2025-08-14T15:10:38-05:00 2024-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-10-01 952821104 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENR 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 TED D SIROTTA SENIOR VP/CFO 6612002000 2025-08-14 1 1 SHELBY NETZ CPA P01405265 4147775500 2025-08-13 2023 2025-03-06 01:10:19Z KEVIN KLOCKENGA 23845 MCBEAN PARKWAY VALENCIA CA 91355 516666826 0 X WWW.HENRYMAYO.COM X 1972 CA TO BE THE MOST PATIENT-CENTRIC HOSPITAL ANYWHERE. 15 12 2063 338 227736 0 6272093 17457056 435062999 478803430 6933258 6731522 5900707 9219091 454169057 512211099 5103020 6999132 0 0 183854950 181154789 0 0 0 260409697 295634160 449367667 483788081 4801390 28423018 576910432 628864827 361918092 368914269 214992340 259950558 TO BE THE MOST PATIENT-CENTRIC HOSPITAL ANYWHERE. 0 0 427231673 6568207 482989539 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS. THE HOSPITAL HAD 63,072 PATIENT DAYS DURING THE YEAR. THE HOSPITAL ALSO PROVIDED SERVICES FOR 70,497 EMERGENCY VISITS. 76% OF TOTAL HOSPITAL INPATIENT ADMITS (EXCLUDING NEWBORNS) ARE ADMITTED THROUGH THE EMERGENCY ROOM. 430925 430925 TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. 427662598 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 1 0 0 1 282 0 1 2063 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CA X RICHARD KIM 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 KEVIN KLOCKENGA PRESIDENT/CEO 40.00 0.50 X X 903751 0 35417 ANA FONSECA TRUSTEE 0.50 X 0 0 0 CHRIS LUECHTEFELD TRUSTEE 0.50 0.50 X 0 0 0 DALE DONOHOE TRUSTEE 0.50 X 0 0 0 DONALD KIMBALL TRUSTEE 0.50 0.50 X 0 0 0 HOLLY SCHROEDER TRUSTEE 0.50 X 0 0 0 JOHN BARSTIS MD TRUSTEE 0.50 X 0 0 0 LAKHBINDER DHANDA MD TRUSTEE 0.50 X 0 0 0 LOUIE-MARC CONTRERAS MD TRUSTEE 0.50 X 0 0 0 MITZI LIKE TRUSTEE 0.50 0.50 X 0 0 0 PETER VELOZ TRUSTEE 0.50 X 0 0 0 ROBERT BENJAMIN TRUSTEE 0.50 X 0 0 0 RUSSELL HANLIN TRUSTEE 0.50 X 0 0 0 SONYA ENGLE TRUSTEE 0.50 X 0 0 0 TODD STEVENS TRUSTEE 0.50 X 0 0 0 TED D SIROTTA SR VP/CFO 40.00 X 533835 0 105421 MARIA VARTANIAN SR VP/CCO 40.00 X 308540 0 59831 CARISSA BORTUGNO VP CLINICAL SUPPORT 40.00 X 299461 0 62630 VICKI L WHITE CNO 40.00 X 160610 0 3726 ROBERT K PRETZLAFF FORMER SR VP CMO & CCO 40.00 X 584039 0 69366 RAY B MOSS VP/CIO 40.00 X 411018 0 69655 MARK A PULEO VP/CHRO 40.00 X 398882 0 75028 OHANNES KANDILIAN DIRECTOR OF PHARMACY 40.00 X 240146 0 37830 KYUNG R KIM SR. DIRECTOR OF FINANCE 40.00 X 235880 0 36568 PATRICK MOODY DIRECTOR OF MARKETING AND PR 40.00 X 229210 0 41495 KATHRYN A ORTEGA CLINCAL RN 40.00 X 236508 0 33474 JOSEPHINE J KAPLAN FORMER DIRECTOR CASE MANAGEMENT 40.00 X 225462 0 21780 ROGER E SEAVER FORMER PRESIDENT/CEO 0.00 0.00 X 814904 0 27315 EVELYN KU FORMER CNO 0.00 X 233360 0 63666 5815606 0 743202 577 1 1 0 SODEXO INC & AFFILIATES 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 OTHER PURCHASED SERVICES 15957705 INCREMENTAL THERAPY SOLUTIONS LLC 1650 LYNDON FARM CT STE 300 LOUISVILLE KY 40223 MEDICAL PURCHASED SERVICES 9472079 PROLINK HEALTHCARE LLC 4600 MONTGOMERY ROAD STE 300 CINCINNATI OH 45212 PROFESSIONAL SERVICES 8234976 RELEVO HEALTH PC 2100 POWELL STREET STE 400 EMERYVILLE CA 94608 PROFESSIONAL SERVICES - ANESTHESIA 5365042 FACEY MEDICAL FOUNDATION 15451 SAN FERNANDO MISSION BLVD ST MISSION HILLS CA 91345 PROFESSIONAL MEDICAL SERVICES 4606240 125 17447056 10000 17457056 HEALTHCARE SERVICES 621110 478803430 478803430 478803430 6291054 6291054 208289 208289 2871279 457419 2413860 2413860 2413860 4215199 15288 3998308 0 216891 15288 232179 232179 FITNESS CENTER REVENUE 621110 2340435 2340435 INCOME FROM CARE NETWO 621110 1073692 1073692 SUPPORT SERVICES 621110 227736 227736 3163368 771982 2391386 6805231 512211099 482989539 227736 11536768 X 430925 430925 6568207 6568207 4076567 3593170 483397 130103258 114878532 15224726 4794719 4233412 561307 30963012 27357399 3605613 11217233 10129803 1087430 1255722 1255722 484418 484418 30281 30281 210218 210218 82979258 73840672 9138586 606972 606972 4288048 2206225 2081823 8519343 7660821 858522 8120212 5382118 2738094 148332 87273 61059 102755 66421 36334 8646429 6693254 1953175 21338601 21338601 4418829 4418829 MEDICAL SUPPLIES 61453315 60711756 741559 BAD DEBT 44838811 44838811 QUALITY ASSURANCE FEES 25885266 25885266 IMPAIRMENT LOSS 10074761 10074761 12232589 7341103 4891486 483788081 427662598 56125483 0 55381459 110758131 48218130 46157969 6285518 6954181 6275801 5205115 496335514 259138470 256652028 237197044 96425045 119339610 3209808 3401679 104462643 99851098 576910432 628864827 78629300 94227506 3809813 707230 133782615 127727291 90815000 89065000 54881364 57187242 361918092 368914269 X 201588044 245264207 13404296 14686351 214992340 259950558 576910432 628864827 X 28423018 14671909 1863291 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 1 30281 30281 0 PART II-B, LINE 1: FOR THE FISCAL YEAR ENDED 9/30/24, THE ORGANIZATION PARTICIPATED WITH THE CALIFORNIA HOSPITAL ASSOCIATION TO ADVOCATE POSITIVE HEALTHCARE POLICIES FOR HOSPITALS. 5813164 5813164 366507708 161396462 205111246 115120202 97742008 17378194 8894440 8894440 237197044 RECEIVABLE FROM HENRY MAYO NEWHALL FOUNDATION 14442465 RECEIVABLE FROM HENRY MAYO MSO 1342970 PLEDGED LEASE 2076428 OTHER RECEIVABLES 47531362 OTHER CURRENT ASSETS 87223 RIGHT-OF-USE ASSET 34370650 99851098 ESTIMATED THIRD PARTY LIABILITIES 5595239 OTHER LIABILITIES 14734771 LEASE OBLIGATIONS 36857232 57187242 X 477843175 14671909 46475 -49543727 -34825343 512668518 -457419 -457419 512211099 432884957 46475 457419 503894 432381063 51407018 51407018 483788081 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE ("IRC") AND A SIMILAR PROVISION OF STATE LAW. ACCORDINGLY, NO PROVISION FOR INCOME TAXES FOR THIS ENTITY HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS AT SEPTEMBER 30, 2024 AND 2023. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -44,838,811. CHARITY CARE (GROSS CHARGES) -6,568,207. NET ASSET TRANSFER FROM HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 1,863,291. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -457,419. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 457,419. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 44,838,811. CHARITY CARE (GROSS CHARGES) 6,568,207. 1 1 X 1 X 1 X 1 1 0 1 1 1142581 1142581 0.00260 17752115 8767539 8984576 0.02050 18894696 8767539 10127157 0.02310 1595319 1595319 0.00360 5907280 5907280 0.01350 549914 549914 0.00130 8052513 8052513 0.01840 26947209 8767539 18179670 0.04150 1 44838811 67558918 87116335 -19557417 X 1 1 1 TOWER IMAGING VALENCIA OUTPATIENT RADIOLOGY SERVICE 0.50000 0.50000 3 KECK MEDICINE OF USC AND HENRY MAYO NEWHALL MEMORIAL HOSPITAL LLC CANCER SERVICE LINE 0.50000 1 1 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 23845 MCBEAN PKWY VALENCIA CA 91355 WWW.HENRYMAYO.COM 930000206 X X X TRAUMA CENTER HENRY MAYO NEWHALL MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE SCHEDULE H, PART V, SECTION C X 1 23 1 HTTPS://WWW.HENRYMAYO.COM/ABOUT-US/COMMUNITY-INVOLVEMENT/ 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: HENRY MAYO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN FY22, AS REQUIRED BY STATE AND FEDERAL LAW. THE CHNA IS A PRIMARY TOOL USED BY HENRY MAYO TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW IT WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUSED ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA.THE CHNA EXAMINED UP-TO-DATE DATA SOURCES FOR THE SERVICE AREA TO COMPILE COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, BIRTH INDICATORS, LEADING CAUSES OF DEATH, COVID-19, ACUTE AND CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE, AND PREVENTIVE PRACTICES. HENRY MAYO CONDUCTED TARGETED INTERVIEWS TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. THERE WERE TWENTY-ONE (21) INTERVIEWS COMPLETED IN MARCH 2022. LEADERS AND/OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE REPRESENTED IN THE SAMPLE. INPUT WAS OBTAINED FROM THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH.THE NEXT COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE COMPLETED BY AUGUST OF 2025. HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: ACCESS TO HEALTH CARE, CHRONIC DISEASES, COVID-19, HOUSING AND HOMELESSNESS AND MENTAL HEALTH WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA. THE ANALYSIS OF THE COMMUNITY INPUT RESULTED IN THE FOLLOWING PRIORITY ORDERING OF THE SIGNIFICANT HEALTH NEEDS:1. ACCESS TO HEALTH CARE2. MENTAL HEALTH3. SUBSTANCE USE4. HOUSING AND HOMELESSNESS5. CHRONIC DISEASES6. PREVENTIVE PRACTICES (SCREENINGS AND IMMUNIZATIONS)7. COVID-198. OVERWEIGHT/OBESITY (HEALTHY EATING AND PHYSICAL ACTIVITY)AS OF THE END OF THE FISCAL YEAR 09/30/24, THE FOLLOWING PROGRESS HAS BEEN MADE WITH RESPECT TO THE PRIORITIES OUTLINED IN THE CHNA AND THE IMPLEMENTATION PLAN ATTACHED: - SEEKING OUT MORE OPPORTUNITIES FOR CLINICAL STAFF TO LECTURE TO COMMUNITY GROUPS ON TOPICS (E.G. DIABETES PREVENTION) IDENTIFIED AS HEALTH NEEDS IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT. FOR EXAMPLE, DIFFERENT HENRY MAYO STAFF MEMBERS GIVE MONTHLY TALKS AT THE SANTA CLARITA VALLEY SENIOR CENTER AND DIFFERENT STAFF MEMBERS REGULARLY PRESENT AT A LOCAL SENIOR LIVING COMMUNITY. - INCREASING MEETING SPACE AVAILABLE TO SUPPORT GROUPS (E.G. AL-ANON) AND LAUNCHING SUPPORT GROUPS (E.G. GRIEF AND DIABETES) FACILITATED BY HENRY MAYO STAFF.- DEPLOYING OUR ONE STAFF MEMBER IN COMMUNITY SETTINGS, E.G. SANTA CLARITA PUBLIC LIBRARY BRANCHES, TO DISSEMINATE HEALTH INFORMATION.FOR SPECIFIC PLAN AND OTHER NEEDS NOT ADDRESSED, PLEASE REFER TO THE ATTACHED COMMUNITY BENEFIT REPORT, PAGES 6-9. SCHEDULE H, PART V, LINE 7A CHNA REPORT DIRECT LINK: HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/3F5A915D-E7CF-4A20-B329-E9EDC4593AD5/HENRY%20MAYO%202022%20CHNA%20REPORT%20FINAL.PDF SCHEDULE H, PART V, LINE 16A FINANCIAL ASSISTANCE POLICY (FAP): HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/00DB9700-F921-447B-88EC-907A477A2A76/FINANCIAL%20ASSISTANCE%20PROGRAM%20POLICY%2005.2024.PDF SCHEDULE H, PART V, LINE 16B FAP APPLICATION FORM: HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/D6CC943E-020F-4905-B76B-FC76D1A9917F/FINANCIAL%20ASSISTANCE%20PROGRAM%2010.10.2022%20APPLICATION.PDF SCHEDULE H, PART V, LINE 16C FAP PLAIN LANGUAGE SUMMARY: HTTPS://WWW.HENRYMAYO.COM/APP/FILES/PUBLIC/0995F2AD-7A89-48F2-8F45-C5B237B3C5C2/MR242D-%20FINAL%20COPY.PDF PART I, LINE 3C: INDIVIDUAL OR HOUSEHOLD UNIT INCOME - UP TO 400% OF THE FPL. EMPLOYMENT STATUS SHALL BE CONSIDERED WHEN DETERMINING INCOME LEVELS. PRIOR INCOME LEVELS MAY NOT MEET THE ESTABLISHED POVERTY LEVEL GUIDELINES; HOWEVER, RECENT UNEMPLOYMENT MAY BE CONSIDERED AS THE CURRENT SOURCE OF INCOME. INDIVIDUAL OR HOUSEHOLD UNIT NET WORTH - UP TO $250,000 (EXCLUDING NET WORTH IN PRIMARY HOMES OF UP TO $500,000 AND RETIREMENT OR DEFERRED COMPENSATION PLANS). WHEN REVIEWING NET WORTH, OTHER FINANCIAL OBLIGATIONS SUCH AS HIGH MEDICAL BILLS SHOULD BE CONSIDERED. PATIENTS WITH HIGH NET WORTH THAT WOULD OTHERWISE DISQUALIFY THEM FOR FINANCIAL ASSISTANCE MAY BE CONSIDERED FOR ELIGIBILITY IF THEY HAVE, FOR EXAMPLE, UNINSURED CATASTROPHIC HEALTH CARE COSTS THAT WOULD SIGNIFICANTLY REDUCE THEIR NET WORTH. HIGH MEDICAL COSTS SHALL MEAN:1. ANNUAL OUT-OF-POCKET COSTS INCURRED BY A PATIENT AT HMNH THAT EXCEED 10% OF THE PATIENT'S FAMILY INCOME IN THE PRIOR 12 MONTHS;2. ANNUAL OUT-OF-POCKET MEDICAL EXPENSES THAT EXCEED 10% OF THE PATIENT'S FAMILY INCOME, IF THE PATIENT PROVIDES DOCUMENTATION OF THE PATIENT'S MEDICAL EXPENSES PAID BY THE PATIENT OR THE PATIENT'S FAMILY IN THE PRIOR 12 MONTHS;SELF-PAY PATIENTS ADMITTED THROUGH THE EMERGENCY DEPARTMENT, PER EMTALA GUIDELINES, WITH INSUFFICIENT INFORMATION PROVIDED BY THE PATIENT TO FULLY EVALUATE ELIGIBILITY TESTS, AND THE ABILITY TO PAY WHICH CANNOT BE RELIABLY DETERMINED, WILL BE CLASSIFIED AS CHARITY. IF INFORMATION BECOMES AVAILABLE LATER THAT WOULD DISQUALIFY THE PATIENT FROM MEETING THE FINANCIAL ASSISTANCE CRITERIA, THEN THE PATIENT ACCOUNT WILL BE RECLASSIFIED TO THE APPROPRIATE PAYER CLASS.PATIENTS WHO QUALIFY FOR MEDI-CAL, BUT WHERE HMNH DOES NOT RECEIVE PAYMENT FOR THEIR ENTIRE STAY ARE ELIGIBLE FOR CHARITY CARE FOR DENIED STAYS, DENIED DAYS OF CARE, AND NONCOVERED SERVICES. THESE DENIALS AND ANY LACK OF PAYMENT FOR NON-COVERED SERVICES PROVIDED TO MEDI-CAL PATIENTS ARE TO BE CLASSIFIED AS CHARITY. THESE PATIENTS ARE RECEIVING THE SERVICE, AND THEY DO NOT HAVE THE ABILITY TO PAY FOR IT. IN ADDITION, MEDICARE PATIENTS WHO HAVE MEDI-CAL COVERAGE FOR THEIR CO-INSURANCE/DEDUCTIBLES, FOR WHICH MEDI-CAL DOES NOT MAKE PAYMENT, AND MEDICARE DOES NOT ULTIMATELY PROVIDE BAD DEBT REIMBURSEMENT WILL ALSO BE INCLUDED AS CHARITY. THESE PATIENTS ARE RECEIVING A SERVICE FOR WHICH A PORTION OF THE RESULTING BILL IS NOT BEING REIMBURSED.TRAUMA SERVICES RENDERED TO PATIENT MEDICAL CONDITIONS MEETING THE DEFINITION OF BILLABLE TRAUMA CARE, PER OUR TRAUMA CARE AGREEMENTS WITH THE LOS ANGELES COUNTY AND THE STATE OF CALIFORNIA, WILL BE CLASSIFIED AS CHARITY CARE. THESE PATIENTS WILL NOT BE BILLED FOR THEIR SERVICES.PATIENTS WHO ARE ELIGIBLE FOR GOVERNMENT SPONSORED, LOW-INCOME ASSISTANCE PROGRAMS (I.E., MEDI-CAL, OUT OF STATE MEDICAID, CALIFORNIA CHILDREN'S SERVICES AND ANY OTHER APPLICABLE FEDERAL, STATE OR LOCAL LOW-INCOME PROGRAM) ARE PRESUMED TO BE INDIGENT. THEREFORE, SUCH PATIENTS MAY BE CONSIDERED AS PRESUMPTIVELY ELIGIBLE UNDER THE FAP WHEN PAYMENT IS NOT MADE BY THE GOVERNMENTAL PROGRAM. RATIONALE FOR SUCH PRESUMPTIVE DETERMINATION SHALL BE DOCUMENTED IN THE PATIENT ACCOUNT. PART III, LINE 2: THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CARRYING AMOUNT OF PATIENT ACCOUNTS RECEIVABLE IS REDUCED BY BAD DEBT ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 4: FROM PAGE 16 OF THE AUDITED FINANCIAL STATEMENTS, ATTACHED:GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED OR UNDERINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGES, BY ANY CONTRACTUAL ADJUSTMENT, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENT TO NET PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE HOSPITAL HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND OTHER PATIENT BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. PART III, LINE 8: 100% INCLUDED IN THE COMMUNITY BENEFIT PACKAGE. COST METHODOLOGY IS COST ACCOUNTING SYSTEM. PART VI, LINE 2: NEEDS ASSESSMENT: HENRY MAYO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022, AS REQUIRED BY STATE AND FEDERAL LAW. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A PRIMARY TOOL USED BY HENRY MAYO TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW IT WILL REINVEST IN THE COMMUNITY, IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES, TO ADDRESS UNMET COMMUNITY NEEDS. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUS ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: HTTPS://WWW.HENRYMAYO.COM/PATIENTS-VISITORS/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE/FINANCIAL-POLICIES/ PART VI, LINE 4: COMMUNITY INFORMATION: PAGE 3-5 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 5: PAGE 5-11 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 WILLIAM S HART UNION HIGH SCHOOL DISTRICT 21380 CENTRE POINTE PARKWAY SANTA CLARITA CA 91350 611454418 314103 0 TO PROVIDE ATHLETIC TRAINERS AT HIGH SCHOOLS IN THE COMMUNITY TO HELP REDUCE INJURIES AND KEEP STUDENT ATHLETES SAFE ID ME PROMOTIONS 18401 BURBANK BLVD SUITE 116 TARZANA CA 91356 470941148 501(C)(3) 33935 0 TO SUPPORT COMMUNITY HEALTH EDUCATION BRIDGE TO HOME SCV 23752 NEWHALL AVE SANTA CLARITA CA 91321 954587823 501(C)(3) 23847 0 CAPITAL CAMPAIGN PLEDGE SANTA CLARITA VALLEY ECONOMIC 26455 ROCKWELL CANYON ROAD UNIVERSITY CENTER 263 VALENCIA CA 91355 954133918 501(C)(3) 27700 0 TO SUPPORT LOCAL ECONOMIC DEVELOPMENT SOROPTIMIST INTERNATIONAL OF VALENCIA PO BOX 801352 SANTA CLARITA CA 91380 954834196 501(C)(3) 8500 0 SPONSORSHIPS TO SUPPORT WOMEN AND GIRLS IN LOCAL COMMUNITIES UNITED STATES POSTAL SERVICE 28201 FRANKLIN PARKWAY SANTA CLARITA CA 91383 410760000 GOVERNMENT 16540 0 TO PROVIDE COMMUNITY HEALTH EDUCATION THROUGH YOUR HEALTH MAGAZINE 2024 NORTHEAST VALLEY HEALTH CORP 1172 N MACLAY AVENUE SAN FERNANDO CA 91340 237120632 501(C)(3) 6300 0 TO SUPPORT PROVIDING PRIMARY HEALTHCARE TO MEDICALLY UNDERSERVED RESIDENCE 6 1 CHARITY CARE (GROSS CHARGES) - HENRY MAYO NEWHALL HOSPITAL 952 6568207 PART I, LINE 2: THE HOSPITAL ASSISTS INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED BY PROVIDING CHARITY CARE. THIS IS APPLIED BY FOLLOWING THE HOSPITAL'S CHARITY CARE POLICY. THIS POLICY IS ADMINISTERED THROUGH THE PATIENT FINANCIAL SERVICE AND PATIENT ACCESS DEPARTMENTS OF THE HOSPITAL. PART II: THE HOSPITAL SUPPORTS (PROVIDES GRANTS TO) ORGANIZATIONS THAT EITHER DO WORK IN AREAS RELATED TO THE HEALTH NEEDS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT, AND TO ORGANIZATIONS THAT SUPPORT LOCAL ECONOMIC DEVELOPMENT. FOR THE HEALTH-RELATED ACTIVITIES WE TRACK HOW MANY PEOPLE WE REACH AT PARTICULAR EVENTS, CLASSES OR SEMINARS. FOR ECONOMIC ACTIVITIES WE SUPPORT ORGANIZATIONS THAT HAVE BROAD COMMUNITY PARTICIPATION. GRANTS ARE ALSO PROVIDED TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. PART III: PATIENTS MEETING CERTAIN CRITERIA UNDER THE CHARITY CARE POLICY MAY RECEIVE HEALTHCARE SERVICES AT NO CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. 1 X X X X 1 1 0 0 0 0 0 1 0 KEVIN KLOCKENGA PRESIDENT/CEO 519467 0 333931 0 50353 0 16875 0 18542 0 939168 0 0 0 ROGER E SEAVER FORMER PRESIDENT/CEO 170049 0 514292 0 130563 0 16500 0 10815 0 842219 0 0 0 ROBERT K PRETZLAFF FORMER SR VP CMO & CCO 420904 0 116000 0 47135 0 39000 0 30366 0 653405 0 0 0 TED D SIROTTA SR VP/CFO 377556 0 112000 0 44279 0 74131 0 31290 0 639256 0 0 0 RAY B MOSS VP/CIO 307492 0 72000 0 31526 0 47828 0 21827 0 480673 0 0 0 MARK A PULEO VP/CHRO 273799 0 75500 0 49583 0 44965 0 30063 0 473910 0 0 0 MARIA VARTANIAN SR VP/CCO 252828 0 24000 0 31712 0 34476 0 25355 0 368371 0 0 0 CARISSA BORTUGNO VP CLINICAL SUPPORT 227708 0 40500 0 31253 0 37639 0 24991 0 362091 0 0 0 EVELYN KU FORMER CNO 152467 0 35000 0 45893 0 47828 0 15838 0 297026 0 0 0 OHANNES KANDILIAN DIRECTOR OF PHARMACY 195221 0 18000 0 26925 0 12223 0 25607 0 277976 0 0 0 KYUNG R KIM SR. DIRECTOR OF FINANCE 180946 0 37161 0 17773 0 11960 0 24608 0 272448 0 0 0 PATRICK MOODY DIRECTOR OF MARKETING AND PR 165479 0 36127 0 27604 0 11779 0 29716 0 270705 0 0 0 KATHRYN A ORTEGA CLINCAL RN 199373 0 7500 0 29635 0 12116 0 21358 0 269982 0 0 0 JOSEPHINE J KAPLAN FORMER DIRECTOR CASE MANAGEMENT 161137 0 37286 0 27039 0 0 0 21780 0 247242 0 0 0 VICKI L WHITE CNO 124608 0 0 0 36002 0 0 0 3726 0 164336 0 0 0 PART I, LINES 4A-B SOME EMPLOYEES RECEIVED A SEVERANCE PAYMENT DURING THE CALENDER YEAR. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. HENRY MAYO NEWHALL MEMORIAL HOSPITAL HAD A SERP (SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN) OF WHICH ONLY ONE OF ITS FORMER EMPLOYEES PARTICIPATED, ROGER SEAVER. THERE WERE NO AMOUNTS PAID OUT IN THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. HENRY MAYO NEWHALL MEMORIAL HOSPITAL HAS A 457(F) PLAN, OF WHICH THE FOLLOWING EMPLOYEES LISTED ON SCHEDULE J, PART II PARTICIPATE: KEVIN KLOCKENGA, VICKI WHITE, CARISSA BORTUGNO, MARK A. PULEO, RAY B. MOSS, ROBERT K. PRETZLAFF, EVELYN KU, MARIA VARTANIAN AND TED D. SIROTTA. THERE WERE NO AMOUUNTS PAID TO PARTICIPANTS IN THE FISCAL YEAR ENDED SEPTEMBER 30, 2024. PART I, LINE 7 BONUSES ARE TIED TO QUANTITATIVE AND QUALITATIVE CRITERIA. ONE OF THE CRITERIA FOR THE BONUSES IS EBIDA MARGIN. A CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SCJ1 2014-02-05 70780579 FINANCE AND REFINANCE FACILITY 1 0 0 B CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EAL8 2017-02-03 115072912 FINANCE AND REFINANCE FACILITY 0 0 0 C CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EDN1 2021-03-10 33921350 REFINANCE SERIES 2013A AND 2013B BONDS 0 0 0 D CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EDW1 2021-03-10 6539029 FINANCE AND REFINANCE FACILITY 0 0 0 A 10335000 59665000 70780579 1141054 1692946 29092467 38854112 2017 0 1 1 1 B 4175000 115072912 1455316 85000000 28617596 2019 1 0 1 1 C 8105000 33921350 221771 33699579 2021 1 0 1 1 D 6539029 39029 6500000 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/28/2019 ISSUER NAME: CALIFORNIA PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/01/2019 LOUIE-MARC CONTRERAS TRUSTEE 416383 PROFESSIONAL FEES CONSISTENT WITH FAIR MARKET VALUE AND DETERMINED AT ARMS-LENGTH 0 LAKHBINDER DHANDA TRUSTEE 31463 PROFESSIONAL FEES CONSISTENT WITH FAIR MARKET VALUE AND DETERMINED AT ARMS-LENGTH 0 PARTIKSHA DHANDA FAMILY MEMBER OF TRUSTEE 42112 WAGES 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS AND CHIEF FINANCIAL OFFICER REVIEWED THE ENTIRE FORM 990 RETURN BEFORE DISTRIBUTION TO THE BOARD AND PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO READ THE CONFLICT OF INTEREST POLICY AND COMPLETE A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE AND RESULTS OF ANY CONFLICT, IF ANY, WOULD BE REPORTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. BOARD MEMBERS ARE AWARE AND REMINDED OF THE HOSPITAL'S FIDUCIARY RESPONSIBILITY IN REPORTING CONFLICTS OF INTEREST. THE CONFLICT OF INTEREST FORMS ARE REQUIRED TO BE UPDATED ON AN ANNUAL BASIS. IF A CONFLICT IS IDENTIFIED, THE BOARD MEMBER WOULD BE EXCUSED FROM VOTING ON ANY APPLICABLE MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATIONS'S CEO AND EXECUTIVE MANAGEMENT COMPENSATION ARE DETERMINED THROUGH THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT CONSULTANT, AND BOARD OF DIRECTOR APPROVAL. COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OTHER KEY EMPLOYEES AND MANAGEMENT OF THE ORGANIZATION RECEIVE PERFORMANCE REVIEWS ANNUALLY AND RATINGS ARE APPLIED THAT SUGGEST THE PERCENTAGE OF SALARY INCREASE. PERCENTAGES ARE DETERMINED THROUGH MARKET SURVEYS DONE BY HUMAN RESOURCES AND APPROVED EACH YEAR VIA THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 52,936,105. MANAGEMENT AND GENERAL EXPENSES 5,963,553. TOTAL EXPENSES 58,899,658. CONSULTING AND MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 5,318,665. TOTAL EXPENSES 5,318,665. REGISTRY: PROGRAM SERVICE EXPENSES 15,585,902. MANAGEMENT AND GENERAL EXPENSES 86,795. TOTAL EXPENSES 15,672,697. OTHER PURCHASED SERVICES - CARE NETWORK: MANAGEMENT AND GENERAL EXPENSES 1,252,468. TOTAL EXPENSES 1,252,468. OTHER SERVICES- CLINICS: MANAGEMENT AND GENERAL EXPENSES 1,835,770. TOTAL EXPENSES 1,835,770. FORM 990, PART XI, LINE 9: NET ASSET TRANSFER FROM HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 1,863,291. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT PROCESS FOR THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. 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