2022-11-15T17:51:16-06:00 2021-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2021-01-01 942823538 MARIN GENERAL HOSPITAL MARI 4159257000 250 BON AIR ROAD GREENBRAE CA 94904 DAVID KLEIN MD MBA CEO 4159257000 2022-11-12 1 DAVID KLEIN MD MBA 999009999 MICHAEL LUMSDEN P01262236 4159561500 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MARINHEALTH MEDICAL CENTER DAVID KLEIN MD MBA 250 BON AIR ROAD GREENBRAE CA 94904 496672744 0 X WWW.MYMARINHEALTH.ORG X 1991 CA TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES IN A COMPASSIONATE AND HEALING ENVIRONMENT. 12 11 2099 200 0 0 21075746 14953296 417508107 477439390 2448697 1437608 2011725 -169142 443044275 493661152 28161658 27806970 0 0 242683137 253527978 0 0 0 186701982 211699783 457546777 493034731 -14502502 626421 591205169 579435408 431456036 405138337 159749133 174297071 X TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES IN A COMPASSIONATE AND HEALING ENVIRONMENT. 0 0 449773970 27806970 477439390 MARIN GENERAL HOSPITAL DBA MARINHEALTH MEDICAL CENTER IS A 327-BED INDEPENDENT HOSPITAL WITH DEEP ROOTS IN THE COMMUNITY. WE HAVE BEEN MEETING THE HEALTHCARE NEEDS OF THE NORTH BAY SINCE FIRST OPENING OUR DOORS AS MARIN GENERAL HOSPITAL IN 1952. AS MARIN'S ONLY FULL-SERVICE, ACUTE CARE HOSPITAL, WE PROVIDE COMPREHENSIVE CARE ACROSS ALL MAJOR SERVICE LINES. OUR LEVEL III TRAUMA CENTER AND EMERGENCY DEPARTMENT RECEIVE 70% OF THE COUNTY'S AMBULANCE TRAFFIC, AND WE PROVIDE LIFE-SAVING CARE FOR OUR STROKE AND HEART ATTACK PATIENTS. WE ALSO OFFER THE ONLY HOSPITAL-BASED LABOR & DELIVERY UNIT IN MARIN. ADDITIONAL SERVICES PROVIDED INCLUDE: BEHAVIORAL HEALTH; CANCER CARE; CRITICAL CARE; EMERGENCY & TRAUMA; IMAGING & RADIOLOGY; STROKE CARE; SPINE & BRAIN CARE; AND SURGERY & PROCEDURES, AMONGST MANY OTHER SPECIALTIES.AS A DISTRICT HOSPITAL, OWNED BY MARIN HEALTHCARE DISTRICT, WE ANSWER ONLY TO THE COMMUNITY WE SERVE. THIS GIVES US THE FLEXIBILITY TO PLAN CARE THAT TRULY MEETS OUR COMMUNITY'S NEEDS. BUILDING ON A DECADES-LONG RELATIONSHIP, MARINHEALTH AND UCSF HEALTH FORMED A STRATEGIC ALLIANCE IN 2019 THAT EXPANDS ACCESS TO HIGH-QUALITY CLINICAL CARE IN MARIN COUNTY AND THROUGHOUT THE NORTH BAY. 449773970 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 310 0 1 2099 1 0 0 0 0 0 0 0 0 0 0 1 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X ERIC BRETTNER 4154642090 100B DRAKES LANDING SUITE 190 GREENBRAE CA 94904 ANDREA SCHULTZ CHAIR 2.00 0.50 X X 0 0 0 ROBERT PEIRCE VICE CHAIR 2.00 0.00 X X 0 0 0 JOSEPH C EUPHRAT TREASURER / SECRETARY 2.00 0.00 X X 0 0 0 JOE ABRAMS BOARD MEMBER 2.00 1.00 X 0 0 0 JOSHUA ADLER MD BOARD MEMBER 2.00 0.00 X 0 0 0 ANN KAO MD BOARD MEMBER 2.00 0.00 X 0 0 0 MARK R LARET BOARD MEMBER 2.00 0.00 X 0 0 0 MICHAEL K KWOK MD BOARD MEMBER 2.00 0.00 X 0 0 0 DENISE LUCY EDD BOARD MEMBER 2.00 0.00 X 0 0 0 GENE MARIE O'CONNELL RN MS BOARD MEMBER 2.00 2.00 X 0 0 0 MARA PEREZ PHD BOARD MEMBER 2.00 0.00 X 0 0 0 WALTER B ROSE BOARD MEMBER THROUGH 5/2021 2.00 0.00 X 0 0 0 DAVID KLEIN MD MBA CEO & BOARD MEMBER 46.00 4.00 X X 1287288 0 37742 ERIC BRETTNER CHIEF FINANCIAL OFFICER 46.00 4.00 X 624301 0 44237 KARIN SHAVELSON MD FAAP CHIEF MEDICAL OFFICER 50.00 0.00 X 570115 0 26117 LINDA LANG CHIEF HUMAN RESOURCES OFFICER 48.00 2.00 X 525529 0 43681 KARIN REESE RN MS CHIEF NURSING OFFICER THROUGH 4/2021 50.00 0.00 X 506152 0 4021 ELIZABETH KOLCUN CHIEF DEVELOPMENT OFFICER 4.00 46.00 X 459545 0 48461 ANDREW APOLINARSKI MSN RN CNL CHIEF NURSING OFFICER START 4/2021 50.00 0.00 X 336224 0 136700 MARY FRIEDMAN CHIEF STRATEGY OFFICER 48.00 2.00 X 331184 0 52808 COLIN LEARY JD GENERAL COUNSEL 50.00 0.00 X 241240 0 23415 GREGORY LEE IR / CATH / EP TECH LEAD 40.00 0.00 X 601240 0 54900 SANDY AUGUSTUS RN CLINICAL REGISTERED NURSE III 36.00 0.00 X 470453 0 69758 CHUN LI CHIEF CLIN PHYSICIST & DIR RAD ONC 40.00 0.00 X 339263 0 118389 ELIZABETH WADE RN CLINICAL REGISTERED NURSE II 36.00 0.00 X 421726 0 33562 SUSAN CUMMING MD MEDICAL DIRECTOR, PATIENT EXPERIENCE 40.00 0.00 X 359895 0 54327 ERIC PIFER MD FORMER CMO AND CMIO 0.00 0.00 X 473680 0 0 7547835 0 748118 852 1 1 0 PRIMA MEDICAL GROUP 4 HAMILTON LANDING SUITE 100 NOVATO CA 94949 PHYSICIAN SERVICES 21062530 CARDIOVASCULAR ASSOCIATES 2 BON AIR ROAD STE 100 LARKSPUR CA 94939 PHYSICIAN SERVICES 13063690 CALIFORNIA ADVANCED IMAGING MED ASSOC 500 REDWOOD BLVD 300 NOVATO CA 94947 PHYSICIAN SERVICES 8004097 MEDEFIS INC 2121 N 117TH AVE SUITE 200 OMAHA NE 68164 REGISTERED NURSE SERVICES 6474664 PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BLVD SUITE 200 NOVATO CA 94949 PHYSICIAN SERVICES 6189708 217 9481128 5449833 22335 14953296 NET PATIENT SERVICE REVENUE 624100 429347751 429347751 CAPITATION REVENUE 624100 42823966 42823966 OTHER OPERATING REVENUE 624100 5267673 5267673 477439390 1229516 1229516 244288 244288 2197815 2975396 -777581 -777581 -777581 36196 -36196 -36196 -36196 CAFETERIA 722514 608439 608439 608439 493661152 477439390 0 1268466 X 27712559 27712559 94411 94411 5298761 1579330 3719431 189469949 171152550 18317399 8290580 7087496 1203084 36520591 32398856 4121735 13948097 12281431 1666666 1447959 1447959 487941 487941 258444 258444 112593464 104391516 8201948 1776130 1776130 497428 445944 51484 1556875 1395738 161137 14429929 13878983 550946 25592 25592 7969695 7969695 21370514 21370514 1982457 1784211 198246 MEDICAL SUPPLIES 23074187 23074187 REPAIRS & MAINTENANCE 15102594 13578074 1524520 LICENSES & TAXES 2732411 2732411 RENTAL EQUIPMENT 1083192 1083192 5310971 2513191 2797780 493034731 449773970 43260761 0 68515104 48229996 8391083 1871115 490346 880651 64334699 65821758 4605577 4659699 6660982 7429475 6569966 7513566 442675992 257450076 169023209 185225916 113437468 81564904 20436820 21789282 3060461 5198781 1111007 741007 124568447 148509258 591205169 579435408 75226125 85211721 55507840 34571330 97812758 97355791 80999661 81028209 121909652 106971286 431456036 405138337 X 133271318 147988246 26477815 26308825 159749133 174297071 591205169 579435408 X 626421 1313402 -540000 13148115 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10542 10542 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO (I) THE CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS, AND (II) THE DISTRICT HOSPITAL LEADERSHIP FORUM. A PORTION OF THESE DUES PAID WERE USED FOR LOBBYING PURPOSES. 29211815 27053286 2158529 171036464 69653750 101382714 208437280 159232719 49204561 33990433 1510321 32480112 185225916 OTHER RECEIVABLES 20796007 DEPOSITS 21429317 DUE FROM RELATED ORGANIZATIONS 20758874 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3063995 OPERATING LEASE RIGHT-OF-USE ASSETS 47379349 BENEFICIAL INTEREST IN MARINHEALTH FOUNDATION 35081716 148509258 WORKERS' COMPENSATION OBLIGATION 4939782 POST-RETIREMENT HEALTH OBLIGATION 8370986 PENSION BENEFIT OBLIGATION 18797891 PROFESSIONAL LIABILITY OBLIGATION 1413000 UCSF CONTRACT LIABILITY 20000000 OPERATING LEASE LIABILITIES 53449627 106971286 1 1 X 1 X 400.000000000000 1 X 1 1 1 0 1 1 973310 973310 0.00200 84168313 37758366 46409947 0.09410 85141623 37758366 47383257 0.09610 607365 22230 585135 0.00120 2310587 2310587 0.00470 28823107 28823107 0.05850 31741059 22230 31718829 0.06440 116882682 37780596 79102086 0.16050 1 7155720 1369902 97219340 139843251 -42623911 X 1 1 1 1 MARIN GENERAL HOSPITAL DBA MARINHEALTH MEDICAL CENTER 250 BON AIR ROAD GREENBRAE CA 94904 WWW.MYMARINHEALTH.ORG 110000361 X X X ACUTE PSYCHIATRIC HOSPITAL MARIN GENERAL HOSPITAL DBA MARINHEALTH 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.MYMARINHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/ X 1 19 1 HTTPS://WWW.MYMARINHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/ 0 1 X 400.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X WWW.MYMARINHEALTH.ORG/PATIENTS-VISITORS/MEDICAL-CENTER-PATIENTS-VISITORS/ X WWW.MYMARINHEALTH.ORG/PATIENTS-VISITORS/MEDICAL-CENTER-PATIENTS-VISITORS/ X WWW.MYMARINHEALTH.ORG/PATIENTS-VISITORS/MEDICAL-CENTER-PATIENTS-VISITORS/ X X X X X X 1 X 0 X X X X 1 X 0 0 MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 5: A BROAD RANGE OF COMMUNITY MEMBERS PROVIDED COMMUNITY INPUT THROUGH KEY INFORMANT INTERVIEWS, GROUP INTERVIEWS, AND FOCUS GROUPS. INDIVIDUALS WITH THE KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE CONSULTED. THESE INDIVIDUALS INCLUDED REPRESENTATIVES FROM HEALTH DEPARTMENTS, SCHOOL DISTRICTS, LOCAL NON-PROFITS, AND OTHER REGIONAL PUBLIC AND PRIVATE ORGANIZATIONS AS WELL AS COMMUNITY LEADERS, CLIENTS OF LOCAL SERVICE PROVIDERS, AND OTHER INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND SUB-POPULATIONS THAT FACE UNIQUE BARRIERS TO HEALTH (E.G., RACE/ETHNIC MINORITY POPULATIONS, INDIVIDUALS EXPERIENCING HOMELESSNESS). INTERVIEWS WERE CONDUCTED WITH 31 KEY INFORMANTS BETWEEN 8/30/2018 10/15/2018 WITH REPRESENTATIVES FROM: THE MARIN FOOD POLICY COUNCIL, CANAL ALLIANCE, CITY OF SAN RAFAEL, MARIN TRANSIT, MARIN COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, RX SAFE MARIN, NATIONAL ALLIANCE OF MENTAL ILLNESS MARIN, NORTH MARIN COMMUNITY SERVICES, COSTAL HEALTH ALLIANCE, MARIN CITY HEALTH AND WELLNESS CENTER, MARIN COMMUNITY CLINICS, ROTACARE CLINIC OF SAN RAFAEL, MARIN ECONOMIC FORUM, SAN RAFAEL CHAMBER OF COMMERCE, NOVATO CHAMBER OF COMMERCE, LATINO COUNCIL OF MARIN, NORTH BAY LEADERSHIP COUNCIL, MARIN CENTER FOR INDEPENDENT LIVING, BUCKELEW PROGRAMS, WHISTLESTOP, CASA ALLEGRA, MARIN VENTURES, MARIN IHSS PUBLIC AUTHORITY, RITTER CENTER, HOMEWARD BOUND, ST. VINCENT DE PAUL SOCIETY, MARIN HOUSING AUTHORITY, WHOLE PERSON CARE, AND DOWNTOWN STREETS TEAM. IN ADDITION, THREE FOCUS GROUPS WERE HELD ON 9/5/2018, 9/21/2018, AND 10/2/2018; FOCUS GROUPS WERE CONDUCTED IN ENGLISH AND SPANISH, ENGAGING 22 COMMUNITY MEMBERS. MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 6A: MHMC CONDUCTED ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN CONJUNCTION WITH HEALTHY MARIN PARTNERSHIP, WHICH INCLUDES ALL ACUTE-CARE HOSPITALS IN MARIN COUNTY: MARINHEALTH MEDICAL CENTER, KAISER FOUNDATION HOSPITAL - SAN RAFAEL, AND SUTTER HEALTH - NOVATO COMMUNITY HOSPITAL. MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 6B: THE ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES WHO ARE MEMBERS OF HEALTHY MARIN PARTNERSHIP, WITH WHICH MARINHEALTH MEDICAL CENTER CONDUCTED ITS 2019 CHNA INCLUDE: MARIN COUNTY HEALTH & HUMAN SERVICES, HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA NORTH BAY LEADERSHIP COUNCIL, MARIN COUNTY OFFICE OF EDUCATION, MARIN COMMUNITY FOUNDATION, AND SAN RAFAEL CHAMBER OF COMMERCE. MARIN GENERAL HOSPITAL DBA MARINHEALTH PART V, SECTION B, LINE 11: WITH THE 2020-2022 IMPLEMENTATION STRATEGY, MARINHEALTH MEDICAL CENTER WILL ADDRESS THE HEALTH NEEDS OF: ACCESS TO HEALTHCARE; HEALTHY EATING AND ACTIVE LIVING; HOUSING AND HOMELESSNESS; MENTAL HEALTH/SUBSTANCE USE; AND VIOLENCE/INJURY PREVENTION THROUGH A COMMITMENT OF COMMUNITY BENEFIT PROGRAMS AND CHARITABLE RESOURCES.ACCESS TO CARE: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED FINANCIAL ASSISTANCE FOR UNINSURED/UNDERINSURED AND LOW-INCOME RESIDENTS; (II) PROVIDED TRANSPORTATION SERVICES FOR PERSONS WHO LACKED TRANSPORTATION TO ACCESS HEALTH CARE SERVICES; (III) REACHED 1,164 INDIVIDUALS WITH COMPASSIONATE DISCHARGE SERVICES AND PRESCRIPTIONS; (IV) SUPPORTED PRIMARY CARE AND SPECIALTY CARE SERVICES FOR THE UNINSURED AT MARINHEALTH MEDICAL NETWORK CLINICS; (V) SUPPORTED OPERATION ACCESS IN THEIR WORK TO PROVIDE DONATED OUTPATIENT SURGICAL AND SPECIALTY CARE FOR THE UNINSURED AND UNDERSERVED. MARINHEALTH MEDICAL CENTER WAIVED HOSPITAL CHARGES AND PROVIDED GRANT FUNDS FOR OPERATION ACCESS CLIENTS, ENABLING 248 UNINSURED INDIVIDUALS TO RECEIVE 368 NEEDED SURGICAL AND/OR DIAGNOSTIC SERVICES, HELPING TO RESTORE THEIR QUALITY OF LIFE. IN ADDITION, THROUGH OPERATION ACCESS MARINHEALTH-AFFILIATED PHYSICIAN VOLUNTEERS PROVIDED 29 SURGICAL PROCEDURES AND DIAGNOSTIC SERVICES FOR 27 UNINSURED INDIVIDUALS; (VI) PROVIDED FREE EDUCATION, COUNSELING, AND SUPPORT TO 856 BREASTFEEDING MOTHERS; (VII) PROVIDED OUTPATIENT CARE COORDINATION AND TRANSITIONS OF CARE THROUGH THE SUPPORTIVE CARE CENTER, ADDRESSING BARRIERS TO CARE FOR VULNERABLE PATIENTS AND THEIR CAREGIVERS; (VIII) ASSISTED 17,015 INDIVIDUALS WITH HEALTH INSURANCE ENROLLMENT IN PARTNERSHIP WITH MARIN COMMUNITY CLINICS; (IX) IDENTIFIED 486 COVID-19 CASES IN PARTNERSHIP WITH CANAL ALLIANCE; (X) PROVIDED 929 UNDUPLICATED INDIVIDUALS WITH DENTAL SERVICES IN PARTNERSHIP WITH PETALUMA HEALTH CENTER DBA COASTAL HEALTH ALLIANCE; AND (XI) PROVIDED A MOBILE CARE TEAM WITH A VAN EQUIPPED WITH COVID TESTING CAPABILITY AND PERSONAL PROTECTIVE EQUIPMENT, WHICH PROACTIVELY VISITED NURSING HOMES FOR EDUCATION, TESTING PATIENTS, TESTING STAFF, AND PROVIDING THEM WITH PROPER USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE). HEALTHY EATING AND ACTIVE LIVING: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) DISTRIBUTED THE FREE HEALTH CONNECTION E-NEWSLETTER AND QUARTERLY EDUCATIONAL PODCASTS TO THE PUBLIC AND PROVIDED EDUCATION ON HEALTHY EATING AND ACTIVE LIVING; (II) FACILITATED A CAREGIVER CLASS THAT EDUCATED 30 COMMUNITY CAREGIVERS WHO WORKED WITH PERSONS WITH DIABETES AND OTHER CHRONIC DISEASES; (III) PROVIDED FREE ADVICE TO THE PUBLIC ON NUTRITION NEEDS THROUGH REGISTERED DIETITIAN NUTRITIONISTS; (IV) THROUGH THE BRADEN DIABETES CENTER, PROVIDED FREE DIABETES SUPPORT GROUPS, COMMUNITY EDUCATION, AND SCREENINGS. IN 2021, 278 COMMUNITY MEMBERS PARTICIPATED EITHER IN-PERSON OR VIRTUALLY; (V) THROUGH THE INTEGRATIVE WELLNESS CENTER, PROVIDED EDUCATION, SUPPORT GROUPS, NUTRITION CLASSES, AND QI GONG EVENTS FREE TO THE PUBLIC. IN 2021, MORE THAN 1,880 COMMUNITY MEMBERS WERE SERVED; (VI) DELIVERED 25,885 ORGANIC, MEDICALLY TAILORED MEALS TO INDIVIDUALS WITH A SERIOUS ILLNESS AND THEIR FAMILY MEMBERS IN PARTNERSHIP WITH CERES COMMUNITY PROJECT.HOUSING AND HOMELESSNESS: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 1,180 INDIVIDUALS EXPERIENCING HOMELESSNESS WITH QUALITY HEALTH CARE SERVICES, INCLUSIVE OF MEDICAL, MENTAL HEALTH, AND ALCOHOL/DRUG TREATMENT SERVICES IN PARTNERSHIP WITH RITTER CENTER, A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) THAT ASSISTS MARIN'S LOW-INCOME AND HOMELESS POPULATION; (II) IN PARTNERSHIP WITH NORTH MARIN COMMUNITY SERVICES, 419 HOUSEHOLDS RECEIVED FINANCIAL ASSISTANCE; 1,255 OLDER ADULTS, CHILDREN, AND FAMILIES REMAINED HOUSED THROUGH FINANCIAL ASSISTANCE FOR EVICTION PREVENTION; (III) PROVIDED 77 INDIVIDUALS EXPERIENCING HOMELESSNESS WITH A STABLE ENVIRONMENT TO RECUPERATE AND RECEIVE WRAPAROUND SUPPORT SERVICES TO PROMOTE ECONOMIC INDEPENDENCE, HOUSING STABILITY AND ESTABLISH A MEDICAL HOME IN PARTNERSHIP WITH HOMEWARD BOUND. THIS RESULTED IN PREVENTING 945 AVOIDABLE HOSPITAL DAYS; (IV) PROVIDED 206 LOW-INCOME INDIVIDUALS WITH FREE ACUTE MEDICAL CARE AND MEDICATIONS IN PARTNERSHIP WITH ROTACARE BAY AREA CLINIC, THE ONLY FREE CLINIC IN MARIN COUNTY SERVING THE ADULT POPULATION.MENTAL HEALTH AND SUBSTANCE USE: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED ACCREDITED HOSPITAL INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH CARE SERVICES, INCLUDING PARTIAL HOSPITALIZATION AND A CO-OCCURRING BEHAVIORAL HEALTH AND SUBSTANCE USE; (II) IN PARTNERSHIP WITH THE HUCKLEBERRY TEEN YOUTH PROGRAM, BUCKELEW PROGRAMS, COMMUNITY INSTITUTE FOR PSYCHOTHERAPY, AND NORTH MARIN COMMUNITY SERVICES, MORE THAN 1,000 YOUTH AND ADULTS WERE PROVIDED BILINGUAL, CULTURALLY SENSITIVE MENTAL HEALTH COUNSELING SESSIONS; (III) FORTY-EIGHT SENIORS RECEIVED COGNITIVE BEHAVIORAL THERAPY, HEALTHY IDEAS BEHAVIORAL ACTIVATION AND LINKAGES TO OTHER SERVICES, AS NEEDED, IN PARTNERSHIP WITH JEWISH FAMILY AND CHILDREN'S SERVICES. IN ADDITION,18 FAMILY MEMBERS AND CAREGIVERS WERE PROVIDED THERAPY AND LINKAGES TO COMMUNITY RESOURCES; (IV) PROVIDED TRANSPORTATION FOR SENIORS IN THE BEHAVIORAL HEALTH PROGRAM TO INCREASE ACCESS TO CARE; (V) IN PARTNERSHIP WITH COMMUNITY ACTION MARIN, 4,500 COMMUNITY MEMBERS WERE ABLE TO ACCESS SUPPORT THROUGH A WARMLINE IN ENGLISH AND SPANISH; (VI) IN PARTNERSHIP WITH SAN GERONIMO VALLEY COMMUNITY CENTER, HELD A LET'S TALK SPEAKER SERIES FOCUSING ON SUBSTANCE USE, TEEN DEVELOPMENT AND PARENTING; AND (VII) SUPPORTED MARIN CITY COMMUNITY DEVELOPMENT CORPORATION, A SUBSTANCE USE RECOVERY-ORIENTED MENTAL HEALTH PROGRAM FOR THOSE WITH SERIOUS MENTAL ILLNESS, INCLUDING TRANSITIONAL AGE YOUTH.VIOLENCE AND INJURY PREVENTION: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 186 WEST MARIN SENIORS WITH CASE MANAGEMENT SERVICES, HOME-DELIVERED MEALS AND FREQUENT CONTACT VIA PHONE, FACETIME AND ZOOM; (II) HOSTED 2,500 YOUTH PARTICIPATED IN HEALTH EDUCATION, SUBSTANCE USE PREVENTION, AND SEXUAL VIOLENCE PREVENTION WORKSHOPS WITH HUCKLEBERRY YOUTH PROGRAMS; (III) PROVIDED 5,000 INDIVIDUALS AND FAMILIES WITH SUPPORT SERVICES TO PREVENT AND ADDRESS SUBSTANCE USE, MENTAL HEALTH, ISOLATION, SEXUAL HEALTH AND TRAUMA WITH SAN GERONIMO VALLEY COMMUNITY CENTER; (IV) HOSTED 750 BOY SCOUTS THROUGH THE AMERICAN COLLEGE OF SURGEON'S STOP THE BLEED TRAINING, WHICH ENCOURAGES BYSTANDERS TO BECOME TRAINED, EQUIPPED, AND EMPOWERED TO HELP IN A BLEEDING EMERGENCY BEFORE PROFESSIONAL HELP ARRIVES.MARINHEALTH MEDICAL CENTER HAS CHOSEN TO CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN THE ORGANIZATION'S AREAS OF FOCUS AND EXPERTISE. KNOWING THAT THERE ARE NOT SUFFICIENT RESOURCES TO ADDRESS ALL OF THE COMMUNITY HEALTH NEEDS, MARINHEALTH MEDICAL CENTER CHOSE TO ADDRESS THOSE HEALTH NEEDS THAT HAVE THE POTENTIAL FOR THE LARGEST IMPACT. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, MARINHEALTH MEDICAL CENTER WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA: ECONOMIC SECURITY, EDUCATION, MATERNAL AND INFANT HEALTH, ORAL HEALTH, AND SOCIAL CONNECTIONS. 12 2 - MARINHEALTH BONE DENSITY TESTING 100A DRAKES LANDING ROAD SUITE 140 GREENBRAE CA 94904 BONE DENSITY TESTING CLINIC 3 - MARINHEALTH BRADEN DIABETES CENTER 1100 SOUTH ELISEO DRIVE SUITE 2 GREENBRAE CA 94903 DIABETES CENTER 4 - MARINHEALTH BREAST HEALTH CENTER 100A DRAKES LANDING ROAD SUITE 140 GREENBRAE CA 94904 BREAST HEALTH CENTER 5 - MARINHEALTH CANCER CARE 1350 SOUTH ELISEO DRIVE GREENBRAE CA 94904 CANCER CARE CENTER 6 - MARINHEALTH CT SCAN SUITE 2 BON AIR ROAD SUITE 140 GREENBRAE CA 94904 CT SCAN CENTER 7 - MARINHEALTH HEARING & SPEECH 1350 SOUTH ELISEO DRIVE SUITE 130 LARKSPUR CA 94939 HEARING & SPEECH CENTER 8 - MARINHEALTH INTEGRATIVE WELLNESS CENTER 1350 SOUTH ELISEO DRIVE SUITE 140 GREENBRAE CA 94904 INTEGRATIVE WELLNESS CENTER 9 - MARINHEALTH LACTATION SERVICES 250 BON AIR ROAD FLOOR 4 GREENBRAE CA 94904 LACTATION SERVICES CENTER 10 - MARINHEALTH OUTPATIENT IMAGING CENTER 1240 SOUTH ELISEO DRIVE SUITE 103 GREENBRAE CA 94904 OUTPATIENT IMAGING CENTER 11 - MARINHEALTH OUTPATIENT MRI 1260 SOUTH ELISEO DRIVE SUITE 100 GREENBRAE CA 94904 OUTPATIENT MRI CENTER 12 - MARINHEALTH OUTPATIENT PHYSICAL THERAPY 1350 SOUTH ELISEO DRIVE SUITE 250 GREENBRAE CA 94904 OUTPATIENT PHYSICAL THERAPY 13 - MARINHEALTH OUTPATIENT IMAGING CENTER NO 4000 CIVIC CENTER DRIVE SUITE 209 SAN RAFAEL CA 94903 OUTPATIENT IMAGING CENTER PART I, LINE 3C: TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINE (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: 1) SPECIAL CIRCUMSTANCES CHARITY CARE: A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, INELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE HOSPITAL'S CHARITY CARE ELIGIBILITY CRITERIA. 2) CATASTROPHIC CHARITY CARE: FULL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 10% OF PATIENT'S FAMILY INCOME.3) UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. 4) PROMPT PAYMENT DISCOUNT: ADDITIONAL DISCOUNT FOR PATIENTS RECEIVING THE UNINSURED DISCOUNT OF AT LEAST 10% WHO PAYS ESTIMATED BILL PRIOR TO DISCHARGE. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS ON LINES 7B, AND 7C. COST ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS ON LINES 7A, 7E, 7F, AND 7I. PART III, LINE 2: THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON SCHEDULE H, PART III, LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 4: MHMC'S AUDITED FINANCIAL STATEMENTS DOES NOT HAVE A SEPARATE BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE FOOTNOTE WHICH ADDRESSES "PATIENTS ACCOUNTS RECEIVABLE, NET" CAN BE FOUND ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT AS MEDICARE RATES ARE NON-NEGOTIABLE AND SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. BY CONTINUING TO TREAT PATIENTS ELIGIBLE TO MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. ADDITIONALLY, IRS REV. RUL. 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.ALL MEDICARE REVENUES AND COSTS WERE INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: THE MEDICAL CENTER INCLUDES AN EXTENDED PAYMENT PLAN TO ALLOW PAYMENT OF THE DISCOUNTED PRICE OVER TIME. THE MEDICAL CENTER AND THE PATIENT MAY NEGOTIATE THE TERMS OF THE PAYMENT PLAN. THE MEDICAL CENTER WILL NOT CHARGE INTEREST ON THE EXTENDED PAYMENT PLAN DEBT. AN EXTENDED PAYMENT PLAN MAY BE NEGOTIATED WITH THE PATIENT IF THE PATIENT FAILS TO MAKE ALL CONSECUTIVE PAYMENTS DURING A 90-DAY PERIOD. PRIOR TO DECLARING AN EXTENDED PAYMENT PLAN INOPERABLE THE PATIENT MUST BE: 1. CONTACTED OR ATTEMPTED TO BE CONTACTED BY TELEPHONE (LAST KNOWN NUMBER)2. GIVEN NOTICE IN WRITING THAT THE PLAN MAY BE INOPERABLE (LAST KNOWN ADDRESS)3. INFORMED THAT THERE IS AN OPPORTUNITY TO RE-NEGOTIATE THE PAYMENT PLAN.UNTIL THE PAYMENT PLAN IS DECLARED INOPERABLE, NO REPORT MAY BE MADE TO A CONSUMER CREDIT REPORTING AGENCY AND NO CIVIL ACTION MAY COMMENCE. ANY ADVANCING OF DEBT FOR COLLECTION OR REPORTING REQUIRES THE APPROVAL OF EACH PATIENT BY THE DIRECTOR OF PATIENT FINANCIAL SERVICES. ADVANCING OF DEBT COLLECTION SHALL OCCUR AFTER 150 DAYS OF AN INOPERABLE PAYMENT PLAN. CREDIT REPORTING SHALL NOT OCCUR UNTIL AFTER 150 DAYS OF THE PAYMENT PLAN BEING INOPERABLE.IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING MARINHEALTH MEDICAL CENTER'S CHARITY CARE ELIGIBILITY CRITERIA, THE PATIENT ACCOUNT MAY BE CONSIDERED CHARITY CARE, EVEN IF THEY WERE ORIGINALLY CLASSIFIED FOR COLLECTION OR AS A BAD DEBT. COLLECTION AGENCY PATIENT ACCOUNTS MEETING CHARITY CARE CRITERIA SHOULD BE RETURNED TO MARINHEALTH MEDICAL CENTER'S BILLING OFFICE AND REVIEWED FOR CHARITY CARE ELIGIBILITY. PART VI, LINE 2: IN ADDITION TO THE TRIENNIAL CHNA, HEALTH NEEDS ARE MONITORED AS FOLLOWS: (I) MARIN HEALTHCARE DISTRICT BOARD MEETINGS, WHICH INCLUDE PUBLIC COMMENTS AND WHICH THE HOSPITAL CEO ATTENDS AND SHARES COMMUNITY INPUT WITH HOSPITAL STAFF AS APPROPRIATE; (II) HOSPITAL BOARD MEMBERS ARE ALL COMMUNITY RESIDENTS AND SHARE COMMUNITY HEALTH CONCERNS WHEN APPROPRIATE; AND (III) COMMUNITY COMMENTS ON THE TRIENNIAL CHNA AND IMPLEMENTATION STRATEGY ARE COLLECTED ON THE HOSPITAL WEBSITE AND ARE MONITORED BY THE COMMUNITY RELATIONS DEPARTMENT. PART VI, LINE 3: A) CHARITY CARE INFORMATION PROVIDED AT PATIENT INTAKE: EXCEPT IN THE CASE OF EMERGENCY SERVICES, MARINHEALTH MEDICAL CENTER SHALL PROVIDE PATIENTS WITH INFORMATION REGARDING CHARITY CARE AND DISCOUNT PAYMENTS DURING THE PATIENT INTAKE PROCESS. MARINHEALTH MEDICAL CENTER SHALL ALSO PROVIDE PATIENTS WITH CONTACT INFORMATION FOR A MARINHEALTH MEDICAL CENTER EMPLOYEE OR OFFICE FROM WHICH THE PATIENT MAY OBTAIN FURTHER INFORMATION ABOUT CHARITY CARE AND DISCOUNT PAYMENTS. THE INFORMATION PROVIDED SHALL BE IN THE PRIMARY LANGUAGE(S) OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. A LANGUAGE IS A PRIMARY LANGUAGE OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA IF 5% OR MORE OF MARINHEALTH MEDICAL CENTER'S LOCAL POPULATION SPEAKS THE LANGUAGE. B) CHARITY CARE INFORMATION PROVIDED AT ALL OTHER TIMES: MARINHEALTH MEDICAL CENTER SHALL PROVIDE PATIENTS WITH INFORMATION REGARDING CHARITY CARE AND DISCOUNT PAYMENTS DURING THE INTAKE PROCESS, OR AT ANY OTHER TIME UPON PATIENT REQUEST. MARINHEALTH MEDICAL CENTER SHALL PROVIDE UNINSURED PATIENTS WITH THE MARINHEALTH MEDICAL CENTER CHARITY CARE APPLICATION FORM, THE "STATEMENT OF FINANCIAL CONDITION," IMMEDIATELY UPON PATIENT REQUEST. THE INFORMATION PROVIDED SHALL BE IN THE PRIMARY LANGUAGE(S) OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. A LANGUAGE IS A PRIMARY LANGUAGE OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA IF 5% OR MORE OF MARINHEALTH MEDICAL CENTER'S LOCAL POPULATION SPEAKS THE LANGUAGE. C) PUBLIC NOTICE AND POSTING: PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE THROUGH THIS POLICY SHOULD BE MADE BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION. NOTICES MUST BE POSTED IN AT LEAST THE EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMITTING OFFICES, AND MEDICAL CENTER OUTPATIENT SERVICE SETTINGS. POSTED NOTICES SHALL BE IN LANGUAGES REFLECTING THAT SPOKEN IN THE SERVICE AREA IS 5% OR MORE OF THE POPULATIONS SPEAK THIS LANGUAGE. POSTED NOTICES SHALL CONTAIN THE FOLLOWING INFORMATION: 1) A STATEMENT INDICATING THAT MARINHEALTH MEDICAL CENTER HAS A FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS WHO MAY NOT BE ABLE TO PAY THEIR BILL AND THAT THIS POLICY PROVIDES FOR FULL OR PARTIAL CHARITY CARE WRITE-OFF.2) IDENTIFICATION OF A MEDICAL CENTER CONTACT PHONE NUMBER THAT THE PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND ABOUT HOW TO APPLY FOR ASSISTANCE.D) INCLUDE POLICY INFORMATION ON BILLS AND STATEMENTS SENT TO PATIENTS INDICATING:1) IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR QUALIFY FOR CHARITY CARE OR DISCOUNT PAYMENT FROM MARINHEALTH MEDICAL CENTER. THE INCOME REQUIREMENTS SHALL BE STATED ON THE NOTICE.2) NOTIFICATION TO THE PATIENT THAT EMERGENCY PHYSICIANS ARE REQUIRED TO HAVE A DISCOUNT POLICY TO UNINSURED AND HIGH MEDICAL COST PATIENTS WHICH MAY HAVE DIFFERENT ELIGIBILITY CRITERIA THAN THAT OF THE MEDICAL CENTER BUT AT LEAST AT 350% OF THE FPL. 3) A MEDICAL CENTER PHONE NUMBER THAT PATIENTS MAY CALL FOR FURTHER INFORMATION. 4) POSTING NOTICE OF THE AVAILABILITY OF ASSISTANCE AND A CONTACT PHONE NUMBER ON MARINHEALTH MEDICAL CENTER'S WEB SITE. 5) PROVIDING UNINSURED PATIENTS A DOCUMENT OUTLINING THE TYPES OF FINANCIAL ASSISTANCE AVAILABLE. PART VI, LINE 4: MARINHEALTH MEDICAL CENTER IS LOCATED AT 250 BON AIR ROAD, GREENBRAE, CA 94904. THE HOSPITAL SERVICE AREA COMPRISES ALL OF MARIN COUNTY AND INCLUDES THE CITIES OF: BELVEDERE, CORTE MADERA, FAIRFAX, LARKSPUR, MILL VALLEY, NOVATO, ROSS, SAN ANSELMO, SAN RAFAEL, SAUSALITO, TIBURON, AND THE COASTAL TOWNS OF STINSON BEACH, BOLINAS, POINT REYES, INVERNESS, MARSHALL, AND TOMALES. THE SERVICE AREA WAS DETERMINED FROM THE COMMUNITIES THAT REFLECT A MAJORITY OF PATIENT ADMISSIONS. MARIN COUNTY IS NORTH OF SAN FRANCISCO BY WAY OF THE GOLDEN GATE BRIDGE. THE COUNTY INCLUDES VAST AREAS OF OPEN SPACE, INCLUDING NATIONAL PROTECTED AREAS (SUCH AS MUIR WOODS NATIONAL MONUMENT), STATE AND LOCAL PROTECTED AREAS (SUCH AS MARIN COUNTY DEPARTMENT OF PARKS AND OPEN SPACE), AND STATE PARKS (SUCH AS MOUNT TAMALPAIS). MUCH OF MARIN'S POPULATION LIVES ALONG THE HIGHWAY 101 CORRIDOR, CREATING AN URBAN ENVIRONMENT IN THE EASTERN-CENTRAL PART OF THE COUNTY AND A MORE RURAL ENVIRONMENT ALONG THE COAST AND THE HIGHWAY 1 CORRIDOR IN WEST MARIN. MARIN HAS CONSISTENTLY BEEN RANKED BY THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS AS ONE OF THE HEALTHIEST COUNTIES IN CALIFORNIA. FOR 9 OUT OF THE PAST 10 YEARS, MARIN HAS EARNED THE TOP SPOT ON THIS LIST. THERE IS MUCH TO CELEBRATE REGARDING THE POSITIVE HEALTH OUTCOMES IN OUR COUNTY YET CLEAR INEQUITIES STILL EXIST, ILLUSTRATING THAT NOT ALL MARIN COUNTY RESIDENTS ARE ABLE TO ACHIEVE POSITIVE HEALTH OUTCOMES.MARIN COUNTY IS HOME TO 260,814 RESIDENTS. WITH A MEDIAN AGE OF 46.141 AND A HIGH PERCENTAGE OF OLDER ADULTS, MARIN COUNTY IS ONE OF THE "OLDEST" COUNTIES IN THE BAY AREA. PERSONS OVER THE AGE OF 60 ARE ESTIMATED TO NUMBER 72,684, COMPRISING 28% OF THE COUNTY'S TOTAL POPULATION. BY 2030, PERSONS OVER 60 WILL ACCOUNT FOR AT LEAST 33% OF THE POPULATION. STATEWIDE, PERSONS OVER 60 ACCOUNT FOR 18% OF THE POPULATION. YOUTH, 19 AND UNDER, MAKE UP 22% OF MARIN'S POPULATION. DUE TO THE HIGH COST OF LIVING IN MARIN COUNTY, FAMILIES WITH YOUNG CHILDREN FACE SIGNIFICANT CHALLENGES. ALMOST ONE-FOURTH (23%) OF MARIN COUNTY CHILDREN ARE LIVING AT OR BELOW 199% OF THE FEDERAL POVERTY LEVEL ($50,000 FOR A FAMILY OF 4). FAMILIES MUST MAKE DIFFICULT DECISIONS ABOUT PAYING FOR HOUSING, PAYING FOR FOOD, AND PAYING FOR QUALITY CHILDCARE AND EDUCATION FOR THEIR CHILDREN. IN MARIN COUNTY, 51% OF THE POPULATION IS FEMALE AND 49% IS MALE.THE MAJORITY OF THE POPULATION IN MARIN COUNTY IS NON-HISPANIC WHITE (71.9%); 15.6% OF THE POPULATION IS HISPANIC/LATINO; 5.6% OF THE POPULATION IS ASIAN; AND 2.3% OF THE POPULATION IS BLACK/AFRICAN AMERICAN. THE REMAINING 4.6% OF THE POPULATION IS MULTIPLE RACES, OTHER RACES, NATIVE ALASKANS, NATIVE HAWAIIANS AND NATIVE AMERICANS. PART VI, LINE 5: MARINHEALTH MEDICAL CENTER IS THE ONLY FULL-SERVICE ACUTE CARE HOSPITAL IN THE COUNTY AND THE ONLY HOSPITAL WITH AN OBSTETRICAL SERVICE OR IN PATIENT BEHAVIORAL HEALTH SERVICE. IT SERVES AS THE TRAUMA CENTER FOR MARIN COUNTY AND SURROUNDING AREAS. THE BOARD OF DIRECTORS IS COMPOSED OF UNCOMPENSATED COMMUNITY RESIDENTS. ALL FUNDS ARE USED TO IMPROVE HEALTH CARE SERVICES, MAINTAIN UP-TO-DATE FACILITIES, AND SUPPORT TRAINING PROGRAMS FOR HEALTH PROFESSIONALS IN AREAS SUCH AS NURSING, PHARMACY, RADIOLOGY, RESPIRATORY THERAPY, REHABILITATION SERVICES AND BEHAVIORAL HEALTH. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS. PART VI, LINE 6: MARIN HEALTHCARE DISTRICT IS THE GENERAL MEMBER OF MARINHEALTH MEDICAL CENTER; MARIN HEALTHCARE DISTRICT IS RESPONSIBLE FOR PROMOTING THE HEALTH AND WELFARE OF THE RESIDENTS OF MARIN COUNTY, INCLUDING MAINTAINING COUNTY-WIDE ACCESS TO CARE THROUGH THE MARIN HEALTHCARE DISTRICT HEALTH CENTERS. IN ADDITION, MARINHEALTH MEDICAL CENTER OPERATES IN CONJUNCTION WITH MARINHEALTH MEDICAL NETWORK, WHICH IS A MEDICAL FOUNDATION OFFERING A WIDE RANGE OF PHYSICIANS AND PROVIDERS. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 SAN RAFAEL CHAMBER OF COMMERCE 817 MISSION AVE SAN RAFAEL CA 94901 940839470 501(C)(6) 12000 0 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 1400 N DUTTON AVE SUITE 20 SANTA ROSA CA 95401 135613797 501(C)(3) 25000 0 GENERAL SUPPORT TEDXMARINORG PARTNERSHIP 644 BOLINAS ROAD FAIRFAX CA 94930 472577374 5500 0 GENERAL SUPPORT IPROMOTEU CORP DEPT LA 23232 PASADENA CA 91185 522217134 5140 0 GENERAL SUPPORT PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BLVD SUITE 200 NOVATO CA 94949 271376321 501(C)(3) 27653004 0 GENERAL SUPPORT 2 3 SCHOLARSHIPS 6 5000 PATIENT ASSISTANCE 112 87393 PROFESSIONAL DEVELOPMENT 3 818 VOLUNTEER SUPPORT 1 1200 PART I, LINE 2: FOR GRANTS TO INDIVIDUALS, THE ORGANIZATION PRE-SCREENS THE INDIVIDUALS FOR ELIGIBILITY. GRANTS ARE PAID DIRECTLY TO THE PROVIDER OF SERVICES TO PATIENTS. THE HOSPITAL DOES NOT REQUIRE ACCOUNTING OF THE USE OF GRANT FUNDS PROVIDED, HOWEVER, THE ORGANIZATION HISTORICALLY HAS A CLOSE WORKING RELATIONSHIP WITH GRANTEES LISTED ON SCHEDULE I, PART II. IN THE CASES OF GENERAL PURPOSE GRANTS, THE GRANTEE'S CHARITABLE PURPOSE IS REVIEWED PRIOR TO THE ISSUANCE OF THE GRANT. X X X 1 0 0 0 0 0 0 0 0 DAVID KLEIN MD MBA CEO & BOARD MEMBER 1221391 0 62333 0 3564 0 14500 0 23242 0 1325030 0 0 0 ERIC BRETTNER CHIEF FINANCIAL OFFICER 561558 0 61501 0 1242 0 14856 0 29381 0 668538 0 0 0 GREGORY LEE IR / CATH / EP TECH LEAD 601240 0 0 0 0 0 43283 0 11617 0 656140 0 0 0 KARIN SHAVELSON MD FAAP CHIEF MEDICAL OFFICER 551058 0 18000 0 1057 0 14500 0 11617 0 596232 0 0 0 LINDA LANG CHIEF HUMAN RESOURCES OFFICER 434135 0 85237 0 6157 0 20127 0 23554 0 569210 0 0 0 SANDY AUGUSTUS RN CLINICAL REGISTERED NURSE III 470453 0 0 0 0 0 41553 0 28205 0 540211 0 0 0 KARIN REESE RN MS CHIEF NURSING OFFICER THROUGH 4/2021 163454 0 80000 0 262698 0 0 0 4021 0 510173 0 0 0 ELIZABETH KOLCUN CHIEF DEVELOPMENT OFFICER 381020 0 77845 0 680 0 19080 0 29381 0 508006 0 0 0 ERIC PIFER MD FORMER CMO AND CMIO 0 0 0 0 473680 0 0 0 0 0 473680 0 0 0 ANDREW APOLINARSKI MSN RN CNL CHIEF NURSING OFFICER START 4/2021 319552 0 15000 0 1672 0 115329 0 21371 0 472924 0 0 0 CHUN LI CHIEF CLIN PHYSICIST & DIR RAD ONC 327116 0 10000 0 2147 0 107258 0 11131 0 457652 0 0 0 ELIZABETH WADE RN CLINICAL REGISTERED NURSE II 421726 0 0 0 0 0 12191 0 21371 0 455288 0 0 0 SUSAN CUMMING MD MEDICAL DIRECTOR, PATIENT EXPERIENCE 341458 0 15000 0 3437 0 24946 0 29381 0 414222 0 0 0 MARY FRIEDMAN CHIEF STRATEGY OFFICER 276623 0 54222 0 339 0 23427 0 29381 0 383992 0 0 0 COLIN LEARY JD GENERAL COUNSEL 240804 0 0 0 436 0 12115 0 11300 0 264655 0 0 0 PART I, LINE 4A KARIN REESE, RN, MS RECEIVED A SEVERANCE PAYMENT OF $261,542 DURING THE 2021 CALENDAR YEAR; ERIC PIFER, MD RECEIVED A SEVERANCE OF $473,680. BOTH PAYMENTS HAVE BEEN REPORTED AS TAXABLE COMPENSATION TO THE INDIVIDUALS AND REPORTED WITHIN "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SUG7 2018-05-23 100032761 CONSTRUCT NEW HOSPITAL FACILITY/AMBULATORY SERVICES BLDG/PARKING STRUCTURE 0 0 0 A 100032761 1132761 1100000 73963743 24969018 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 MARINHEALTH MEDICAL CENTER (MHMC) HAS ONE GENERAL MEMBER, MARIN HEALTHCARE DISTRICT (MHD), A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA. IN ADDITION, THE BYLAWS PROVIDE FOR A "SPECIAL MEMBER" (WITH THE POWER TO NOMINATE 2 MEMBERS OF THE BOARD OF DIRECTORS): THE REGENTS OF THE UNIVERSITY OF CALIFORNIA ON BEHALF OF UCSF HEALTH. FORM 990, PART VI, SECTION A, LINE 7A MARIN HEALTHCARE DISTRICT (THE "GENERAL MEMBER") DOES NOT HAVE THE POWER TO APPOINT MEMBERS OF THE GOVERNING BODY; HOWEVER, THE GENERAL MEMBER DOES HAVE THE RIGHT TO REJECT ALL APPOINTEES TO THE BOARD OF DIRECTORS. THE REGENTS OF THE UNIVERSITY OF CALIFORNIA ON BEHALF OF UCSF HEALTH (THE "SPECIAL MEMBER") MAY NOMINATE TWO MEMBERS OF THE BOARD OF DIRECTORS, WHO MUST ALSO BE APPROVED BY THE GENERAL MEMBER. FORM 990, PART VI, SECTION A, LINE 7B NEITHER THE BOARD NOR ANY OFFICER OR EMPLOYEE OF MHMC MAY TAKE ANY OF THE FOLLOWING ACTIONS, OR APPROVE A SUBSIDIARY OR AN AFFILIATE TAKING THE FOLLOWING ACTIONS, WITHOUT THE PRIOR APPROVAL, OR ANY OF THE SPECIFIED ACTIONS, OF THE GENERAL MEMBER: (A) ANY CORPORATE MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THIS CORPORATION THAT WOULD CHANGE THE GENERAL MEMBER'S STATUS AS SOLE CORPORATE MEMBER OR OWNER OF THE LAND AND ASSETS LEASED BY THIS CORPORATION; (B) ANY TRANSACTION REQUIRING THE CONSENT OR APPROVAL OF THE GENERAL MEMBER PURSUANT TO THE LEASE OF THE MHMC CAMPUS AND FACILITIES BY THE GENERAL MEMBER TO THIS CORPORATION, COMMENCING DECEMBER 2, 2015, AS IT HAS BEEN OR MAY BE AMENDED ("THE LEASE"). (C) ANY MATERIAL TRANSFER BY SALE, LEASE, DEBT OR ENCUMBRANCE, OR OTHER DISPOSITION, OF ANY OF THE ASSETS OF THE CORPORATION, REAL OR PERSONAL, OUTSIDE THE ORDINARY COURSE OF HOSPITAL BUSINESS. NOTWITHSTANDING THE FOREGOING, THE FOLLOWING WILL NOT REQUIRE THE PRIOR APPROVAL OF THE GENERAL MEMBER: (I) ANY TRANSACTION AMOUNTING TO A TRANSFER OF LESS THAN TEN PERCENT (10%) OF THE ASSETS OF THE CORPORATION, AS OF THE MONTH IMMEDIATELY PRECEDING THE TRANSACTION, TO ANOTHER LEGAL ENTITY IN CONNECTION WITH AN AFFILIATION OR JOINT VENTURE INVESTMENT OR SERVICE OPERATION OFF THE MHMC CAMPUS; (II) A FINANCING TRANSACTION, INCLUDING, BUT NOT LIMITED TO, DEBT FINANCING OR BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS, EXPECTED TO AMOUNT IN TOTAL PRINCIPAL VALUE TO LESS THAN TEN PERCENT (10%) OF NET PATIENT SERVICES REVENUE, AS OF THE MONTH IMMEDIATELY PRECEDING THE TRANSACTION; (III) THE GENERAL MEMBER SHALL IN ITS DISCRETION CONSIDER EXTENDING THE ABOVE THRESHOLD REQUIREMENTS BASED ON ADDITIONAL PERCENTAGES OF TOTAL ASSETS OR PATIENT REVENUE, AND ANY SUCH ALLOWANCE SHALL COMPLY WITH APPLICABLE CALIFORNIA LAWS OR REGULATIONS GOVERNING TRANSFERS OF ASSETS OF A HEALTHCARE DISTRICT (E.G., HEALTH & SAFETY CODE SECTION 32121 (P)). (D) IN ADDITION TO THRESHOLDS FOR APPROVALS REQUIRED FOR INDIVIDUAL TRANSACTIONS DESCRIBED IN SUBSECTION (C) ABOVE, APPROVAL OF THE GENERAL MEMBER SHALL BE REQUIRED FOR ANY TRANSACTION WHICH, ON A PROFORMA BASIS, WOULD CAUSE THE CORPORATION TO BE IN VIOLATION OF ANY FINANCIAL LOAN OR BOND COVENANT, AS THEY EXIST AT THE TIME OF THE TRANSACTION, OR THAT WOULD CAUSE THE CORPORATION'S DEBT TO CAPITALIZATION RATIO TO EXCEED 50%. (E) ANY TRANSACTIONS WITH LONG-TERM (MORE THAN THREE-YEAR) LAND OR FACILITY IMPACTS (E.G., NEW CONSTRUCTION OR RENOVATION) REQUIRING GENERAL MEMBER APPROVAL PURSUANT TO THE LEASE OR COSTING THE EQUIVALENT OF TEN PERCENT (10%) OR MORE OF MHMC THEN EXISTING TOTAL ASSETS (APPROXIMATELY $27 MILLION AT DECEMBER 31, 2015). (F) ANY LONG-TERM CAMPUS DEVELOPMENT PLAN THAT RESTRICTS FUTURE LAND USE OPTIONS OR REQUIRES REGULATORY CHANGES TO LAND USE PERMITS/DESIGNATIONS WILL REQUIRE GENERAL MEMBER APPROVAL. (G) ANY TRANSACTION THAT CAUSES OR IS ANTICIPATED TO CAUSE A DOWNGRADE IN BOND RATING BY A STANDARD RATING AGENCY REQUIRES GENERAL MEMBER APPROVAL REGARDLESS OF SIZE OF THE TRANSACTION. (H) THE GENERAL MEMBER SHALL RETAIN AN INDEPENDENT AUDIT FIRM CONSISTENT WITH STANDARD INDUSTRY FINANCIAL PRACTICE ON BEHALF OF THE CORPORATION. THE AUDIT FIRM WILL THEN PROVIDE SERVICES TO MHMC'S MANAGEMENT AND ITS BOARD AS OVERSEEN BY THE MHMC BOARD AUDIT SUBCOMMITTEE. FINAL AUDIT REPORTS WILL BE PRESENTED TO THE GENERAL MEMBER (SUBJECT TO PUBLIC REVIEW), THE BOARD, AND MANAGEMENT OF MHMC. (I) CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL, OR SUBSTANTIALLY ALL (50 PERCENT OR GREATER), OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THIS CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. (J) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION. (K) BYLAW APPROVALS (L) ANY CHANGES TO THE MISSION STATEMENT OF THE CORPORATION FOR MHMC. (M) ANY CHANGES TO THE CORPORATE DISSOLUTION RIGHTS (INITIATION OF DISSOLUTION AND DISPOSITION OF ASSETS) OF THE GENERAL MEMBER. (N) APPROVAL OF INDIVIDUALS FOR BOARD MEMBERSHIP. IN ADDITION, THE SPECIAL MEMBER SHALL HAVE THE FOLLOWING RIGHTS AND PRIVILEGES: (A) TO NOMINATE INDIVIDUALS TO SERVE ON THE BOARD OF DIRECTORS AS "SPECIAL MEMBER NOMINEES; AND (B) TO APPROVE CERTAIN AMENDMENTS TO THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTANT, IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE DEPARTMENT. THE DRAFT FORM 990 IS THEN REVIEWED BY THE CONTROLLER AND CFO; ADJUSTMENTS ARE MADE, AS NECESSARY. A COMPLETE COPY OF THE FORM 990 IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH INDIVIDUAL BOARD MEMBER AND OFFICER SIGNS AN ACKNOWLEDGEMENT FORM THAT THEY HAVE READ THE CONFLICT OF INTEREST POLICY. IN ADDITION, A DISCLOSURE STATEMENT IS COMPLETED BY ALL OFFICERS AND BOARD MEMBERS ANNUALLY. ON THIS STATEMENT THE COVERED INDIVIDUAL LISTS A WIDE RANGE OF INFORMATION WHICH INCLUDES BUSINESS RELATIONSHIPS, EMPLOYMENT RELATIONSHIPS, PROPERTY INTERESTS, AND THOSE OF RELATED PARTIES. THE CEO AND BOARD CHAIR REVIEWS THESE STATEMENTS AND MONITORS SITUATIONS THAT MAY POSE A POTENTIAL CONFLICT OF INTEREST. THE CEO AND BOARD CHAIR MAY CONSULT WITH LEGAL COUNSEL AS NECESSARY. IN THE EVENT OF A POTENTIAL CONFLICT OF INTEREST, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE AND NATURE OF THE RELATIONSHIP. THE BOARD CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE CONFLICT. UNTIL THE POTENTIAL CONFLICT IS RESOLVED, THE BOARD CHAIR MAY REQUEST THE CONFLICTED INDIVIDUAL TO LEAVE THE ROOM OR NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE CONFLICTED INDIVIDUAL SHALL REFRAIN FROM VOTING ON ANY MATTER RELATED TO THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE HOSPITAL'S BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE EXECUTIVE COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS-LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF THE HOSPITAL'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. IN ORDER TO ENSURE EXTERNAL COMPETITIVENESS, NATIONAL, CALIFORNIA AND LOCAL MARKET AREA COMPENSATION DATA COMPARISONS ARE REVIEWED. COMPETITIVE ANALYSIS INCLUDES: (A) BASE SALARY, (B) TOTAL CASH (BASE SALARY + ANNUAL INCENTIVE), AND (C) TOTAL REMUNERATION (BASE SALARY + ANNUAL INCENTIVE + BENEFITS AND LONG-TERM INCENTIVE). THIS ANALYSIS INCLUDES COMPARABLE ORGANIZATIONS AND GEOGRAPHIC CONSIDERATIONS. FOR THE MOST SENIOR EXECUTIVE POSITIONS, NATIONAL AND REGIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS THE HOSPITAL ARE MOST APPROPRIATE. ALL OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION UNDERGO A REVIEW ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 55,510,482. MANAGEMENT AND GENERAL EXPENSES 8,201,948. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,712,430. PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 48,881,034. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,881,034. FORM 990, PART XI, LINE 9: BENEFIT PLAN RELATED CHANGES 12,777,071. CHANGE IN BENEFICIAL INTEREST IN MARINHEALTH FOUNDATION 371,044. MHMC PETCT LLC 250 BON AIR ROAD GREENBRAE CA 94904 942823538 INVESTMENT HOLDING COMPANY (INVESTMENT IN MARIN PET/CT IMAGING LLC) CA 0 2138320 MARIN GENERAL HOSPITAL MARIN HEALTHCARE DISTRICT 100B DRAKES LANDING ROAD SUITE 250 GREENBRAE CA 94904 911886269 HEALTH CARE CA N/A 0 MARIN GENERAL HOSPITAL FOUNDATION 1350 SOUTH ELISEO DRIVE SUITE 110 GREENBRAE CA 94904 946127213 FUNDRAISING CA 501(C)(3) LINE 12A, I MARIN GENERAL HOSPITAL 1 PRIMA MEDICAL FOUNDATION 9 COMMERCIAL BLVD SUITE 200 NOVATO CA 94949 271376321 PHYSICIAN MEDICAL FOUNDATION CA 501(C)(3) LINE 10 MARIN GENERAL HOSPITAL 1 MARIN PETCT IMAGING LLC 4000 CIVIC CENTER DRIVE SUITE 110 SAN RAFAEL CA 94903 833116653 DIAGNOSTIC IMAGING CA MHMC PETCT LLC RELATED -149214 1472821 0 0 0.51000 0 1 1 1 1 0 0 0 1 0 1 1 1 1 1 1 1 1 1 MARIN GENERAL HOSPITAL FOUNDATION C 9481128 BOOK VALUE MARIN GENERAL HOSPITAL FOUNDATION D 200128 BOOK VALUE MARIN GENERAL HOSPITAL FOUNDATION O 663086 BOOK VALUE PRIMA MEDICAL FOUNDATION B 27653004 BOOK VALUE PRIMA MEDICAL FOUNDATION D 20558746 BOOK VALUE PRIMA MEDICAL FOUNDATION L 6189708 BOOK VALUE MARIN PETCT IMAGING LLC B 1633419 BOOK VALUE