2023-03-16T15:09:15-05:00 2021-12-31 910189318 MOSS ADAMS LLP 3121 W MARCH LN STE 200 STOCKTON CA 952192367 990 2021-01-01 941201197 DAMERON HOSPITAL ASSOCIATION DAME 2099445550 525 WEST ACACIA STREET STOCKTON CA 95203 KATIE DELMORE FINANCE OFFICER 2099445550 2023-03-16 1 KATIE DELMORE 999009999 TRACY S PAGLIA P00366884 2099556100 2023-03-16 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z TERRI DAY 525 WEST ACACIA STREET STOCKTON CA 95203 165619967 0 X WWW.DAMERONHOSPITAL.ORG X 1912 CA WE SUPPORT PHYSICIANS AND OUR EMPLOYEES IN PROVIDING QUALITY CARE IN A SAFE, CARING ENVIRONMENT. 6 6 696 7 81800 51402 4708790 4331117 136381259 159159873 1231050 10454 -241700 -225087 142079399 163276357 0 0 0 0 54101656 55203790 0 0 0 106774195 119279528 160875851 174483318 -18796452 -11206961 97253994 96194904 43408842 53576475 53845152 42618429 X WE SUPPORT PHYSICIANS AND OUR EMPLOYEES IN PROVIDING QUALITY CARE IN A SAFE, CARING ENVIRONMENT. 0 0 150362626 0 158758693 DAMERON HOSPITAL IS A JOINT COMMISSION ACCREDITED, 202-BED, NOT-FOR-PROFIT COMMUNITY HOSPITAL DELIVERING EXCELLENT HEALTHCARE TO GENERATIONS OF SAN JOAQUIN COUNTY RESIDENTS FOR OVER 100 YEARS AND IS A NATIONALLY RECOGNIZED AS A LEADER IN QUALITY AND SAFETY. DAMERON HOSPITAL STRIVES TO PROMOTE HEALING AND WELLNESS THROUGH COMPASSIONATE, QUALITY AND COST-EFFECTIVE CARE TO MEET THE IDENTIFIED NEEDS OF THE COMMUNITY WE SERVE. DAMERON HOSPITAL IS PROUD OF ITS PAST AND IS DEDICATED TO ITS FUTURE IN PROVIDING SERVICES TO THE COMMUNITY TO MEET THEIR HEALTHCARE NEEDS. IN KEEPING WITH A HEALTHIER COMMUNITY, DAMERON HOSPITAL IS A SMOKE-FREE, TOBACCO-FREE ENVIRONMENT.DAMERON HOSPITAL EXISTS SOLELY TO SERVE THE HEALTHCARE NEEDS OF THE GREATER STOCKTON AREA AND SAN JOAQUIN COUNTY, PROVIDING THE COMMUNITY WITH ADVANCED TECHNOLOGY AND STATE-OF-THE-ART DIAGNOSTIC AND THERAPEUTIC EQUIPMENT, AS WELL AS FACILITIES FOR INPATIENT, OUTPATIENT, OCCUPATIONAL SERVICES AND AMBULATORY CARE CENTER. DAMERON HOSPITAL OFFERS A BROAD ARRAY OF SERVICES FOR THE HEALTH MAINTENANCE FOR ALL AGE GROUPS.COMPREHENSIVE PATIENT SERVICES INCLUDE BARIATRIC, CARDIOLOGY, ORTHOPEDICS, EMERGENCY/URGENT CARE, AND IMAGING SPECIALTIES. 150362626 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 67 0 1 696 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X KATIE DELMORE 2099445550 525 W ACACIA ST STOCKTON CA 95203 X LARRY BEDNARZ REGISTERED NURSE 40.00 X 250863 0 22498 MARIA VILLARREAL REGISTERED NURSE 40.00 X 242202 0 29643 SHAUN FILLON REGISTERED NURSE 40.00 X 233583 0 28981 CECILIA JAVIER SR. DIRECTOR, LABORATORY 40.00 X 222701 0 28387 MELISSA DAY SENIOR DIRECTOR NURSING 40.00 X 214720 0 27305 WILLIAM TREZZA CHAIRMAN OF THE BOARD 10.00 X X 0 0 0 DANIEL DIXON VICE CHAIRMAN 10.00 X X 0 0 0 BRIAN MARTUCCI SECRETARY 10.00 X X 0 0 0 MICHAEL HAKEEM BOARD MEMBER 10.00 X 0 0 0 KATHY LAGORIO-JANSSEN BOARD MEMBER 10.00 X 0 0 0 HON RONALD NORTHUP BOARD MEMBER 10.00 X 0 0 0 ERIC CORNWELL CMO 40.00 X 0 0 0 TERRI DAY PRESIDENT/CEO/INTERIM CFO 40.00 X 0 0 0 SANJEEV GOSWAMI CHIEF OF STAFF 40.00 X 0 0 0 JASON WHITNEY CFO (EFF. 1/21) 40.00 X 0 0 0 1164069 0 136814 161 0 1 1 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 REGISTERED NURSING SERVICES 5172878 CEP AMERICA ANESTHESIA PC 2100 POWELL STREET SUITE 400 EMERYVILLE CA 94608 ANESTHESIOLOGIST SERVICES 4556111 PACIFIC HEART & VASCULAR MEDICAL 1801 E MARCH LANE STE D400 STOCKTON CA 95210 CARDIAC IMAGING PHYSICIAN SERVICES 3466816 ADVENTIST HEALTH SYSTEMWEST 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 MANAGEMENT SERVICES 2982014 SOUND PHYSICIANS OF CALIF P O BOX 742936 LOS ANGELES CA 90074 HOSPITALIST PHYSICIAN SERVICES 2700181 27 4331110 7 4331117 PATIENT SERVICE REV. 621110 81341394 81341394 MEDICAL/MEDICARE PYMTS 621110 48601749 48601749 HOSPITAL FEE 621110 23107040 23107040 CAFETERIA 722210 369971 369971 REBATES/REFUNDS 621110 124892 124892 5614827 5614827 159159873 9953 9953 2204 -2204 -2204 -2204 379525 500 379524 0 1 500 501 501 1588860 1961882 -373022 -401180 28158 OTHER INCOME 900099 96497 96497 INCOME FROM K-1 541900 53642 53642 150139 163276357 158758693 81800 104747 X 36620735 33373776 3246959 1031609 955801 75808 14268542 12435873 1832669 3282904 2979003 303901 2982014 1377981 1604033 484720 484720 294803 294803 42937121 36276890 6660231 30266899 29980531 286368 8171238 522677 7648561 2544257 2300688 243569 25269 9911 15358 53229 50975 2254 27474 27474 5971633 5971633 1275912 1275912 BAD DEBTS PROVISION 14346472 14346472 MEDI-CAL HOSPITAL FEE E 9769118 9769118 DUES & SUBSCRIPTIONS 127747 11297 116450 FOUNDATION 1622 1622 174483318 150362626 24120692 0 60534 3000 7897759 1460851 12258494 18778925 3712247 3763062 1932225 2200667 218809527 171718236 51821459 47091291 189761 7881 436914 395890 18944601 22493337 97253994 96194904 32140265 43165877 11268577 10410598 43408842 53576475 X 53837309 42610586 7843 7843 53845152 42618429 97253994 96194904 -11206961 -19762 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5182186 5182186 98392137 65299634 33092503 1560764 1450451 110313 105010233 98117564 6892669 8664207 6850587 1813620 47091291 COST REPORT SETTLEMENT RECEIVABLE 18469973 DUE FROM MEDICAL GROUP 4023364 22493337 RISK MANAGEMENT PROGRAMS 4940047 RETIREE MEDICAL LIABILITY 4669551 OTHER NONCURRENT LIABILITIES 801000 10410598 1 1 1 X 350.000000000000 1 X 150.000000000000 1 1 0 1 1 681549 681549 0.00430 48727309 23185738 25541571 0.15950 49408858 23185738 26223120 0.16380 49408858 23185738 26223120 0.16380 1 14346472 4309356 29860000 37932062 -8072062 X 1 1 1 1 DAMERON HOSPITAL ASSOCIATION 525 WEST ACACIA STREET STOCKTON CA 95203 WWW.DAMERONHOSPITAL.ORG 030000024 X X X DAMERON HOSPITAL ASSOCIATION 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X SEE SCH H PART VI - NEEDS ASSESSMENT X SEE SCH H PART VI - NEEDS ASSESSMENT 1 20 0 1 1 1 50000 1 X 350.000000000000 150.000000000000 X 1 1 X X X X 1 X SCH H PART VI-PATIENT EDUC X SCH H PART VI-PATIENT EDUC X X X X 1 X 0 X X X X X 1 X 0 0 DAMERON HOSPITAL ASSOCIATION PART V, SECTION B, LINE 5: THE CHNA WAS A COLLABORATIVE EXAMINATION OF HEALTH IN SAN JOAQUIN COUNTY, UPDATING AND BUILDING ON WORK DONE IN PRIOR YEARS, INCLUDING MANY OF THE THEMES IDENTIFIED IN PREVIOUS CHNA CYCLES. THE 2019 CHNA PROCESS APPLIED A SOCIAL DETERMINANTS OF HEALTH FRAMEWORK AND EXAMINED SAN JOAQUIN COUNTY'S SOCIAL, ENVIRONMENTAL, AND ECONOMIC CONDITIONS THAT IMPACT HEALTH IN ADDITION TO EXPLORING FACTORS RELATED TO DISEASES, CLINICAL CARE, AND PHYSICAL HEALTH. 6 ANALYSIS OF THIS BROAD RANGE OF CONTRIBUTING FACTORS RESULTED IN IDENTIFICATION OF THE TOP HEALTH NEEDS FOR THE COUNTY. THE 2019 CHNA ASSESSED THE HEALTH ISSUES AND CONTRIBUTING FACTORS WITH GREATEST IMPACT AMONG VULNERABLE POPULATIONS THAT DISPROPORTIONATELY HAVE POORER HEALTH OUTCOMES ACROSS MULTIPLE HEALTH NEEDS. THE CHNA EXPLORED DISPARITIES FOR POPULATIONS RESIDING IN SPECIFIC GEOGRAPHIC AREAS REFERRED TO HERE AS "PRIORITY NEIGHBORHOODS", AS WELL AS DISPARITIES AMONG THE COUNTY'S DIVERSE ETHNIC POPULATIONS. THESE ANALYSES WILL INFORM INTERVENTION STRATEGIES TO PROMOTE HEALTH EQUITY. THE 2019 CHNA UTILIZED A MIXED-METHODS APPROACH. THE CORE TEAM, THE PUBLIC HEALTH SERVICES EPIDEMIOLOGISTS, AND AD LUCEM CONSULTING REVIEWED SECONDARY DATA AVAILABLE THROUGH KAISER PERMANENTE'S CHNA DATA PLATFORM AND COMPILED ADDITIONAL DATA FROM NATIONAL, STATEWIDE, AND LOCAL SOURCES TO PROVIDE A MORE COMPLETE PICTURE OF HEALTH IN SAN JOAQUIN COUNTY. THESE DATA WERE COMPARED TO BENCHMARK DATA AND ANALYZED TO IDENTIFY POTENTIAL AREAS OF NEED. IN ADDITION, AD LUCEM CONSULTING, IN CONCERT WITH THE CORE TEAM, COLLECTED PRIMARY DATA VIA KEY INFORMANT INTERVIEWS AND FOCUS GROUPS THAT OFFERED A WIDE RANGE OF OPINIONS ABOUT ISSUES THAT MOST IMPACT THE HEALTH OF THE COMMUNITY, AS WELL AS EXAMPLES OF EXISTING RESOURCES THAT WORK TO ADDRESS THOSE NEEDS, AND SUGGESTIONS FOR CONTINUED PROGRESS IN IMPROVING THESE ISSUES. THE ANALYZED QUANTITATIVE AND QUALITATIVE DATA WERE TRIANGULATED TO IDENTIFY THE TOP HEALTH NEEDS IN THE COUNTY. A SUMMARY HEALTH NEED PROFILE WAS THEN CREATED FOR EACH OF THESE. A MULTI-STEP PROCESS WAS CONDUCTED TO RANK THE HEALTH NEEDS INTO HIGHEST, MEDIUM AND LOWER PRIORITY. FIRST, PRIORITIES WERE COLLECTED FROM THE COMMUNITY-BASED ON: 1) RESPONSES TO A SURVEY WITH OLDER ADULTS DESIGNED TO CAPTURE THEIR PERSPECTIVES ON PRIORITY HEALTH NEEDS FACING THEIR COMMUNITIES; 2) A MEETING HELD WITH TRACY COMMUNITY RESIDENTS TO PRESENT THE SECONDARY AND PRIMARY DATA AND COLLECT THEIR INPUT ON PRIORITY HEALTH NEEDS; 3) THE RESULTS OF THE OLDER ADULT SURVEY AND TRACY COMMUNITY MEETING WERE SHARED WITH THE CHNA STEERING COMMITTEE, ALONG WITH THE HEALTH NEED PROFILES. FINAL HEALTH NEED PRIORITIZATION TOOK PLACE AT THIS MEETING, WHERE THE STEERING COMMITTEE REACHED CONSENSUS AS TO WHICH OF THE HEALTH NEEDS SHOULD BE A PRIORITY FOR ACTION. THIS PRIORITIZATION WAS BASED ON CRITERIA IDENTIFIED BY THE CORE TEAM. THESE METHODS, THE DATA COLLECTED AND THE RESULTING PRIORITIZED COMMUNITY HEALTH NEEDS ARE PRESENTED IN THIS REPORT AND IN THE APPENDICES. DAMERON HOSPITAL ASSOCIATION PART V, SECTION B, LINE 6A: ADVENTIST HEALTH LODI MEMORIAL, COMMUNITY MEDICAL CENTERS, DIGNITY HEALTH ST. JOSEPH'S MEDICAL CENTER, FIRST 5 SAN JOAQUIN, HEALTH NET, HEALTH PLAN OF SAN JOAQUIN, KAISER PERMANENTE, SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, AND SUTTER HEALTH DAMERON HOSPITAL ASSOCIATION PART V, SECTION B, LINE 11: THE IMPLEMENTATION PLAN WAS DEVELOPED FOLLOWING A DISTINCT THREE STEP STRATEGIC PLANNING PROCESS. FIRST, THE HEALTH NEEDS IDENTIFIED IN THE CHNA WERE PRIORITIZED BY MEMBERS OF THE SJC2HAC. SECOND, DAMERON HOSPITAL SELECTED FOUR OF THE PRIORITIZED HEALTH NEEDS AS A PRIMARY FOCUS FOR THE PURPOSES OF MEETING THE HEALTH NEEDS OF THE COMMUNITY. THOSE CHOSEN MOST CLOSELY ALIGNED WITH THE HOSPITAL'S MISSION AND ORGANIZATIONAL CAPABILITIES. THE THIRD, AND FINAL STEP WAS THE DEVELOPMENT OF AN IMPLEMENTATION PLAN.STEP 1: PRIORITIZING HEALTH NEEDSTHE SJC2HAC PRIORITIZED AND RANKED THE IDENTIFIED COMMUNITY HEALTH NEEDS. EACH HEALTH NEED WAS RANKED ALONG TWO DIMENSIONS: 1) THE SIGNIFICANCE OR SEVERITY OF THE HEALTH NEED; AND 2) THE ABILITY OF A HOSPITAL TO MAKE A NOTABLE IMPACT ON THE IDENTIFIED HEALTH NEED.STEP 2: IDENTIFY HEALTH NEEDS FOR DAMERON HOSPITAL'S 2020 FOCUSDAMERON HOSPITAL IDENTIFIED THREE PRIMARY HEALTH NEEDS, FROM THE ELEVEN, THAT ALIGNED WITH ITS MISSION AND ORGANIZATIONAL CAPABILITIES. DAMERON HOSPITAL'S MISSION IS TO SUPPORT PHYSICIANS AND OUR EMPLOYEES IN PROVIDING QUALITY PATIENT CARE IN A SAFE AND CARING ENVIRONMENT.STEP 3: STRATEGIC PLANNINGTHIS PROCESS FOLLOWED TWO KEY STEPS. FIRST, PERSONNEL IN THE HOSPITAL WERE RECRUITED TO PARTICIPATE AND DEVELOP THE IMPLEMENTATION PLAN. SECOND, DAMERON HOSPITAL LEADERSHIP EVALUATED THE IMPLEMENTATION PLAN AND ITS ALIGNMENT TO THE COMMUNITY NEEDS ASSESSMENT. THE FINAL PLAN IS DEPICTED IN STRATEGIC PLAN (PGS. 20-22 OF THE COMMUNITY BENEFIT REPORT) THIS EVALUATION AND PRIORITIZATION RESULTS WERE USED AS THE ROADMAP FOR OUR 2020 COMMUNITY BENEFIT PLAN. DAMERON HOSPITAL ASSOCIATION PART V, SECTION B, LINE 20E: - DOCUMENTED ITS DETERMINATION OF WHETHER INDIVIDUALS WERE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY.- NOTIFIED INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY IN COMMUNICATIONS WITH THE INDIVIDUALS REGARDING THE INDIVIDUAL'S BILLS.- NOTIFIED INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION.- NOTIFIED INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY PRIOR TO DISCHARGE. PART V, SECTION B, LINE 10 THE HOSPITAL FACILITY'S 2020 IMPLEMENTATION STRATEGY IS CURRENTLY POSTED AT THE URL PROVIDED, AND HAS BEEN ATTACHED TO THIS FILING AS THE STRATEGY MAY NOT HAVE BEEN POSTED FOR THE ENTIRE YEAR ON THE WEBSITE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 14,346,472. PART II, COMMUNITY BUILDING ACTIVITIES: * COMMUNITY SUPPORT- FREE INTERPRETER SERVICES FOR PATIENTS AND THEIR DESIGNATED SUPPORT PERSON.- TAXI/BUS TRANSPORTATION TO AND FROM THE HOSPITAL/CLINIC, IF NEEDED.* LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERSLEADERSHIP STOCKTON IS A PROGRAM DESIGNED TO INSPIRE A NEW GENERATION OF MEN AND WOMEN TO ASSUME LEADERSHIP ROLES IN THE COMMUNITY. THE NINE-MONTH PROGRAM CHALLENGES AND PREPARES INDIVIDUALS FROM DIVERSE BACKGROUNDS TO BECOME INFLUENTIAL IN THE REGION'S FUTURE. TO DEVELOP EDUCATED AND MOTIVATED COMMUNITY LEADER PARTICIPANTS ARE EXPOSED TO CIVIC, CIVIL, EDUCATION, HEALTHCARE AND NON-PROFIT ENTITIES. PARTICIPANTS HEARD FROM AREA HEALTHCARE LEADERS ABOUT THE CURRENT AND FUTURE STATE OF HEALTHCARE. DIANE VIGIL, DIRECTOR OF COMMUNITY BENEFITS PRESENTED ON BEHALF OF DAMERON HOSPITAL. THE ROUNDTABLE DISCUSSION ENABLED PARTICIPANTS TO LEARN ABOUT HOSPITAL AND HEALTHCARE FACILITIES LOCATED THROUGHOUT GREATER STOCKTON COMMUNITY. A QUESTION AND ANSWER PERIOD CONCLUDED THE FORUM.* HEALTHIER COMMUNITY COALITION:DAMERON HOSPITAL IS AN ACTIVE PARTICIPANT IN THE SAN JOAQUIN COUNTY HEALTHIER COMMUNITY COALITION. THE PURPOSES OF THE COALITION ARE: A) TO PROVIDE LEADERSHIP IN THE DEVELOPMENT AND COORDINATION OF HEALTH STATUS IMPROVEMENT EFFORTS IN SAN JOAQUIN COUNTY; B) TO PROVIDE A FORUM FOR HEALTH SERVICES STAKEHOLDERS TO SHARE IDEAS AND INFORMATION ABOUT PROJECTS AND SEEK COLLABORATIVE PARTNERS; AND C) TO WORK COLLABORATIVELY AND ENCOURAGE THE EFFORTS OF OTHER COLLABORATIVE ATTEMPTING TO RESPOND TO COMMUNITY HEALTH ISSUES AND PROBLEMS. DAMERON HOSPITAL COLLABORATED ON CREATING AN ALL-INCLUSIVE FREE AND CONFIDENTIAL SERVICE HELPLINE FOR LOCAL RESOURCES. THE 211 HELPLINE, LAUNCHED IN 2015, IS AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK. DAMERON STAFF HAS CO-CHAIRED THIS COALITION AND PARTICIPATED IN KEY LEADERSHIP ROLES SINCE 2011. ITS PURPOSE IS TO MAKE IT EASY FOR PEOPLE TO FIND THE HELP THEY NEED, WHEN THEY NEED IT. (HTTP://WWW.211.ORG)DAMERON HOSPITAL PARTICIPATED IN THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), WHICH IS PUBLICLY AVAILABLE AT HTTP://HEALTHTHIERSANJOAQUIN.ORG. ADDITIONAL DETAIL ABOUT IDENTIFIED NEEDS, DATA COLLECTED, COMMUNITY INPUT OBTAINED, AND PRIORITIZATION METHODS USED CAN BE FOUND IN THE CHNA REPORT. THE SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED ARE:1. OBESITY/DIABETES2. EDUCATION3. YOUTH DEVELOPMENT4. ECONOMIC SECURITY5. VIOLENCE AND INJURY6. SUBSTANCE USE7. ACCESS TO HOUSING8. ACCESS TO CARE9. MENTAL HEALTH10. ORAL HEALTH11. ASTHMA/AIR QUALLITYCOMMUNITY HEALTH IMPROVEMENT PLAN:DAMERON HOSPITAL'S COMMUNITY BENEFIT DIRECTOR PARTICIPATED IN CREATING THE SAN JOAQUIN COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THE CHIP PROCESS WAS GUIDED BY THE CHNA CORE PLANNING GROUP MADE UP OF NOT-FOR-PROFIT HOSPITALS, TWO MEDICAID MANAGED CARE PLANS, COMMUNITY MEDICAL CENTERS (FEDERALLY QUALIFIED HEALTH CENTERS), PUBLIC HEALTH SERVICES, FIRST 5 SAN JOAQUIN, AND COMMUNITY PARTNERSHIPS FOR FAMILIES. THE CHIP PROCESS ALSO ENGAGED ITS BROADLY REPRESENTATIVE CHNA STEERING COMMITTEE AS WELL AS ADDITIONAL SUBJECT MATTER EXPERTS, WHICH ALTOGETHER INCLUDED HEALTH AND SOCIAL SERVICE PROVIDERS, EDUCATORS, BEHAVIORAL HEALTH AND AFFORDABLE HOUSING ADVOCATES, LAW ENFORCEMENT OFFICERS, LAND USE AND TRANSPORTATION PLANNERS, AND POLICYMAKERS. THE PROCESS IDENTIFIED THREE PRIORITY ISSUES: HEALTHY EATING/ACTIVE LIVING, HIGH-QUALITY EDUCATION COMMUNITY SAFETY AND SOCIAL SUPPORTS.WITH THESE ISSUES SERVING AS THE FOUNDATION FOR THE CHIP, THE CORE PLANNING GROUP AND STEERING COMMITTEE DEVELOPED GOALS, OBJECTIVES, STRATEGIES, AND ACTION ITEMS FOR EACH PRIORITY. CHIP IS A RESOURCE FOR MULTIPLE PARTNERS AND COLLABORATORS IN OUR WORK TO SET PRIORITIES AND COORDINATE AND TARGET RESOURCES.*COMMUNITY HEALTH IMPROVEMENT ADVOCACY:1. DAMERON HAS OFFERED FLU SHOT CLINICS IN THE COMMUNITY.2. DAMERON'S LINACIA PHARMACY HAS PROVIDED PHARMACEUTICALS AT NO COST TO A NUMBER OF INDIGENT PATIENTS.3. DAMERON PROVIDES COMPLIMENTARY USE OF CLASROOMS FOR VARIOUS COMMUNITY EDUCATION AND SUPPORT GROUPS.4. DAMERON HAS A VOLUNTEER PROGRAM FOR COMMUNITY MEMBERS WILLING TO DONATE THEIR TIME IN A HEALTH CAREENVIRONMENT.5. DAMERON DONATES MATERIALS, EQUIPMENT AND SUPPLIES TO COMMUNITY GROUPS.6. DAMERON SPONSORS HEALTH-RELATED COMMUNITY EVENTS AND ACTIVITIES*WORKFORCE DEVELOPMENT:DECISION MEDICINE:THIS TWO-WEEK PROGRAM, SPONSORED BY SAN JOAQUIN MEDICAL SOCIETY, IS DESIGNED TO INTRODUCE HIGH SCHOOL STUDENTS TO THE FIELD OF MEDICINE THROUGH PERSONAL MENTORING OPPORTUNITIES AND SITE VISITS WITH BEHIND-THE-SCENES ACCESS TO SOME OF OUR REGIONAL HOSPITALS, CLINICS AND PUBLIC HEALTH CENTERS. DECISION MEDICINE 2018 TOOK PLACE AT VARIOUS LOCATIONS IN NORTHERN CALIFORNIA, INCLUDING HOSPITALS, VARIOUS CLINICS AND INSIDE ACTUAL PRIVATE OFFICES OF PARTICIPATING PHYSICIANS IN SAN JOAQUIN COUNTY. DAMERON HOSPITAL PROVIDED A FULL EIGHT-HOUR DAY OF STUDENT INTERACTIVE TOURS INTO THE CORE LABORATORY, THE PATHOLOGY LABORATORY, AND TOUR OF THE HOSPITAL DATA CENTER; DIDACTIC LECTURES ON BASIC HEMATOLOGY & COMPARATIVE CELLULAR MORPHOLOGY AND FORENSIC PATHOLOGY; LECTURE FROM STANFORD/DAMERON HEART PROGRAM SURGEON, DR. MARIA CURRIE; HANDS-ON LABORATORY EXERCISES FOR PHLEBOTOMY, BLOOD SPECIMEN PREPARATION, BLOOD SMEAR TECHNIQUE, DIFFERENTIAL STAINING TECHNIQUE, BLOOD SMEAR EXAMINATION BY LIGHT MICROSCOPY, AND BLOOD TYPING. IN ADDITION, STUDENTS WERE PROVIDED AN INDIVIDUAL COMPLETE BLOOD ANALYSIS (CBC), A PRELIMINARY ABO BLOOD GROUP DETERMINATION, HISTORICAL INFORMATION ABOUT DAMERON HOSPITAL AND CAREER INFORMATION IN PATHOLOGY AND LABORATORY MEDICINE. DAMERON HOSPITAL HOSTED TWENTY-FOUR STUDENTS (TWENTY-TWO GIRLS AND 2 BOYS) THAT INCLUDED LUNCH AND REFRESHMENTS THROUGHOUT THE DAY. THE COMMUNITY BENEFIT DIRECTOR COORDINATES THIS PROGRAM FOR DAMERON HOSPITAL. VOLUNTEERS INCLUDE A BOARD MEMBER, CHIEF INFORMATION OFFICER, TELEMETRY DIRECTOR, HOSPITAL EXECUTIVE LEADERSHIP TEAM MEMBER, LABORATORY MEDICAL DIRECTOR, LABORATORY MANAGER, SEVERAL CLINICAL LABORATORY SCIENTISTS, PATIENT RELATIONS COORDINATOR, AND HEALTH EDUCATOR. SAN JOAQUIN MEDICAL SOCIETY TRACKING OF DECISION MEDICINE GRADUATES HAS YIELDED ONE PRACTICING PHYSICIAN; ONE IN RESIDENCY, SEVENTEEN IN MED SCHOOL; TWO BS/MD PROGRAM; 90 PRE-MED MAJORS IN UNDERGRAD; TWO NURSING; TWO PHYSICIAN ASSISTANTS; AND TWO DENTIST.HEALTH CAREERS ACADEMY:THE HEALTH CAREERS ACADEMY (HCA) WAS ESTABLISHED IN 2011 BY THE STOCKTON UNIFIED SCHOOL DISTRICT TO MEET THE GROWING COMMUNITY NEED FOR HEALTHCARE CLINICIANS IN STOCKTON AND THE GREATER SAN JOAQUIN COUNTY. HCA HAS A STUDENT POPULATION OF 497 STUDENTS WITH A SENIOR CLASS OF 121. THE GOAL OF HCA IS TO PRODUCE STUDENTS WHO HAVE BEEN CHALLENGED WITH A RIGOROUS COLLEGE PREP CURRICULUM, AS WELL AS TEACHING THEM HEALTH CAREER TECHNICAL SKILLS. STUDENTS ARE PROVIDED WITH COMMUNITY SERVICE OPPORTUNITIES TO GAIN BETTER SENSE OF COMMUNITY AWARENESS AND ARE EXPOSED TO VARIOUS MEDICAL PROFESSIONS DURING THEIR PRN ROUNDS. UPON GRADUATION, THEY LEAVE PREPARED TO JOIN THE WORKFORCE; PURSUE FURTHER HEALTH RELATED VOCATIONAL TRAINING; OR ATTEND A FOUR-YEAR COLLEGE. DAMERON HOSPITAL STAFF IS COMMITTED TO OFFERING SPEAKERS, MENTORS AND PARTICIPATE IN MOCK INTERVIEW AT THE REQUEST OF THE HCA. OUR COMMUNITY BENEFIT DIRECTOR SERVES ON THE HCA COMMUNITY COMMITTEE TO ENHANCE THE LEARNING EXPERIENCES OF OUR FUTURE HEALTH CARE PROFESSIONS. 2019 MARKS THE FIRST GRADUATING CLASS YIELDING A MED SCHOOL GRADUATE.ASSOCIATION OF CALIFORNIA NURSE LEADERS (ACNL):THIS ASSOCIATION WAS CREATED AND IS EMBRACED BY NURSE LEADERS THROUGHOUT CALIFORNIA. ITS MISSION IS TO DEVELOP NURSE LEADERS; ADVANCE PROFESSIONAL PRACTICE; INFLUENCE HEALTH POLICY; AND PROMOTE QUALITY AND PATIENT SAFETY. WITH HEALTH CARE REFORM, IMPLEMENTATION OF THE IOM FUTURE OF NURSING INITIATIVES, PROFESSIONAL PRACTICE ISSUES AND REGULATORY MANDATES, CHALLENGES AND OPPORTUNITIES FOR NURSE LEADERS HAVE NEVER BEEN GREATER. ACNL HELPS NURSE LEADERS ADDRESS THESE ISSUES TOGETHER. ACNL PROVIDES ESSENTIAL INFORMATION, STATEWIDE NETWORKING WITH PEERS, PROGRESSIVE LEADERSHIP DEVELOPMENT PROGRAMS AND TIMELY EDUCATIONAL ACTIVITIES. DAMERON HOSPITAL'S NURSING DIRECTORS ARE MEMBERS OF THE NORTH CENTRAL CHAPTER THAT INCLUDES MONTHLY CHAPTER MEETINGS, PARTICIPATION IN ACNL PROJECTS AND SPONSORING ANNUAL ACNL CONFERENCES. DAMERON HOSPITAL CONTINUED ITS ACNL MEMBERSHIP AND ACTIVE PARTICIPATION THROUGH 2018. PART III, LINE 4: THE ORGANIZATION DETERMINES THE AMOUNT THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY BASED UPON A QUERY OF THE COLLECTIONS SYSTEM (GOLDEN STATE COLLECTIONS) - 10% OF ESTIMATED BAD DEBT EXPENSE.ANY DISCOUNTS AND/OR PAYMENTS APPLIED TO A PATIENT'S ACCOUNT ARE NOT REVERSED BEFORE WRITING THE ACCOUNT OFF TO BAD DEBT. IN OTHER WORDS, THE NET BALANCE OF THE ACCOUNT IS WHAT'S WRITTEN OFF.BAD DEBT EXPENSE IS NOT INCLUDED AS A COMMUNITY BENEFIT IN THE HOSPITAL'S COMMUNITY BENEFIT REPORT.BAD DEBT EXPENSE FOOTNOTE - SEE AUDITED FINANCIAL STATEMENTS, PAGE 7 AND 8, FOOTNOTE 1, PATIENT ACCOUNTS RECEIVABLE SECTION. PART III, LINE 8: IF MEDICARE DOES NOT REIMBURSE OUR COSTS FOR PATIENT CARE, THE EXCESS OF COST OVER REIMBURSEMENT SHOULD BE CONSIDERED A BENEFIT TO THE COMMUNITY WE SERVE.MEDICARE USES THE MEDICARE COST REPORT PROGRAM IN COMPUTING THE COST IN PROVIDING MEDICAL CARE SERVICES FOR MEDICARE BENEFICIARIES. THE MEDICARE COST REPORT CALCULATES ROUTINE COSTS USING PER DIEM METHODOLGY AND THE ANCILLARY COST IS CALCULATED USING COST TO CHARGE RATIOS. PART III, LINE 9B: IN ACCORDANCE WITH THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICY, PATIENTS WILL BE MADE AWARE OF THE AVAILABILITY OF CHARITY CARE AND DISCOUNTED PAYMENT OPTIONS ON THE HOSPITAL'S WEBSITE, AT ALL POINTS OF REGISTRATION IN THE HOSPITAL, AS WELL AS IN CONNECTION WITH BILLING STATEMENTS ISSUED BY THE HOSPITAL.THE PATIENT ACCOUNTING DEPARTMENT SENDS THE RESPONSIBLE PARTY A FINAL BILL AT LEAST 90 DAYS FROM THE DATE THE HOSPITAL PROVIDES THE FIRST POST-DISCHARGE BILLING STATEMENT, INFORMING THE RESPONSIBLE PARTY OF THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICY, A PLAIN LANGUAGE SUMMARY OF THAT POLICY AND THE PATIENT'S RIGHTS, AS REQUIRED UNDER CALIFORNIA HEALTH AND SAFETY CODE SECTION 127430(A), THE PHONE NUMBER THE RESPONSIBLE PARTY CAN CALL FOR MORE INFORMATION IF INTERESTED IN APPLYING, THE COLLECTIONS ACTIONS THAT MAY BE PURSUED IN THE EVENT OF NONPAYMENT, AND THE DEADLINE FOR WHEN THOSE ACTIONS MAY BE COMMENCED (SUCH DEADLINE TO BE AT LEAST 30 DAYS FROM THE DATE OF THE FINAL BILL IS SENT). THE PATIENT ACCOUNTING DEPARTMENT WILL ALSO ATTEMPT TO CALL OR OTHERWISE ORALLY INFORM THE RESPONSIBLE PARTY OF THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICY AND HOW THE RESPONSIBLE PARTY MAY OBTAIN ASSISTANCE WITH THE APPLICATION PROCESS. THE RESPONSIBLE PARTY IS REQUESTED TO FORWARD ANY INSURANCE INFORMATION OR TO MAKE PAYMENT OR SUBMIT AN APPLICATION UNDER THE CHARITY CARE AND DISCOUNTED PAYMENT POLICY WITHIN THE STATED DEADLINE OR THE ACCOUNT MAY BE REFERRED TO COLLECTIONS. COLLECTIONS ACTIONS MAY INCLUDE ENGAGING A COLLECTION AGENCY TO ASSIST WITH OBTAINING PAYMENT, REPORTING THE PATIENT'S ACCOUNT TO A CONSUMER CREDIT REPORTING AGENCY, DEFERRING, DENYING OR REQUIRING A PAYMENT BEFORE PROVIDING ELECTIVE, NON-MEDICALLY NECESSARY SERVICES BECAUSE OF THE PATIENT'S NONPAYMENT OF ONE OR MORE BILLS FOR PREVIOUSLY PROVIDED CARE, COMMENCING A CIVIL ACTION AGAINST THE PATIENT FOR NONPAYMENT, WAGE GARNISHMENT, BANK GARNISHMENT AND ABSTRACT LIENS ON REAL PROPERTY AS WELL AS BUSINESS GARNISHMENT IF RESPONSIBLE PARTY IS THE BUSINESS OWNER. HOWEVER, FOR A PATIENT THAT LACKS COVERAGE, THE HOSPITAL, ANY ASSIGNEE OF THE HOSPITAL, OR OTHER OWNER OF THE PATIENT DEBT, INCLUDING A COLLECTION AGENCY, WILL NOT REPORT ADVERSE INFORMATION TO A CONSUMER CREDIT REPORTING AGENCY OR COMMENCE CIVIL ACTION AGAINST THE PATIENT FOR NONPAYMENT AT ANY TIME PRIOR TO 150 DAYS AFTER THE INITIAL BILLING. THIS PERIOD SHALL BE EXTENDED IF THE PATIENT HAS A PENDING APPEAL FOR COVERAGE OF THE SERVICES UNTIL A FINAL DETERMINATION OF THE APPEAL IS MADE.IF THE RESPONSIBLE PARTY REQUESTS FINANCIAL ASSISTANCE, THE REQUEST IS FORWARDED TO THE CREDIT AND COLLECTIONS DEPARTMENT AND THE PATIENT IS SENT AN APPLICATION UNDER THE CHARITY CARE AND DISCOUNTED PAYMENT POLICY IDENTIFYING THE CHARITY PROCESS AND THE DOCUMENTATION REQUIRED FOR PROCESSING. THE RESPONSIBLE PARTY IS GIVEN 30 DAYS TO COMPLETE AND RETURN THE APPLICATION AND SUPPORTING DOCUMENTS. IF THE COLLECTIONS PROCESS HAS ALREADY BEGUN, IT SHALL BE SUSPENDED DURING THIS TIME. IF AN INCOMPLETE APPLICATION IS RECEIVED, THE HOSPITAL WILL PROVIDE WRITTEN NOTICE DESCRIBING ADDITIONAL INFORMATION NEEDED AND WILL PROVIDE THE CONTACT INFORMATION, INCLUDING THE TELEPHONE NUMBER AND OFFICE LOCATION, OF A PERSON WHO CAN PROVIDE INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICY AND ASSISTANCE WITH COMPLETING THE APPLICATION.COLLECTIONS SHALL REMAIN SUSPENDED UNTIL A DETERMINATION OF ELIGIBILITY IS MADE OR THE HOSPITAL HAS DETERMINED, AFTER A REASONABLE PERIOD OF TIME, THE PATIENT HAS FAILED TO RESPOND TO REQUESTS FOR ADDITIONAL INFORMATION TO COMPLETE THE APPLICATION. IF A COMPLETE APPLICATION IS RECEIVED, THE HOSPITAL WILL DETERMINE THE PATIENT'S ELIGIBILITY AND WILL NOTIFY THE PATIENT IN WRITING OF THE DETERMINATION AND THE BASIS FOR THE DETERMINATION. IF THE PATIENT IS DETERMINED TO BE ELIGIBLE FOR ASSISTANCE UNDER THE CHARITY CARE AND DISCOUNTED PAYMENT POLICY, (1) IF SUCH ASSISTANCE IS IN THE FORM OF A DISCOUNT, THE PATIENT WILL RECEIVE A BILLING STATEMENT THAT INDICATES THE AMOUNT OWED, HOW THAT AMOUNT WAS DETERMINED, AND STATES OR DESCRIBES HOW THE PATIENT CAN OBTAIN INFORMATION REGARDING THE AMOUNT GENERALLY BILLED ("AGB") FOR THE CARE PROVIDED, AND (2) THE PATIENT WILL BE REFUNDED ANY AMOUNTS PAID OVER THE AMOUNT FOR WHICH THE PATIENT HAS BEEN DETERMINED UNDER THE CHARITY CARE AND DISCOUNTED PAYMENT POLICY TO BE RESPONSIBLE. THE HOSPITAL SHALL FURTHER TAKE ALL REASONABLY AVAILABLE MEASURES TO ADDRESS ANY ADVERSE INFORMATION REPORTED TO CREDIT REPORTING AGENCIES. THE HOSPITAL WILL ACCEPT APPLICATIONS UNDER THE CHARITY CARE AND DISCOUNTED PAYMENT POLICY UNTIL 240 DAYS FROM THE DATE THE HOSPITAL PROVIDES THE FIRST POST-DISCHARGE BILLING STATEMENT.EXTENDED PAYMENT PLANS FOR THE AMOUNT OWED MAY BE ARRANGED FOR THOSE UNABLE TO PAY THEIR ACCOUNT IN FULL PURSUANT TO THE HOSPITAL'S CHARITY CARE AND DISCOUNTED PAYMENT POLICY. REQUESTS FOR PAYMENT PLANS EXCEEDING THE HOSPITAL'S SCHEDULE MAY BE REFERRED TO THE HOSPITAL'S DESIGNEE FOR HANDLING. IF THE ACCOUNT IS NOT PAID OR SATISFACTORY PAYMENT ARRANGEMENTS MADE, THE ACCOUNT IS SENT FOR PRE-COLLECTION TO THE CREDIT AND COLLECTIONS DEPARTMENT OR ITS DESIGNEE, AS DESCRIBED IN THE CHARITY CARE AND DISCOUNTED PAYMENT POLICY. THE HOSPITAL MAY DECLARE AN EXTENDED PAYMENT PLAN (INCLUDING A REASONABLE PAYMENT PLAN) INOPERATIVE IF THE PATIENT FAILS TO MAKE ALL CONSECUTIVE PAYMENTS DURING A 90-DAY PERIOD. BEFORE DECLARING AN EXTENDED PAYMENT PLAN INOPERATIVE, THE HOSPITAL, COLLECTION AGENCY OR ASSIGNEE SHALL MAKE A REASONABLE ATTEMPT TO CONTACT THE PATIENT BY TELEPHONE, GIVE WRITTEN NOTICE THAT THE EXTENDED PAYMENT PLAN MAY BECOME INOPERATIVE, AND INFORM THE PATIENT THAT S/HE MAY RENEGOTIATE THE TERMS OF THE PAYMENT PLAN. PART VI, LINE 2: THE HOSPITAL'S CHNA AND 2020 IMPLEMENTATION STRATEGY ARE POSTED ON THE HOSPITAL'S WEBSITE AT:WWW.DAMERONHOSPITAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/DAMERON HOSPITAL IS A MEMBER OF THE SAN JOAQUIN COUNTY COMMUNITY HEALTH ASSESSMENT COLLABORATIVE (SJC2HAC), WHICH IS RESPONSIBLE FOR PRODUCING AND RELEASING, EVERY THREE YEARS, THE HEALTHIER SAN JOAQUIN COUNTY COMMUNITY ASSEMENT. THE SAN JOAQUIN COUNTY 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PRESENTS A COMPREHENSIVE PICTURE OF COMMUNITY HEALTH THAT ENCOMPASSES THE CONDITIONS THAT IMPACT HEALTH IN OUR COUNTY. THE OVERALL GOAL IS TO INFORM AND ENGAGE LOCAL DECISION-MAKERS, KEY STAKEHOLDERS, AND THE COMMUNITY-AT-LARGE IN EFFORTS TO IMPROVE THE HEALTH AND WELL-BEING OF ALL SAN JOAQUIN COUNTY RESIDENTS.THE SAN JOAQUIN COUNTY COMMUNITY HAS A LONG TRADITION OF WORKING COLLABORATIVELY AND HAS CONDUCTED A JOINT TRIENNIAL CHNA FOR MANY YEARS. THIS COLLABORATIVE EFFORT STEMS FROM A DESIRE TO ADDRESS LOCAL NEEDS AND A DEDICATION TO IMPROVING THE HEALTH OF EVERYONE IN THE COMMUNITY.SAN JOAQUIN COUNTY WILL USE THE RESULTS OF THIS CHNA TO DRIVE THE DEVELOPMENT OF A JOINT COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP), WHICH WILL IDENTIFY LONG-TERM, SYSTEMATIC STRATEGIES AND ACTIONS TO ADDRESS HEALTH NEEDS. COMMUNITY PARTNERS ACROSS THE COUNTY WILL WORK TOGETHER TO SET PRIORITIES AND COORDINATE AND TARGET RESOURCES. THE 2019 CHNA REPORT WILL BE AVAILABLE AT: WWW.HEALTHIERSANJOAQUIN.ORG.ADDITIONALLY, THE HOSPITALS INVOLVED IN THE CHNA WILL EACH DEVELOP AN IMPLEMENTATION PLAN TO OUTLINE HOW THEY WILL BE ADDRESSING PRIORITY HEALTH NEEDS. THESE STRATEGIES WILL BUILD ON A HOSPITAL'S OWN ASSETS AND RESOURCES, AS WELL AS ON EVIDENCE-BASED STRATEGIES AND BEST PRACTICES, WHEREVER POSSIBLE. THEIR IMPLEMENTATION STRATEGIES (IS) WILL BE FILED WITH THE INTERNAL REVENUE SERVICE. BOTH THE CHNA AND THE IMPLEMENTATION STRATEGIES, ONCE FINALIZED, WILL BE POSTED PUBLICLY ON EACH OF THE HOSPITALS' WEBSITES. PART VI, LINE 3: THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (FAP) IS POSTED ALONG WITH THE COMPLETE FAP POLICY AND FAP APPLICATION ON THE HOSPITAL'S WEBSITE AT:HTTPS://WWW.DAMERONHOSPITAL.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE/THE HOSPITAL SHALL OFFER A PAPER COPY OF A PLAIN LANGUAGE SUMMARY OF THIS POLICY TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS, INCLUDING FOR INDIVIDUALS WHO RECEIVED EMERGENCY OR OUTPATIENT CARE AND WERE NEVER ADMITTED AS INPATIENTS. A CONSPICUOUS WRITTEN NOTICE ON BILLING STATEMENTS WILL NOTIFY AND INFORM RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY. SUCH NOTICE SHALL PROVIDE THE TELEPHONE NUMBER OF THE HOSPITAL'S DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE POLICY AND THE APPLICATION PROCESS AND THE DIRECT WEBSITE ADDRESS WHERE COPIES OF THE FAP, FINANCIAL ASSISTANCE APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY MAY BE OBTAINED. SIGNAGE REGARDING THE POLICY, HOW TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND HOW TO OBTAIN COPIES OF THE POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY, IS POSTED AT ALL POINTS OF REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT, THE BILLING OFFICE, THE ADMISSIONS OFFICE AND OTHER OUTPATIENT SETTINGS. PRIOR TO COMMENCING COLLECTION ACTIVITIES, THE HOSPITAL OR ITS DESIGNEE SHALL PROVIDE THE PATIENT WITH WRITTEN NOTICE CONTAINING A PLAIN LANGUAGE SUMMARY OF THE PATIENT'S RIGHTS PURSUANT TO CALIFORNIA HEALTH AND SAFETY CODE SECTION 127430(A), AND A STATEMENT THAT NONPROFIT CREDIT COUNSELING SERVICES MAY BE AVAILABLE IN THE AREA.THE HOSPITAL WILL, IN ADDITION TO INFORMING PATIENTS ABOUT THIS POLICY, NOTIFY AND INFORM MEMBERS OF THE COMMUNITY ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY AS WELL AS HOW OR WHERE TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND THE FINANCIAL ASSISTANCE APPLICATION PROCESS AND TO OBTAIN COPIES OF THE FAP, FINANCIAL ASSISTANCE APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY. THE HOSPITAL WILL MAKE THIS POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY OF THE POLICY AVAILABLE IN ENGLISH AND IN ANY OTHER LANGUAGE THAT THE HOSPITAL DETERMINES IS SPOKEN BY POPULATIONS IN THE COMMUNITY WITH LIMITED ENGLISH PROFICIENCY CONSTITUTING THE LESSER OF 1,000 INDIVIDUALS OR 5 PERCENT OF THE COMMUNITY SERVED BY THE HOSPITAL. HOSPITAL FINANCIAL COUNSELORS WILL ATTEMPT TO CONTACT REGISTERED INPATIENTS DURING THEIR HOSPITAL STAY TO ASSESS PATIENTS' NEEDS AND IDENTIFY THOSE PATIENTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL MAY UTILIZE INTERNAL STAFF OR THIRD PARTY AGENTS TO ASSIST PATIENTS IN APPLYING FOR MEDICAL ASSISTANCE PROGRAMS FUNDED BY CITY, COUNTY, STATE OR FEDERAL PROGRAMS. PART VI, LINE 4: I. GEOGRAPHIC DESCRIPTION OF THE COMMUNITY SERVEDSAN JOAQUIN COUNTY CONTAINS BOTH RURAL AND URBAN AREAS. COMMUNITIES AND CITIES MAINTAIN THEIR UNIQUE GEOGRAPHIC IDENTITIES, SEPARATED BY AGRICULTURE AND OPEN SPACE LANDS. THE COUNTY INCLUDES SEVEN INCORPORATED CITIES STOCKTON, TRACY, MANTECA, LODI, LATHROP, RIPON AND ESCALON AS WELL AS MANY SMALL WELL-ESTABLISHED RURAL COMMUNITIES IN THE UNINCORPORATED AREAS.II. DEMOGRAPHIC PROFILE OF THE COMMUNITY SERVEDTABLE 1. DEMOGRAPHIC PROFILE - SAN JOAQUIN COUNTYRACE/ETHNICITY SOCIOECONOMIC DATATOTAL POPULATION 779,233 LIVING IN POVERTY (<100% FEDERALPOVERTY LEVEL)13.6%ASIAN 18.5% BLACK 8.3% HISPANIC/LATINO1 43% NATIVE AMERICAN/ALASKA NATIVE 2.1% PACIFIC ISLANDER/NATIVE HAWAIIAN 0.9%MULTIPLE RACES 5.6%WHITE ALONE 64.5%UNEMPLOYMENT 9.6%UNINSURED POPULATION 6% PART VI, LINE 5: IN ADDITION TO OUR MEDICAL SERVICES AND PROGRAMS, DAMERON HOSPITAL ALSO OFFERS THE FOLLOWING COMMUNITY BENEFIT AND OUTREACH SERVICES: - VOLUNTEER PROGRAM FOR COMMUNITY MEMBERS WILLING TO DONATE THEIR TIME IN A HEALTH CARE ENVIRONMENT - SPONSORSHIP OF HEALTH-RELATED COMMUNITY EVENTS AND ACTIVITIES- EMPLOYEE VOLUNTEER TIME - TAXI/BUS TR OF MATERIALS, EQUIPMENT AND SUPPLIES TO COMMUNITY GROUPSANSPORTATION TO AND FROM THE HOSPITAL/CLINIC, IF NEEDED MEDICAL EDUCATION FOR COMMUNITY PHYSICIANS - REFERRAL SERVICE TO COMMUNITY SUB-SPECIALTIES AT TERTIARY CENTERS, FOR POPULATION AGE 21 OF UNDER - PARTICIPATION IN THE DECISION MEDICINE PROGRAM EXPOSING HIGH SCHOOL STUDENTS TO HEALTH CARE CAREERS TO ENCOURAGE YOUTH TO GIVE BACK TO THE COMMUNITY AND CONSIDER A CAREER IN MEDICINE - ON-SITE FREE WIRELESS INTERNET ACCESS AND NOTARY SERVICES - WORKFORCE DEVELOPMENT - HEALTH PROFESSIONAL EDUCATION - ONLINE HEALTH CENTER "FOLLOWMYHEALTH" - STAFF PARTICIPATION IN CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENTS - PROVIDE A CLINICAL SETTING FOR UNDERGRADUATE/VOCATIONAL TRAINING TO STUDENTS ENROLLED IN OUTSIDE PROGRAMS - UNREIMBURSED MEDI-CAL, MEDICARE, CHARITY CARE, AND UNINSURED PATIENT DISCOUNTS- FREE INTERPRETER SERVICES FOR PATIENTS AND THEIR DESIGNATED SUPPORT PERSON. PART VI, LINE 6: (NOT PART OF AFFILIATED HEALTHCARE SYSTEM) PART VI, LINE 7, REPORTS FILED WITH STATES CA X X X X X 0 0 0 0 0 0 0 1 0 LARRY BEDNARZ REGISTERED NURSE 130807 0 0 0 120056 0 8222 0 14276 0 273361 0 0 0 MARIA VILLARREAL REGISTERED NURSE 147014 0 1051 0 94137 0 9049 0 20594 0 271845 0 0 0 SHAUN FILLON REGISTERED NURSE 130560 0 0 0 103023 0 8015 0 20966 0 262564 0 0 0 CECILIA JAVIER SR. DIRECTOR, LABORATORY 217701 0 5000 0 0 0 13062 0 15325 0 251088 0 0 0 MELISSA DAY SENIOR DIRECTOR NURSING 209720 0 5000 0 0 0 12583 0 14722 0 242025 0 0 0 PART I, LINE 7 EXECUTIVE INCENTIVE COMPENSATION IS SET BASED ON MEETING A SPECIFIC SET OF METRICS ESTABLISHED ANNUALLY BY THE CEO AND EXECUTIVE TEAM AND APPROVED BY THE BOARD. METRICS GENERALLY INCLUDE QUALITY, FINANCE, PATIENT SAFETY, PATIENT EXPERIENCE, EMPLOYEE ENGAGEMENT AND MEANINGFUL USE GOALS. FORM 990, PART VII, LINE 5: ADVENTIST HEALTH COMPENSATED THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A: ERIC CORNWELL HAD REPORTABLE COMPENSATION IN THE AMOUNT OF $432,761 AND OTHER COMPENSATION IN THE AMOUNT OF $45,404. TERRI DAY HAD REPORTABLE COMPENSATION IN THE AMOUNT OF $493,094. SANJEEV GOSWAMI HAD REPORTABLE COMPENSATION IN THE AMOUNT OF $34,200. DAMERON MEDICAL GROUP ENTITY IS OWNED BY THE CMO OF THE HOSPITAL 264000 SUPPORT FEES 0 FORM 990, PART VI, SECTION A, LINE 3 DAMERON HOSPITAL ASSOCIATION HAS ENTERED INTO AN AGREEMENT WITH ADVENTIST HEALTH SYSTEM/WEST TO PROVIDE THE FOLLOWING: - DAY-TO-DAY MANAGEMENT AND OPERATION SERVICES FOR THE HOSPITAL, INCLUDING ALL USUAL AND CUSTOMARY RESPONSIBILITIES, DUTIES, AND OBLIGATIONS IN CONNECTION WITH OPERATING AND MAINTAINING THE HOSPITAL AS A NONPROFIT HOSPITAL IN COMPLIANCE WITH REGULATIONS AND STANDARDS. THIS INCLUDES SERVICES OF SENIOR MANAGMENT PERSONNEL AS DEEMED NECESSARY TO SUPPORT PERSONNEL AS DEEMED NECESSARY. - MANAGE AND SUPERVISE ALL HOSPITAL EMPLOYED AND CONTRACTED PERSONNEL AND WILL ANALYZE THE WORKFORCE AND PROVIDE A RECOMMENDED STAFFING PLAN. - RESPONSIBLE FOR BILLING AND COLLECTION OF CHARGES FOR ALL SERVICES PROVIDED BY THE HOSPITAL, FOLLOWING THE HOSPITAL'S CURRENT CHARGE SCHEDULES AND COLLECTION POLICIES, INCLUDING THE CHARITY CARE POLICY. - TAKE OVER PAYMENT OF EXPENSES, INVOICES, ACCOUNTS PAYABLE, AND OTHER OBLIGATIONS OF THE HOSPITAL IN ACCORDANCE WITH THE HOSPITAL'S POLICIES. THEY ARE ALLOWED ACCESS TO THE BANK ACCOUNTS, AND EXPENSES EXCEEDING $250,000 REQUIRE DAMERON BOD APPROVAL. - OVERSEE THE ACCOUNTING SYSTEM AND PREPARE MONTHLY, QUARTERLY, AND ANNUAL FINANCIAL STATEMENTS AND BOOKKEEPING. - MANAGE ALL CURRENT VENDOR AGREEMENTS AND LOOK TO RENEGOGIATE CONTRACTS WITH UNFAVORABLE TERMS. ANY CONTRACT NEGOTIATIONS OF $250,000 OR MORE REQUIRE DAMERON BOD APPROVAL. ALL CAPITAL PLAN PROJECTS MUST RECEIVE DAMERON BOD APPROVAL. AND ENSURE THE HOSPITAL REMAINED FULLY LICENSED AND CERTIFIED FOR PARTICIPATION IN GOVERNMENT PROGRAMS AND OTHER THIRD PARTY PAYOR PROGRAMS - SHALL ASSESS AND RECOMMEND IMPROVEMENTS AND EFFICIENCIES TO THE HOSPITAL'S OPERATIONS INCLUDING IMPROVING FINANCIAL EFFECTIVENESS, QUALITY OF OPERATIONS, CAPITAL BUDGET, AND EXPENDITURES. THE DOB WILL ULTIMATELY MAKE DECISIONS RELATED TO THE CAPITAL BUDGET, EXPENDITURES, AND INVESTMENTS. - DEVELOP BRANDING FOR BOARD APPROVAL - DAMERON HOSPITAL ASSOCIATION MUST OBTAIN CONSENT FROM ADVENTIST PRIOR TO TAKING THE FOLLOWING ACTIONS: AUTHROIZE OR APPROVE THE TRANSFER OR DISPOSE OF REAL OR PERSONAL PROPERTY (EXCEPT OBSELETE ITEMS); ENTER INTO DEBT THAT CREATES LIENS ON REAL OR PERSONAL PROPERTY OF THE HOSPITAL; EXECUTE LEASES, CONTRACTS, OR AGREEMENTS; TERMINATE LICENSES, CERTIFICATIONS, OR PERMITS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CFO AND ACCOUNTING MANAGER. THE RETURN IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH INDIVIDUAL FIDUCIARY MUST EXECUTE A CONFLICTS OF INTEREST DISCLOSURE STATEMENT AND QUESTIONNAIRE AT LEAST ANNUALLY AND MUST PROMPTLY REPORT ALL FACTS REGARDING ANY NEW TRANSACTION THAT MIGHT CREATE A CONFLICT OF INTEREST AS SOON AS THEY BECOME AWARE OF ANY SUCH TRANSACTION. IT IS EACH FIDUCIARY'S DUTY TO MAKE A FULL DISCLOSURE AS PROVIDED HEREIN OF ALL MATERIAL FACTS REGARDING ANY POSSIBLE CONFLICT OF INTEREST, TO DESCRIBE THE SITUATION OR TRANSACTION, AND TO DISCLOSE THE DETAILS OF THE EMPLOYEE, MEDICAL STAFF OFFICER, OR RELATED PARTY'S INTEREST IN THE SITUATION OR TRANSACTION. ALL FIDUCIARIES SHALL REPORT ALL POSSIBLE CONFLICTS OF INTEREST TO THE CHIEF EXECUTIVE OFFICER, OR HER DESIGNEE. THE CHIEF EXECUTIVE OFFICER, OR DESIGNEE, SHALL CONDUCT SUCH REVIEW AS APPROPRIATE, AND REFER SUCH INFORMATION TO THE BOARD OF DIRECTORS OF THE HOSPITAL. THE BOARD OF DIRECTORS SHALL REVIEW SUCH CONFLICTS AND DISCLOSURES. THE BOARD OF DIRECTORS MAY CONSULT WITH LEGAL COUNSEL AND SUCH OTHER AUTHORITIES AS MAY BE DESIRED, AND MAY REQUEST ANY ADDITIONAL INFORMATION DEEMED RELEVANT, INCLUDING THE SOURCE AND AMOUNT OF ANY INCOME OR FINANCIAL INTEREST OR OTHER ECONOMIC BENEFIT TO BE DERIVED BY SUCH PERSON FROM THE SITUATION OR TRANSACTION. IT IS THE POLICY OF THE BOARD OF DIRECTORS THAT THE EXISTENCE OF ANY INTEREST DESCRIBED WITHIN THE CORPORATE COMPLIANCE & REGULATORY AFFAIRS POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. EACH FIDUCIARY HAS A CONTINUING RESPONSIBILITY TO SCRUTINIZE ANY TRANSACTION IN WHICH THE FIDUCIARY OR A RELATED PARTY IS DIRECTLY OR INDIRECTLY INTERESTED FOR POTENTIAL CONFLICT OF INTEREST AND TO MAKE A FULL DISCLOSURE AS PROVIDED HEREIN. THE CHIEF EXECUTIVE OFFICER, OR THE BOARD OF DIRECTORS SHALL AS PROVIDED HEREIN THEN DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND SHALL TAKE THE APPROPRIATE ACTION. ALL DECISIONS REGARDING CONFLICTS OF INTEREST REST IN THE SOLE DISCRETION OF THE BOARD OF DIRECTORS IN THE EXERCISE OF ITS ULTIMATE JUDGMENT OF THE BEST INTERESTS OF THE HOSPITAL. ALL OFFICERS WHO ARE EMPLOYEES, ALONG WITH THE REST OF MANAGEMENT AND THE BOARD ARE SUBJECT TO AN ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE INCENTIVE COMPENSATION IS SET BASED ON MEETING A SPECIFIC SET OF THE BOARD. METRICS GENERALLY INCLUDE QUALITY, FINANCE, PATIENT SAFETY, YEAR, THE BOARD APPOINTS AN EXECUTIVE COMPENSATION COMMITTEE TO 1) REVIEW PERFORMANCE AGAINST ESTABLISHED GOALS AS WELL AS OVERALL EXECUTIVE METRICS ESTABLISHED ANNUALLY BY THE CEO AND EXECUTIVE TEAM AND APPROVED BY PATIENT EXPERIENCE, EMPLOYEE ENGAGEMENT AND MEANINGFUL USE GOALS. EACH AND APPROVE AN ANNUAL EXECUTIVE COMPENSATION PLAN; 2) TO EVALUATE EXECUTIVE PERFORMANCE; AND 3) TO SET THE OVERALL EXECUTIVE COMPENSATION PLAN FOR THE FOLLOWING YEAR. THE CEO PROVIDES RECOMMENDATIONS CONCERNING THE PERFORMANCE AND COMPENSATION OF THE EXECUTIVES FOR BOARD APPROVAL. THE EXECUTIVE COMPENSATION COMMITTEE AND CHAIRMAN OF THE BOARD EVALUATE THE CEO AND APPROVE THE CEO'S COMPENSATION. THE ANNUAL EXECUTIVE COMPENSATION PLAN IS DEVELOPED AND PRESENTED TO THE BOARD BY AN INDEPENDENT HEALTHCARE COMPENSATION EXPERT WHO ALSO ADVISES AND GUIDES THE BOARD AS TO MARKET AND OTHER FACTORS AFFECTING EXECUTIVE AND CEO COMPENSATION. THIS INCLUDES BUT IS NOT LIMITED TO BASE COMPENSATION, THE EXECUTIVE INCENTIVE PROGRAM AND RECOMMENDED PERFORMANCE AND MARKET COMPENSATION ADJUSTMENTS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC TO VIEW. FORM 990, PART IX, LINE 11G NURSE REGISTRY: PROGRAM SERVICE EXPENSES 12,067,298. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,067,298. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 600,495. MANAGEMENT AND GENERAL EXPENSES 515,342. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,115,837. PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 3,222,610. MANAGEMENT AND GENERAL EXPENSES 2,926,985. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,149,595. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 6,230,987. MANAGEMENT AND GENERAL EXPENSES 1,678,903. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,909,890. PHARMACY AND LABORATORY OUTSOURCING: PROGRAM SERVICE EXPENSES 2,931,906. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,931,906. MAINTENANCE: PROGRAM SERVICE EXPENSES 2,762,110. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,762,110. MEDICAL RECORDS OUTSOURCING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,453,881. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,453,881. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,461,484. MANAGEMENT AND GENERAL EXPENSES 85,120. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,546,604. DAMERON HOSPITAL FOUNDATION 525 WEST ACACIA STREET STOCKTON CA 95203 942811364 SUPPORT DAMERON HOSPITAL ASSOCIATION CA 501(C)(3) LINE 7 DAMERON HOSPITAL ASSOCIATION 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0