2025-09-12T10:26:16-05:00 2024-10-31 390859910 BAKER TILLY ADVISORY GROUP LP 2882 PROSPECT PARK DR STE 300 RANCHO CORDOVA CA 95670 990 2023-11-01 941450151 MARSHALL MEDICAL CENTER MARS 5306221441 1100 MARSHALL WAY PLACERVILLE CA 95667 SIRI NELSON PRESIDENT/CEO 5306221441 2025-09-09 1 1 AMY L HENDLEY P01300654 9165038100 2025-09-09 2023 2025-03-06 01:10:19Z SIRI NELSON 1100 MARSHALL WAY PLACERVILLE CA 95667 344356150 0 X WWW.MARSHALLMEDICAL.ORG X 1957 CA TO IMPROVE THE HEALTH OF OUR COMMUNITY AND OFFER HEALTH SERVICES OF SUPERIOR VALUE AND QUALITY. 13 12 1819 120 0 0 3454804 1134267 325634558 339575189 -1279738 1295493 3215971 1626722 331025595 343631671 15000 12300 0 0 156832089 165390358 0 0 0 165344031 174842458 322191120 340245116 8834475 3386555 339775718 350530200 149067796 150729348 190707922 199800852 X MARSHALL MEDICAL CENTER PROUDLY SERVES THE WESTERN SLOPE OF EL DORADO COUNTY. OUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITY AND OFFER HEALTH SERVICES OF SUPERIOR VALUE AND QUALITY, CENTERED ON THE GOALS AND NEEDS OF OUR PATIENTS. WE STRIVE TO DELIVER SERVICE THAT EXCEEDS OUR PATIENTS' EXPECTATIONS. 0 0 253347227 12300 339575189 SEE SCHEDULE OIN KEEPING WITH THE COMMITMENT TO IMPROVE THE HEALTH OF OUR COMMUNITY AND OFFER HEALTH SERVICES OF SUPERIOR VALUE AND QUALITY, THE FOLLOWING WILL BE CONSIDERED WHEN INDIVIDUALS WHO NEED HEALTH CARE CANNOT PAY:- PROVIDING FREE CARE AND/OR SUBSIDIZED CARE;- PROVIDING CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND- PROVIDING HEALTH/WELLNESS ACTIVITIES AND COMMUNITY EDUCATION PROGRAMS.NOT ONLY DOES MARSHALL MEDICAL CENTER PROVIDE LOW-COST CARE TO INDIVIDUALS COVERED BY GOVERNMENT PROGRAMS AND THOSE UNABLE TO AFFORD HEALTH CARE, BUT IT ALSO HELPS PATIENTS FIND AND ACCESS PRIVATE AND GOVERNMENTAL RESOURCES FOR HEALTH CARE BENEFITS. MARSHALL MEDICAL CENTER RECOGNIZES BELOW-COST REIMBURSEMENTS AS CHARITY AND UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. INPATIENT SERVICES IN TAX YEAR 2023 WERE PROVIDED TO 4,380 PATIENTS. SOME EXAMPLES OF INPATIENT SERVICES INCLUDED:- 323 BABIES DELIVERED- 3 SPECIAL PROCEDURES PERFORMED- 154 CARDIAC CATHETERIZATIONS- 142,823 LABORATORY TESTS PERFORMED- 4,983 CT SCANS- 7,070 RADIOLOGY PROCEDURES PERFORMEDOUTPATIENT SERVICES IN TAX YEAR 2023 WERE PROVIDED TO 209,828 PATIENTS. SOME EXAMPLES FOR OUTPATIENT SERVICES INCLUDED:- 36,952 EMERGENCY ROOM VISITS- 3,066 OUTPATIENT SPECIAL PROCEDURES PERFORMED- 36,861 RADIOLOGY PROCEDURES PERFORMED- 539 CARDIAC CATHETERIZATIONS- 487,924 LABORATORY TESTS PERFORMED- 14,621 CT SCANS- 24,782 RURAL HEALTH CLINIC VISITS- 17,535 CARDIOLOGY CLINIC VISITS- 4,348 PULMONOLOGY CLINIC VISITS- 7,095 ONCOLOGY CLINIC VISITS- 7,751 OP INFUSION CLINIC VISITS- 2,420 RHEUMATOLOGY CLINIC VISITS- 16,792 PEDIATRIC CLINIC VISITS- 9,307 OB CLINICS VISITS- 8,141 CANCER PROGRAM CASES- 64,709 FAMILY PRACTICE CLINICS VISITS- 10,383 GASTROENTEROLOGY CLINIC VISITS- 2,254 ENT CLINIC VISITS- 3,353 HEARING CLINIC VISITS- 16,241 ORTHOPEDIC CLINIC VISITS- 6,084 SURGERY CLINIC VISITS- 4,954 UROLOGY CLINIC VISITS- 869 PSYCHIATRY CLINIC VISITS- 3,865 PODIATRY CLINIC VISITS- 3,963 HBO & WOUND CARE CLINIC VISITS- 22,874 HOSPITALISTS VISITS- 6,453 CARES CLINIC VISITS- 1,525 SPECIALTY SERVICES VISITSMARSHALL MEDICAL CENTER RECOGNIZES IT HAS AN OBLIGATION TO PROVIDE SERVICES ABOVE AND BEYOND ITS ROLE AS A HEALING FACILITY. THE FOLLOWING COMMUNITY BENEFITS DEMONSTRATE THE TANGIBLE WAYS IN WHICH THE ORGANIZATION IS FULFILLING ITS MISSION:- BLOOD PRESSURE CLINICS;- FLU CLINICS;- VOLUNTEER PROGRAM;- FOR YOUR HEALTH (A COMMUNITY MAGAZINE);- CANCER RESOURCE CENTER;- PALLIATIVE CARE PROGRAM;- HOLIDAY FOOD DRIVE FOR VARIOUS FOOD BANKS;- SEXUAL ASSAULT RESPONSE TEAM PROGRAM;- COMMUNITY HEALTH LIBRARY;- CHILDBIRTH CLASSES;- CONGESTIVE HEART ACTIVE TELEPHONE TREATMENT PROGRAM;- SCHOLARSHIPS;- PHARMACEUTICAL TRIALS;- USE OF HOSPITAL CONFERENCE ROOMS FOR COMMUNITY-BASED ORGANIZATIONS;- SEMINARS AND SUPPORT GROUPS;- FREE TRAINING FOR PHARMACY STUDENTS, NURSING STUDENTS, LVN STUDENTS, AND OTHER HEALTHCARE PROFESSIONALS;- SMOKING CESSATION PROGRAM;- CONTRIBUTED TO THE COMMUNITY THROUGH VOLUNTEER SERVICE TO ORGANIZATIONS, INCLUDING CHAMBERS OF COMMERCE;- LOW-COST MAMMOGRAPHY PROGRAM;- HELD NUMEROUS COMMUNITY HEALTH EDUCATION CLASSES;- MARSHALL MEDICAL CENTER'S CHAPLAIN PROVIDED 1,731 PATIENT VISITS AND CONDUCTED TWO MEMORIAL SERVICES;- ACCEL PROGRAM (LOCAL PROJECT TO COORDINATE THE SAFETY NETWORK FOR EL DORADO COUNTY);- ELECTRONIC HEALTH INFORMATION EXCHANGE;- PROVIDED FREE TRANSPORTATION TO PATIENTS UNABLE TO AFFORD TRANSPORTATION;- PROVIDED MEETING LOCATION FOR NUMEROUS SUPPORT GROUPS (MENTAL HEALTH FIRST AID, STROKE EDUCATION AND SUPPORT AND MORE) AT NO CHARGE;- COMMUNITY SPONSORSHIPS INCLUDING BUT NOT LIMITED TO, CENTER FOR VIOLENCE-FREE RELATIONSHIPS, SOROPTIMIST INTERNATIONAL, HANDS4HOPE, AND ROTARY CLUB OF EL DORADO HILLS; AND- ENCOURAGED EMPLOYEES TO PARTICIPATE IN VARIOUS COMMUNITY-BUILDING ORGANIZATIONS INCLUDING, BUT NOT LIMITED TO EL DORADO COUNTY ECONOMIC DEVELOPMENT CORP, LEADERSHIP EL DORADO, EL DORADO UNION HIGH SCHOOL DISTRICT CAREER EDUCATION ADVISORY COMMITTEE, AND VARIOUS HEALTH ORGANIZATION BOARDS. 253347227 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 129 0 1 1819 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CA X JOEL ENGELMANN 5306262606 1100 MARSHALL WAY PLACERVILLE CA 95667 SIRI NELSON PRESIDENT/CEO 39.00 1.50 X X 654913 0 28912 LAURIE ELDRIDGE CHIEF FINANCIAL OFFICER (THRU 10/24) 39.00 1.00 X 369308 0 78279 MARTIN ENTWISTLE - ASSOCIATE CHIEF MEDICAL OFFICER/VP POP. HEALTH 40.00 1.50 X 365078 0 15006 BRETT APPLEBERG - CHIEF HUMAN RESOURCES OFFICER (THRU 04/24) 40.00 0.00 X 301797 0 4374 CYNTHIA RICE CHIEF NURSING OFFICER 40.00 0.00 X 301025 0 31079 JONATHAN RUSSELL CHIEF AMBULATORY OFFICER 40.00 0.50 X 280025 0 26997 BRIAN GOLDSMITH MD CHIEF MEDICAL OFFICER 40.00 0.00 X 284394 0 11885 MARTIN DALY VP OF INFORMATION TECHNOLOGY 40.00 0.00 X 271549 0 12828 MINDY DANOVARO EXECUTIVE DIRECTOR OF PHILANTHROPY 39.00 1.00 X 268183 0 12775 JANICE RANGER - EXECUTIVE DIRECTOR OF FINANCE (THRU 09/23) 40.00 0.00 X 243606 0 3778 ROBIN MCATEE OPERATING ROOM RN 40.00 0.00 X 240614 0 5170 CORINA BRONNY STAFF RN - ICU 40.00 0.00 X 232439 0 2857 JON HAUGAARD CHAIR 2.00 0.00 X X 0 0 0 THOMAS CUMPSTON VICE CHAIR 2.00 1.00 X X 0 0 0 JOHN R KNIGHT SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 SEAN ANDERSON MD CHIEF OF STAFF 2.00 0.00 X 0 0 0 GEORGE NIELSEN PAST CHAIR (THRU 02/24) 2.00 0.00 X 0 0 0 ANNA BLAIR RN DIRECTOR 2.00 0.00 X 0 0 0 GERARDO GALANG MD DIRECTOR 2.00 0.00 X 0 0 0 ANDREA HOWARD DIRECTOR 2.00 1.00 X 0 0 0 ALEXIS LONG MD DIRECTOR 2.00 0.00 X 0 0 0 ED MANANSALA EDD DIRECTOR (THRU 01/24) 2.00 0.00 X 0 0 0 MIKE PERVIS DIRECTOR 2.00 0.00 X 0 0 0 CHRISTEEN REEG DIRECTOR (THRU 08/24) 2.00 0.00 X 0 0 0 SYLVIA STEPHENSON DIRECTOR 2.00 0.00 X 0 0 0 KIM STOLL DIRECTOR 2.00 1.00 X 0 0 0 BRIAN VEERKAMP DIRECTOR 2.00 0.00 X 0 0 0 3812931 0 233940 400 0 1 0 EL DORADO MULTISPECIALTY MED GROUP 1095 MARSHALL WAY PLACERVILLE CA 95667 MULTISPECIALTY CARE SERVICES 27343450 MARSHALL PRIMARY CARE MED ASSOC 2882 PROSPECT PARK DR RANCHO CORDOVA CA 95670 PHYSICIAN PRIMARY CARE SERVICES 13969089 EL DORADO ANESTHESIA MED GROUP 113 MIRAMONT COURT EL DORADO HILLS CA 95670 ANESTHESIA SERVICES 5249726 AYA HEALTHCARE INC PO BOX 123519 DALLAS TX 75312 HEALTHCARE STAFFING 2344564 OBHG CALIFORNIA PC 777 LOWNDES HILL ROAD BUILDING 1 GREENVILLE SC 29607 OB/GYN CARE SERVICES 2105668 50 175242 681335 277690 1134267 PATIENT REVENUE, NET 621110 338506542 338506542 EL DORADO SURGERY CENT 621110 1068647 1068647 339575189 1332335 1332335 373339 178156 195183 195183 195183 509481 546323 -36842 -36842 -36842 CAFETERIA REVENUE 900099 762171 762171 MISCELLANEOUS REVENUE 900099 669368 669368 1431539 343631671 339575189 0 2922215 X 12300 12300 3227240 2616752 610488 108936467 86709060 22227407 5903309 3762095 2141214 37923436 30686052 7237384 9399906 7516188 1883718 2980582 12000 2968582 400732 400732 245659 245659 23373 23373 65911318 60745266 5166052 204337 22 204315 1677641 621743 1055898 8824029 8824029 7368276 1596942 5771334 289728 131367 158361 262692 8718 253974 2904201 2904201 14488993 14488993 1683315 428978 1254337 MEDICAL SUPPLIES 46981266 46821327 159939 BAD DEBT EXPENSE 5244372 5244372 REGISTRY 1428886 1045128 383758 SECURITY 1263994 1263994 12659064 5388917 7270147 340245116 253347227 86897889 0 30983920 22243320 23793490 15423806 77846315 83333621 1180566 959893 5024348 5830048 4664463 2789120 345030007 208346367 120548029 136683640 31840356 36466670 4752442 5503196 39141789 41296886 339775718 350530200 45568108 50524745 77061096 76158005 23266664 19524629 3171928 4521969 149067796 150729348 X 190707922 199800852 190707922 199800852 339775718 350530200 X 3386555 5790517 -84142 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 23373 23373 340221743 340245116 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 24137 60250 15967 23373 123727 250000 250000 250000 250000 1000000 1500000 7175 7789 0 0 14964 X 1 0.10 0 0 0 1 0 0.00 0 7191083 7191083 173062891 93566192 79496699 30434049 22615824 7818225 118483554 92164351 26319203 15858430 15858430 136683640 PREPAID PENSION COSTS 32299276 RIGHT-OF-USE LEASE ASSET 4355548 UNAMORTIZED LOAN COSTS 2458644 THIRD PARTY COST SETTLEMENT 1242907 OTHER ASSETS 940511 41296886 LEASE LIABILITY 4411883 THIRD PARTY PAYOR SETTLEMENTS 110086 4521969 X 344130516 5790517 -47300 5743217 338387299 5244372 5244372 343631671 335037586 36842 36842 335000744 5244372 5244372 340245116 PART II, LINE 9: MARSHALL MEDICAL CENTER HAS ONE CONSERVATION EASEMENT FOR THE PROTECTION OF NATURAL HABITAT, WHICH WAS OBTAINED ON APRIL 16, 2003. THE CONSERVATION EASEMENT IS INCLUDED AS PART OF LAND THAT IS INCLUDED IN PROPERTY AND EQUIPMENT ON THE BALANCE SHEET. NO REVENUE OR MATERIAL EXPENSES ARE ASSOCIATED WITH THE EASEMENT. PART X, LINE 2: THE MEDICAL CENTER IS A TAX-EXEMPT ORGANIZATION AND IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES, EXCEPT FOR UNRELATED BUSINESS INCOME, IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IN ADDITION, THE MEDICAL CENTER QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. THE PROVISION FOR INCOME TAXES WAS $0 FOR THE YEARS ENDED OCTOBER 31, 2024 AND 2023. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 152,974. LOSS ON SALE OF FIXED ASSETS 36,842. GRANT REVERSAL FOR FY 2023 -237,116. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 5,244,372. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS 36,842. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 5,244,372. 1 1 X 1 X 149.000000000000 1 X 450.000000000000 1 1 0 1 1 10 568 6651476 3378571 3272905 0.00960 10 568 6651476 3378571 3272905 0.00960 14 11913 4653325 1271083 3382242 0.00990 0 223 4890436 0 4890436 0.01430 161961 0 161961 0.00050 14 12136 9705722 1271083 8434639 0.02470 24 12704 16357198 4649654 11707544 0.03430 1 50000 412 0 412 0.00000 3 140 242523 0 242523 0.00070 4 50140 242935 242935 0.00070 1 5244372 614640 66279251 126565434 -60286183 X 1 1 1 EL DORADO SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.87000 0.00000 0.13000 1 1 MARSHALL MEDICAL CENTER 1100 MARSHALL WAY PLACERVILLE CA 95667 WWW.MARSHALLMEDICAL.ORG 30000059 X X X MARSHALL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE LINE 7D X X 1 21 1 SEE LINE 7D 0 1 X 149.000000000000 450.000000000000 X X X X X 1 1 X X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 5: SEVENTEEN (17) PHONE INTERVIEWS WERE CONDUCTED DURING JUNE 2022. COMMUNITY STAKEHOLDERS IDENTIFIED BY THE HOSPITAL WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT INTERVIEWS. INTERVIEW PARTICIPANTS INCLUDED A BROAD RANGE OF STAKEHOLDERS CONCERNED WITH HEALTH AND WELLBEING IN EL DORADO COUNTY, WHO SPOKE TO ISSUES AND NEEDS IN THE COMMUNITIES SERVED BY THE HOSPITAL.MARSHALL ALSO CONDUCTED SURVEYS WITH COMMUNITY RESIDENTS TO OBTAIN INPUT ON HEALTH NEEDS, BARRIERS TO CARE AND RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED HEALTH NEEDS. THE SURVEYS WERE AVAILABLE IN AN ELECTRONIC FORMAT THROUGH A SURVEYMONKEY LINK. THE SURVEYS WERE COLLECTED FROM JUNE 6 TO JULY 11, 2022. DURING THIS TIME, 62 COMMUNITY MEMBERS COMPLETED THE SURVEY. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.MARSHALLMEDICAL.ORG/ABOUT-US/COMMUNITY-BENEFIT/. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 11: IN FY24, MARSHALL ENGAGED IN ACTIVITIES AND PROGRAMS THAT ADDRESSED THE PRIORITY HEALTH NEEDS IDENTIFIED IN THE FY23-FY25 IMPLEMENTATION STRATEGY. MARSHALL COMMITTED TO COMMUNITY BENEFIT EFFORTS THAT ADDRESSED BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE), CHRONIC DISEASE PREVENTION, MANAGEMENT, AND TREATMENT, AND SUPPORT FOR THE HEALTH AND WELFARE OF THE COMMUNITY. SELECTED ACTIVITIES AND PROGRAMS THAT HIGHLIGHT THE HOSPITAL'S COMMITMENT TO THE COMMUNITY ARE DETAILED BELOW.ACCESS TO BEHAVIORAL HEALTH SERVICES (MENTAL HEALTH AND SUBSTANCE USE):RESPONSE TO NEED:1. MARSHALL CARES (CLINICALLY ASSISTED RECOVERY & EDUCATION SERVICES) - CARES TREATS OPIATE USE DISORDER AND HAS GROWN INTO A CLINIC FOCUSED ON SUPPORTIVE TREATMENT FOR PEOPLE WITH ANY SUBSTANCE DEPENDENCY, INCLUDING ALCOHOL, TOBACCO, STIMULANTS, OPIOIDS, BENZODIAZEPINES, AND OTHER SEDATIVE HYPNOTICS. CLINIC SERVICES SERVED 822 PEOPLE AND INCLUDED COMPREHENSIVE MEDICATION ASSISTED TREATMENT WITH A PHYSICIAN, COUNSELING, CASE MANAGEMENT AND BEHAVIORAL HEALTH SUPPORT SERVICES.2. MEDICATION ASSISTED TREATMENT (MAT) - SINCE DECEMBER 2016, MARSHALL HAS PARTICIPATED IN A JOINT EFFORT WITH THE EL DORADO COMMUNITY HEALTH CENTER (EDCHC) AND THE CALIFORNIA HEALTHCARE FOUNDATION TO PROVIDE MEDICATION ASSISTED TREATMENT (MAT) FOR OPIOID ADDICTION. WHEN PEOPLE COME TO MARSHALL'S EMERGENCY DEPARTMENT IN WITHDRAWAL, THEY WORK WITH A SUBSTANCE USE NAVIGATOR (SUN) AND ARE OFFERED PARTICIPATION IN THE MAT/ED BRIDGE PROGRAM, WHICH INCLUDES BUPRENORPHINE TO ALLEVIATE WITHDRAWAL SYMPTOMS. THROUGH THE EDCHC AND MARSHALL CARES, THEY ARE ALSO REFERRED TO OUTPATIENT THERAPY, WHERE THEY MEET WITH A DOCTOR WITHIN 48 HOURS. THE PROGRAM INCLUDES GROUP SESSIONS, COUNSELING, AND SOCIAL SERVICES. IN FY24, THE SUN CONSULTED WITH 900 PEOPLE. BEYOND OPIOID USE DISORDER TREATMENT, MARSHALL HAS ALSO ENGAGED TO SUPPORT TREATING ALCOHOL USE DISORDER, NICOTINE USE DISORDER, AS WELL AS METHAMPHETAMINE USE. FENTANYL-SPECIFIC USE AND OVERDOSE CONTINUES TO RISE AS SIGNIFICANT PUBLIC HEALTH IMPACT DUE TO ITS HIGHLY CONCENTRATED AND OFTEN POLLUTED NATURE, PARTICULARLY IN SEMI-RURAL WESTERN EL DORADO COUNTY.3. OVERDOSE RECOGNITION AND PREVENTION - OUTREACH TO THE COMMUNITY FOR EDUCATION ON SUBSTANCE USE TREATMENT, OVERDOSE PREVENTION AND STIGMA REDUCTION. COMMUNITY PROGRAMS REACHED 60 PEOPLE. THROUGH AN OUTREACH PARTNERSHIP WITH ASSOCIATION GUADALUPANA, MARSHALL PARTICIPATED IN A HEALTH FAIR AT ST PATRICK'S CATHOLIC CHURCH IN PLACERVILLE FOR SPANISH-SPEAKING COMMUNITY MEMBERS. IN ADDITION, THE HOSPITAL PARTICIPATED IN COMMUNITY OUTREACH EVENTS, INCLUDING THE CATALYST COMMUNITY KIDS EXPO, PLACERVILLE FARMERS MARKET, NATIONAL NIGHT OUT, THE CENTER FOR VIOLENCE FREE RELATIONSHIPS, AND THE NEW MORNING YOUTH AND FAMILY SERVICES YOUTH SHELTER. THE FOCUS WAS ON PROVIDING SUBSTANCE USE EDUCATION AND ACCESS TO OVERDOSE PREVENTION SUPPLIES. THESE COMMUNITY EVENTS REACHED 698 PEOPLE.CHRONIC DISEASE PREVENTION, MANAGEMENT AND TREATMENT:RESPONSE TO NEED:1. POPULATION HEALTH - THE MARSHALL POPULATION HEALTH TEAM COORDINATED THE COMMUNITY SERVICES THAT MARSHALL PROVIDED, WITH THE OBJECTIVE OF STRENGTHENING THE CONTINUUM OF CARE PROVIDED TO OUR PATIENTS AND THE COMMUNITY. DRIVEN BY PRIMARY CARE PROVIDERS, AND WITH ENGAGEMENT OF CLINIC STAFF AND SPECIALISTS, MARSHALL PLACED A PARTICULAR FOCUS ON SCREENINGS FOR BREAST CANCER, COLON CANCER AND DIABETES AND MET OR EXCEEDED ITS PERFORMANCE TARGETS IN ALL THREE AREAS. POPULATION HEALTH, IN ADDITION TO COORDINATING HEALTH PROMOTION ACTIVITIES FOR EXISTING PATIENTS, COMPLETED 7 OUTREACH EVENTS REACHING OVER 200 PEOPLE TO EDUCATE THE COMMUNITY REGARDING CANCER SCREENINGS AND HEALTH PROMOTION ACTIVITIES.2. COMMUNITY CARE NETWORK (CCN) - THE CCN FOCUSES ON IMPROVING THE EFFECTIVENESS AND QUALITY OF CARE FOR HIGH-RISK PATIENTS. THROUGH THE COMMUNITY CARE NETWORK (CCN) HIGH RISK PATIENT CASE MANAGEMENT, TRANSITIONAL CASE MANAGEMENT (TCM) AND ENHANCED CARE MANAGEMENT (ECM) PROGRAMS, MARSHALL ASSISTS CHRONICALLY ILL PATIENTS WITH HEALTH CARE COORDINATION AND MANAGEMENT, IN-HOME CARE, MEDICAL SUPPLIES, AND VOLUNTEER HEALTH COACHES, AT NO COST. CCN REMOVES OBSTACLES THAT OFTEN PREVENT PEOPLE FROM RECEIVING ROUTINE AND PREVENTIVE CARE. THESE PROGRAMS REDUCE READMISSIONS AND UNNECESSARY EMERGENCY ROOM VISITS. FOR PEOPLE WITH MORE COMPLEX NEEDS, A TEAM OF SOCIAL WORKERS, LVNS, RN CASE MANAGERS, PHARMACISTS, DIABETES EDUCATORS, DIETITIANS, AND PHYSICAL THERAPISTS WORK WITH THEM IN THEIR HOMES TO NAVIGATE THEIR PATHS TO IMPROVED HEALTH AND OVERCOME COMMUNITY BARRIERS. IN FY24, 4,538 PEOPLE WERE REACHED THROUGH THESE CCN PROGRAMS.3. CONGESTIVE HEART ACTIVE TELEPHONE TREATMENT (CHATT) - THE CHATT PROGRAM HELPED PEOPLE MANAGE CONGESTIVE HEART FAILURE. CHATT IMPROVED QUALITY OF LIFE, REDUCED CHF COMPLICATIONS AND HELPED KEEP PEOPLE WITH CHF OUT OF THE HOSPITAL. THIS SERVICE INCLUDED FREQUENT TELEPHONE CALLS FROM A REGISTERED NURSE, WHO SPECIALIZES IN CARDIOVASCULAR CARE. IN FY24, CHATT SERVED 284 INDIVIDUALS.CANCER RESOURCE CENTER:MARSHALL'S CANCER RESOURCE CENTER PROVIDED CLASSES, SUPPORT GROUPS AND SERVICES. SERVICES WERE AVAILABLE TO ANYONE IMPACTED BY CANCER IN EL DORADO COUNTY.- TRANSPORTATION IS A WELL-KNOWN BARRIER TO ACCESSING HEALTH CARE, ESPECIALLY IN RURAL AREAS. THE CANCER RESOURCE CENTER PROVIDED 21 PEOPLE WITH 58 ROUND TRIP RIDES AS WELL AS PROVIDED 102 PEOPLE WITH 308 GAS CARDS.- THE WIG BANK SERVED 64 PEOPLE AND PROVIDED 42 WIGS.- PROVIDED 38 NO-COST MAMMOGRAMS.- PROVIDED LODGING ASSISTANCE FOR 11 PEOPLE WHO COULD NOT AFFORD THE COST OF A HOTEL ROOM WHILE OBTAINING CANCER TREATMENT.- 85 PEOPLE PARTICIPATED IN A COMMUNITY WIDE MAKING STRIDES AGAINST BREAST CANCER PREVENTION EVENT.- NUTRITION CONSULTATIONS AND SERVICES REACHED 232 PEOPLE.- 272 PEOPLE WITH CANCER WERE PROVIDED WITH CASE MANAGEMENT NAVIGATION SERVICES.- 462 PEOPLE RECEIVED PSYCHOSOCIAL DISTRESS SCREENING.- SOCIAL WORK CONSULTATIONS AND SERVICES ASSISTED 233 PEOPLE.5. HEALTH EDUCATION - IN FY24, MARSHALL REACHED 230 COMMUNITY MEMBERS WITH THE FOLLOWING COMMUNITY HEALTH EDUCATION SESSIONS:- DEMENTIA AWARENESS- JOINT REPLACEMENT EDUCATION- SMOKING CESSATION- WEIGHT LOSS MANAGEMENTDIABETES AND NUTRITION EDUCATION:HEALTHY LIVING CLASSES WERE PROVIDED MONTHLY TO 145 PEOPLE. THESE FREE VIRTUAL CLASSES, LED BY A NURSE, PROVIDED INFORMATION ON THE BASICS OF DIABETES SELF-MANAGEMENT. CLASSES INCLUDED: UNDERSTANDING DIABETES AND PLANNING FOR SUCCESS AND HEALTHY EATING FOR DIABETES.IN ADDITION, MARSHALL PROVIDED TELE-VISITS FOR THE DIABETES IN PREGNANCY PROGRAM, A GESTATIONAL DIABETES PROGRAM THAT REACHED 53 PEOPLE. PARTICIPANTS LEARNED ABOUT NUTRITION AND MEAL PLANNING, CONTROLLING BLOOD SUGAR, EXERCISE AND EMOTIONAL SUPPORT RESOURCES.REMOTE PATIENT MANAGEMENT FOR RURALLY ISOLATED INDIVIDUALS:MARSHALL, IN PARTNERSHIP WITH UC DAVIS, CONTINUED A PILOT PROGRAM TO IDENTIFY APPROACHES TO OVERCOMING CHALLENGES IN THE DEPLOYMENT OF REMOTE PATIENT MANAGEMENT DEVICES TO THOSE LIVING IN RURAL COMMUNITIES, WHICH INCLUDE CONNECTIVITY, FEAR OF TECHNOLOGY, AND DESIRE TO BE COMPLETELY INDEPENDENT. OUR GOAL IS TO PROACTIVELY IDENTIFY NEEDS AND CONNECT INDIVIDUALS TO SERVICES IN THE COMMUNITY. 12 UNIQUE INDIVIDUALS WERE SERVED THROUGH THIS PILOT PROGRAM, PROVIDING CRITICAL INTELLIGENCE TO INFORM FUTURE PROGRAM DEVELOPMENT.SUPPORT GROUPS:COMMUNITY EDUCATION AND SUPPORT GROUPS WERE OFFERED TO COMMUNITY MEMBERS THROUGH ONLINE OPTIONS, INCLUDING ZOOM. THE SUPPORT GROUPS INCLUDED:- BARIATRIC SURGERY - 40 ATTENDEES- STROKE - 300 ENCOUNTERSSUPPORT FOR THE HEALTH AND WELFARE OF THE COMMUNITY RESPONSE TO NEED:1. FINANCIAL AID AND HEALTH INSURANCE ASSISTANCE - PROVIDED FINANCIAL ASSISTANCE THROUGH FREE AND DISCOUNTED CARE FOR HEALTH CARE SERVICES, CONSISTENT WITH MARSHALL MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY. OFFERED ASSISTANCE TO ENROLL IN PUBLIC HEALTH INSURANCE PROGRAMS.2. TRANSPORTATION AND OTHER MEDICAL NEEDS - PROVIDED TRANSPORTATION TO PEOPLE WHO COULD NOT AFFORD TRANSPORTATION TO OR FROM MEDICAL SERVICES AND APPOINTMENTS. FOR PEOPLE LIVING IN POVERTY, THE HOSPITAL PROVIDED MEDICATIONS, ASSISTED LIVING, AND CARE MANAGEMENT SERVICES.3. COMMUNITY HEALTH LIBRARY - MARSHALL'S COMMUNITY HEALTH LIBRARY CONTAINS OVER 5,000 RESOURCES, WHICH WERE MADE AVAILABLE AT NO CHARGE FOR USE BY COMMUNITY RESIDENTS. STAFF LIBRARIANS ALSO CONDUCTED MEDICAL TOPIC SEARCHES FOR COMMUNITY MEMBERS. IN FY24, 276 COMMUNITY MEMBERS ACCESSED THESE SERVICES. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 13B: WHEN ANY PATIENT'S SINGLE VISIT RESPONSIBILITY EXCEEDS $50,000, THE BALANCE ABOVE $50,000 WILL BE DISCOUNTED BY 50% AS CATASTROPHIC ADJUSTMENT AUTOMATICALLY UPON FINAL BILLING. PATIENTS ARE NOT REQUIRED TO APPLY FOR THIS PROGRAM TO BE ENTITLED TO THIS 50% OVER $50,000 DISCOUNT. IF THE PATIENT APPLIES AND QUALIFIES FOR THE FINANCIAL ASSISTANCE PROGRAM, THE REMAINING BALANCE WILL RECEIVE THE APPROPRIATE REDUCTION IN ADDITION TO THE CATASTROPHIC ADJUSTMENT. A PATIENT WHOSE FAMILY INCOME DOES NOT EXCEED 450% OF THE FEDERAL POVERTY LEVEL MAY QUALIFY FOR CHARITY CARE ON THE BASIS OF HIGH MEDICAL COSTS, WHICH IS DEFINED TO MEAN ANY OF THE FOLLOWING: 1) ANNUAL OUT-OF-POCKET COSTS PAID AT THIS FACILITY EXCEED 10% OF SUCH PATIENTS' FAMILY GROSS INCOME AND ESSENTIAL LIVING EXPENSES IN THE PRIOR 12 MONTHS, OR 2) ANNUAL OUT-OF-POCKET EXPENSES THAT EXCEED 10% OF SUCH PATIENT'S FAMILY GROSS INCOME AND ESSENTIAL LIVING EXPENSES, 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. THIS SHALL NOT INCLUDE OUT-OF-POCKET COSTS FOR INSURANCE PREMIUMS. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 15E: WHEN ANY PATIENT'S SINGLE VISIT RESPONSIBILITY EXCEEDS $50,000, THE BALANCE ABOVE $50,000 WILL BE DISCOUNTED BY 50% AS CATASTROPHIC ADJUSTMENT AUTOMATICALLY UPON FINAL BILLING. PATIENTS ARE NOT REQUIRED TO APPLY FOR THIS PROGRAM TO BE ENTITLED TO THIS 50% OVER $50,000 DISCOUNT. IF THE PATIENT APPLIES AND QUALIFIES FOR THE FINANCIAL ASSISTANCE PROGRAM, THE REMAINING BALANCE WILL RECEIVE THE APPROPRIATE REDUCTION IN ADDITION TO THE CATASTROPHIC ADJUSTMENT.A PATIENT WHOSE FAMILY INCOME DOES NOT EXCEED 450 PERCENT OF THE FEDERAL POVERTY LEVEL MAY QUALIFY FOR CHARITY CARE ON THE BASIS OF HIGH MEDICAL COSTS, WHICH IS DEFINED TO MEAN ANY OF THE FOLLOWING:1. ANNUAL OUT-OF-POCKET COSTS PAID AT THIS FACILITY EXCEED 10% OF SUCH PATIENTS' FAMILY GROSS INCOME AND ESSENTIAL LIVING EXPENSES IN THE PRIOR 12 MONTHS; OR2. ANNUAL OUT-OF-POCKET EXPENSES THAT EXCEED 10% OF SUCH PATIENT'S FAMILY GROSS INCOME AND ESSENTIAL LIVING EXPENSES, 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.THIS SHALL NOT INCLUDE OUT-OF-POCKET EXPENSES FOR INSURANCE PREMIUMS. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE AVAILABLE ONLINE AT HTTPS://WWW.MARSHALLMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-INFORMATION/INSURANCE-BILLING-INFORMATION/BUSINESS-OFFICE/HELP-PAYING-YOUR-BILL/,MARSHALL MEDICAL CENTER'S HOSPITAL BILLING DEPARTMENT ALSO ATTEMPTS TO MAKE CONTACT WITH PATIENTS TO INFORM THEN THAT THEY SHOULD APPLY FOR FINANCIAL ASSISTANCE. PART V, SECTION B, LINE 11 (CONTINUED): 4. STREET NURSING AND OUTREACH PROGRAM - THE STREET NURSING AND OUTREACH PROGRAM PROVIDED TRAUMA-INFORMED CARE DIRECTLY TO UNHOUSED AND UNSTABLY HOUSED COMMUNITY MEMBERS. THE PROGRAMS PROVIDED CARE AT LOCATIONS THROUGHOUT EL DORADO COUNTY, INCLUDING THE PLACERVILLE AND GEORGETOWN LIBRARIES, UPPER ROOM DINING HALL, GREEN VALLEY CHURCH SHOWER PROGRAM, AND THE NAVIGATION CENTER OPERATED BY VOLUNTEERS OF AMERICA.SERVICES INCLUDED MEDICAL COORDINATION, MENTAL HEALTH REFERRALS, HOUSING NAVIGATION, BENEFITS ASSISTANCE, TRANSPORTATION SUPPORT, AND RESOURCE DISTRIBUTION (E.G., HYGIENE KITS, FOOD, CLOTHING, TENTS, AND MEDICAL SUPPLIES). THE STREET OUTREACH TEAM COMPLETED 782 FACE-TO-FACE ENGAGEMENTS, 1,862 PHONE CONTACTS, AND HOSTED 17 OUTREACH EVENTS, REACHING AN AVERAGE OF 27 INDIVIDUALS PER EVENT. IN TOTAL, 105 INDIVIDUALS WERE PROVIDED WITH ONGOING CASE MANAGEMENT SUPPORT. THE STREET MEDICINE TEAM PROVIDED DIRECT MEDICAL CARE TO 152 UNIQUE PATIENTS, ADDRESSING CHRONIC DISEASES, ACUTE ILLNESS, WOUND CARE, MEDICATION ACCESS, AND HEALTH EDUCATION. MOBILE CARE WAS DELIVERED AT ENCAMPMENTS, SHELTERS, AND TRANSITIONAL HOUSING SITES, HELPING PATIENTS MANAGE HEALTH CONDITIONS OUTSIDE OF TRADITIONAL CARE SYSTEMS.KEY OUTREACH INITIATIVES INCLUDED: HYDRATION STATIONS WERE PROVIDED DURING EXTREME HEAT DAYS, OFFERING GATORADE, WATER, AND COOLING ITEMS. TWO FOOD INSECURITY EVENTS DISTRIBUTED 37 FOOD BASKETS. FIVE FLU VACCINATION CLINICS, IN PARTNERSHIP WITH EL DORADO COUNTY PUBLIC HEALTH, ADMINISTERED 47 VACCINES. COLD WEATHER RESPONSE EVENTS DISTRIBUTED SLEEPING BAGS, INSULATED TENTS, GLOVES, HAND WARMERS, AND PONCHOS. WILDFIRE EVACUATION RESPONSE. MARSHALL PARTNERED WITH THE AMERICAN RED CROSS TO SUPPORT A MEDICAL CLINIC AT A DESIGNATED EVACUATION CENTER DURING THE CROZIER FIRE. STAFF PROVIDED OUTREACH AND CARE FOR FIVE CONSECUTIVE DAYS, OFFERING MEDICAL SUPPORT, EMOTIONAL REASSURANCE, AND RESOURCES TO COMMUNITY MEMBERS DISPLACED BY THE FIRE.5. EMERGENCY EVACUATION SHELTER CLINIC PLANNING - IN ADDITION TO THE SERVICES PROVIDED ABOVE, THE STREET NURSING AND OUTREACH PROGRAM HAS UNDERTAKEN EMERGENCY PREPAREDNESS PLANNING TO BUILD THE INFRASTRUCTURE NECESSARY TO DEPLOY AN EMERGENCY EVACUATION SHELTER MEDICAL / NURSING CLINIC. MARSHALL HAS PROVIDED THESE SERVICES IN THE PAST AND HAVE ANALYZED THE COMPONENTS NECESSARY TO DEPLOY RAPIDLY AND PROVIDE SUFFICIENT CARE IN THE COMMUNITY. THE PROGRAM NOW HAS A TRAILER PREPARED WITH URGENT CARE SUPPLIES, ELECTRONIC EQUIPMENT FOR REGISTRATION AND DOCUMENTATION, VITAL SIGN EQUIPMENT, AND FIRST AID/MINOR WOUND CARE SUPPLIES. THIS ENSURES THAT OUR VULNERABLE POPULATIONS ARE ABLE TO RAPIDLY AND PROACTIVELY RECEIVE CARE WHILE DISPLACED AND THAT MARSHALL IS PREPARED TO RESPOND WITH URGENCY.STOP THE BLEEDMARSHALL TRAINED STAFF MEMBERS AS INSTRUCTORS TO EDUCATE COMMUNITY MEMBERS TO TREAT INJURIES CAUSED BY HOME ACCIDENTS, MOTOR VEHICLE ACCIDENTS, ACTIVE SHOOTERS, BOMBINGS, AND WORK-RELATED INJURIES. IN FY24, MARSHALL STAFF INSTRUCTORS TRAINED 329 EL DORADO COUNTY RESIDENTS, WHICH INCLUDED ONLINE COURSES AND IN-PERSON TRAINING.1. FALL PREVENTION - PROVIDED THE MATTER OF BALANCE FALL PREVENTION CLASS THAT ENGAGED 19 COMMUNITY MEMBERS.2. COMMUNITY HEALTH MAGAZINE - FOR YOUR HEALTH IS MARSHALL'S QUARTERLY MAGAZINE, WHICH WAS WIDELY DISTRIBUTED THROUGHOUT EL DORADO COUNTY AND AVAILABLE IN DIGITAL FORMAT ON THE HOSPITAL'S WEBSITE. TOPICS IN FY24 INCLUDED STROKE AWARENESS, CANCER CARE, SKIN CANCER PREVENTION, AND GENERAL WELLNESS.3. CHILDBIRTH CLASSES - PROVIDED FREE OR LOW-COST EDUCATIONAL CLASSES TO THE COMMUNITY, INCLUDING CHILDBIRTH CLASSES. CLASSES WERE SELF-PACED AND VIRTUAL AND WERE PAIRED WITH LIVESTREAM Q & A SESSIONS. CLASS TOPICS INCLUDED: HEALTHY PREGNANCY, BREASTFEEDING, AND BABY CARE. 58 COMMUNITY MEMBERS PARTICIPATED IN ENGLISH AND SPANISH. 2 1 - CARES 1045 MARSHALL WAY PLACERVILLE CA 95667 OTHER OUTPATIENT CLINIC - CLINICALLY ASSISTED RECOVERY AND EDUCATION SERVICE 2 - PSYCHIATRY & NEUROLOGY 3581 PALMER DRIVE SUITE 202 CAMERON PARK CA 95682 OTHER OUTPATIENT CLINIC PART I, LINE 3C: MARSHALL MEDICAL CENTER IS COMMITTED TO SERVING THE MEMBERS OF OUR COMMUNITY. WE WANT TO MAKE SURE THAT YOU ARE GIVEN EVERY OPPORTUNITY TO APPLY FOR ANY FINANCIAL ASSISTANCE, INCLUDING CHARITY CARE, FOR WHICH YOU MAY BE ELIGIBLE. YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF YOU SUBMIT THE NECESSARY DOCUMENTATION AND EITHER: (1) YOUR FAMILY INCOME IS BELOW 450% OF THE CURRENT FEDERAL POVERTY GUIDELINES; OR (2) YOU INDIVIDUALLY OR YOUR FAMILY HAS HIGH MEDICAL COSTS. YOU WOULD HAVE HIGH MEDICAL COSTS IF YOUR INDIVIDUAL OR YOUR FAMILY ANNUAL OUT-OF-POCKET COSTS EXCEED 10% OF YOUR OR YOUR FAMILY GROSS INCOME AND ESSENTIAL LIVING EXPENSES IN THE PRIOR 12 MONTHS. THE SPECIFIC LEVEL OF ASSISTANCE YOU MAY BE ELIGIBLE FOR WILL DEPEND ON YOUR PARTICULAR FAMILY INCOME LEVEL. PART I, LINE 7: BEGINNING WITH TAX YEAR 2014, MARSHALL MEDICAL CENTER IMPLEMENTED A COST ACCOUNTING SYSTEM TO ESTIMATE DIRECT AND INDIRECT COSTS OF PROVIDING PATIENT CARE. THE RESULTING COST-TO-CHARGE RATIO WAS APPLIED TO GROSS REVENUES ASSOCIATED WITH FINANCIAL ASSISTANCE AND MEANS-TESTED PROGRAMS IN ORDER TO CALCULATE FINANCIAL ASSISTANCE AT COST. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $5,244,372. PART II, COMMUNITY BUILDING ACTIVITIES: WORKFORCE DEVELOPMENT - MARSHALL LEADERSHIP PARTICIPATED IN THE EL DORADO UNION HIGH SCHOOL DISTRICT CAREER TECHNICAL EDUCATION ADVISORY COMMITTEE, A GROUP OF PRIVATE ENTITIES THAT ASSIST THE HIGH SCHOOL DISTRICT PLAN AND PREPARE FOR TECHNICAL CAREERS AND EDUCATION OFFERINGS. 50 STUDENTS PARTICIPATED IN THE HEALTH CAREER EXPLORATION DAY.ADVOCACY - HOSPITAL REPRESENTATIVES ENGAGED IN ADVOCACY EFFORTS THAT SUPPORTED THE COMMUNITY.ECONOMIC DEVELOPMENT - HOSPITAL LEADERS SUPPORTED LOCAL CHAMBERS OF COMMERCE AND FOCUSED ON ISSUES RELATED TO COMMUNITY HEALTH AND SAFETY. PART III, LINE 2: MARSHALL MEDICAL CENTER MAKES A BEST EFFORT TO APPLY ALL KNOWN DISCOUNTS AND PAYMENTS POSTED TO THE PATIENT ACCOUNT PRIOR TO DETERMINATION OF BAD DEBT WRITE-OFF. NON-COMPLIANT PATIENTS MAY RESULT IN THE DELAY OF PROPERLY APPLIED DISCOUNTS.IN ACCORDANCE WITH CALIFORNIA HEALTH AND SAFETY CODE SECTIONS 127400 ET SEQ., MARSHALL MEDICAL CENTER DISCOUNTS PAYMENTS AND PROVIDES CHARITY CARE TO FINANCIALLY QUALIFIED PATIENTS. PATIENTS WHO QUALIFY FOR THESE DISCOUNTS OR CHARITY CARE UNDER OUR POLICIES INCLUDE PATIENTS WHO MEET BOTH OF THE FOLLOWING QUALIFICATIONS:1. THE PATIENT EITHER IS SELF-PAY OR HAS HIGH MEDICAL COSTS, AS DEFINED IN OUR DISCOUNT PAYMENT AND CHARITY CARE POLICIES; AND2. THE PATIENT HAS A FAMILY INCOME (AS DEFINED IN THE POLICIES) THAT DOES NOT EXCEED 350% OF THE FEDERAL POVERTY LEVEL. PART III, LINE 3: MARSHALL MEDICAL CENTER ESTIMATES THAT APPROXIMATELY 11.72% OF ALL PATIENT ACCOUNTS ASSIGNED TO BAD DEBT MIGHT BE ATTRIBUTABLE TO PATIENTS WHO MIGHT HAVE QUALIFIED FOR FINANCIAL ASSISTANCE HAD THOSE PATIENTS PROVIDED SUFFICIENT INFORMATION TO BECOME QUALIFIED. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" SECTION IN NOTE 1, PAGE 12, IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DISCUSSION OF THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: MARSHALL MEDICAL CENTER USES A COST ACCOUNTING SYSTEM, MAKING A BEST EFFORT TO APPLY ALL KNOWN DISCOUNTS AND PAYMENTS POSTED TO THE PATIENT ACCOUNT PRIOR TO DETERMINATION OF BAD DEBT WRITE-OFFS. NON-COMPLIANT PATIENTS MAY RESULT IN THE DELAY OF PROPERLY APPLIED DISCOUNTS.THE SHORTFALL INCURRED ON MEDICARE PATIENTS CAN BE CONSIDERED A COMMUNITY BENEFIT BECAUSE MARSHALL MEDICAL CENTER IS THE ONLY HOSPITAL FACILITY WITHIN APPROXIMATELY 25 MILES. THEREFORE, PATIENTS WOULD HAVE TO TRAVEL OUTSIDE OF THE COMMUNITY TO OBTAIN HEALTHCARE SERVICES. THE ONLY OTHER HOSPITAL FACILITY IN EL DORADO COUNTY IS APPROXIMATELY 50 MILES FROM PLACERVILLE AND PATIENTS WOULD HAVE TO TRAVERSE A 7,000+ FOOT ELEVATION MOUNTAIN PASS TO OBTAIN HEALTHCARE SERVICES FROM THAT FACILITY. OUR PATIENT POPULATION IS HEAVILY MEDICARE-WEIGHTED AND MARSHALL PROVIDES A VAST AMOUNT OF CARE TO THIS MEDICARE POPULATION, WHICH TEND TOWARDS MORE ACUTE ILLNESSES THAT MAKE TRAVEL DIFFICULT. BECAUSE WE ARE A COMMUNITY-BASED HOSPITAL, WE HAVE TO PROVIDE A BROAD RANGE OF SERVICES TO MEET THE NEEDS OF THE COMMUNITY, WHICH IMPACTS OUR ABILITY TO SPECIALIZE IN MORE FOCUSED SERVICES. PART III, LINE 9B: AT THE TIME OF REGISTRATION AND IN THE FIRST BILLING STATEMENT, PATIENTS ARE PRESENTED WITH ALL DISCOUNT AND PROGRAM OPTIONS AVAILABLE. BILLING STATEMENTS 2 THROUGH 5 REMIND THE PATIENT OF DISCOUNTS AVAILABLE. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED COVERAGE OR FOR MARSHALL MEDICAL CENTER'S OWN FINANCIAL ASSISTANCE PROGRAM, MARSHALL MEDICAL CENTER SHALL NOT KNOWINGLY SEND OR ASSIGN SUCH PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY PRIOR TO 180 DAYS FROM THE DATE OF MARSHALL MEDICAL CENTER'S INITIAL BILLING OF THAT ACCOUNT. PRIOR TO FILING ANY LEGAL ACTION AGAINST A PATIENT, THE DEBT COLLECTION AGENCY WILL (A) PERFORM AN ANALYSIS OF THE PATIENT'S ASSETS AND INCOME TO DETERMINE WHETHER THE PATIENT HAS ASSETS AND INCOME SUFFICIENT TO JUSTIFY FILING THE LEGAL ACTION, (B) PRESENT THE ANALYSIS TO MARSHALL MEDICAL CENTER'S DIRECTOR OF HOSPITAL PATIENT BILLING, IN SUCH FORMAT AS MARSHALL MEDICAL CENTER MAY REQUEST, AND (C) OBTAIN THE DIRECTOR'S APPROVAL FOR FILING THE LEGAL ACTION AGAINST THE PATIENT. PART VI, LINE 2: THE COMMUNITY'S HEALTHCARE NEEDS ARE DETERMINED BASED ON MANY FACTORS INCLUDING BUT NOT LIMITED TO MARKET STUDIES, PHYSICIAN FEEDBACK BASED ON THE NEEDS OF THEIR PATIENTS, HEALTH MANPOWER STUDIES, SURVEYS, AND A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. PART VI, LINE 3: AT THE TIME OF REGISTRATION, EVERY UNINSURED PATIENT IS PRESENTED WITH A DOCUMENT THAT OUTLINES ALL THE FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS, AS WELL AS THE ORGANIZATIONAL CHARITY CARE POLICY THAT THEY MAY BE ABLE TO QUALIFY FOR. MARSHALL MEDICAL CENTER PROVIDES, AT ITS EXPENSE, PRIVATE CONSULTANTS AND COUNTY MEDI-CAL EMPLOYEES WHO WORK WITH PATIENTS DURING AND AFTER SERVICES TO ASSIST THEM IN COMPLETING THE NECESSARY FORMS, TO FILE ALL THE NECESSARY DOCUMENTS, AND TO ATTEND ANY REQUISITE APPOINTMENTS WITH PROVIDING AGENCIES. FINANCIAL COUNSELORS ARE ALSO PROVIDED TO ASSIST PATIENTS IN UNDERSTANDING ELIGIBILITY REQUIREMENTS RELATED TO QUALIFYING FOR CHARITY CARE. PART VI, LINE 4: MARSHALL MEDICAL CENTER SERVES APPROXIMATELY 158,730 RESIDENTS ON THE WESTERN SLOPE OF THE SIERRAS IN EL DORADO COUNTY. OTHER PERTINENT DEMOGRAPHICS ABOUT OUR HOSPITAL SERVICE AREA FOR TAX YEAR 2023 INCLUDE:- 20.6% IS UNDER AGE 18; 57.9% IS AGE 18-64 AND 21.5% IS AGE 65 AND OVER- PERCENTAGE LIVING IN POVERTY IS 7.9%- PERCENTAGE LACKING HIGH SCHOOL DIPLOMA IS 6.0% (EL DORADO COUNTY)- PERCENTAGE UNINSURED IS 3.6%- ETHNIC PERCENTAGES ARE: WHITE 80.1%, HISPANIC 10.6%, ASIAN 4.3%, AFRICAN AMERICAN 0.8%, NATIVE AMERICAN, PACIFIC ISLANDER OR OTHER RACE 4.2% PART VI, LINE 5: MARSHALL MEDICAL CENTER PROMOTES THE HEALTH OF THE COMMUNITY THROUGH A LARGE AND VARIED ARRAY OF HEALTHCARE SERVICES INCLUDING BUT NOT LIMITED TO INPATIENT SERVICES (OBSTETRICS, SURGERIES, RADIOLOGY, DIAGNOSTIC CARDIAC CATHETERIZATIONS) AND OUTPATIENT SERVICES (EMERGENCY ROOM, OUTPATIENT SURGERIES, RADIOLOGY, LABORATORY, DIAGNOSTIC CARDIAC CATHETERIZATIONS, NUMEROUS FAMILY AND SPECIALTY CLINICS, RURAL HEALTH CLINIC, CANCER PROGRAMS, AND HOME HEALTH VISITS). WE RECOGNIZE THAT WE HAVE AN OBLIGATION TO PROVIDE SERVICES ABOVE AND BEYOND OUR ROLE AS A HEALING FACILITY.- OPEN MEDICAL STAFF: WE OFFER AN "OPEN MEDICAL STAFF" MODEL EXCEPT FOR A FEW SELECT SPECIALTIES, WHICH ARE "EXCLUSIVE CONTRACTS".- COMMUNITY BOARD: OUR BOARD OF DIRECTORS IS COMPRISED OF 14 VOLUNTEER COMMUNITY MEMBERS. THEY DEDICATE NUMEROUS HOURS OF THEIR OWN TIME TO CONTRIBUTE TO A POSITIVE HEALTH ENVIRONMENT THROUGH MARSHALL MEDICAL CENTER.- USE OF SURPLUS FUNDS: EXCESS REVENUE (SURPLUS FUNDS) ARE RETAINED FOR FUTURE COMMUNITY NEEDS INCLUDING BUT NOT LIMITED TO CAPITAL IMPROVEMENTS, EXPANSION OF NEW SERVICES AND TECHNOLOGICAL IMPROVEMENTS. THE COMMUNITY-BASED BOARD OF DIRECTORS CONTROLS THE DIRECTION OF THE USE OF SURPLUS FUNDS. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 EL DORADO COUNTY CHAMBER OF COMMERCE 542 MAIN STREET PLACERVILLE CA 95667 941328508 501(C)(6) 12300 0 GENERAL OPERATING SUPPORT 0 1 PART I, LINE 2: MARSHALL MEDICAL CENTER'S ASSISTANCE TO EITHER AN ORGANIZATION OR AN INDIVIDUAL IS LIMITED. THE PROCEDURES FOR MONITORING THE GRANTS ARE DIFFERENT FOR EACH TYPE OF ASSISTANCE. MARKETING SPONSORSHIP ASSISTANCE - THE AMOUNTS TO EACH ORGANIZATION ARE NOMINAL AND USUALLY GIVEN TO NONPROFIT ORGANIZATIONS. NO MONITORING IS NEEDED ON THESE DONATED MONIES BASES ON MATERIALITY AND CRITERIA FOR SELECTION. PROGRAM SUPPORT RELATED TO PAYROLL FUNDING - MONITORING IS CONDUCTED AS THE FUNDS ARE ISSUED TO COVER THE PAYROLL AND BENEFIT EXPENSES OF A RELATED NONPROFIT ORGANIZATION. ADDITIONALLY, THE GRANT RECIPIENT SHARES A BOARD MEMBER WITH MARSHALL MEDICAL CENTER AND RECIPIENT MANAGEMENT REPORTS TO MARSHALL MEDICAL CENTER'S BOARD OF DIRECTORS ON AN ANNUAL BASIS. PROGRAM SUPPORT RELATED TO COMMUNITY HEALTH ISSUES - THIS FINANCIAL ASSISTANCE IS GIVEN TO A HEALTHCARE NONPROFIT FOR COMMUNITY HEALTH NEEDS. THE CARE MANAGER FOR THE RECEIVING ORGANIZATION ATTENDS CASE MANAGEMENT MEETINGS HERE AT MARSHALL AND GIVES PERIODIC VERBAL REPORTS ON PROGRESS MADE WITH THE GRANTED MONEY. THE ORGANIZATION ALSO PROVIDES COMPREHENSIVE WRITTEN REPORTS REGARDING PROGRESS ON AN ANNUAL BASIS TO MANAGEMENT. X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 SIRI NELSON PRESIDENT/CEO 547091 0 107822 0 0 0 23725 0 5187 0 683825 0 0 0 LAURIE ELDRIDGE CHIEF FINANCIAL OFFICER (THRU 10/24) 324812 0 44496 0 0 0 72359 0 5920 0 447587 0 0 0 MARTIN ENTWISTLE - ASSOCIATE CHIEF MEDICAL OFFICER/VP POP. HEALTH 337333 0 27745 0 0 0 13725 0 1281 0 380084 0 0 0 BRETT APPLEBERG - CHIEF HUMAN RESOURCES OFFICER (THRU 04/24) 276797 0 25000 0 0 0 0 0 4374 0 306171 0 0 0 CYNTHIA RICE CHIEF NURSING OFFICER 274775 0 26250 0 0 0 30298 0 781 0 332104 0 0 0 JONATHAN RUSSELL CHIEF AMBULATORY OFFICER 255947 0 24078 0 0 0 20916 0 6081 0 307022 0 0 0 BRIAN GOLDSMITH MD CHIEF MEDICAL OFFICER 260406 0 23988 0 0 0 11095 0 790 0 296279 0 0 0 MARTIN DALY VP OF INFORMATION TECHNOLOGY 252024 0 19525 0 0 0 12047 0 781 0 284377 0 0 0 MINDY DANOVARO EXECUTIVE DIRECTOR OF PHILANTHROPY 267183 0 1000 0 0 0 9792 0 2983 0 280958 0 0 0 JANICE RANGER - EXECUTIVE DIRECTOR OF FINANCE (THRU 09/23) 45100 0 102974 0 95532 0 0 0 3778 0 247384 0 0 0 ROBIN MCATEE OPERATING ROOM RN 229661 0 7453 0 3500 0 0 0 5170 0 245784 0 0 0 CORINA BRONNY STAFF RN - ICU 223336 0 9103 0 0 0 0 0 2857 0 235296 0 0 0 PART I, LINE 1A ROBIN MCATEE RECEIVED $3,500 OF GROSS-UP PAYMENTS. THIS IS INCLUDED IN TAXABLE INCOME. PART I, LINE 4A JANICE RANGER RECEIVED A SEVERANCE PAYMENT OF $95,532. THE TERMS AND CONDITIONS ARE AVAILABLE TO THE IRS UPON REQUEST. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UVPO 2020-04-27 54734815 SEE PART VI 0 0 0 B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033L6R3 2015-04-09 30423048 SEE PART VI 0 0 0 A 56046673 2911731 166675 636674 2289428 27641555 19459114 3630705 1 0 0 0 B 6080000 30423055 3849054 498389 791050 29133616 2015 1 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 1 0 0 0 0 1 1 B 0 0 1 1 0 0 0 0 1 A 1 B 1 COLUMN A, PART I (F): THE BONDS CURRENTLY REFUNDED THE BORROWER'S SERIES 2004B BONDS (ORIGINALLY ISSUED ON MARCH 25, 2004) AS WELL AS FOR THE FINANCING AND RENOVATIONS TO CERTAIN HEALTH FACILITIES, TO FUND A DEBT SERVICE RESERVE, TO PAY RELATED CAPITALIZED INTEREST AND TO PAY COST OF ISSUANCE RELATED TO THE BONDS. COLUMN A, PART II, LINE 3: THE TOTAL PROCEEDS SHOWN IN PART II, LINE 3 DIFFERS FROM THE ISSUE PRICE SHOWN IN PART I, COLUMN (E) DUE TO INTEREST EARNINGS ON INVESTED PROCEEDS. COLUMN A, PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE SECURITY OR PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATE IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY OR PAYMENT TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. COLUMN A, PART IV, LINE 2 (B): THE PORTION OF THE BOND PROCEEDS USED FOR CURRENT REFUNDING HAS MET THE 6-MONTH EXPENDITURE EXCEPTION. COLUMN B, PART I (F): THE BONDS CURRENTLY REFUNDED THE BORROWER'S SERIES 2004A BONDS (ORIGINALLY ISSUED ON MARCH 25, 2004). COLUMN B, PART II, LINE 4: THE SERIES 2015 BOND RESERVE ACCOUNT WAS FUNDED BY BOND PROCEEDS OF THE SERIES 2004A AND SERIES 2012A BONDS. COLUMN B, PART II, LINE 13: PROCEEDS OF THE BONDS WERE ISSUED FOR THE PURPOSE OF CURRENT REFUNDING; THEREFORE, THE PROJECT PERIOD IS NOT APPLICABLE FOR THIS BOND ISSUE. COLUMN B, PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE SECURITY OR PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATE IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY OR PAYMENT TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. COLUMN B, PART IV, LINE 2 (C): THE REBATE COMPUTATION WAS PERFORMED AS OF APRIL 9, 2020 AND SHOWED NO REBATE DUE. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD, THE PAST CHAIR, THE PRESIDENT/CEO, THE CHIEF OF THE MEDICAL STAFF, AND THE LONGEST-TENURED MEDICAL GROUP DIRECTOR. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION IT TAKES CANNOT CONFLICT WITH THE POLICIES AND PRIOR RESOLUTIONS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 SIRI NELSON, JONATHAN RUSSELL, AND MARTIN ENTWISTLE WERE BOARD MEMBERS OF EL DORADO SURGERY CENTER DURING THE FISCAL YEAR ENDED OCTOBER 31, 2024. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, MANAGEMENT (CFO AND EXECUTIVE DIRECTOR OF FINANCE) REVIEWED THE FORM 990 IN DETAIL. ANY APPROPRIATE CHANGES WERE MADE. THE FULL GOVERNING BOARD OF DIRECTORS (BOD) HAS DELEGATED THE RESPONSIBILITY OF REVIEWING THE FORM 990 PRIOR TO FILING WITH THE IRS TO THE BOD AUDIT COMMITTEE, A SUBCOMMITTEE OF THE FULL GOVERNING BOD, SO THE FORM 990 WAS THEN SUBMITTED TO THE GOVERNING BOD AUDIT COMMITTEE. THE AUDIT COMMITTEE PERFORMED A HIGH-LEVEL REVIEW OF THE FORM 990 AND REQUESTED MANAGEMENT TO MAKE ANY CHANGES THE COMMITTEE DEEMED NECESSARY. PRIOR TO FILING THE FORM 990 WITH THE IRS, THE AUDIT COMMITTEE PROVIDED A SUMMARY TO THE FULL GOVERNING BOD OF THE BOD AUDIT COMMITTEE'S REVIEW OF THE FORM 990. AT ANY TIME, BOTH BEFORE OR AFTER FILING, THE COMPLETE FORM 990 WAS AVAILABLE UPON REQUEST TO ANY MEMBER OF THE GOVERNING BOD. FORM 990, PART VI, SECTION B, LINE 12C CHIEF ADMINISTRATIVE OFFICERS, VICE PRESIDENTS, DIRECTORS, ASSISTANT DIRECTORS, PURCHASING STAFF, LEGAL STAFF, COMPLIANCE STAFF, AND MEMBERS OF THE GOVERNING BOARD ARE REQUIRED TO ANNUALLY PROVIDE A DISCLOSURE STATEMENT IDENTIFYING ANY ORGANIZATIONS IN WHICH THE INDIVIDUAL OR AN IMMEDIATE FAMILY MEMBER HAS AN INTEREST IN. THERE IS NO MINIMUM AMOUNT OF VALUE OF AN ITEM, SERVICE, OR ARRANGEMENT THAT WILL TRIGGER A CONFLICT OF INTEREST. DISCLOSURE STATEMENTS ARE REVIEWED BY THE CEO FOR ANY ACTUAL OR POTENTIAL CONFLICTS. THE CEO'S DISCLOSURE STATEMENT IS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEES OF THE GOVERNING BOARD. THE GOVERNING BOARD'S DISCLOSURE STATEMENTS ARE REVIEWED BY THE ADMINISTRATIVE OFFICE PERSONNEL. SHOULD ANY TRANSACTION INVOLVING POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARISE, THE CEO APPOINTS A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE ARRANGEMENT IN QUESTION, CONCLUDE THAT THE TRANSACTION IS FAIR AND REASONABLE TO THE HOSPITAL, BE APPROVED IN GOOD FAITH BY A VOTE OF THE DIRECTORS THAT DO NOT HAVE A CONFLICT, AND THAT THE HOSPITAL COULD NOT OBTAIN A MORE ADVANTAGEOUS ARRANGEMENT UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD DETERMINES THE CEO'S COMPENSATION WITH INPUT FROM THE AUDIT AND COMPLIANCE COMMITTEES, USING DATA COMPILED FROM THE CALIFORNIA HEALTHCARE ASSOCIATION'S ALLIED FOR HEALTH EXECUTIVE COMPENSATION SURVEY, WILLIS TOWERS WATSON EXECUTIVE COMPENSATION SURVEY, AND OTHER SOURCES SUCH AS AN INDEPENDENT COMPENSATION CONSULTANT, ALL IN ACCORDANCE WITH THE HOSPITAL'S EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT. THE PROCESS FOR DETERMINING THE CEO'S COMPENSATION INVOLVES THE EXECUTIVE TEAM MEETING WITH THE BOARD TO DISCUSS COMPENSATION MATTERS. KASSY PAUL, EXECUTIVE ASSISTANT TO THE BOARDS, RECORDS THESE DISCUSSIONS IN THE BOARD MINUTES, WHICH ARE THEN APPROVED AT THE FOLLOWING BOARD MEETING. THE CEO'S TOTAL REWARDS PACKAGE IS REVIEWED EVERY THREE YEARS BY OUTSIDE CONSULTANTS. IN 2024, THIS REVIEW WAS CONDUCTED BY WILLIS TOWERS WATSON. ADDITIONALLY, THE CEO IS ELIGIBLE FOR THE ANNUAL INCENTIVE PROGRAM (AIP) AND MERIT INCREASES, CONSISTENT WITH OTHER ASSOCIATES. THE CEO DETERMINES COMPENSATION FOR OFFICERS AND KEY EMPLOYEES. EXECUTIVE COMPENSATION SURVEYS, AN INDEPENDENT COMPENSATION CONSULTANT, AND COMPARABILITY DATA WERE USED TO DETERMINE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 56,253,769. MANAGEMENT AND GENERAL EXPENSES 1,392,170. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,645,939. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,491,497. MANAGEMENT AND GENERAL EXPENSES 3,773,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,265,379. FORM 990, PART XI, LINE 9: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 152,974. GRANT REVERSAL FOR FY 2023 -237,116. 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