2021-08-12T15:36:37-05:00 2020-09-30 390859910 BAKER TILLY US LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2019-10-01 952821104 HENRY MAYO NEWHALL MEMORIAL HOSPITAL HENR 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 TED D SIROTTA SENIOR VP/CFO 6612002000 2021-08-04 1 LAWRENCE H MOHR CPA P00447603 6128764500 2021-07-28 2019 2022-09-23 18:48:47Z ROGER E SEAVER 23845 MCBEAN PARKWAY VALENCIA CA 91355 421723622 0 X WWW.HENRYMAYO.COM X 1972 CA TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS, AND IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH COMPASSION AND EXCELLENCE. 15 12 2160 327 320034 0 5882138 12016098 387805190 359809714 8528975 2800082 9082765 7376443 411299068 382002337 3624904 5234300 0 0 165088343 157621849 0 0 0 212067605 217975009 380780852 380831158 30518216 1171179 532097855 558511458 326295789 351466463 205802066 207044995 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS, AND IMPROVE THE HEALTH OF OUR COMMUNITY THROUGH COMPASSION AND EXCELLENCE IN HEALTHCARE SERVICES. 0 0 341979126 4639739 363718372 TO PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF SANTA CLARITA VALLEY AND SURROUNDING AREAS. THE HOSPITAL HAD 51,184 PATIENT DAYS DURING THE YEAR. WE ALSO PROVIDED SERVICES FOR 59,109 EMERGENCY VISITS. 77% OF TOTAL HOSPITAL INPATIENT ADMITS (EXCLUDING NEWBORNS) ARE ADMITTED THROUGH THE EMERGENCY ROOM. 594561 594561 TO SUPPORT GENERAL OPERATIONS OF HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION, AN AFFILIATE TO THE HOSPITAL. 342573687 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 1 0 0 0 1 1 1 1 0 0 1 254 0 1 2160 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 1 CA X RICHARD KIM 6612002000 23845 MCBEAN PARKWAY VALENCIA CA 91355 ROGER E SEAVER PRESIDENT/CEO 40.00 0.50 X X 830764 0 75567 KINGMAN HO MD CHIEF MEDICAL OFFICER 40.00 X 503430 0 56032 TED D SIROTTA SR VP/CFO 40.00 X 420325 0 60023 LARRY R KIDD SR VP/CCO 40.00 X 434003 0 45160 RAY B MOSS VP/CIO 40.00 X 311766 0 48811 JONATHAN S MILLER VP-FACILTY/SUPPORT 40.00 X 289663 0 41370 MARK A PULEO VP/CHRO 40.00 X 275842 0 51763 PAIGE E HEAPHY - VP - PERFORMANCE MGMT (TO 10/2019) 40.00 X 297643 0 26648 JENNIFER R CASTALDO VP/CNO 40.00 X 283557 0 38834 ALEXANDRA DIEBOLD-FOX DIRECTOR OF ICU 40.00 X 200587 0 32526 BRITTA E DEVOLDER OR SR. DIRECTOR 40.00 X 202902 0 22309 ROBERTO A DUBON NUCLEAR MED TECH 40.00 X 200221 0 23336 PENNY HAMMER NURSING OFFICE DIRECTOR 40.00 X 207633 0 15825 MARIA B SARTE ICU - CLINICAL RN 40.00 X 210973 0 0 JOHN BARSTIS MD TRUSTEE 0.50 0.00 X 0 0 0 ROBERT BENJAMIN TRUSTEE 0.50 0.00 X 0 0 0 MARK CHAMBERLAIN TRUSTEE 0.50 0.00 X 0 0 0 LAKHBINDER DHANDA MD TRUSTEE 2.14 0.00 X 0 0 0 SONYA ENGLE TRUSTEE 0.50 0.00 X 0 0 0 JUDY FISH TRUSTEE 0.50 0.00 X 0 0 0 CHERI FLEMING TRUSTEE 0.50 0.00 X 0 0 0 RUSSELL HANLIN TRUSTEE 0.50 0.00 X 0 0 0 DONALD KIMBALL TRUSTEE 0.50 0.50 X 0 0 0 CHRIS LUECHTEFELD TRUSTEE 0.50 0.50 X 0 0 0 ROSCOE MARTER MD TRUSTEE 0.50 0.00 X 0 0 0 DON NISHIGUCHI MD TRUSTEE 8.08 0.00 X 0 0 0 DALE R DONOHOE TRUSTEE 0.50 0.00 X 0 0 0 TODD STEVENS TRUSTEE 0.50 0.00 X 0 0 0 CRAIG PETER TRUSTEE (THROUGH 3/7/2020) 0.50 0.00 X 0 0 0 4669309 0 538204 462 0 1 0 SODEXO INC & AFFILIATES 9801 WASHINGTON BLVD GAITHERSBURG MD 20878 OTHER PURCHASED SERVICES 13392309 BERNARDS BROS INC 555 FIRST ST SAN FERNANDO CA 91340 CONSTRUCTION 5410965 INTERSTATE REHABILITATION LLC 333 E GLENOAKS BLVD SUITE 204 GLENDALE CA 61207 MEDICAL PURCHASED SERVICES 5085745 FACEY MEDICAL FOUNDATION 15451 SAN FERNANDO MISSION BLVD S MISSION HILLS CA 91345 PROFESSIONAL SERVICES 3902966 MEDEFIS INC 12400 HIGH BLUFF DRIVE SUITE 100 SAN DIEGO CA 92130 PROFESSIONAL SERVICES 2623272 223 845625 10947058 223415 223415 12016098 HEALTHCARE SERVICES 621110 359809714 359809714 359809714 2946460 2946460 1114546 1043078 71468 71468 71468 38531829 37669600 1008607 862229 -1008607 -146378 -146378 INCOME FROM CARE NETWO 621110 2843929 2843929 FITNESS CENTER REVENUE 621110 1064729 1064729 SUPPORT SERVICES 621110 320034 320034 3076283 3076283 7304975 382002337 363718372 320034 5947833 X 1126512 1126512 4107788 4107788 4091201 3606069 485132 113389929 101760293 11629636 4209123 3746119 463004 25509650 22661023 2848627 10421946 9269334 1152612 1277393 22802 1254591 331422 331422 19900 19900 130668 130668 52449085 43208050 9241035 128780 45518 83262 2839129 2444683 394446 6647264 5978736 668528 8742012 6815054 1926958 160315 77283 83032 93420 55223 38197 11061273 8565186 2496087 25091286 25091286 1741657 1741657 MEDICAL SUPPLIES 45811937 44537843 1274094 BAD DEBT 29540386 29540386 QUALITY ASSURANCE FEES 21202913 21202913 REPAIR & MAINTENANCE 4118336 3287306 831030 6587833 3682623 2905210 380831158 342573687 38257471 0 48006328 62625820 243271 26467277 63147652 55774860 5911973 6768080 14733714 4007320 521209463 229914688 307355501 291294775 76914826 80642756 1069009 1638005 14715581 29292565 532097855 558511458 87358652 81404769 2301991 6530229 220568146 215959112 10479084 10479084 5587916 37093269 326295789 351466463 X 196588482 199290075 9213584 7754920 205802066 207044995 532097855 558511458 1171179 71750 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 1 19900 19900 0 PART II-B, LINE 1: FOR THE FISCAL YEAR ENDED 9/30/20, THE ORGANIZATION PARTICIPATED WITH THE CALIFORNIA HOSPITAL ASSOCIATION TO ADVOCATE POSITIVE HEALTHCARE POLICIES FOR HOSPITALS. 5282104 5282104 367575234 118769950 248805284 141793107 111144738 30648369 6559018 6559018 291294775 RECEIVABLE FROM HENRY MAYO NEWHALL FOUNDATION 7801804 RECEIVABLE FROM HENRY MAYO MSO 835193 PLEDGED LEASE 2258221 OTHER RECEIVEABLES 18302081 RECEIVABLE FOR HENRY MAYO CIN 52303 OTHER CURRENT ASSETS 42963 29292565 DEFERRED RENT 1544931 ESTIMATED THIRD PARTY LIABILITIES 8601240 ADVANCE PAYMENTS 26222103 PAYABLE TO AFFILIATE 724995 37093269 X 349512761 71750 43770 -33648174 -33532654 383045415 -1043078 -1043078 382002337 348269832 43770 1043078 1086848 347182984 33648174 33648174 380831158 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, 2020 AND 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -29,540,386. CHARITY CARE (GROSS CHARGES) -4,107,788. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -1,043,078. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1,043,078. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 29,540,386. CHARITY CARE (GROSS CHARGES) 4,107,788. 1 1 X 1 X 1 X 1 1 0 1 1 1007017 1007017 0.00260 22611511 9940435 12671076 0.03330 23618528 9940435 13678093 0.03590 1104702 1104702 0.00290 592990 592990 0.00160 826037 826037 0.00220 2523729 2523729 0.00670 26142257 9940435 16201822 0.04260 2 25000 25000 0.00010 4 626 29000 29000 0.00010 6 626 54000 54000 0.00020 1 29540386 53772864 77399115 -23626251 X 1 1 1 TOWER IMAGING VALENCIA OUTPATIENT RADIOLOGY SERVICE 0.50000 0.50000 2 HENRY MAYO NEWHALL URGENT CARE CLINICS LLC URGENT CARE OPERATION 0.51000 0.49000 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 18 1 0 0 1 X HTTPS://WWW.HENRYMAYO.COM/COMMUNITY/ X 1 19 1 HTTPS://WWW.HENRYMAYO.COM/COMMUNITY/ 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.HENRYMAYO.COM/SITE-SEARCH/?C=FAP X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 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 NEWHALL HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN TAX YEAR 2018 (FISCAL YEAR 2019) AS REQUIRED BY STATE AND FEDERAL LAW. 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 PRESENT COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, MATERNAL AND INFANT HEALTH, LEADING CAUSES OF DEATH, DISABILITY AND DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND MISUSE, AND PREVENTIVE PRACTICES. WHEN APPLICABLE, THESE DATA SETS WERE PRESENTED IN THE CONTEXT OF CALIFORNIA AND COMPARED TO THE HEALTHY PEOPLE 2020 OBJECTIVES. TARGETED INTERVIEWS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. TWENTY-ONE (21) INTERVIEWS WERE COMPLETED IN JUNE 2019. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE 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. INPUT WAS OBTAINED FROM THE LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH. HENRY MAYO NEWHALL MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: ACCESS TO HEALTH CARE, CANCER, DIABETES, HEART DISEASE AND MENTAL HEALTH WERE RANKED AS THE TOP FIVE PRIORITY NEEDS IN THE SERVICE AREA. THE CALCULATIONS OF THE COMMUNITY INPUT RESULTED IN THE FOLLOWING PRIORITY ORDERING OF THE SIGNIFICANT HEALTH NEEDS:1. ACCESS TO HEALTH CARE2. CANCER3. DIABETES4. HEART DISEASE5. MENTAL HEALTH6. SUBSTANCE USE AND MISUSE7. PREMATURE BIRTHS8. ALZHEIMER'S DISEASE9. PREVENTIVE PRACTICES (SCREENINGS AND IMMUNIZATIONS)10. OVERWEIGHT AND OBESITY11. HOUSING AND HOMELESSNESS12. ASTHMA13. LIVER DISEASEFOR SPECIFIC PLAN AND OTHER NEEDS NOT ADDRESSED, PLEASE REFER TO THE ATTACHED COMMUNITY BENEFIT REPORT, PAGES 8-10. PART V, SECTION B: HENRY MAYO NEWHALL MEMORIAL HOSPITALLINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.HENRYMAYO.COM/DOCUMENTS/FAP-FINAL.REPLACEMENT-WITH-NEW-HYPER-LINKS-010720-REVISED.PDFHENRY MAYO NEWHALL MEMORIAL HOSPITALLINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.HENRYMAYO.COM/DOCUMENTS/PLAIN-LANGUAGE-SUMMARY-REVISED-202017-FINAL.PDF PART I, LINE 3C: INDIVIDUAL OR HOUSEHOLD UNIT INCOME - UP TO 350% 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 SHOULD 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.HMNH DEEMS 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) TO BE INDIGENT. THEREFORE, SUCH PATIENTS MAY BE CONSIDERED AS ELIGIBLE PRESUMPTIVELY 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 17 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: HENRY MAYO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN TAX YEAR 2018 (FISCAL YEAR 2019), 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 GIVE BACK TO 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: PAGE 8- 10 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 4: PAGE 3 - 5 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 5: PAGE 8-16 OF THE COMMUNITY BENEFIT PACKAGE WHICH IS ATTACHED. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 HENRY MAYO NEWHALL MEMORIAL HEALTH FOUNDATION 23845 MCBEAN PKWY VALENCIA CA 91355 953849903 501(C)(3) 594561 TO SUPPORT GENERAL OPERATIONS OF THE FOUNDATION, AN AFFILIATE OF THE HOSPITAL AMERICAN CANCER SOCIETY 25020 W AVE STANFORD SUITE 170 VALENCIA CA 91355 131788491 501(C)(3) 10000 COMMUNITY CANCER EDUCATION BRIDGE TO HOME 23752 NEWHALL AVE SANTA CLARITA CA 91321 954587823 501(C)(3) 41250 TO SUPPORT A HOMELESS SHELTER CITY OF SANTA CLARITA 23920 VALENCIA BLVD SUITE 100 SANTA CLARITA CA 91355 954133918 GOVERNMENT 15000 TO SUPPORT HEALTHY COMMUNITY ACTIVITIES COC FOUNDATION 26455 ROCKWELL CYN RD VALENCIA CA 91355 953574259 501(C)(3) 130001 TO SUPPORT NURSING EDUCATION FUTBOL FOUNDATION OF SANTA CLARITA 27822 FREMONT CT VALENCIA CA 91355 462616530 501(C)(3) 10000 TO SUPPORT YOUTH FITNESS HEALTH IMPACT 663 13TH ST SUITE 300 OAKLAND CA 94612 820570413 501(C)(3) 5000 TO SUPPORT NURSING PROFESSIONAL DEVELOPMENT ID ME PROMOTIONS 18401 BURBANK BLVD SUITE 116 TARZANA CA 91356 470941148 501(C)(3) 5033 TO SUPPORT COMMUNITY HEALTH EDUCATION NORTHEAST VALLEY HEALTH CORP 1172 NO MACLAY AVENUE SAN FERNANDO CA 913401300 237120632 501(C)(3) 5000 TO SUPPORT ACCESS TO CARE FOR THE MEDICAL POPULATION PARTNERS IN CARE FOUNDATION INC 732 MOTT ST 150 SAN FERNANDO CA 91340 953954057 501(C)(3) 5000 TO SUPPORT ACCESS TO CARE FOR THE MEDICAL POPULATION SANTA CLARITA VALLEY CHAMBER OF COMMERCE 27451 TOURNEY ROAD 160 SANTA CLARITA CA 91355 611386679 501(C)(6) 5950 TO SUPPORT LOCAL ECONOMIC DEVELOPMENT SANTA CLARITA VALLEY ECONOMIC 26455 ROCKWELL CANYON ROAD UNIVERSITY CENTER 263 VALENCIA CA 91355 954133918 501(C)(3) 14050 TO SUPPORT LOCAL ECONOMIC DEVELOPMENT UNITED STATES POSTAL SERVICE PO BOX 894757 LOS ANGELES CA 901894757 410760000 GOVERNMENT 22191 TO SUPPORT COMMUNITY HEALTH EDUCATION WILLIAM S HART UNION HIGH SCHOOL DISTRICT 21380 CENTRE POINTE PARKWAY SANTA CLARITA CA 91350 611454418 501(C)(3) 132614 TO PROVIDE ATHLETIC TRAINERS AT HIGH SCHOOLS IN THE COMMUNITY TO HELP REDUCE INJURIES & KEEP STUDENT ATHLETES SAFE 12 2 CHARITY CARE (GROSS CHARGES) - HENRY MAYO NEWHALL HOSPITAL 579 4107788 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 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. X 1 1 X X X X 0 1 0 0 0 0 0 1 0 ROGER E SEAVER PRESIDENT/CEO 484603 0 260000 0 86161 0 33000 0 42567 0 906331 0 146000 0 KINGMAN HO MD CHIEF MEDICAL OFFICER 401332 0 56149 0 45949 0 31709 0 24323 0 559462 0 0 0 TED D SIROTTA SR VP/CFO 325421 0 58247 0 36657 0 33000 0 27023 0 480348 0 0 0 LARRY R KIDD SR VP/CCO 320068 0 60915 0 53020 0 33000 0 12160 0 479163 0 0 0 RAY B MOSS VP/CIO 228196 0 38086 0 45484 0 24166 0 24645 0 360577 0 0 0 JONATHAN S MILLER VP-FACILTY/SUPPORT 221346 0 33559 0 34758 0 23182 0 18188 0 331033 0 0 0 MARK A PULEO VP/CHRO 206377 0 33924 0 35541 0 23139 0 28624 0 327605 0 0 0 PAIGE E HEAPHY - VP - PERFORMANCE MGMT (TO 10/2019) 195972 0 38053 0 63618 0 8109 0 18539 0 324291 0 0 0 JENNIFER R CASTALDO VP/CNO 201632 0 35836 0 46089 0 23387 0 15447 0 322391 0 0 0 ALEXANDRA DIEBOLD-FOX DIRECTOR OF ICU 156536 0 25138 0 18913 0 10194 0 22332 0 233113 0 0 0 BRITTA E DEVOLDER OR SR. DIRECTOR 158777 0 20867 0 23258 0 0 0 22309 0 225211 0 0 0 ROBERTO A DUBON NUCLEAR MED TECH 191145 0 143 0 8933 0 6066 0 17270 0 223557 0 0 0 PENNY HAMMER NURSING OFFICE DIRECTOR 162016 0 24619 0 20998 0 7168 0 8657 0 223458 0 0 0 MARIA B SARTE ICU - CLINICAL RN 209425 0 145 0 1403 0 0 0 0 0 210973 0 0 0 PART I, LINE 4B HENRY MAYO NEWHALL MEMORIAL HOSPITAL HAS A SERP (SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN) OF WHICH ONLY ONE OF ITS EMPLOYEES PARTICIPATES, ROGER SEAVER. THE AMOUNT OF BENEFIT PAID IN THE CURRENT YEAR INCLUDED ON SCHEDULE J, PART II, (B)(II) IS $146,000. PART I, LINE 7 BONUSES ARE TIED TO QUANTITATIVE AND QUALITATIVE CRITERIA. ONE OF THE CRITERIA FOR THE BONUSES IS TIED TO FINANCIAL METRICS SUCH AS EBITDA MARGIN AND ACHIEVING COST PER UNIT OF SERVICE. A CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-06 25000000 FINANCE AND REFINANCE FACILITY 0 0 0 B CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 2013-12-06 35000000 FINANCE AND REFINANCE FACILITY 0 0 0 C CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SCJ1 2014-02-05 70780579 FINANCE AND REFINANCE FACILITY 0 0 0 D CALIFORNIA PUBLIC FINANCE AUTHORITY 474447476 13057EAL8 2017-02-03 115072912 FINANCE AND REFINANCE FACILITY 0 0 0 A 8700000 25000000 272183 5002611 19725206 2016 1 1 1 1 B 14400000 35000000 381056 7003656 27615288 2016 1 1 1 1 C 2220000 70780579 1141054 1692946 20092467 38854112 2017 0 1 1 1 D 115072912 1455316 85000000 28194396 423200 2019 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 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 0 0 1 0 0 0 0 1 D 0 0 0 1 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: 03/18/2019 ISSUER NAME: CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2019 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: 03/18/2019 DON NISHIGUCHI DON NISHIGUCHI, MD - TRUSTEE 51360 PROFESSIONAL FEES AS DETERMINED AT ARMS-LENGTH AMOUNT 0 LAKHBINDER DHANDA LAKHBINDER DHANDA, MD - TRUSTEE 16500 PROFESSIONAL FEES AS DETERMINED AT ARMS-LENGTH AMOUNT 0 KRYSTLE SEAVER FAMILY MEMBER OF OFFICER 41135 WAGES, WHERE INTERESTED PERSON DID NOT SUPERVISE OR HAVE OTHER DECISION-MAKING AUTHORITY ON AMOUNTS PAID. 0 KATHERINE DUNN FAMILY MEMBER OF TRUSTEE 93972 WAGES 0 PARTIKSHA DHANDA FAMILY MEMBER OF TRUSTEE 81331 WAGES 0 X PANDEMIC PHARMACEUTICALS 93 124800 COMPARABLE SALES X PANDEMIC OTHER MEDICAL SUPPLIES 73 98615 COMPARABLE SALES 0 0 0 0 PART I, COLUMN (B): PART I, COLUMN B LISTS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS, CHIEF EXECUTIVE OFFICER 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 FULL BOARD. BOARD MEMBERS ARE AWARE AND REMINDED OF THE HOSPITAL'S FIDUCIARY RESPONSIBILITY IN REPORTING CONFLICTS OF INTEREST. THERE HAVE BEEN CIRCUMSTANCES WHERE A CONFLICT OF INTEREST EXISTS AND IT HAS BEEN DISCLOSED TO THE BOARD OF DIRECTORS. 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. 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 AND APPROVAL 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 36,567,879. MANAGEMENT AND GENERAL EXPENSES 4,800,859. TOTAL EXPENSES 41,368,738. CONSULTING AND MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 3,597,020. MANAGEMENT AND GENERAL EXPENSES 1,501,787. TOTAL EXPENSES 5,098,807. REGISTRY: PROGRAM SERVICE EXPENSES 3,043,151. MANAGEMENT AND GENERAL EXPENSES 94,335. TOTAL EXPENSES 3,137,486. OTHER PURCHASED SERVICES - CIN: MANAGEMENT AND GENERAL EXPENSES 2,768,140. TOTAL EXPENSES 2,768,140. OTHER SERVICES- CLINICS: MANAGEMENT AND GENERAL EXPENSES 75,914. TOTAL EXPENSES 75,914. 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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