENUE CODE AND UNITED STATES TREASURY DEPARTMENT REGULATIONS. IN THEIR OCTOBER 31, 2012, OPINION LETTER, HAYGROUP WROTE, WE BELIEVE WE HAVE COMPARED THE EXECUTIVE COMPENSATION TO COMPENSATION AND BENEFITS PAID TO EXECUTIVES OF ORGANIZATIONS WITH LIKE SERVICES BY LIKE ENTERPRISES UNDER LIKE CIRCUMSTANCES, AND AS RESULT, WE BELIEVE THAT COMPENSATION AND BENEFITS PAID TO THE EXECUTIVES ARE REASONABLE WITHIN THE MEANING OF SECTION 53.4958-4(B)(1)(II)(A) OF THE TREASURY REGULATIONS. THE EXECUTIVE POSITIONS THAT ARE INCLUDED IN THE BIENNIAL EXECUTIVE COMPENSATION REVIEW INCLUDE THE PRESIDENT/CEO, CHIEF MEDICAL OFFICER/CHIEF INFORMATION OFFICER, CHIEF FINANCIAL OFFICER, CHIEF NURSING OFFICER, CHIEF HUMAN RESOURCES OFFICER, CHIEF CLINICAL SERVICES OFFICER, CHIEF STRATEGY OFFICER, CHIEF COMPLIANCE OFFICER, CHIEF PATIENT SUPPORT OPERATIONS OFFICER, CHIEF COMMUNICATIONS OFFICER, AND CEO (CITRUS VALLEY HEALTH FOUNDATION). FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST AN AUDIT REPORT IS AVAILABLE AS REQUIRED. NO OTHER DOCUMENTS ARE AVAILABLE. OTHER FEES FORM 990, PART IX, LINE 11G MEDICAL DOCTOR'S FEE: PROGRAM SERVICE EXPENSES 5,797,296. MANAGEMENT AND GENERAL EXPENSES 478,061. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,275,357. CONSULTING: PROGRAM SERVICE EXPENSES 1,489,022. MANAGEMENT AND GENERAL EXPENSES 122,789. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,611,811. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST -93,637. PASSTHROUGH INCOME DIFFERENCE -20,697. AUDITED FINANCIAL STATEMENTS PART XII LINES 2B: THE FINANCIAL STATEMENTS OF CITRUS VALLEY HEALTH PARTNERS, INC. AND ITS AFFILIATES, CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, FOOTHILL PRESBYTERIAN HOSPITAL, CITRUS VALLEY HEALTH FOUNDATION, INC., AND GLENDORA SURGERY CENTER, WERE AUDITED ON A CONSOLIDATED BASIS. AUDIT AND COMPLIANCE COMMITTEE FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS HAS CONSTITUTED AN AUDIT AND COMPLIANCE COMMITTEE AND DELEGATED TO THAT COMMITTEE THE RESPONSIBLITY FOR ENAGING INDEPENDENT AUDITORS AND MONITORING THE AUDIT PROCESS. THIS STRUCTURE HAS BEEN IN EFFECT IN PRIOR YEARS AND WAS NOT CHANGED IN 2012. REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J THE OFFICERS REPORTED ON PART VII OF FORM 990 ARE COMPENSATED BY AN AFFILIATED ENTITY, CITRUS VALLEY HEALTH PARTNERS (CVHP). THE COMPENSATION AMOUNTS REPORTED IN PART VII OF FORM 990 REPRESENT 100% OF THE COMPENSATION PAID BY CVHP TO THE OFFICERS. THE OFFICERS ALSO SERVE AS CORPORATE OFFICERS FOR CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, INC., FOOTHILL PRESBYTERIAN HOSPITAL AND CITRUS VALLEY HEALTH FOUNDATION, INC., ALL AFFILIATES OF THE TAXPAYER. IN ACCORDANCE WITH OUR UNDERSTANDING OF THE FORM 990 INSTRUCTIONS, SIMILAR PART VII DISCLOSURES ARE MADE IN EACH OF THE AFOREMENTIONED AFFILIATES 990 RETURNS. REPORTABLE HOURS FOR RELATED ORGANIZATIONS PART VII, SECTION A THE OFFICERS SERVE AS COPORATE OFFICERS FOR CITRUS VALLEY HEALTH PARTNERS (CVHP), CITRUS VALLEY MEDICAL CENTER, INC. (CVMC), CITRUS VALLEY HOSPICE (CVH), INC., FOOTHILL PRESBYTERIAN HOSPITAL (FPH) AND CITRUS VALLEY HEALTH FOUNDATION, INC. (CVHF), ALL AFFILIATES OF THE TAXPAYER. THE NUMBER OF HOURS DEVOTED BY THE CORPORATE OFFICERS TO THE AFFILIATES ARE AS FOLLOWS. ELVIA FOULKE DEVOTED 5, 5, 1, AND 9 HOURS TO FPH, CVH, CVHF, AND CVHP, RESPECTIVELY. ROBERT CURRY DEVOTED 4, 2, 2, AND 18 HOURS TO FPH, CVH, CVHF, AND CVHP, RESPECTIVELY. RAJESH SHARMA DEVOTED 4, 2, 2, AND 18 HOURS TO FPH, CVH, CVHF, AND CVHP, RESPECTIVELY. FILING OF FORM 1098C 990 PART V LINE 7H THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF AUTOMOBILES, BOATS, AIRPLANES OR OTHER VEHICLES. CONSEQUENTLY NO FORMS 1098C WERE FILED. CITRUS VALLEY HEALTH PARTNERS INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 953885523 EXEMPT ORGANIZATION SUPPORT & MANAGEMENT CA 501 (C) (3) 11 TYPE II N/A 0 CITRUS VALLEY HEALTH FOUNDATION INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 952534063 EXEMPT ORGANIZATION SUPPORT CA 501 (C) (3) 11 TYPE I N/A 0 FOOTHILL PRESBYTERIAN HOSPITAL INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 952413054 ACUTE CARE HOSPITAL CA 501 (C) (3) 3 N/A 0 CITRUS VALLEY HOSPICE INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 917225108 953493611 HOME HEALTH & HOSPICE CARE CA 501 (C) (3) 9 N/A 0 GLENDORA SURGERY CENTER 315 E ROUTE 66 101 GLENDORA CA 91740 510492499 OUTPATIENT SURGERY CENTER CA N/A S 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 CITRUS VALLEY HEALTH FOUNDATION C 681863 FAIR MARKET VALUE FOOTHILL PRESBYTERIAN HOSPITAL O -408457 FAIR MARKET VALUE CITRUS VALLEY HOSPICE O -117613 FAIR MARKET VALUE FOOTHILL PRESBYTERIAN HOSPITAL O 545786 FAIR MARKET VALUE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, SCHEDULE R, PART V, NUMBER 2, CODE O: THE SALARIES REPORTED ON FORM 990 ARE PROCESSED THROUGH CITRUS VALLEY HEATLH PARTNERS. CITRUS VALLEY HEALTH PARTNERS ACTS AS A COMMON PAYMASTER FOR AFFILIATED ENTITIES, CITRUS VALLEY MEDICAL CENTER, CITRUS VALLEY HEALTH FOUNDATION AND CITRUS VALLEY HOSPICE. CITRUS VALLEY HEALTH PARTNERS FILED ONE FORM W-3 WHICH SHOWS A COMBINED NUMBER OF 3,004 EMPLOYEES. THE NUMBER OF EMPLOYEES FOR EACH ENTITY IS REPORTED SEPARATELY ON ITS OWN FORM 990 PART I LINE 5. CITRUS VALLEY MEDICAL CENTER'S FORM 990 REPORTED A TOTAL OF 2,569 EMPLOYEES, CITRUS VALLEY HOSPICE'S FORM 990 REPORTED 100 EMPLOYEES, CITRUS VALLEY HEALTH FOUNDATION'S FORM 990 REPORTED 8 EMPLOYEES AND CITRUS VALLEY HEALTH PARTNER'S FORM 990 REPORTED 327 EMPLOYEES.