2018-11-14T17:15:19-06:00 2017-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2017-01-01 951816005 BEVERLY COMMUNITY HOSPITAL ASSOCIATION BEVE 3237261222 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 906404308 LARRY PUGH SENIOR VICE PRESIDENT/CFO 3237261222 2018-11-09 1 LAUREN HAVERLOCK P00545829 4159561500 2018-11-09 12.129.7.100 2018-11-09 20:28:32 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 5029E8FD9FE66385FA59B177B15FCADA276E8E0F 2017 2019-02-21 02:37:17Z ALICE CHENG 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 906404308 205645354 0 X WWW.BEVERLY.ORG X 1949 CA TO BE A LEADING INDEPENDENT, NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION, AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 11 10 1085 105 0 0 562238 261399 188374363 204164838 41683 142234 281862 1076883 189260146 205645354 5000 0 0 0 63607672 66133731 0 0 0 116204828 128919793 179817500 195053524 9442646 10591830 156351860 193299943 86931460 113287256 69420400 80012687 TO BE A LEADING INDEPENDENT, NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION, AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 0 0 118038903 147154503 INPATIENT AND OUTPATIENT HOSPITAL SERVICES - HOSPITAL SERVICES PROVIDED BY BEVERLY COMMUNITY HOSPITAL ASSOCIATION INCLUDED 9,206 INPATIENT ADMISSONS, 20,824 OUTPATIENT VISITS, AND 38,233 EMERGENCY ROOM VISITS IN 2017. CARE IS PROVIDED WITHOUT CHARGE TO PATIENTS WHO MEET SPECIFIED CRITERIA UNDER THE CHARITY CARE POLICY. THE COST OF CHARITY CARE PROVIDED TOTALED $1,069,000 IN 2017. 45730421 0 57010335 CAPITATION SERVICES - BEVERLY COMMUNITY HOSPITAL ASSOCIATION CONTRACTS WITH BLUE CROSS OF CALIFORNIA AND HEALTH NET OF CALIFORNIA TO PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AT FULL RISK TO ENROLLED MEDI-CAL BENEFICIARIES WHO ARE CONCURRENTLY ENROLLED WITH A LOCAL MEDICAL GROUP. ENROLLMENT DURING 2017 WAS 1,178,198 MEMBER MONTHS. 163769324 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 675 0 1 1085 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X LARRY PUGH 3237255095 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 X CARLOS MANUEL HARO PHD CHAIRMAN 2.00 2.00 X X 0 0 0 DENTON GUTHRIE CPA FIRST VICE CHAIRPERSON 2.00 2.00 X X 0 0 0 LYLA EDDINGTON EDD SECOND VICE CHAIRPERSON 2.00 2.00 X X 0 0 0 GAUTAM GANGULY MD TREASURER 2.00 2.00 X X 0 0 0 ROSEMARY OROZCO SECRETARY 2.00 2.00 X X 0 0 0 GARY R EINSTEIN ESQ BOARD MEMBER 2.00 2.00 X 0 0 0 GOHARIK GABRIEL BOARD MEMBER 2.00 3.00 X 0 0 0 AZIZ KHAN MD BOARD MEMBER 2.00 2.00 X 0 0 0 CARLOS MAKABALI MD BOARD MEMBER 2.00 2.00 X 56500 0 0 RENEE D MARTINEZ BOARD MEMBER 2.00 2.00 X 0 0 0 ALMA PEREZ SPHR BOARD MEMBER 2.00 2.00 X 0 0 0 ALICE CHENG PRESIDENT & CEO 40.00 3.00 X 510927 0 20111 LARRY PUGH SENIOR VP/CFO 40.00 3.00 X 324638 0 8526 WENDY R BEESLEY SENIOR VP/COO 40.00 0.00 X 283058 0 16096 JOHN G BARNES ADMINISTRATIVE DIRECTOR, H.R. 40.00 0.00 X 228346 0 13260 KATHRYN ROSS VP OF NURSING THROUGH 4/2017 40.00 0.00 X 157521 0 1925 K LAWRENCE COHEN MD CHIEF MEDICAL OFFICER 40.00 0.00 X 309040 0 0 LORETTA MANNDAVIS CIO THROUGH 11/2017 40.00 0.00 X 322569 0 11613 ASHLEY LI REGISTERED NURSE 36.00 0.00 X 191873 0 6495 ROY RORICK REGISTERED NURSE 36.00 0.00 X 190299 0 17243 LESTER FUJIMOTO VP OF DEV AND COMMUNITY RELATIONS 16.00 24.00 X 183097 0 1275 JOEL LAZARO REGISTERED NURSE 36.00 0.00 X 179312 0 17138 2937180 0 113682 143 0 1 0 SODEXHO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GAITHERSBURG MD 20878 FOOD & HOUSEKEEPING SERVICES 3506408 SOUTHLAND MANAGEMENT GROUP INC 3300 E SOUTH STREET SUITE 307 LONG BEACH CA 90805 DIALYSIS SERVICES 1003550 PARADIGM MEDICAL MANAGEMENT 23332 HAWTHORNE BLVD SUITE 301 TORRANCE CA 90505 WOUND CARE MANAGEMENT SERVICES 879984 ALLIED UNIVERSAL SECURITY SERVICES 161 WASHINGTON ST SUITE 600 CONSHOHOCKEN PA 19428 SECURITY SERVICES 765700 DOYLE & SCHAFER LLP 8105 IRVINE CENTER DRIVE SUITE 520 IRVINE CA 92618 LEGAL SERVICES 353981 113 261399 261399 NET PATIENT SERVICE REVENUE 621990 147154503 147154503 PREMIUM REVENUE 621990 57010335 57010335 204164838 91737 91737 45656 45656 59990 0 59990 59990 59990 4841 0 4841 4841 4841 REBATES & REFUNDS 900099 540976 540976 MISCELLANEOUS REVENUE 900099 432629 432629 BENEFICIAL INTEREST IN FOUNDATION 900099 43288 43288 1016893 205645354 204164838 0 1219117 X 1929947 524986 1404961 50516291 46171493 4344798 364151 160775 203376 9383142 4063460 5319682 3940200 3715824 224376 591012 591012 4110081 4110081 64539715 62047219 2492496 425846 310005 115841 1189110 1189110 513968 395585 118383 3453 1731 1722 166881 166881 6623341 1914331 4709010 2330903 2330903 HOSPITAL FEE PROGRAM 21000380 21000380 MEDICAL SUPPLIES 17603090 17591828 11262 EQUIPMENT RENTALS 4815883 2659943 2155940 5006130 3211764 1794366 195053524 163769324 31284200 0 11544023 11877132 20268814 25512135 20001651 20718808 222782 904496 3041177 3507201 1248547 989252 169445001 88241903 73569636 81203098 1475738 1475738 298011 298011 24681481 46814072 156351860 193299943 20019002 22090510 40638073 61126640 4575157 4978402 21699228 25091704 86931460 113287256 X 69420400 80012687 69420400 80012687 156351860 193299943 10591830 457 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 147991 147991 0 PART II-B, LINE 1: BEVERLY COMMUNITY HOSPITAL ASSOCIATION SUPPORTS CERTAIN INITIATIVES AND ISSUES THAT ARE HEALTHCARE RELATED AND CONSISTENT WITH ITS MISSION OF PROMOTING HEALTHCARE IN THE COMMUNITY. EXPENDITURES INCURRED TO SUPPORT THESE INITIATIVES MAY BE CONSIDERED TO BE LOBBYING EXPENDITURES. AN INDIRECT EXPENDITURE OF THE HOSPITAL'S MEMBERSHIP DUES PAID TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) WERE USED FOR LOBBYING ACTIVITIES. 1398730 1398730 114864696 61879490 52985206 584120 584120 0 19771051 15746478 4024573 32826404 10031815 22794589 81203098 DUE FROM RELATED PARTIES 3805713 THIRD PARTY PAYOR RECEIVABLES 30023610 UNAMORTIZED LOAN COSTS 2859 MALPRACTICE/WORKER'S COMP INSURANCE RECEIVABLES 3687000 ASSETS LIMITED AS TO USE 7438918 BENEFICIAL INTEREST IN AFFILIATE 1482330 OTHER RECEIVABLES 271014 DEPOSITS 102628 46814072 ACCRUED SELF-INSURED LIABILITIES 7290969 CAPITAL LEASE LIABILITIES 637642 DUE TO RELATED PARTIES 3906775 MEDICAL CLAIMS LIABILITIES 12408353 SHARED RISK LIABILITY 847965 25091704 X PART X, LINE 2: THE CORPORATION RECOGNIZES THE TAX EXPENSE OR PROVISION FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. 1 1 X 1 X 350.000000000000 1 X 450.000000000000 1 1 1 0 1 1 1449090 1449090 0.00740 88310551 76594557 11715994 0.06010 89759641 76594557 13165084 0.06750 4935283 4935283 0.02530 602745 602745 0.00310 5538028 5538028 0.02840 95297669 76594557 18703112 0.09590 24657 24657 0.00010 24657 24657 0.00010 1 8033985 0 33737366 29305287 4432079 X 1 1 1 1 BEVERLY HOSPITAL 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 WWW.BEVERLY.ORG 930000389 X X X BEVERLY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.BEVERLY.ORG/ABOUT-US/IN-THE-COMMUNITY/ X 1 16 1 WWW.BEVERLY.ORG/ABOUT-US/IN-THE-COMMUNITY/ 0 1 X 350.000000000000 450.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.BEVERLY.ORG/PATIENTS/ X HTTPS://WWW.BEVERLY.ORG/PATIENTS/ X HTTPS://WWW.BEVERLY.ORG/PATIENTS/ X X X X X X 1 X 0 X 1 X 0 0 BEVERLY HOSPITAL PART V, SECTION B, LINE 5: TARGETED INTERVIEWS AND FOCUS GROUPS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. SEVENTEEN (17) INTERVIEWS WERE COMPLETED IN JUNE AND JULY, 2016. FOR THE INTERVIEWS, COMMUNITY STAKEHOLDERS IDENTIFIED BY BEVERLY HOSPITAL WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. INPUT WAS OBTAINED FROM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH OFFICIALS. AT THE BEGINNING OF EACH INTERVIEW, THE PURPOSE OF THE INTERVIEW IN THE CONTEXT OF THE ASSESSMENT WAS EXPLAINED, THE STAKEHOLDERS WERE ASSURED THEIR RESPONSES WOULD REMAIN CONFIDENTIAL, AND CONSENT TO PROCEED WAS GIVEN.FOUR FOCUS GROUPS WERE CONDUCTED IN JULY 2016 AND ENGAGED 43 PERSONS. THE FOCUS GROUP MEETINGS WERE HOSTED BY TRUSTED COMMUNITY ORGANIZATIONS. AN AGENCY CONTACT WAS AVAILABLE TO ANSWER ANY QUESTIONS AT EACH FOCUS GROUP. AT THE BEGINNING OF EACH FOCUS GROUP, THE PURPOSE OF THE FOCUS GROUP AND THE COMMUNITY ASSESSMENT WERE EXPLAINED, THE PARTICIPANTS WERE ASSURED THEIR RESPONSES WOULD NOT BE ATTRIBUTED TO THEM AS RESPONSES WOULD BE AGGREGATED. ONE OF THE FOCUS GROUPS WAS CONDUCTED IN SPANISH WITH A BILINGUAL FACILITATOR. THE FOCUS GROUP DISCUSSIONS WERE VOICE RECORDED FOR EASE OF DOCUMENTING THE DISCUSSION. BEFORE BEGINNING THE DISCUSSION, THE FACILITATOR ASKED FOR ORAL CONSENT FROM EACH OF THE PARTICIPANTS THAT THEY WISHED TO PARTICIPATE IN THE FOCUS GROUP AND AGREED TO BE VOICE RECORDED. THE FOCUS GROUP PARTICIPANTS WERE ASKED TO SHARE THEIR PERSPECTIVES RELATED TO TOPICS WITHIN THE FOLLOWING AREAS: (I) BIGGEST ISSUES AND HEALTH CONCERNS FACING THE COMMUNITY; (II) ISSUES, CHALLENGES, BARRIERS FACED BY COMMUNITY MEMBERS SPECIFIC TO THE IDENTIFIED HEALTH NEEDS; (III) SPECIAL POPULATIONS OR GROUPS THAT ARE MOST AFFECTED BY A HEALTH NEED; (IV) PROGRAMS AND RESOURCES AVAILABLE TO ADDRESS THE HEALTH NEEDS; (V) HOW THE HOSPITAL CAN HELP ADDRESS THE COMMUNITY NEEDS; AND (VI) OTHER COMMENTS OR CONCERNS. A LIST OF THE STAKEHOLDER INTERVIEW RESPONDENTS, THEIR TITLES AND ORGANIZATIONS, AND THE FOCUS GROUPS CAN BE FOUND IN ATTACHMENT 1 OF THE CHNA POSTED ON THE ORGANIZATION'S WEBSITE. BEVERLY HOSPITAL PART V, SECTION B, LINE 11: TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE 2016 CHNA, THE HOSPITAL PLANS TO BUILD ON PREVIOUS CHNA EFFORTS AND EXISTING INITIATIVES, WHILE ALSO CONSIDERING NEW STRATEGIES AND EFFORTS TO IMPROVE HEALTH. THE FOLLOWING CRITERIA WERE USED BY THE HOSPITAL'S LEADERSHIP TEAM TO DETERMINE WHICH SIGNIFICANT HEALTH NEEDS BCHA WILL ADDRESS IN THE IMPLEMENTATION STRATEGY: (I) WHETHER THERE IS CAPACITY TO ADDRESS THE ISSUE, (II) WHETHER THERE ARE PROGRAMS, SYSTEMS, STAFF, AND SUPPORT RESOURCES IN PLACE TO ADDRESS THE ISSUE; (III) ARE THERE EXISTING RESOURCES COMMITTED TO THE ISSUE; AND (IV) DOES BCHA HAVE THE COMPETENCIES AND EXPERTISE TO ADDRESS THE ISSUE, AND DOES THE ISSUE FIT WITH THE ORGANIZATIONAL MISSION. AS A RESULT OF THE REVIEW OF THE NEEDS AND APPLICATION OF THE ABOVE CRITERIA, BCHA WILL ADDRESS: ACCESS TO CARE; CHRONIC DISEASES; MENTAL HEALTH; OVERWEIGHT AND OBESITY; AND PREVENTIVE PRACTICES THROUGH A COMMITMENT OF COMMUNITY BENEFIT PROGRAMS AND CHARITABLE RESOURCES.BCHA WILL ADDRESS ACCESS TO CARE BY TAKING THE FOLLOWING ACTIONS: (I) PROVIDING FINANCIAL ASSISTANCE THROUGH BOTH FREE AND DISCOUNTED CARE FOR HEALTH CARE SERVICES, CONSISTENT WITH THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY; (II) PROVIDE TRANSPORTATION SUPPORT TO INCREASE ACCESS TO HEALTH CARE SERVICES; (III) OFFER INFORMATION AND ENROLLMENT ASSISTANCE IN THE COVERED CALIFORNIA HEALTH CARE EXCHANGE AND OTHER LOW-COST-INSURANCE PROGRAMS, AS WELL AS INFORMATION ABOUT MEDICARE BENEFITS UPDATES; (IV) PURSUE FEDERALLY QUALIFIED HEALTH CARE STATUS FOR HOSPITAL-BASED CLINICS TO PROVIDE PRIMARY CARE SERVICES TO UNDERSERVED POPULATIONS; (V) RENOVATE THE EMERGENCY DEPARTMENT TO DOUBLE THE NUMBER OF ED BEDS AVAILABLE; AND (VI) PARTNER WITH HEALTH CARE PROVIDERS TO OPEN AN URGENT CARE FACILITY IN MONTEBELLO. IN ORDER TO ACCOMPLISH THE PLANNED ACTIVITIES, BCHA ANTICIPATES COLLABORATING WITH BOTH ALTAMED HEALTH SERVICES AND THE CENTER FOR HEALTHCARE RIGHTS.BCHA WILL ADDRESS CHRONIC DISEASE BY TAKING THE FOLLOWING ACTIONS: (I) THROUGH THE DIABETES CENTER, PROVIDE FREE DIABETES EDUCATION AND HOST DIABETES EVENTS (INCLUDING BLOOD GLUCOSE SCREENING AND NUTRITION CLASSES); (II) OFFER CPR CLASSES; (III) HOST HEALTH AND WELLNESS FAIRS FOR SENIORS, INCLUDING SCREENINGS; (IV) INCREASE CARDIAC AWARENESS THROUGH HEALTH EDUCATION AND SCREENING TESTS TO IDENTIFY CARDIAC DISEASE; (V) PROVIDE SUPPORT GROUPS TO ASSIST THOSE WITH CHRONIC DISEASES AND THEIR FAMILIES; (VI) PROVIDE PUBLIC HEALTH EDUCATION IN THE MEDIA AND COMMUNITY HEALTH AWARENESS EVENTS TO ENCOURAGE HEALTH BEHAVIORS AND PREVENT CHRONIC DISEASES; AND (VII) PURSUE STROKE CENTER DESIGNATION. IN ORDER TO ACCOMPLISH THE PLANNED ACTIVITIES, BCHA ANTICIPATES COLLABORATING WITH THE AMERICAN DIABETES ASSOCIATION, THE AMERICAN HEART ASSOCIATION, THE AMERICAN STROKE ASSOCIATION, THE CITY OF MONTEBELLO, LOCAL CHURCHES, THE MONTEBELLO POLICE DEPARTMENT EMS AGENCY, THE MONTEBELLO-COMMERCE YMCA, THE MONTEBELLO UNIFIED SCHOOL DISTRICT, SENIOR CENTERS, AND TELACU - SENIOR VILLAS.BCHA WILL ADDRESS MENTAL HEALTH BY TAKING THE FOLLOWING ACTIONS: (I) OFFER COMMUNITY HEALTH EDUCATION, COMMUNITY LECTURES, PRESENTATIONS, AND WORKSHOPS; (II) SUPPORT MULTISECTOR COLLABORATIVE EFFORTS THAT SUPPORT ACCESS TO MENTAL HEALTH SERVICES; (III) INCREASE COMMUNITY AWARENESS OF PREVENTION EFFORTS AND AVAILABILITY OF RESOURCES TO ADDRESS MENTAL AND BEHAVIORAL HEALTH CONCERNS; AND (IV) PURSUE FEDERALLY QUALIFIED HEALTH CARE STATUS FOR HOSPITAL-BASED CLINICS TO PROVIDE MENTAL HEALTH CARE SERVICES TO UNDERSERVED POPULATIONS. IN ORDER TO ACCOMPLISH THE PLANNED ACTIVITIES, BCHA ANTICIPATES COLLABORATING WITH: THE CITY OF MONTEBELLO, THE LA COUNTY DEPARTMENT OF PUBLIC HEALTH, THE MONTEBELLO-COMMERCE YMCA; AND THE NATIONAL ALLIANCE ON MENTAL ILLNESS.BCHA WILL ADDRESS OVERWEIGHT AND OBESITY BY TAKING THE FOLLOWING ACTIONS: (I) OFFER COMMUNITY HEALTH EDUCATION, COMMUNITY LECTURES, PRESENTATIONS, AND WORKSHOPS; (II) HOST HEALTH AND WELLNESS FAIRS THAT INCLUDE SCREENINGS FOR BMI, BLOOD PRESSURE, AND BLOOD GLUCOSE; (III) SUPPORT THE KIDSFIT PROGRAM, A 12-WEEK SESSION TO HELP OVERWEIGHT CHILDREN AND THEIR FAMILIES DEVELOP HEALTHY EATING AND PHYSICAL ACTIVITY HABITS; (IV) PROVIDE NUTRITION CLASSES FOR THE COMMUNITY; AND (V) SUPPORT INCREASED BREASTFEEDING EDUCATION THROUGH THE BABY-FRIENDLY HOSPITAL INITIATIVE. IN ORDER TO ACCOMPLISH THE PLANNED ACTIVITIES, BCHA ANTICIPATES COLLABORATING WITH: THE EAST LOS ANGELES NETWORK FOR HEALTH CALIFORNIA, THE LA COUNTY DEPARTMENT OF PUBLIC HEALTH, THE MONTEBELLO-COMMERCE YMCA, PEDIATRICIANS, AND WIC.BCHA WILL ADDRESS PREVENTIVE PRACTICES BY TAKING THE FOLLOWING ACTIONS: (I) PROVIDE FREE HEALTH SCREENINGS; (II) PROVIDE EDUCATION AND RESOURCES FOCUSED ON HEALTHY LIVING AND DISEASE PREVENTION TO BE OFFERED IN ENGLISH AND SPANISH; (III) PROVIDE EDUCATION TO TEENS ON ABSTINENCE, BIRTH CONTROL, SEXUALLY TRANSMITTED DISEASES, AND PREGNANCY PREVENTION; (IV) OFFER FREE CHILDHOOD IMMUNIZATIONS AND ADULT FLU SHOTS; (V) PROVIDE TB TESTING; (VI) THROUGH HOSPITAL-BASED CLINICS, OFFER BREAST AND CERVICAL CANCER SCREENINGS AT LOW AND NO-COST FOR WOMEN THROUGH THE FAMILY PACT AND EVERY WOMAN COUNTS PROGRAMS; AND (VII) PURSUE FEDERALLY QUALIFIED HEALTH CARE STATUS FOR HOSPITAL-BASED CLINICS TO PROVIDE PRIMARY CARE SERVICES TO UNDERSERVED POPULATIONS. IN ORDER TO ACCOMPLISH THE PLANNED ACTIVITIES, BCHA ANTICIPATES COLLABORATING WITH: THE LOCAL CHAMBER OF COMMERCE, THE CITY OF MONTEBELLO, THE FIREFIGHTERS ASSOCIATION, LOCAL CHURCHES, THE MONTEBELLO POLICE DEPARTMENT, THE MONTEBELLO SCHOOL DISTRICT HEAD START PROGRAM, THE MONTEBELLO UNIFIED SCHOOL DISTRICT, THE MONTEBELLO-COMMERCE YMCA, THE PICO RIVERA WOMEN'S CLUB, AND SENIOR CENTERS.TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, BCHA WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA, INCLUDING: DENTAL HEALTH, SUBSTANCE ABUSE, AND TEEN PREGNANCY. KNOWING THAT THERE ARE NOT SUFFICIENT RESOURCES TO ADDRESS ALL THE COMMUNITY HEALTH NEEDS, BCHA CHOSE TO CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN THE ORGANIZATION'S AREAS OF FOCUS AND EXPERTISE. 2 1 - WOMEN'S CARE CENTER 1920 W WHITTIER BLVD MONTEBELLO CA 90640 OUTPATIENT CLINIC - COMPREHENSIVE PERINATAL SERVICES PROGRAM (CPSP) 2 - FAMILY CARE CENTER 101 E BEVERLY BLVD MONTEBELLO CA 90640 OUTPATIENT CLINIC - COMPREHENSIVE PRIMARY CARE SERVICES PART I, LINE 7: BEVERLY HOSPITAL USES COST TO CHARGE RATIO TO DETERMINE THE AMOUNTS ON SCHEDULE H, PART I, LINE 7A AND 7B. COST ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS ON PART I, LINES 7E AND 7F. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT: IN 2017, THE HOSPITAL PROVIDED SUPPORT TO THE CHAMBERS OF COMMERCE IN WHITTIER, MONTEBELLO, PICO RIVERA, SANTA FE SPRINGS, CITY OF COMMERCE AND ROSEMEAD. AS PART OF THE HOSPITAL'S WORK WITH EACH CHAMBER, HOSPITAL STAFF ACTIVELY PARTICIPATE IN EVENTS SUCH AS THE ANNUAL MONTEBELLO BUSINESS EXPO, THE INSTALLATION DINNERS FOR MONTEBELLO AND PICO RIVERA AND ATTEND LOCAL BUSINESS RIBBON CUTTING CEREMONIES. IN OCTOBER, BEVERLY HOSPITAL HOSTED AN ANNUAL TRI-CHAMBER BREAKFAST WHERE THE CHAMBERS FROM MONTEBELLO, SANTA FE SPRINGS AND COMMERCE JOIN TO UPDATE LOCAL BUSINESSES ON THE VARIOUS ENDEAVORS THE HOSPITAL IS UNDERTAKING.WORKFORCE DEVELOPMENT: THE HOSPITAL PARTICIPATED IN A NUMBER OF COLLEGE AND HIGH SCHOOL-HOSTED HEALTH CARE CAREER DAYS TO PROVIDE INFORMATION ON HEALTH CARE CAREERS, INCLUDING EL RANCHO HIGH SCHOOL, VAIL HIGH SCHOOL, STANDBRIDGE COLLEGE, WEST COAST UNIVERSITY. THESE EVENTS REACHED THOUSANDS OF STUDENTS. BEVERLY HOSPITAL SERVED AS A TRAINING SITE FOR 40 STUDENTS IN THE MONTEBELLO UNIFIED SCHOOL DISTRICT REGIONAL OCCUPATIONAL PROGRAM. IT ALSO PROVIDED TRAINING OPPORTUNITIES FOR 66 STUDENTS INTERESTED IN A CAREER IN HEALTH CARE THROUGH THE APPLIED TECHNOLOGY CENTER MONTEBELLO HIGH SCHOOL PATHWAYS PROGRAM. PART III, LINE 2: BAD DEBT EXPENSE IS ESTIMATED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT REGULARLY REVIEWS COLLECTIONS DATA BY MAJOR PAYOR SOURCES. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S SELF-PAY PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED TO SELF-PAY PATIENTS. PART III, LINE 4: THE FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS (ATTACHED TO THIS FORM 990) WHICH ADDRESSES "PROVISION FOR BAD DEBTS AND "ALLOWANCE FOR DOUBTFUL ACCOUNTS" CAN BE FOUND ON PAGE 10 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: A COST TO CHARGE RATIO IS USED TO DETERMINE THE MEDICACRE ALLOWABLE COSTS OF CARE ON SCHEDULE H, PART III, LINE 6. PART III, LINE 9B: PATIENTS IN THE PROCESS OF QUALIFYING FOR GOVERNMENT OR HOSPITAL LOW-INCOME FINANCIAL ASSISTANCE PROGRAMS WILL NOT BE ASSIGNED TO COLLECTIONS PRIOR TO 150 DAYS FROM THE DATE OF INITIAL BILLING. ADDITIONALLY, LOW-INCOME PATIENTS, WHO AT THE SOLE DISCRETION OF THE HOSPITAL ARE REASONABLY COOPERATING TO SETTLE AN OUTSTANDING HOSPITAL BILL, WILL NOT BE SENT TO AN OUTSIDE COLLECTION AGENCY IF DOING SO WOULD NEGATIVELY IMPACT THE PATIENT'S CREDIT. PART VI, LINE 2: NEEDS ASSESSMENT: THE 2016 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH A COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY-SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. PART VI, LINE 3: PUBLIC NOTICES ARE POSTED OF THE FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE IN THE HIGH VOLUME INPATIENT, OUTPATIENT, AND EMERGENCY SERVICE AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED IN THE PATIENT FINANCIAL AND COLLECTION DEPARTMENTS. THESE NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE. PART VI, LINE 4: THE POPULATION OF THE BEVERLY HOSPITAL SERVICE AREA WAS 710,992. CHILDREN AND YOUTH, AGES 0-17, MAKE UP 27.8% OF THE POPULATION; 59.3% ARE ADULTS, AGES 18-64; AND 12.2% OF THE POPULATION ARE SENIORS, 65 AND OVER. IN THE SERVICE AREA, 77.1% OF THE POPULATION IS HISPANIC/LATINO; 17.1% OF THE RESIDENTS ARE ASIAN; 4.8% ARE WHITE; 0.6% ARE AFRICAN AMERICAN; AND 0.9% ARE AMERICAN INDIAN/ALASKAN NATIVE OR OTHER OR MULTIPLE RACE/ETHNICITY. THIS IS A MUCH HIGHER PERCENTAGE OF HISPANICS/LATINOS AND A MUCH LOWER PERCENTAGE OF WHITES THAN FOUND AT THE COUNTY LEVEL. THERE ARE ALSO A HIGHER PERCENTAGE OF ASIANS AND A LOWER PERCENTAGE OF BLACKS THAN FOUND COUNTY-WIDE. THE LANGUAGES SPOKEN AT HOME BY AREA RESIDENTS MIRROR THE RACIAL/ETHNIC MAKE-UP OF THE BEVERLY HOSPITAL SERVICE AREA COMMUNITIES: SPANISH IS SPOKEN IN THE HOME AMONG 65.1% OF THE POPULATION; ENGLISH IS SPOKEN AT HOME AMONG 18.9% OF THE POPULATION; 15% OF THE POPULATION SPEAK AN ASIAN LANGUAGE; AND 1% OF THE POPULATION SPEAKS ANOTHER LANGUAGE AT HOME. THE MEDIAN HOUSEHOLD INCOME RANGES FROM $37,082 TO $70,841. PART VI, LINE 5: OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY INCLUDE: (I) THE BOARD OF DIRECTORS IS MADE UP OF PRIMARILY OF MEMBERS OF THE SURROUNDING COMMUNITY WHO ARE NOT PAID BY BEVERLY HOSPITAL; (II) THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUITY FOR, DEPENDNG ON NEED; AND (III) SURPLUS FUNDS ARE APPLIED TO IMPROVE PATIENT CARE AND MEDICAL EDUCATION.ADDITIONALLY, BEVERLY HOSPITAL HAS AN ARRAY OF COMMUNITY OUTREACH PROGRAMS WHICH HELP TO PROMOTE THE HEALTH OF ITS SURROUNDING COMMUNITY. THESE PROGRAMS INCLUDE: FREE CHILDHOOD IMMUNIZATIONS FOR NEWBORNS TO THE AGE OF 18; MATERNITY CLASSES AND EVENTS; KIDSFIT AND TEENSFIT PROGRAMS, WHICH ARE DESIGNED TO HELP OVERWEIGHT KIDS DEVELOP GOOD EATING AND EXERCISE HABITS; A 50+ CONNECTION PROGRAM, WHICH PROVIDES REDUCED RATES ON PRESCRIPTIONS, MEDICAL EQUIPMENT, LEGAL COUNSELING, DENTAL AND VISION SERVICES, AND SOCIAL ACTIVITIES; SUPPORT GROUPS (GRIEF, ALZHEIMERS AND DEMENTIA, CAREGIVERS); AND VARIOUS HEALTH EDUCATION & SCREENINGS. PART VI, LINE 7, REPORTS FILED WITH STATES CA X X X X 1 0 0 0 0 1 0 0 0 ALICE CHENG PRESIDENT & CEO 419899 0 83036 0 7992 0 3991 0 16120 0 531038 0 0 0 LARRY PUGH SENIOR VP/CFO 300097 0 12863 0 11678 0 2182 0 6344 0 333164 0 0 0 WENDY R BEESLEY SENIOR VP/COO 245232 0 35900 0 1926 0 1926 0 14170 0 299154 0 0 0 JOHN G BARNES ADMINISTRATIVE DIRECTOR, H.R. 202120 0 19813 0 6413 0 1593 0 11667 0 241606 0 0 0 KATHRYN ROSS VP OF NURSING THROUGH 4/2017 60174 0 20469 0 76878 0 567 0 1358 0 159446 0 0 0 K LAWRENCE COHEN MD CHIEF MEDICAL OFFICER 309040 0 0 0 0 0 0 0 0 0 309040 0 0 0 LORETTA MANNDAVIS CIO THROUGH 11/2017 198002 0 19609 0 104958 0 1551 0 10062 0 334182 0 0 0 ASHLEY LI REGISTERED NURSE 191821 0 0 0 52 0 1451 0 5044 0 198368 0 0 0 ROY RORICK REGISTERED NURSE 190299 0 0 0 0 0 1487 0 15756 0 207542 0 0 0 LESTER FUJIMOTO VP OF DEV AND COMMUNITY RELATIONS 162194 0 12863 0 8040 0 1275 0 0 0 184372 0 0 0 JOEL LAZARO REGISTERED NURSE 178750 0 0 0 562 0 1385 0 15753 0 196450 0 0 0 PART I, LINE 4A THE CIO RECEIVED A SEVERANCE OF $104,364 DURING 2017, WHICH IS REPORTED AS "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). ADDITIONALLY, THE VP OF NURSING RECEIVED A SEVERANCE OF $52,380, WHICH IS REPORTED AS "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). PART I, LINE 6 THE ORGANIZATION PAYS BONUSES TO CERTAIN EMPLOYEES OF THE ORGANIZATION CONTINGENT ON VARIOUS PERFORMANCE MEASURES, ONE OF WHICH INCLUDES THE ORGANIZATION MEETING BUDGETED FINANCIAL MEASURES. A CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SLL6 2015-12-02 41768337 IMPROVEMENT, RENOVATION, AND EQUIPPING HOSPITAL/REFUND BOND DATED 9/30/2015 0 0 0 B CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 13080SRG1 2017-05-09 20998252 IMPROVEMENT, RENOVATION, AND EQUIPPING HOSPITAL 0 0 0 A 41768337 537891 768338 11364482 29097626 1 0 1 1 B 21043908 396800 13208290 7438918 0 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 SCHEDULE K, PART I, COLUMN (E) AND PART II, COLUMN (B), LINE 3: THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND THE TOTAL PROCEEDS OF ISSUE IN PART II, LINE 3 FOR THE BOND DATED 5/9/2017 REPRESENTS INVESTMENT EARNINGS FROM PROCEEDS. FORM 990, PART VI, SECTION B, LINE 11B A PUBLIC ACCOUNTING FIRM PREPARED THE FORM 990 IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE STAFF. A DRAFT FORM 990 IS THEN REVIEWED BY THE CFO AND CEO; ADJUSTMENTS ARE MADE, AS NECESSARY. THE COMPLETED FORM 990 IS THEN REVIEWED IN ITS ENTIRETY BY ALL MEMBERS OF THE GOVERNING BOARD BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE A QUESTIONNAIRE ANNUALLY. QUESTIONNAIRES SUBMITTED BY OFFICERS (OTHER THAN THE PRESIDENT/CEO) AND KEY EMPLOYEES ARE REVIEWED BY THE PRESIDENT/CEO. QUESTIONNAIRES SUBMITTED BY THE PRESIDENT/CEO AND DIRECTORS ARE REVIEWED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. ALL DISCLOSED CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS. IF A CONFLICT IS IDENTIFIED, THE CONFLICTED INDIVIDUAL WILL NOT PARTICIPATE IN DELIBERATIONS AND DECISIONS IMPACTING THE CONFLICTED MATTER. FORM 990, PART VI, SECTION B, LINE 15 CURRENT COMPARATIVE COMPENSATION INFORMATION IS OBTAINED FROM AN INDEPENDENT FIRM, MOST RECENTLY IN 2017. THE PRESIDENT & CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS USES THIS INFORMATION AND ITS EVALUATION OF PERFORMANCE TO SET THE ANNUAL COMPENSATION OF THE PRESIDENT/CEO. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. THE PRESIDENT & CEO EVALUATION COMMITTEE ALSO SETS THE TARGET LEVEL OF ANNUAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES, WHICH IS NOT TO EXCEED THE 50TH PERCENTILE OF THE MARKET ANALYSIS PERFORMED BY THE INDEPENDENT COMPENSATION CONSULTANTS. THE PRESIDENT/CEO USES THE SAME PROCESS TO DETERMINE THE ANNUAL COMPENSATION ADJUSTMENTS OF OTHER OFFICERS AS WELL AS KEY EMPLOYEES. THE PRESIDENT/CEO DISCUSS THESE PROPOSED ANNUAL COMPENSATION ADJUSTMENTS WITH THE PRESIDENT & CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE PRESIDENT/CEO. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS TO VIEW THE CONFLICT OF INTEREST POLICY SHOULD BE MADE TO ADMINISTRATION, AND ARE MADE AVAILABLE UPON REQUEST. THE HOSPITAL DOES NOT MAKE EITHER THE GOVERNING/ORGANIZING DOCUMENTS OR AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, COLUMN (D) CARLOS MAKABALI, MD IS A MEMBER OF THE BOARD WHO DEVOTES AN AVERAGE OF TWO HOURS PER WEEK RELATING TO HIS ACTIVITIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION REPORTED FOR HIM ON FORM 990, PART VII, SECTION A, COLUMN (D) IS RELATED TO PROFESSIONAL MEDICAL SERVICES PROVIDED TO THE HOSPITAL AND ARE UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK LISTED FOR HIM ON FORM 990, PART VII, SECTION A, COLUMN (B). FORM 990, PART IX, LINE 11G CAPITATED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 45,881,623. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,881,623. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 8,214,554. MANAGEMENT AND GENERAL EXPENSES 1,008,470. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,223,024. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,951,042. MANAGEMENT AND GENERAL EXPENSES 1,484,026. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,435,068. MONTEBELLO COMMUNITY HEALTH SERVICES INC 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C)(3) LINE 12B, II BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 BEVERLY HOSPITAL FOUNDATION 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 237429685 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(C)(3) LINE 7 BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 BEVERLYCARE 1920 WEST WHITTIER BOULEVARD MONTEBELLO CA 90640 471545656 HEALTH CARE SERVICES FOR LOW-INCOME INDIVIDUALS CA 501(C)(3) LINE 10 BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 BEVERLY MSO 309 WEST BEVERLY BOULEVARD MONTEBELLO CA 90640 352596953 MANAGEMENT SERVICE ORGANIZATION CA N/A C 1 0 0 1 1 1 0 0 0 0 1 1 0 1 1 1 0 1 0 0 BEVERLY HOSPITAL FOUNDATION C 261399 BOOK VALUE BEVERLY HOSPITAL FOUNDATION D 160587 BOOK VALUE BEVERLY HOSPITAL FOUNDATION O 164782 BOOK VALUE MONTEBELLO COMMUNITY HEALTH SERVICES INC D 3603626 BOOK VALUE MONTEBELLO COMMUNITY HEALTH SERVICES INC E 3906775 BOOK VALUE MONTEBELLO COMMUNITY HEALTH SERVICES INC J 117289 BOOK VALUE MONTEBELLO COMMUNITY HEALTH SERVICES INC K 287734 BOOK VALUE