2012-10-30T17:27:28-05:00 2011-12-31 330155525 HBLA CERTIFIED PUBLIC ACCOUNTANTS INC 19600 FAIRCHILD STE 320 IRVINE CA 92612 990 2011-01-01 952413054 FOOTHILL PRESBYTERIAN HOSPITAL - MORRIS L JOHNSTON MEMORIAL FOOT 6269638411 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 RAJESH SHARMA SR VP 6269387577 2012-10-17 1 EDWARD E BENOE P00032866 9498332815 2011 2016-02-24 21:20:13Z FOOTHILL PRESBYTERIAN HOSPITAL ROBERT H CURRY 140 W COLLEGE ST PO BOX 6108 COVINA CA 917225108 78456696 0 X CVHP.ORG X 1965 CA OPERATION OF ACUTE CARE HOSPITAL. 19 15 637 103 37117 32837 69684 309038 72833403 73096927 53667 69560 613391 692184 73570145 74167709 1500 0 0 0 37253924 39542343 0 0 0 33444964 33538543 70700388 73080886 2869757 1086823 54517964 52275490 16951805 14219727 37566159 38055763 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 62936133 73096927 FOOTHILL PRESBYTERIAN HOSPITAL IS AN ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE TO THE SURROUNDING COMMUNITY. FPH PROVIDES FOR, ON AVERAGE, 55 PATIENTS PER DAY. TOTAL ADJUSTED INPATIENT DAYS WERE 31,985. OUTPATIENT AND EMERGENCY VISITS TOTALED 58,951. FPH PROVIDED CHARITY CARE AT COST TOTALING $1,226,000, UNREIMBURSED MEDI-CAL COST TOTALING $6,033,000 AND OTHER COMMUNITY BENEFIT COST TOTALING $307,000. DURING 2011, FPH RECORDED A NET SUPPLEMENTAL MEDI-CAL PAYMENTS OF $414,000 FROM THE CALIFORNIA HOSPITAL FEE PROGRAM FOR THE HOSPITAL SERVICES TO MEDI-CAL PATIENTS COVERED FOR THE 6-MONTH PERIOD FROM JANUARY 1, 2011 TO JUNE 30, 2011. COMMUNITY WELLNESS SERVICES IS COMMITTED TO IMPROVING THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH STATUS OF OUR COMMUNITIES AND TO CONSERVE AND ENHANCE THE ORGANIZATION'S 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. 62936133 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 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 1 0 0 0 0 0 1 0 0 0 0 1 X 93 0 1 637 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 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 PO BOX 6108 COVINA CA 91722 X BERNARD BOLLINGER JR ESQ 3.00 X 0 0 0 JACQUELINE BRACY MD 3.00 X 0 0 0 CLIFFORD CHRIST 3.00 X 0 0 0 PATSY GORRELL 3.00 X 0 0 0 MARY KIRCHEN IHM 3.00 X 0 0 0 ARTHUR LUDWICK 3.00 X 0 0 0 GARY E MATHEWSON 3.00 X 0 0 0 KHAN HAMEED MD 3.00 X 0 19032 0 BILL W TANG MD 3.00 X 0 27800 0 EDWARD M TRONAAS EDD 3.00 X 0 0 0 EARL WASHINGTON 3.00 X 0 0 0 CARL WILLIAMS 3.00 X 0 0 0 ROBERT H CURRY 4.00 X X 0 794706 26905 HAROLD BORAK SR 3.00 X 0 0 0 PATRICIA GOMER LCSW 3.00 X 0 0 0 J PAUL HOLLAND MD 3.00 X 0 0 0 TERI MEISTER ESQ 3.00 X 0 0 0 WILLIAM HANES MD 3.00 X 0 160033 0 JOHN DI MARE JR MD 3.00 X 188000 0 0 OJ RODRIGUEZ 3.00 X 0 0 0 GURJEET KALKAT MD 3.00 X 0 0 0 ELVIA FOULKE 5.00 X 0 563643 14128 LOIS CONYERS 4.00 X 0 411255 12523 RAJESH SHARMA 4.00 X 0 56336 2725 DIANA LUGO-ZENNER 40.00 X 0 309740 18561 STANLEY KOZAKA 40.00 X 198445 0 18070 JOHN CASSARA 40.00 X 177803 0 14077 CHANDRA REDDY 40.00 X 201086 0 16359 JEAN SIROIS 40.00 X 178300 0 12986 943634 2342545 136334 85 0 1 0 QUESTAR ENGINEERING 17841 MITCHELL NORTH IRVINE CA 92614 ENGINEERING/MGMT 829246 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 900745826 MRI PROVIDER 128688 SOUTHERN CALIFORNIA HOSPITALIST PO BOX 8206 ANAHEIM CA 92812 STAFFING SERVICES 102254 3 306067 2971 309038 PATIENT REV/MEDICARE/M 900099 71152899 71152899 HOSPITAL FEE PROGRAM R 900099 1876999 1876999 GRANT PROGRAM 900099 67029 67029 73096927 48881 48881 167640 0 167640 167640 37117 130523 4300916 8750 4253458 35529 47458 -26779 20679 20679 CAFETERIA 900099 198989 198989 REBATES & REFUNDS 900099 159244 159244 OTHER MISC PROGRAM REV 900099 155837 155837 10474 185 10289 524544 74167709 73252949 37117 568605 390666 128560 262106 29599753 29087500 512253 362735 357872 4863 6727571 6638907 88664 2461618 2433485 28133 5016 5016 150 150 15608 15608 943809 554653 389156 9434525 9418155 16370 842038 842038 11576 8073 3503 210157 210157 3227236 3218638 8598 805147 805147 UNRELATED BUS INC TAX 9721 9721 PURCHASED SERVICES 10849848 3570452 7279396 BAD DEBT EXPENSE 3778651 3778651 HOSPITAL FEE PROGRAM 1462577 1462577 1942484 1878679 63805 73080886 62936133 10144753 0 4569564 2696209 11752378 12214343 1743 2611 695732 687725 289184 925459 78042085 46921906 31795691 31120179 1695323 1684332 440859 464331 3277490 2480301 54517964 52275490 11141574 8801783 4235143 3867485 1575088 1550459 16951805 14219727 X 35094211 35779467 1449157 1241268 1022791 1035028 37566159 38055763 54517964 52275490 X 1086823 -597219 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1022791 12237 1035028 1012394 10397 1022791 997293 15101 1012394 1017468 -20175 997293 1.00000 0 0 1173257 1173257 42169827 19405321 22764506 34699001 27516585 7182416 31120179 OTHER CURRENT LIABILITIES 181849 MALPRACTICE RESERVE LONG TERM 577000 CAPITAL LEASE PAYABLE 791610 1550459 74167709 73080886 1086823 -82811 -514408 -597219 489604 69586000 -82811 -82811 69668811 4498898 4498898 74167709 69206000 0 69206000 3874886 3874886 73080886 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PERMANENTLY RESTRICTED ASSETS ARE RESTRICTED INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF RESTRICTED FUNDS 117,268. PASSTHROUGH INCOME DIFFERENCE -25,162. DECREASE IN BENEFICIAL INTEREST CVHF -300,447. TRANSFERS FROM CVHF -306,067. TOTAL TO SCHEDULE D, PART XI, LINE 8: -514,408. PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED INCOME ACTIVITY 70,000. INVESTMENT FEES INCLUDED IN INCOME 15,608. PASSTHROUGH INCOME DIFFERENCE 25,162. ROUNDING DIFFERENCE -112. BANK CHARGES INCLUDED IN INCOME 3,075. DECREASE IN BENEFICIAL INTEREST CVHF 300,447. PROVISION FOR BAD DEBTS 3,778,651. TRANSFER FROM CVHF 306,067. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED INCOME ACTIVITY 77,899. ROUNDING DIFFERENCE -347. INVESTMENT FEES INCLUDED IN INCOME 15,608. BANK CHARGES INCLUDED IN INCOME 3,075. BAD DEBT EXPENSE 3,778,651. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 1226000 1226000 0.01680 12287151 6668250 5618901 0.07690 13513151 6668250 6844901 0.09370 307121 307121 0.00420 307121 307121 0.00420 13820272 6668250 7152022 0.09790 1 3778651 0 16970077 19295985 -2325908 X 1 1 1 1 FOOTHILL PRESBYTERIAN HOSPITAL

250 SOUTH GRAND AVENUE GLENDORA CA 91741

X X X FOOTHILL PRESBYTERIAN HOSPITAL 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 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/A PART I, LINE 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 MEDI-CAL PAYMENTS OF $414,422 FROM THE CALIFORNIA HOSPITAL FEE PROGRAM ("PROGRAM") FOR THE HOSPITAL SERVICES TO MEDI-CAL PATIENTS WHICH COVERED THE 6-MONTH PERIOD FROM JANUARY 1, 2011 TO JUNE 30, 2011.THE PROGRAM WAS SIGNED INTO LAW AND WAS APPROVED BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) AND BECAME EFFECTIVE IN SEPTEMBER 2010. 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. FPH PROVIDED APPROXIMATELY 1,550 DAYS OF QUALITY HEALTH CARE SERVICES TO MEDI-CAL BENEFICIARIES DURING THIS 6-MONTH PERIOD, AND 3,511 MEDI-CAL DAYS FOR THE YEAR.DUE TO DEEP FUNDING CUTS TO 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 FPH 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 FPH THAT FUTURE SIMILAR PROGRAMS BE APPROVED AND IMPLEMENTED. 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 ABOVE MEDICARE ALLOWABLE COSTS. 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, NON-ALLOWABLE MEALS, HOME OFFICE BUILDING COSTS, AND OTHER NON-ALLOWABLE EXPENSES. IF THE ESTIMATED ADDITIONAL ALLOCATED DISALLOWABLE MEDICARE COSTS OF $673,510 WERE INCLUDED IN LINE 6, THE (SHORTFALL) ON LINE 7 WOULD BE ($2,999,418). 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. FOOTHILL PRESBYTERIAN HOSPITAL 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 LIAISONS 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. FOOTHILL PRESBYTERIAN HOSPITAL PART V, SECTION B, LINE 4: COMMUNITY HEALTH NEEDS ASSESSMENT - THE HOSPITAL FACILITY'S NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:- CITRUS VALLEY MEDICAL CENTER - COVINA, CA- KAISER FOUNDATION HOSPITAL - BALDWIN PARK, CA FOOTHILL PRESBYTERIAN HOSPITAL PART V, SECTION B, LINE 19D: THE HOSPITAL DETERMINED, DURING THE TAX YEAR, THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-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 PROCEDURES 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: 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.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 SCHOOLS, CHILD-CARE AGENCIES, CHURCHES, FAMILY RESOURCE CENTERS, CLINICS, COMMUNITY BASED ORGANIZATION, ETC. TO IDENTIFY UNINSURED CHILDREN AND ADULTS, AND PROVIDE SERVICES WITHIN THEIR NEIGHBORHOODS. 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:FOOTHILL PRESBYTERIAN HOSPITAL (FPH) TOGETHER WITH ITS AFFILIATE CITRUS VALLEY MEDICAL CENTER (CVMC) SERVES AN URBAN COMMUNITY OF NEARLY ONE MILLION PEOPLE IN THE SAN GABRIEL VALLEY. CVMC HAS TWO HOSPITALS: INTER-COMMUNITY CAMPUS IN COVINA AND QUEEN OF THE VALLEY CAMPUS IN WEST COVINA. FOLLOWING IS A SUMMARY OF THE MAJOR DEMOGRAPHICS OF THE HOSPITAL AND ITS AFFILIATES' 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 FPH'S INPATIENT DAYS SERVED: MEDI-CAL AND MEDI-CAL MANAGED CARE 17.6%, MEDICARE AND MEDICARE MANAGED CARE, 53.1%, MANAGED CARE 24.5%, AND SELF-PAY 4.7%. APPROXIMATELY 8 OTHER HOSPITALS ARE SERVICING THE AREAS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:FOOTHILL PRESBYTERIAN HOSPITAL, A FULLY ACCREDITED 105 BED NONPROFIT HOSPITAL, HAS PROUDLY SERVED THE COMMUNITIES OF GLENDORA, AZUSA, LA VERNE AND SAN DIMAS SINCE 1973. KEY SERVICES: FULL RANGE OF GENERAL ACUTE CARE SERVICES. CITRUS VALLEY HEALTH PARTNERS OUTPATIENT DIABETES EDUCATION PROGRAM - RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION AS A CENTER OF EXCELLENCE FOR DIABETES EDUCATION. 37-BED DIABETES CARE UNIT. 13-BED CARL E. WYNN NEWBORN INN - STATE-OF-THE-ART, PRIVATE-ROOM MATERNITY CARE. 9-BED CORONARY CARE UNIT. 9-BED INTENSIVE CARE UNIT. 37-BED MEDICAL/SURGICAL CARE SERVICES. 24-HOUR EMERGENCY SERVICES, INCLUDING THE ONLY FAA-APPROVED HELIPORT BETWEEN SAN BERNARDINO AND ARCADIA LITHOTRIPSY SERVICES. CITRUS VALLEY CENTERS FOR REHABILITATION SERVICES - OFFERING SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY SERVICES FOR CHILDREN AND ADULTS. THE HOSPITAL IS GOVERNED BY A 19-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 345 PHYSICIANS, OF WHICH 140 ARE MEMBERS OF ITS ACTIVE STAFF (DEFINED AS ADMITTING MORE THAN TWELVE PATIENTS PER YEAR). THE TEN MOST ACTIVE ADMITTING PHYSICIANS ACCOUNTED FOR APPROXIMATELY 55.7% OF TOTAL ADMISSIONS TO FPH. THESE PHYSICIANS HAD SPECIALTIES OF INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY AND PULMONARY MEDICINE - 81.2% OF THE TOTAL MEDICAL STAFF MEMBERS AND 97.9% OF THE ACTIVE MEDICAL STAFF 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: CVHP, THE SOLE CORPORATE MEMBER OF CITRUS VALLEY MEDICAL CENTER (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 FPH AND ITS AFFILIATE ORGANIZATIONS.CVMC OPERATES ACUTE CARE HOSPITALS WITH A TOTAL OF 518 LICENSED BEDS AND PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE COMMUNITIES SURROUNDING ITS TWO MEDICAL CENTER CAMPUSES: QUEEN OF THE VALLEY CAMPUS LOCATED IN WEST COVINA WITH 325 LICENSED BEDS, AND INTER-COMMUNITY CAMPUS LOCATED IN COVINA WITH 193 LICENSED BEDS. 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.COMMUNITY OUTREACH: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 0 0 0 0 0 0 0 0 0 ROBERT H CURRY 0 572964 0 119592 0 102150 0 6651 0 20254 0 821611 0 0 WILLIAM HANES MD 0 160033 0 0 0 0 0 0 0 0 0 160033 0 0 JOHN DI MARE JR MD 188000 0 0 0 0 0 0 0 0 0 188000 0 0 0 ELVIA FOULKE 0 394869 0 86345 0 82429 0 0 0 14128 0 577771 0 0 LOIS CONYERS 0 278627 0 76323 0 56305 0 2025 0 10498 0 423778 0 0 DIANA LUGO-ZENNER 0 229068 0 48534 0 32138 0 3954 0 14607 0 328301 0 0 STANLEY KOZAKA 194641 0 3613 0 191 0 3687 0 14383 0 216515 0 0 0 JOHN CASSARA 167820 0 7988 0 1995 0 3276 0 10801 0 191880 0 0 0 CHANDRA REDDY 200974 0 0 0 112 0 4041 0 12318 0 217445 0 0 0 JEAN SIROIS 178249 0 0 0 51 0 1476 0 11510 0 191286 0 0 0 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. CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 2010-03-31 1300000 MEDICAL EQUIPMENT 0 0 1 1300000 872559 427441 2011 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 ELVIA FOULKE OFFICER OF CVHP, INC. AND BOARD MEMBER OF OPTIMA 2311587 CITRUS VALLEY HEALTH PARTNERS, INC. PURCHASES INSURANCE FROM OPTIMA. OPTIMA IS A FULL-SERVICE BROKERAGE COMPANY WHICH IS A WHOLLY OWNED SUBSIDIARY OF THE CALIFORNIA HEALTHCARE INSURANCE COMPANY, INC. 0 FILING OF FORM 1098C 990 PART V LINE 7H THE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES. CONSEQUENTLY THERE WERE NO FORMS 1098C FILED. 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 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 2010. 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 FEBRUARY 8, 2011, 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, EXECUTIVE VICE PRESIDENT/COO, SENIOR VICE PRESIDENT/CFO, SENIOR VICE PRESIDENT/HUMAN RESOURCES, SENIOR VICE PRESIDENT/CIO, CVMC CHIEF MEDICAL OFFICER, CVMC VP MEDICAL AFFAIRS, CEO /CITRUS VALLEY HEALTH FOUNDATION, FPH ADMINISTRATOR/CNE, VICE PRESIDENT/CNE AT CITRUS VALLEY MEDICAL CENTER AND VP PUBLIC RELATIONS AND COMMUNICATIONS. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST AN AUDIT REPORT IS AVAILABLE AS REQUIRED. NO OTHER DOCUMENTS ARE AVAILABLE. 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 ON 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. THE TOP FIVE HIGHLY COMPENSATED EMPLOYEES ARE ALSO COMPENSATED BY CVHP. 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 20, 5, 1, AND 9 HOURS TO CVMC, CVH, CVHF, AND CVHP, RESPECTIVELY. LOIS CONYERS DEVOTED 14, 2, 2, AND 18 HOURS TO CVMC, CVH, CVHF, AND CVHP, RESPECTIVELY. ROBERT CURRY DEVOTED 14, 2, 2, AND 18 HOURS TO CVMC, CVH, CVHF, AND CVHP, RESPECTIVELY. RAJESH SHARMA DEVOTED 14, 2, 2, AND 18 HOURS TO CVMC, CVH, CVHF, AND CVHP, RESPECTIVELY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -82,811. CHANGE IN VALUE OF RESTRICTED FUNDS 117,268. PASSTHROUGH INCOME DIFFERENCE -25,162. DECREASE IN BENEFICIAL INTEREST CVHF -300,447. TRANSFERS FROM CVHF -306,067. TOTAL TO FORM 990, PART XI, LINE 5: -597,219. 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 RESPONSIBILITY FOR ENGAGING INDEPENDENT AUDITORS AND MONITORING THE AUDIT PROCESS. THIS STRUCTURE HAS BEEN IN EFFECT IN PRIOR YEARS AND WAS NOT CHANGED IN 2011. AUDITED FINANCIAL STATEMENTS PART XII LINES 2B AND 2C THE FINANCIAL STATEMENTS OF CITRUS VALLEY HEALTH PARTNERS, INC. AND ITS AFFILIATES, CITRUS VALLEY MEDICAL CENTER, INC., CITRUS VALLEY HOSPICE, FOOTHILL PRESBYTERIAN HOSPITAL, AND CITRUS VALLEY HEALTH FOUNDATION, INC., WERE AUDITED ON A CONSOLIDATED BASIS. CITRUS VALLEY HEALTH PARTNERS INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 91722 953885523 EXEMPT ORGANIZATION SUPPORT & MANAGEMENT CA 501(C)(3) 11 TYPE II N/A 0 CITRUS VALLEY MEDICAL CENTER INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 91722 956006469 ACUTE CARE HOSPITAL CA 501(C)(3) 3 N/A 0 CITRUS VALLEY HEALTH FOUNDATION INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 91722 952534063 EXEMPT ORGANIZATION SUPPORT CA 501(C)(3) 11 TYPE I N/A 0 CITRUS VALLEY HOSPICE INC 140 W COLLEGE STREET PO BOX 6108 COVINA CA 91722 953493611 HOME HEALTH & HOSPICE CARE CA 501(C)(3) 9 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 CITRUS VALLEY HEALTH FOUNDATION C 306067 FAIR MARKET VALUE CITRUS VALLEY MEDICAL CENTER N -367702 FAIR MARKET VALUE CITRUS VALLEY MEDICAL CENTER N 283725 FAIR MARKET VALUE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, SCHEDULE R, PART V, NUMBER 2, CODE N: THE EXECUTIVE SALARIES ARE PROCESSED THROUGH CITRUS VALLEY HEATLH PARTNERS. CITRUS VALLEY HEALTH PARTNERS ACTS AS A COMMON PAYMASTER FOR THE OTHER 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 3,270 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 2,770 EMPLOYEES, CITRUS VALLEY HOSPICE'S FORM 990 REPORTED 121 EMPLOYEES, CITRUS VALLEY HEALTH FOUNDATION'S FORM 990 REPORTED 10 EMPLOYEES AND CITRUS VALLEY HEALTH PARTNER'S FORM 990 REPORTED 369 EMPLOYEES. THE FILING ORGANIZATION FILES ITS OWN FORM W-3, HOWEVER AMOUNTS REPORTED ON SCHEDULE R, PART V, NUMBER 2, CODE N REPRESENT SHARED EMPLOYEE EXPENSES THAT OCCUR BETWEEN THE AFFILIATES.