2025-05-15T14:50:06-05:00 2024-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-07-01 330222508 AVALON MEDICAL DEVELOPMENT CORPORATION AVAL 3105100700 PO BOX 1563 AVALON CA 90704 JASON PARET CEO 3105100700 2025-05-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-05-08 2023 2025-03-06 01:10:19Z CATALINA ISLAND MEDICAL CENTER JASON PARET PO BOX 1563 AVALON CA 90704 19083765 0 X CATALINAISLANDHEALTH.ORG X 1987 CA PROVIDE HEALTHCARE BENEFITS TO THE COMMUNITY OF CATALINA ISLAND AND MORE THAN 1 MILLION VISITORS EACH YEAR. 9 9 135 9 0 0 2914990 5086457 19140299 13979635 13642 -14226 0 0 22068931 19051866 0 0 0 0 8927344 9712311 0 0 0 10327883 9238221 19255227 18950532 2813704 101334 11876797 11694452 2584542 3003459 9292255 8690993 TO PROVIDE QUALITY HEALTHCARE TO EACH INDIVIDUAL AND IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY. 0 0 13162299 0 13979635 PROVIDE HEALTHCARE BENEFITS TO THE COMMUNITY. 13162299 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 0 0 0 0 0 0 0 0 1 1 1 0 0 1 70 0 135 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X CORY CLEAVENGER 3105100700 PO BOX 1563 AVALON CA 90704 CATRINA AWALT CHAIR 1.00 X X 0 0 0 NICOLE HEHENSTEIN VICE CHAIR 1.00 X X 0 0 0 RENEE MACLEOD TREASURER 1.00 X X 0 0 0 JUDY GREER SECRETARY 1.00 X X 0 0 0 DR JOHN CHRISTIAN FOX MEMBER 1.00 X 0 0 0 EHAB MADY MEMBER 1.00 X 0 0 0 DENISE MOTTER MEMBER 1.00 X 0 0 0 TRUDY SALDANA MEMBER 1.00 X 0 0 0 PETE SAVAGE MEMBER 1.00 X 0 0 0 JASON PARET CEO 40.00 X 515908 0 19179 ERIC CAMPBELL CONTRACTED CFO (AS OF 04/24) 40.00 X 0 0 0 JOHN LOVRICH CONTRACTED CFO (THRU 02/24) 40.00 X 278768 0 0 NEIL MACREADY CHIEF DEVELOPMENT OFFICER 40.00 X 246403 0 7215 RONDA REIMBER CNO 40.00 X 232929 0 15834 SANTA DOMINQUEZ NURSE PRACTITIONER 40.00 X 212839 0 19820 KEILI HINIKER RN 40.00 X 165138 0 8469 ELIZABETH LOGAN DIRECTOR OF OUTPATIENT SERVICES 40.00 X 164823 0 9043 1816808 0 79560 19 0 1 0 UCI PHYSICIANS 101 ALDRICH HALL IRVINE CA 92697 EMERGENCY ROOM PHYSICIANS 1167752 MEDEFIS INC PO BOX 5068 NEW YORK NY 100875068 MEDICAL TRAVELER AGENCY 1154424 PM NAGLE CONSULTING LLC 3816 SALISH TRAIL STEVENSVILLE MT 59870 BILLING AND COLLECTION SERVICES 383500 EDWIN MCGROARTY PO BOX 1255 AVALON CA 907041255 PHYSICIAN 337020 ACCUDATA ADVISORS GROUP LLC 440 LOUISIANA ST STE 900 HOUSTON TX 77002 CONSULTANT 249182 17 775000 4237957 73500 5086457 PATIENT SERVICE REVENUE 621990 13979635 13979635 13979635 17673 17673 31899 -31899 -31899 -31899 19051866 13979635 0 -14226 X 643203 643203 6391075 4550637 1840438 38379 16994 21385 2132034 1388229 743805 507620 329953 177667 128974 128974 79842 79842 5491798 4175744 1316054 42014 8403 33611 169786 81978 87808 3629 3629 3202 1546 1656 74042 74042 794855 634695 160160 370254 370254 SUPPLIES 697243 557795 139448 BAD DEBT EXPENSE 581719 581719 DUES AND SUBSCRIPTIONS 140064 67627 72437 EQUIPMENT 46788 22591 24197 614011 296463 317548 18950532 13162299 5788233 0 757537 349547 441058 424314 2802363 4382138 196466 250147 0 160544 6780124 2134167 4372479 4645957 184355 0 3122539 1481805 11876797 11694452 1103522 1248750 34073 0 457685 942162 989262 812547 2584542 3003459 X 9292255 8690993 9292255 8690993 11876797 11694452 101334 -702596 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2665168 553362 2111806 565152 113031 452121 1778691 443409 1335282 1771113 1024365 746748 4645957 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 787472 INTERCOMPANY RECEIVABLES 694333 1481805 LEASE OBLIGATIONS 812547 812547 1 1 1 X 1 X 1 0 0 17825 17825 0.00100 4546696 1660288 2886408 0.15710 4564521 1660288 2904233 0.15810 10000 10000 0.00050 42000 42000 0.00230 4767543 1319103 3448440 0.18770 15000 15000 0.00080 4834543 1319103 3515440 0.19130 9399064 2979391 6419673 0.34940 1 581719 36890 8577411 8632686 -55275 X 1 1 1 1 CATALINA ISLAND MEDICAL CENTER PO BOX 1563 AVALON CA 90704 CATALINAISLANDHEALTH.ORG 930000010 X X X CATALINA ISLAND MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, SECTION C, LINE 7D X X 1 22 1 SEE PART V, SECTION C, LINE 7D 0 1 X 200.000000000000 400.000000000000 X X X X X 0 1 X X X 1 X HTTPS://CATALINAISLANDHEALTH.ORG/NEED-HELP-PAYING-YOUR-BILL/ X HTTPS://CATALINAISLANDHEALTH.ORG/NEED-HELP-PAYING-YOUR-BILL/ X HTTPS://CATALINAISLANDHEALTH.ORG/NEED-HELP-PAYING-YOUR-BILL/ X X X X X 1 X 0 X X X X 1 X 0 0 CATALINA ISLAND MEDICAL CENTER PART V, SECTION B, LINE 5: WE INTERVIEWED 12 LOCAL HEALTH LEADERS, REPRESENTING A BROAD CROSS-SECTION OF CATALINA ISLAND, AND RECEIVED ONLINE SURVEY RESPONSES FROM 69 COMMUNITY MEMBERS. CATALINA ISLAND MEDICAL CENTER PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HTTPS://CATALINAISLANDHEALTH.ORG/WP-CONTENT/UPLOADS/2024/06/CIHEALTH_CHNA_FY2023.PDF CATALINA ISLAND MEDICAL CENTER PART V, SECTION B, LINE 11: IDENTIFIED HEALTH NEED 1: MENTAL HEALTHOBJECTIVE:1) ENSURE ADEQUATE SUPPLY OF PRIMARY CARE PROVIDERS TO MEET SERVICE NEEDS.STRATEGIES:1A) CONTINUE TO PROMOTE THE AVAILABILITY OF LICENSED SOCIAL WORKERS AND COLLABORATE WITH OTHER PROVIDERS TO PUBLICIZE MENTAL HEALTH SERVICES AVAILABLE ON CATALINA ISLAND. 1B) WORK TO BREAK DOWN CULTURAL BARRIERS TO INCREASE PATIENT ACCESS TO PROVIDER SERVICES. 1C) CONTINUE TO UTILIZE AND PROVIDE TELEPSYCH SERVICES.1D) EDUCATE COMMUNITY ON SERVICES AVAILABLE AND FINANCIAL OPTIONS AVAILABLE FOR SERVICES.IDENTIFIED HEALTH NEED 2: HOUSINGOBJECTIVES:1) CIMC TO BECOME EMPLOYER OF CHOICE IN AVALON.2) IMPROVE HEALTH EQUITY ACROSS THE ENTIRE SERVICE AREA.STRATEGIES:1) DEVELOP A HOUSING POLICY THAT MEETS THE NEEDS OF CIMC AND ITS EMPLOYEES.2A) COLLABORATE WITH COMMUNITY ORGANIZATIONS TO INCREASE AVAILABILITY OF LONG-TERM AFFORDABLE RENTALS.2B) COLLABORATE WITH ORGANIZATIONS TO INCREASE ASSISTED HOUSING UNITS ON CATALINA ISLANDIDENTIFIED HEALTH NEED 3: SPECIALTY ACCESSOBJECTIVES:1) EXPLORE, MAINTAIN AND EXPAND SERVICES TO INCREASE PATIENT VOLUME AND MARKET SHARE2) ASSESS SPECIALTY CARE NEEDS OF OUR SERVICE AREA AND FURTHER DEVELOP SPECIALTY CARE NETWORK TO MEET DEMANDS3) EXPLORE OPPORTUNITIES FOR MUTUALLY BENEFICIAL RELATIONSHIP WITH TERTIARY, REGIONAL AND PEER PROVIDERSSTRATEGIES:1A) IMPLEMENT HOSPITAL INFUSION SERVICES PROGRAM1B) EVALUATE FEASIBILITY OF DIALYSIS PROGRAM.1C) DEVELOP COMPREHENSIVE TELEHEALTH SERVICES1D) CREATE MARKETING CAMPAIGNS AROUND THE ADDITION OF NEW PROVIDERS AND SERVICES IN THE COMMUNITY IN BOTH SPANISH AND ENGLISH.2A) PROACTIVELY RECRUIT SPECIALISTS TO COME OUT PHYSICALLY AND VIRTUALLY TO CIMC.3A) EVALUATE OPPORTUNITIES WITH REGIONAL PROVIDERS TO DEVELOP HIGH VALUE, MUTUALLY BENEFICIAL RELATIONSHIPS THAT WOULD BENEFIT OUR SERVICE AREA, PROVIDE ADDITIONAL IN PERSON AND TELEMEDICINE SPECIALTY CONSULTATION/CLINIC OPPORTUNITIES WHILE MAINTAINING CIMC INDEPENDENCE AND FLEXIBILITY TO REFER PATIENTS WHERE APPROPRIATE.IDENTIFIED HEALTH NEED 4: CARE COORDINATION AND EDUCATIONOBJECTIVES:1) EXPLORE OPPORTUNITIES FOR MUTUALLY BENEFICIAL RELATIONSHIP WITH TERTIARY, REGIONAL, AND PEER PROVIDERS2) IMPROVE COMMUNITY HEALTHSTRATEGIES:1A) EVALUATE OPPORTUNITIES WITH REGIONAL PROVIDERS TO DEVELOP HIGH VALUE, MUTUALLY BENEFICIAL RELATIONSHIPS THAT WOULD BENEFIT OUR SERVICE AREA, PROVIDE ADDITIONAL IN PERSON AND TELEMEDICINE SPECIALTY CONSULTATION/CLINIC OPPORTUNITIES WHILE MAINTAINING CIMC INDEPENDENCE AND FLEXIBILITY TO REFER PATIENTS WHERE APPROPRIATE.2A) DEVELOP COMMUNITY OUTREACH PROGRAMS TO IMPROVE COMMUNITY HEALTH (I.E., EXERCISE PROGRAMS, FITNESS CENTER, YOGA, NUTRITION, ETC.)2B) LOOK AT OPPORTUNITIES FOR GREATER COORDINATION OF CARE FOR PATIENTS BETWEEN THE HOSPITAL, AND OTHER HEALTH ORGANIZATIONS IN THE COMMUNITY THAT CAN CONTRIBUTE SUBSTANCE ABUSE SUPPORT, MENTAL HEALTH SUPPORT, CONSISTENT FOLLOW UP TREATMENT, AND HOUSING.2C) FURTHER EDUCATION ON HEALTH SERVICES AVAILABLE AND HEALTHY EATING BEHAVIORS, SUCH AS NUTRITION SERVICES. PUBLICIZE SERVICES THROUGH PRIMARY CARE PHYSICIANS AND SOCIAL MEDIA. CATALINA ISLAND MEDICAL CENTER PART V, SECTION B, LINE 13B: PROPENSITY TO PAY PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. 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 $ 581,719. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE CONSOLIDATED FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTS PATIENTS WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS, A PORTION OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 8: CATALINA ISLAND MEDICAL CENTER IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. BASED ON THE INSTRUCTIONS, THE TOTAL MEDICARE REVENUE SHOWN ON THIS FORM 990 INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE THAT IS ACTUALLY RECEIVED BY THE HOSPITAL FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHODOLOGY AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT CATALINA ISLAND MEDICAL CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: IT IS THE POLICY OF CATALINA ISLAND HEALTH TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR SERVICES. CATALINA ISLAND HEALTH WILL MAKE REASONABLE EFFORTS TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE.COLLECTION PROCEDURES WILL BE APPLIED CONSISTENTLY AND FAIRLY FOR ALL PATIENTS REGARDLESS OF INSURANCE STATUS. ALL COLLECTION PROCEDURES WILL COMPLY WITH APPLICABLE LAWS. FOR THOSE PATIENTS UNABLE TO PAY ALL OR A PORTION OF THEIR BILL, THE APPLICABLE FINANCIAL ASSISTANCE POLICY WILL BE FOLLOWED.PATIENTS WHO QUALIFY FOR CHARITY, I.E., WHOSE INCOME IS UP TO 200% OF FEDERAL POVERTY GUIDELINES (FPG) WILL BE ELIGIBLE FOR FULL CHARITY TOTAL FREE CARE.PATIENTS WHOSE INCOME EXCEEDS THE FPG BUT IS LESS THAN 400% OF FPG WILL BE ELIGIBLE FOR PARTIAL CHARITY CARE (SEE CHARITY CARE POLICY).COLLECTION AGENCIES AND LAW FIRMS MAY BE ENLISTED AFTER ALL REASONABLE COLLECTION AND PAYMENT OPTIONS HAVE BEEN EXHAUSTED. AGENCIES MAY HELP RESOLVE ACCOUNTS WHERE PATIENTS ARE UNCOOPERATIVE IN MAKING PAYMENT, HAVE NOT MADE APPROPRIATE PAYMENTS, OR HAVE BEEN UNWILLING TO PROVIDE REASONABLE FINANCIAL AND OTHER DATA TO SUPPORT THEIR REQUEST FOR FINANCIAL ASSISTANCE. SELF-PAY DISCOUNTS WILL BE AVAILABLE FOR PATIENTS THAT ARE UNINSURED, UNDER-INSURED OR WHERE COVERAGE IS NOT AVAILABLE FROM THEIR INSURANCE COMPANY FOR THE SERVICE BEING RENDERED. ALL SELF-PAY PATIENTS WILL BE SCREENED FOR LINKAGE TO ANY APPROPRIATE FORM OF ASSISTANCE, INCLUDING MEDI-CAL, COVERED CA, HEALTHY FAMILY PROGRAM, OR ANY THIRD-PARTY LIABILITY PROGRAM (AUTOMOBILE INSURANCE, WORKER'S COMPENSATION, ETC.). SELF-PAY PATIENTS WILL BE OFFERED A SELF-PAY DISCOUNT IN ACCORDANCE WITH THE HOSPITAL'S CURRENT DISCOUNT POLICY AND IN COMPLIANCE WITH THE STATE AND FEDERAL GUIDELINES. PART VI, LINE 2: THE HOSPITAL IS LOCATED IN A VERY PRECISE AND SMALL AREA. THE CHNA IS EFFECTIVE AT IDENTIFYING THE NEEDS OF THE COMMUNITY FORMALLY EVERY THREE YEARS AND THE HOSPITAL USES THEIR CARE FEEDBACK MECHANISMS AND THE BOARD, EMPLOYEES AND OTHER STAKEHOLDERS TO UNDERSTAND WHAT OTHER NEEDS MAY REQUIRE ATTENTION IN THE INTERIM. PART VI, LINE 3: WHEN A PATIENT CHECKS INTO THE HOSPITAL OR CLINIC, THE PATIENT (OR REPRESENTATIVE) WILL BE PROVIDED WITH THE SELF-PAY AND CHARITY CARE POLICY GUIDELINES ALONG WITH A CHARITY CARE APPLICATION.INFORMATION ABOUT FINANCIAL ASSISTANCE AVAILABLE FROM CIH SHALL BE DISTRIBUTED AS FOLLOWS: NOTICES IN PATIENT STATEMENTS AND OTHER CORRESPONDENCE DISTRIBUTION OF PATIENT NOTIFICATION AT TIME OF REGISTRATION FOR AN INPATIENT STAY, OUTPATIENT VISITS, EMERGENCY DEPARTMENT (ED) VISIT, RURAL HEALTH CLINIC (RHC) OR FAMILY HEALTH CLINIC (FHC) VISITS. POSTING NOTICES IN HIGH VOLUME AREAS SUCH AS THE: I. PATIENT ACCESS FOR INPATIENT OR OUTPATIENT SERVICES. 2. EMERGENCY DEPARTMENT. 3. PATIENT FINANCIAL SERVICES OFFICE. 4. OTHER PLACES AS CIH MAY ELECT. A. SUCH INFORMATION SHALL BE PROVIDED IN ENGLISH AND CAN BE TRANSLATED UPON REQUEST FOR PATIENTS/GUARANTORS WHO SPEAK OTHER LANGUAGES. 5. PATIENTS WHO ARE ADMITTED THROUGH THE ED SHALL BE NOTIFIED THAT THIS PROGRAM IS AVAILABLE TO THEM TO ALSO ASSIST WITH THE ED PROVIDER BILL UPON DISCHARGE AND THROUGH POSTING IN THE ED. PART VI, LINE 4: CATALINA ISLAND MEDICAL CENTER ("CIMC") SERVES THE POPULATION OF AVALON, CALIFORNIA. AVALON CURRENTLY REPRESENTS APPROXIMATELY 4,400 YEAR-ROUND RESIDENTS. CATALINA ISLAND CAN SEE ON AVERAGE 85,000 VISITORS PER MONTH. X 1 1 X X X 0 0 0 0 0 0 0 0 0 JASON PARET CEO 515908 0 0 0 0 0 15477 0 3702 0 535087 0 0 0 JOHN LOVRICH CONTRACTED CFO (THRU 02/24) 278768 0 0 0 0 0 0 0 0 0 278768 0 0 0 NEIL MACREADY CHIEF DEVELOPMENT OFFICER 246403 0 0 0 0 0 0 0 7215 0 253618 0 0 0 RONDA REIMBER CNO 232929 0 0 0 0 0 0 0 15834 0 248763 0 0 0 SANTA DOMINQUEZ NURSE PRACTITIONER 212839 0 0 0 0 0 6415 0 13405 0 232659 0 0 0 ELIZABETH LOGAN DIRECTOR OF OUTPATIENT SERVICES 164823 0 0 0 0 0 4064 0 4979 0 173866 0 0 0 KEILI HINIKER RN 165138 0 0 0 0 0 0 0 8469 0 173607 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES A HOUSING ALLOWANCE TO THE FOLLOWING INTERESTED PERSONS: - JASON PARET, CEO THE HOUSING ALLOWANCE BENEFIT IS INCLUDED IN TAXABLE INCOME. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION USED A MANAGEMENT COMPANY TO PERFORM MANAGEMENT DUTIES DURING THE YEAR. THE ORGANIZATION CONTRACTED CFO SERVICES FROM LOVRICH TAX AND BUSINESS SERVICES. JOHN LOVRICH, LISTED IN PART VII, SECTION A IS THE OWNER. THE ORGANIZATION PAID $278,678 FOR THESE SERVICES DURING CALENDAR YEAR 2023 AS LISTED IN PART VII, SECTION B. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT FORM 990 IS PROVIDED TO THE BOARD EITHER AT THE BOARD MEETING OR ELECTRONICALLY IF ONE IS NOT SCHEDULED WITHIN A REASONABLE PERIOD BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C PRIOR TO CONDUCTING A BUSINESS SESSION AT A MEETING OF THE BOARD, BOARD MEMBERS SHALL DISCLOSE AND DISCUSS THEIR INDIVIDUAL CONFLICTS OR POTENTIAL CONFLICTS. IN THE EXERCISE OF VOTING RIGHTS BY MEMBERS OF THE BOARD, NO INDIVIDUAL SHALL VOTE ON ANY ISSUE, MOTION OR RESOLUTION WHICH DIRECTLY OR INDIRECTLY INURES TO HIS OR HER BENEFIT FINANCIALLY OR WITH RESPECT TO WHICH HE OR SHE HAS ANY OTHER CONFLICT OF INTEREST, EXCEPT THAT SUCH INDIVIDUAL MAY BE COUNTED IN ORDER TO QUALIFY A QUORUM AND, EXCEPT AS THE BOARD MAY OTHERWISE DIRECT, MAY PARTICIPATE IN THE DISCUSSION OF SUCH AN ISSUE, MOTION OR RESOLUTION IF HE OR SHE FIRST DISCLOSES THE NATURE OF HIS OR HER INTEREST. AFTER DISCLOSURE OF THE POSITION OR FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE WILL LEAVE THE BOARD MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD MEMBERS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S BOARD OF DIRECTORS WILL MAKE DETERMINATIONS REGARDING THE CEO'S COMPENSATION ANNUALLY. THE EXECUTIVE COMPENSATION COMMITTEE CONDUCTS NECESSARY RESEARCH AND DATA COLLECTION, AND BRINGS FORTH RECOMMENDATIONS, SUBJECT TO REVIEW AND ACTION BY THE INDEPENDENT BOARD MEMBERS. THE CEO ESTABLISHES SALARIES OF OTHER OFFICERS IN ACCORDANCE WITH THE ORGANIZATION'S CORPORATE POLICIES. CHANGES ARE SUBJECT TO REVIEW AND APPROVAL BY INDEPENDENT BOARD MEMBERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,893,835. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,893,835. CONSULTING FEES: PROGRAM SERVICE EXPENSES 377,794. MANAGEMENT AND GENERAL EXPENSES 217,887. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 595,681. REPAIRS AND MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 135,169. MANAGEMENT AND GENERAL EXPENSES 77,956. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 213,125. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,768,946. MANAGEMENT AND GENERAL EXPENSES 1,020,211. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,789,157. CATALINA ISLAND MEDICAL CENTER FOUNDATION INC PO BOX 524 AVALON CA 90704 330627293 FUNDRAISING FOR AVALON MEDICAL DEVELOPMENT CORPORATION CA 501(C)(3) LINE 7 AVALON MEDICAL DEVELOPMENT CORPORATION 1 LEO'S CATALINA DRUG STORE 401 CRESCENT AVENUE AVALON CA 90704 753152013 PHARMACY CA AVALON MEDICAL DEVELOPMENT CORPORATION C 1371507 1567615 1.00000 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 CATALINA ISLAND MEDICAL CENTER FOUNDATION INC C 775000 CASH LEO'S CATALINA DRUG STORE Q 635457 CASH