2018-11-12T20:38:40-06:00 2017-12-31 ERNST & YOUNG US LLP 4365 EXECUTIVE DRIVE SUITE 1600 SAN DIEGO CA 92121 990 2017-01-01 951683892 COMMUNITY MEMORIAL HEALTH SYSTEM % KATHRYN YAMADA COMM 8056525050 147 NORTH BRENT STREET VENTURA CA 93003 DAVID GLYER CFO 8056525012 2018-11-12 true JOCELYNE MILLER P00634378 8585357200 164.57.159.254 33577420183165000016 2018-11-12 P 856506003E7717BB4C5FA0BAF50AAA2B61E0405F 7BF2FB13954BDF038D64D0E8F5A7FFD3D5147910 2017 2019-02-21 02:37:17Z GARY K WILDE 147 NORTH BRENT STREET VENTURA CA 93003 444139033 false X WWW.CMHSHEALTH.ORG X 1933 CA TO HEAL, COMFORT AND PROMOTE HEALTH FOR THE COMMUNITIES WE SERVE. 20 19 2657 244 14019 3760020 3460349 382269317 393872009 9013415 3931718 1509894 1906194 396552646 403170270 331864 279852 0 0 182428083 197856337 0 0 0 173685588 187136670 356445535 385272859 40107111 17897411 857554433 891045522 426152557 429322391 431401876 461723131 X SEE SCHEDULE O false false 356768247 0 393872009 PATIENT SERVICES TO INCLUDE 74,692 PATIENT DAYS, 216,608 OUTPATIENT VISITS, AND 262,019 VISITS TO THE CENTERS FOR FAMILY HEALTH (THE HEALTHCARE SYSTEM'S OUTPATIENT CARE CLINICS). SEE SCHEDULE O 954972 279852 0 COMMUNITY OUTREACH PROGRAMS INCLUDE: FREE BLOOD PRESSURE CHECKS; CANCER RESOURCE CENTER AND SUPPORT GROUPS; HEART-AWARE PROGRAM THAT PROVIDES FREE RISK EVALUATION, PREVENTATIVE INFORMATION AND RESOURCES. SEE SCHEDULE O. 788474 0 0 IT IS THE GOAL OF CMHS TO PROMOTE THE HEALTH OF THE COMMUNITY BY FOCUSING ON COMMUNITY EDUCATION OUTREACH, ACCESS TO CARE, UNCOMPENSATED AND UNDER-FUNDED CARE, AND SPONSORSHIP OF COMMUNITY RESOURCES. SEE SCHEDULE O. 0 0 0 358511693 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false true true false false false true true true true false false true 491 0 true 2657 true true true false false false false false false false false false X 20 19 true false false false false false false true true false false true true true true true true true true true false CA X X KATHRYN YAMADA 8056525012 2590 EAST MAIN STREET SUITE 200 VENTURA CA 93003 JEFFREY BRACKETT MD BOARD MEMBER 1.0 0.0 X 13750 0 0 MICHAEL BRADBURY BOARD MEMBER 1.0 0.0 X 0 0 0 LAMAR BUSHNELL MD BOARD MEMBER 1.0 0.0 X 0 0 0 DAVID FUKUTOMI BOARD MEMBER 1.0 0.0 X 0 0 0 TIMOTHY GALLAGHER BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN HAMMER BOARD MEMBER 1.0 0.0 X 0 0 0 JOHN HILL MD BOARD MEMBER 1.0 0.0 X 0 0 0 LYDIA HOPPS BOARD MEMBER 1.0 1.0 X 0 0 0 FRITZ HUNTSINGER BOARD MEMBER 1.0 0.0 X 0 0 0 WILLIAM KEARNEY VICE CHAIR 1.0 1.0 X X 0 0 0 EDIE MARSHALL BOARD MEMBER 1.0 26.0 X 0 0 0 FTED MUEGENBURG JR SECRETARY 1.0 0.0 X X 0 0 0 JEFFREY PAUL BOARD MEMBER 1.0 0.0 X 0 0 0 HELEN PETROFF MD BOARD MEMBER 1.0 0.0 X 0 0 0 MARTIN POPS MD BOARD MEMBER 1.0 0.0 X 0 0 0 RICHARD RUSH MD CHAIR 1.0 0.0 X X 0 0 0 JOHN RUSSELL BOARD MEMBER 1.0 0.0 X 0 0 0 ROY SCHNEIDER MD BOARD MEMBER 1.0 0.0 X 0 0 0 GREGORY SMITH BOARD MEMBER 1.0 0.0 X 0 0 0 GARY WOLFE TREASURER 1.0 0.0 X X 0 0 0 DAVID GLYER CFO 40.0 0.0 X 634546 0 101233 GARY K WILDE PRESIDENT & CEO 32.0 8.0 X 1644972 0 461530 KIMBERLY BRIDGES ASSISTANT VP - CFH 40.0 0.0 X 227288 0 51447 CYNTHIA DEMOTTE VP QUALITY 40.0 0.0 X 277607 0 57109 MICHAEL ELLINGSON VP MARKETING & DEVELOPMENT 32.0 8.0 X 890750 0 63825 CYNTHIA FAHEY CNO 40.0 0.0 X 323126 0 49129 STANLEY FROCHTZWAJG CMO, INPATIENT 40.0 0.0 X 571559 0 100600 WILFRED GARAND VP PLANNING & MANAGED CARE 40.0 0.0 X 324251 0 63406 DIANY KLEIN VP HUMAN RESOURCES 40.0 0.0 X 502399 0 70974 HAADY LASHKARI Chief Admin Ofcr Ojai/VP CMH 40.0 0.0 X 341193 0 92191 EMILIE RAYMAN COMPLIANCE OFFICER 40.0 0.0 X 383847 0 60213 RICHARD REISMAN VP AMBULATORY MEDICINE 36.0 0.0 X 375849 0 5172 RONALD SANDIFER CIO 40.0 0.0 X 467796 0 0 SAMUEL SMALL CHIEF OF MEDICAL EDUCATION 40.0 0.0 X 498897 0 4598 ADAM THUNELL VP OPERATIONS 40.0 0.0 X 517361 0 128887 EUGENE DAY DIRECTOR OF PHARMACY 40.0 0.0 X 236423 0 16381 CARRIE GLENN Admin Director Medical ED 40.0 0.0 X 280463 0 1765 CARLOS LIMON JR PHARMACIST 40.0 0.0 X 223629 0 16381 KEITH MCWILLIAMS Director-Information Systems 40.0 0.0 X 235084 0 13246 MARY SCHMITZ DIRECTOR OF DEVELOPMENT 40.0 0.0 X 229523 0 11286 9200313 0 1369373 439 false true false DIVERSIFIED CLINICAL SERVICES PO BOX 551187 JACKSONVILLE FL 32255 STAFFING SERVICES 1260641 PB BUILDING MAINTENANCE PO BOX 4721 VENTURA CA 93007 JANITORIAL SERVICES 1023667 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 REGISTRY NURSING 964811 KAUFMAN HALL ASSOC LLC 5202 OLD ORCHARD RD SUITE N700 SKOKIE IL 60077 CONSULTING SERVICES 925095 CALIFORNIA CARDIOVASCULAR THORACI 168 N BRENT STREET SUITE 508 VENTURA CA 93003 MEDICAL SERVICES 895865 75 0 275542 177288 3007519 47521 3460349 NET PATIENT SVC REVENUE 621500 359953665 359953665 0 0 MEDI-CAL SUPPLEMENTAL PAYMENTS 621500 28317134 28317134 0 0 CAFETERIA REVENUE 722210 1844893 1844893 0 0 HEALTHCARE SVC RENTAL INC 532000 1551836 1551836 0 0 BREAST/PROSTATE CENTER 900099 1336078 1336078 0 0 868403 868403 0 0 393872009 3719120 3719120 0 0 36033 115942 -79909 0 -79909 -79909 41065419 40852821 212598 212598 212598 0 0 0 0 0 0 0 0 0 REBATES/REFUNDS 900099 1286138 1286138 PHARMACY REVENUE 900099 281679 14019 267660 MEDICAL STAFF REVENUE 900099 251267 251267 167019 167019 1986103 403170270 393872009 14019 5823893 279852 279852 0 0 0 0 0 0 5681963 1076343 4605620 0 0 0 0 0 130928571 126093195 4835376 0 6933221 6933221 0 0 42750353 41138054 1612299 0 11562229 10837749 724480 0 2806216 1457880 1348336 0 1349187 0 1349187 0 321775 0 321775 0 0 0 0 0 0 0 0 0 0 0 28143028 25776735 2366293 0 516626 504778 11848 0 75712616 74790339 922277 0 12778774 12325846 452928 0 535506 150995 384511 0 5437211 5445837 -8626 0 254776 254776 0 0 0 0 0 0 591411 279008 312403 0 7477 0 7477 0 0 0 0 0 12066605 11951839 114766 0 1919398 303899 1615499 0 HOSP QUALITY ASSURANCE FEE 22763811 22763811 0 0 PURCHASED SERVICES 17617507 12895403 4722104 0 RECRUITING 1573020 1311151 261869 0 STATE USE & SALES TAX 780202 770739 9463 0 1961524 1170243 791281 385272859 358511693 26761166 0 0 0 0 27489543 25240214 0 0 59315471 54786966 0 0 0 0 24251659 43715265 9910042 10325912 7515055 8694255 706276740 173182064 479767448 533094676 129078333 124131092 14507490 11633195 7736862 8002566 0 0 97982530 71421381 857554433 891045522 79325809 89055771 0 0 0 0 330932268 325673851 0 0 0 0 5470740 5610000 0 0 10423740 8982769 426152557 429322391 X 425943630 456689739 5458246 5033392 0 0 431401876 461723131 857554433 891045522 X 17897411 10541056 0 0 0 1882788 X false true X true false X false false false 0 false 0 false 0 false 0 false 0 false 0 true 66701 66701 false SCHEDULE C, PART II-B, LINE 1 LOBBYING ACTIVITIES THE ORGANIZATION IS A MEMBER OF THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA AND THE AMERICAN HOSPITAL ASSOCIATIONS. IN 2017, $223,894 WAS INCLUDED IN EXPENSES FOR ANNUAL MEMBERSHIP DUES, A PORTION OF WHICH IS DIRECTED BY THESE ORGANIZATIONS TO CONDUCT LOBBYING ACTIVITIES. 26949901 26949901 132828620 90686857 42141763 112824134 82495207 30328927 433674085 433674085 533094676 CONSTRUCTION FUNDS 48118471 ASSETS LIMITED TO USE 10142046 DEPOSITS WITH INSURANCE CO. 6130023 DUE FROM THIRD PARTIES 3703155 OTHER ASSETS 3327686 71421381 0 SELF-INSURANCE LIABILITIES 6859695 OTHER LIABILITIES 2123074 8982769 X FIN 48(ASC740) Footnote THE FOLLOWING FOOTNOTE IS FROM THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMUNITY MEMORIAL HEALTH SYSTEM: The System accounts for income taxes under the provisions of ASC 740, Income Taxes, which prescribes a recognition threshold and measurement attribute for the consolidated financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. Under ASC 740, the tax benefit from uncertain tax positions may be recognized only if it is more likely than not that the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period that the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers for tax positions that meet the more-likely-than-not recognition criteria. The System completed an analysis of its tax position, in accordance with ASC 740, and determined that there are no uncertain tax positions taken or expected to be taken. No significant tax liability for unrecognized tax benefits, interest, or penalties was accrued as of December 31, 2017 or 2016. The System is subject to routine audits by the taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The System believes it is no longer subject to income tax examinations for years prior to 2014. true true X true X true X 700. true true false true true 1427908 0 1427908 0.00370 76552146 72524689 4027457 0.01050 0 0 0 0.00000 0 77980054 72524689 5455365 0.01420 1375534 14131 1361403 0.00350 9280343 2366517 6913826 0.01790 17059922 14370544 2689378 0.00700 0 0 0 0.00000 279852 0 279852 0.00070 0 27995651 16751192 11244459 0.02910 0 105975705 89275881 16699824 0.04330 1300787 1300787 0.00340 1300787 1300787 0.00340 true 6667074 72628141 92845944 -20217803 true true SEE PART VI IMAGING CENTER 0.51 0.49 SEE PART VI REAL ESTATE 0.6925 0.3075 SEE PART VI MANAGEMENT SERVICES 0.5 0.5 2 1 COMMUNITY MEMORIAL HOSPITAL 147 NORTH BRENT STREET VENTURA CA 93003 WWW.CMHSHEALTH.ORG 050000026 X X X X A 2 OJAI VALLEY COMMUNITY HOSPITAL 1306 MARICOPA HWY OJAI CA 93023 WWW.CMHSHEALTH.ORG 050000045 X X X X X A A 12 false false true X X X X X X X X X 16 true true true true X See Part V, Section C X true 16 true See Part V, Section C false true X 200. 700. X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X true X false false PART V, SECTION B, LINE 5 IN CONDUCTING ITS MOST RECENT CHNA, THE SYSTEM COORDINATED ITS ASSESSMENT WITH THOSE OF THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH AND KAISER HEALTH PLAN, FOUNDATION HOSPITALS AND THE PERMANENTE MEDICAL GROUP. IN ADDITION, THE SYSTEM HELD FOCUS GROUPS WITH VARIOUS COMMUNITY ORGANIZATIONS TO INCLUDE HELP OF OJAI, LOS ROBLES HOME CARE, CLINICAS DEL CAMINO REAL, VENTURA COUNTY AREA AGENCY ON AGING, CALIFORNIA SENIOR LIVING, CAMARILLO HEALTHCARE DISTRICT, AND SEAVIEW IPA. THE FOCUS GROUPS WERE HELD AT BOTH THE COMMUNITY MEMORIAL HOSPITAL AND OJAI VALLEY COMMUNITY HOSPITAL IN OCTOBER 2016 AND INCLUDED MEMBERS OF OTHER NON-PROFIT AND HEALTHCARE ORGANIZATIONS. PART V, SECTION B, LINE 6A & 6B IN CONDUCTING ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, THE SYSTEM COLLABORATED WITH AND UTILIZED THE WORK AND RESOURCES OF THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH AND KAISER HEALTH PLAN, FOUNDATION HOSPITALS AND THE PERMANENTE MEDICAL GROUP. PART V, SECTION B, LINE 7 CHNA WEBSITE http://www.cmhshealth.org/about/community-health-needs-assessment/ PART V, SECTION B, LINE 10 IMPLEMENTATION STRATEGY http://www.cmhshealth.org/about/community-health-needs-assessment/ PART V, SECTION B, LINE 11 THE BOARD OF TRUSTEES FOR COMMUNITY MEMORIAL HEALTH SYSTEM ESTABLISHED A COMMUNITY BENEFIT COMMITTEE FOR ONGOING COMMUNITY BENEFIT ACTIVITIES AND THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS COMMITTEE REVIEWED INFORMATION ON THE COMMUNITY NEEDS FOR THE OJAI VALLEY COMMUNITY HOSPITAL AND COMMUNITY MEMORIAL HOSPITAL SERVICE AREAS. BASED ON PUBLICLY REPORTED HEALTH DATA AND COMMUNITY INPUT, THE COMMITTEE RECOMMENDED THE RANK ORDERING OF SPECIFIC ISSUES FOR EACH COMMUNITY AND MADE ITS RECOMMENDATIONS TO THE CMHS BOARD OF TRUSTEES. THE CMHS BOARD OF TRUSTEES APPROVED THE CHNA AND IMPLEMENTATION STRATEGIES FOR THE SYSTEM'S HOSPITALS. SUBSTANCE ABUSE, MENTAL HEALTH, THE TREATMENT OF CHRONIC AND ACUTE HEALTH CONDITIONS (DIABETES, HEART DISEASE, AND CANCER), SENIOR CARE AND CHILD ABUSE WERE GIVEN PRIORITY FOCUS. THE SYSTEM HAS ADDRESSED THESE AREAS BY RECRUITING SPECIALTY AND FAMILY PHYSICIANS, IMPLEMENTING TELEMEDICINE SERVICES, OFFERING FREE CHRONIC DISEASE DETECTION AND SCREENING SERVICES, AND THROUGH EDUCATIONAL PROGRAMS AND SUPPORT GROUPS. IN ADDITION, PHYSICIAN RESIDENTS IN THE SYSTEM'S GRADUATE MEDICAL EDUCATION PROGRAM ARE PROVIDING FREE HEALTHCARE AND HEALTH EDUCATION IN MEDICALLY UNDERSERVED AREAS OF VENTURA COUNTY. BEGINNING IN 2017, THE SYSTEM BEGAN SUPPORTING VARIOUS SENIOR CARE AND ASSISTED LIVING FACILITIES TO ADDRESS THE NEEDS OF THE COUNTY OF VENTURA'S AGING POPULATION. THE SYSTEM PARTICIPATES IN A HOME HEALTH ALLIANCE TO PROMOTE SENIOR USE OF ADULT DAY HEALTH SERVICES. THE SYSTEM ALSO BEGAN SUPPORTING SEVERAL LOCAL NON-PROFIT ORGANIZATIONS THAT ADDRESS CHILD ABUSE AND CHILDREN IN NEED. IN COLLABORATION WITH THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH, THE SYSTEM FOLLOWED THE LETS GET HEALTHY CALIFORNIA FRAMEWORK FOR PROMOTING COMMUNITY HEALTH: HEALTH ACROSS THE LIFESPAN- - HEALTHY BEGINNINGS - LAYING THE FOUNDATION FOR A HEALTHY LIFE - LIVING WELL - PREVENTING AND MANAGING CHRONIC DISEASE - END OF LIFE - MAINTAINING DIGNITY AND INDEPENDENCE PATHWAYS TO HEALTH- - REDESIGNING THE HEALTH SYSTEM - EFFICIENT, SAFE, AND PATIENT-CENTERED CARE - CREATING HEALTHY COMMUNITIES - ENABLING HEALTHY LIVING - LOWERING THE COST OF CARE - MAKING COVERAGE AFFORDABLE AND ALIGNING FINANCING TO HEALTH OUTCOMES - HTTPS://LETSGETHEALTHY.CA.GOV/GOALS/ ORAL HEALTH IS AN INITIATIVE THAT WAS IDENTIFIED IN THE MOST RECENT CHNA. OJAI VALLEY COMMUNITY HOSPITAL AND COMMUNITY MEMORIAL HOSPITAL DO NOT PROVIDE DENTAL CARE SERVICES. THE SYSTEM WILL CONTINUE TO WORK CLOSELY WITH CLINICAS DEL CAMINO REAL TO PROVIDE ACCESS TO SPECIALTY PHYSICIAN CARE TO ADDRESS UNMET DENTAL CARE NEEDS. CMHS WILL CONTINUE ITS ONGOING PARTICIPATION IN THE HOME HEALTH ALLIANCE AND ASSOCIATION WITH HOME HEALTH PROVIDERS TO BRING AWARENESS AND ACCEPTANCE TO SENIORS IN USING ADULT DAY CARE SERVICES. PROGRESS WILL CONTINUE TO BE MADE TO ADDRESS UNMET BEHAVIORAL HEALTH NEEDS IN THE OJAI COMMUNITY WHICH SHOULD IMPROVE CONDITIONS FOR SAFE HOMES AND FAMILIES. COMMUNITY WHICH SHOULD IMPROVE CONDITIONS FOR SAFE HOMES AND FAMILIES. PART V, SECTION B, LINE 15E CMHS PUBLICIZES A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL IF INTERESTED. MOREOVER, CMHS HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THE SIGNAGE DISPLAYED. PART V, SECTION B, LINE 16A FINANCIAL ASSISTANCE POLICY WEBSITE http://www.cmhshealth.org/patients-and-visitors/patient-information/commun ity-memorial-hospital/financial-services/ PART V, SECTION B, LINE 16B FINANCIAL ASSISTANCE POLICY APPLICATION WEBSITE http://www.cmhshealth.org/patients-and-visitors/patient-information/commun ity-memorial-hospital/financial-services/ PART V, SECTION B, LINE 16C PLAIN LANGUAGE SUMMARY WEBSITE http://www.cmhshealth.org/patients-and-visitors/patient-information/commun ity-memorial-hospital/financial-services/ PART V, SECTION B, LINE 16H DURING 2017 THE SYSTEM WAS IN THE PROCESS OF DEVELOPING A BROCHURE TO BE PASSED OUT AT HEALTH FAIRS, FEE CLINICS AND COMMUNITY EVENTS THAT WILL NOTIFY MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE ABOUT THE AVAILABILITY OF THE FAP. THE BROCHURE WAS COMPLETED IN AUGUST 2018. 23 SAVIERS CENTER FOR FAMILY HEALTH 2921 S SAVIERS ROAD OXNARD CA 93033 OP CLINIC GROSSMAN IMAGING CENTER OF CMH LLC 2001 N SOLAR DRIVE SUITE 135 OXNARD CA 93030 IMAGING CENTER CAMARILLO CENTER FOR FAMILY HEALTH 422 B ARNEILL ROAD CAMARILLO CA 93010 OP CLINIC ASHWOOD CENTER FOR FAMILY HEALTH 116 ASHWOOD DRIVE VENTURA CA 93003 OP CLINIC SANTA PAULA CENTER FOR FAMILY HEALTH 242 E HARVARD BLVD SANTA PAULA CA 93060 OP CLINIC VINEYARD CENTER FOR FAMILY HEALTH 2361 VINEYARD AVENUE OXNARD CA 93036 OP CLINIC AIRPORT MARINA CENTER FOR FAMILY HEALTH 3641 W FIFTH STREET OXNARD CA 93035 OP CLINIC SAN BUENAVENTURA UROLOGY CENTER 2705 LOMA VISTA ROAD SUITE 206 VENTURA CA 93003 OP CLINIC MAIN STREET CENTER FOR FAMILY HEALTH 138 W MAIN STREET VENTURA CA 93001 OP CLINIC MSO PACIFIC INPATIENT PHYSICIANS 147 N BRENT STREET VENTURA CA 93003 OP CLINIC MIDTOWN MEDICAL GROUP CLINIC 2721 E MAIN STREET VENTURA CA 93003 OP CLINIC FILLMORE CENTER FOR FAMILY HEALTH 852 VENTURA STREET FILLMORE CA 93015 OP CLINIC SANTA ROSA CENTER FOR FAMILY HEALTH 5800 SANTA ROSA ROAD CAMARILLO CA 93010 OP CLINIC PORT HUENEME CENTER FOR FAMILY HEALTH 321 E PORT HUENEME ROAD PORT HUENEME CA 93041 OP CLINIC MSO SAN BUENAVENTURA UROGYNECOLOGY 2705 LOMA VISTA ROAD SUITE 206 VENTURA CA 93003 OP CLINIC MSO PATELSPEITEL FAMILY PRACTICE 124 N BRENT STREET VENTURA CA 93003 OP CLINIC OAK VIEW CENTER FOR FAMILY HEALTH 655 N VENTURA AVENUE OAK VIEW CA 93022 OP CLINIC OJAI CENTER FOR FAMILY HEALTH 655 N VENTURA AVENUE OAK VIEW CA 93022 OP CLINIC OJAI MULTISPECIALTY CENTER 117 PIRIE ROAD OJAI CA 93023 OP CLINIC PREMIERE ENDOCRINOLOGY CENTER 3655 W 5TH STREET OXNARD CA 93035 OP CLINIC PREMIERE HEALTH SANTA PAULA 258 262 E HARVARD BLVD SANTA PAULA CA 93060 OP CLINIC MSO VENTURA ORTHOPEDIC SPINE 168 N BRENT STREET SUITE 505 VENTURA CA 93003 OP CLINIC MSO DR RAO CARDIOLOGY PRACTICE 100 N BRENT STREET VENTURA CA 93003 OP CLINIC PART I, LINE 3C IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO USED AN ALGORITHM TO DETERMINE QUALIFICATION OF CHARITY CARE FROM INFORMATION PROVIDED BY PATIENTS AT INTAKE AS WELL AS INFORMATION FROM CREDIT REPORTS. PART I, LINE 7 Costing Method used is cost-to-charge using worksheet 2. PART I, LINE 7B UNREIMBURSED MEDICAID THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) AND AMENDING-LEGISLATION WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA ON JANUARY 1, 2010 AND SEPTEMBER 8, 2010, RESPECTIVELY. THE PRIMARY LEGISLATION (AB 1383) AND AMENDING LEGISLATION (AB 1653) CONTAINS TWO COMPONENTS: THE QUALITY ASSURANCE FEE ACT, WHICH GOVERNS THE "HOSPITAL FEE"QUALITY ASSURANCE FEE" (QA FEE) PAID BY PARTICIPATING HOSPITALS, AND THE MEDI-CAL HOSPITAL PROVIDER STABILIZATION ACT, WHICH GOVERNS SUPPLEMENTAL MEDI-CAL PAYMENTS (SUPPLEMENTAL PAYMENTS) MADE TO PROVIDERS FROM THE FUND. HOSPITAL PARTICIPATION IS MANDATORY, WITH LIMITED EXCEPTIONS. IN JUNE 2012, THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) AMENDED LEGISLATION TO ALLOW FOR THE FEE-FOR-SERVICE PORTION OF THE PROGRAM TO BE ADMINISTERED SEPARATELY FROM THE MANAGED CARE COMPONENT. THERE ARE TWO PROGRAMS THAT HAD ACTIVITY IN 2016 AND 2017: A 36-MONTH HOSPITAL FEE PROGRAM COVERING THE PERIOD FROM JANUARY 1, 2014 THROUGH DECEMBER 31, 2016, AND A 30-MONTH HOSPITAL FEE PROGRAM COVERING THE PERIOD FROM JANUARY 1, 2017 THROUGH JUNE 30, 2019. PRIOR TO 2017, THE TIMING OF REVENUE AND EXPENSE RECOGNITION OF THE PROGRAM WAS BASED ON THE TIMING OF CMS APPROVAL WHICH DID NOT CONSISTENTLY MATCH THE TIMING OF THE VARIOUS HOSPITAL FEE PROGRAMS DUE TO DELAYS IN APPROVALS. WITH THE PASSAGE OF TIME AND THE ADMINISTRATION OF THE PROGRAMS, IT HAS BEEN DETERMINED THAT THERE IS PERSUASIVE EVIDENCE OF AN ARRANGEMENT IN EXISTENCE DESPITE WHETHER CMS HAS FINALIZED THE ACTUAL AMOUNTS PAID. ACCORDINGLY, DURING 2017, THE SYSTEM DETERMINED THAT THE SUPPLEMENTAL PAYMENTS MET ALL CRITERIA RELATED TO REVENUE RECOGNITION AND THE QA FEES ARE BOTH PROBABLE AND ESTIMABLE. ACCORDINGLY, ALL RELATED SUPPLEMENTAL PAYMENTS FOR PERIODS THROUGH DECEMBER 31, 2017 HAVE BEEN RECOGNIZED AS NET PATIENT SERVICE REVENUE AND RELATED QUALITY ASSURANCE FEES. THE SYSTEM MADE PAYMENTS TO THE DHCS FOR THE QA FEE IN THE AMOUNT OF $22,507,259 AND $15,657,798 IN 2017 AND 2016, RESPECTIVELY. THE SYSTEM MADE CALIFORNIA HEALTH FOUNDATION AND TRUST PLEDGE PAYMENTS IN THE AMOUNT OF $256,552 AND $317,864 IN 2017 AND 2016, RESPECTIVELY, AND THE PLEDGE PAYMENTS WERE RECORDED WITHIN QA FEE IN OPERATING EXPENSES WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE SYSTEM RECEIVED SUPPLEMENTAL PAYMENTS OF $28,317,134 AND $35,585,271 OVER THE COURSE OF THE PROGRAM IN 2017 AND 2016, RESPECTIVELY. THE SYSTEM RECORDED THE SUPPLEMENTAL PAYMENTS AS OPERATING REVENUE WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. PART I, LINE 7G NO AMOUNT ATTRIBUTABLE TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G. PART I, LINE 7, COLUMN F THE ORGANIZATION INCLUDED $4,891 OF BAD DEBT EXPENSE IN PART IX. THE AMOUNT HAS BEEN SUBTRACTED FROM THE CALCULATION OF COLUMN F. PART II COMMUNITY BUILDING ACTIVITIES THE SYSTEM REGULARLY RECRUITS FAMILY AND SPECIALTY PHYSICIANS TO FILL THE NEEDS AT ITS OUTPATIENT CLINICS AND HOSPITALS. THE SYSTEM ALSO ASSISTS AFFILIATED MEDICAL GROUPS WITH THE RECRUITMENT OF PHYSICIANS WHERE COMMUNITY NEED IS DEMONSTRATED. THE SYSTEM DETERMINES MARKET NEED BY PERFORMING A MARKET STUDY OF THE NUMBER OF PHYSICIANS NEEDED PER PRACTICE AREA BASED ON POPULATION SIZE. THE SYSTEM IS A FOUNDING MEMBER PARTICIPANT IN THE CHNA COLLABORATIVE WORKGROUP OF HEALTH CARE PROVIDER ORGANIZATIONS LOCATED IN VENTURA COUNTY. THE CHNA COLLABORATIVE MEETS QUARTERLY TO SHARE INFORMATION ON HEALTH IMPROVEMENT INITIATIVES AND PLAN FOR A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT PROJECT IN 2019. THE 2019 JOINT CHNA WILL INCLUDE COORDINATION BETWEEN PARTICIPATING ORGANIZATIONS IN PROGRAMMING TO ADDRESS COMMUNITY HEALTH NEEDS. COMMUNITY HEALTH IMPROVEMENT ADVOCACY THE ACCOUNTABLE CARE ALLIANCE OF VENTURA (ACAV) IS AN ACCOUNTABLE CARE ORGANIZATION (ACO) FORMED BY CMHS IN COLLABORATION WITH COMMUNITY PHYSICIANS. ACAV HAS A CONTRACT WITH MEDICARE TO IMPROVE THE HEALTH, PATIENT EXPERIENCE AND REDUCE COST OF CARE FOR 9,017 MEDICARE FEE-FOR SERVICE BENEFICIARIES. IN 2017, CMHS INVESTED $162,355 IN THE ACAV CONSISTING OF PHYSICIAN AND STAFF LABOR AND ADMINISTRATIVE COSTS. PART III, LINE 2 BAD DEBT IS REPORTED IN THE SAME MANNER AS THE AUDITED FINANCIAL STATEMENTS. PLEASE SEE THE NARRATIVE FOR PART III, LINE 4, FOR FURTHER DETAIL. PART III, LINE 4 THE SYSTEM USED WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, TO DETERMINE THE COST OF ITS BAD DEBT EXPENSE. BAD DEBT FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: THE SYSTEM MANAGES PATIENT ACCOUNT RECEIVABLES BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR CONTRACTUAL DISCOUNTS AND UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE BASED ON MANAGEMENTS ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEMS UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED RELATED TO SELF-PAY PATIENTS, INCLUDING BOTH UNINSURED PATIENTS AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THEIR BALANCE. SIGNIFICANT CHANGES IN PAYER MIX, BUSINESS OFFICE OPERATIONS, GENERAL ECONOMIC CONDITIONS, AND HEALTH CARE COVERAGE PROVIDED BY FEDERAL OR STATE GOVERNMENTS OR PRIVATE INSURERS MAY HAVE A SIGNIFICANT IMPACT ON THE SYSTEMS ESTIMATES AND SIGNIFICANTLY AFFECT THE SYSTEMS LIQUIDITY, RESULTS OF OPERATIONS, AND CASH FLOWS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEMS POLICIES. THE SYSTEM DISCOUNTS UNINSURED SELF-PAY PATIENT CHARGES BY 40% AND CLASSIFIES ACCOUNTS PENDING MEDI-CAL APPROVAL AS SELF-PAY ACCOUNTS IN ITS ACCOUNTS RECEIVABLE AGING REPORT AND APPLIES THE STANDARD UNINSURED DISCOUNT. THE NET ACCOUNT BALANCE IS FURTHER SUBJECT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RESERVE POLICY. SHOULD THE ACCOUNT QUALIFY FOR MEDI-CAL COVERAGE, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND RECLASSIFIED TO MEDI-CAL ACCOUNTS RECEIVABLE WITH THE APPROPRIATE CONTRACTUAL DISCOUNT RATE APPLIED. SHOULD THE ACCOUNT NOT QUALIFY FOR MEDI-CAL COVERAGE BUT QUALIFIES AS CHARITY CARE UNDER THE SYSTEMS CHARITY CARE POLICY, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND THE ENTIRE ACCOUNT BALANCE IS RECORDED AS A CHARITY CARE DEDUCTION. THE SYSTEMS COMBINED ALLOWANCE FOR DOUBTFUL ACCOUNTS, UNINSURED DISCOUNTS, AND CHARITY CARE COVERED APPROXIMATELY 92% OF THE SYSTEMS COMBINED UNINSURED AND SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2017 AND DECEMBER 31, 2016. THE SYSTEMS ALLOWANCE FOR BAD DEBT WAS $32,741,191 AND $38,767,172 AS OF DECEMBER 31, 2017 AND 2016, RESPECTIVELY. THE SYSTEMS PROVISION FOR PATIENT BAD DEBTS DECREASED TO $6,667,074 FROM $12,823,555 THE YEARS ENDED DECEMBER 31, 2017 AND DECEMBER 31, 2016, RESPECTIVELY. PART III, LINE 8 THE ENTIRE SHORTFALL OF MEDICARE EXPENSES OVER MEDICARE REIMBURSEMENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE COSTS ATTRIBUTABLE TO SERVICE MEDICARE PATIENTS. THE SYSTEM IS REIMBURSED FOR SERVICES PROVIDED TO PATIENTS UNDER CERTAIN PROGRAMS ADMINISTERED BY GOVERNMENTAL AGENCIES, WHICH INCLUDES THE MEDICARE PROGRAM. THE MEDICARE PROGRAM CONSISTS OF 24.2% OF THE SYSTEMS NET REVENUE FOR 2017. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FROM THE MEDICARE PROGRAM, AND THE MEDICARE PROGRAM DOES NOT COVER THE COSTS OF TREATING THE SYSTEM'S MEDICARE PATIENTS, ALTHOUGH THE QUALITY OF CARE AND ACCESS TO CARE IS THE SAME FOR ALL PATIENTS, REGARDLESS OF PAYER SOURCE. UNREIMBURSED COST UNDER THE MEDICARE PROGRAM IS A TRUE LOSS TO THE SYSTEM AND THE LOSS IS REFLECTED IN THE SYSTEMS FINANCIAL STATEMENTS. AS SUCH, MEDICARE LOSSES SHOULD BE CONSIDERED A COMMUNITY BENEFIT PROVIDED BY THE SYSTEM. PART III, LINE 9B THE PATIENT'S ABILITY TO PAY IS EVALUATED UPON ADMISSION. A PATIENT FINANCIAL SERVICES STAFF ASSISTS PATIENTS WITH APPLYING FOR LOCAL, STATE AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT. IN THE EVENT THAT NO THIRD PARTY PAYMENT SOURCE IS AVAILABLE, PATIENTS ARE PROVIDED WITH INFORMATION ON THE SYSTEM'S FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE AND CHARITY CARE IS BASED ON A SLIDING SCALE FEE SCHEDULE UTILIZING THE CURRENT UNITED STATES FEDERAL POVERTY GUIDELINES. INFORMATION FROM THE APPLICANT'S FINANCIAL APPLICATION AND SUPPORTING DOCUMENTATION IS USED TO DETERMINE THE AMOUNT OF THE QUALIFIED FINANCIAL ASSISTANCE TO BE GRANTED. THE SYSTEM HAS A WRITTEN COLLECTION POLICY TO PROVIDE FOR AN EQUITABLE PROCESS BY WHICH A PATIENT AND/OR RESPONSIBLE PARTY CAN MAKE A PAYMENT OR PAYMENT ARRANGEMENT PRIOR TO OR AT THE TIME OF SERVICE. THE SYSTEM WILL PROACTIVELY DETERMINE THE PATIENT'S ABILITY TO PAY. A DEPOSIT, BASED UPON SELF-PAY LIABILITY IS COLLECTED PRIOR TO ADMISSION OR AT THE TIME OF SERVICE. FOR PATIENTS WHO ARE UNABLE TO PAY THEIR ESTIMATED LIABILITY AT THE TIME OF SERVICE, THE SYSTEM WILL OFFER A FINANCING OPTION. PATIENTS WHO MEET CHARITY OR INDIGENT GUIDELINES WILL BE REFERRED TO A FINANCIAL ADVOCATE FOR FINANCIAL AID. PART IV, LINE 1 MANAGEMENT COMPANIES AND JOINT VENTURES GROSSMAN IMAGING CENTER OF CMF, LLC BUENAVISTA MEDICAL PROPERTIES, LTD VENTURA CARDIOVASCULAR CO-MANAGEMENT COMPANY, LLC PART VI, LINE 2 NEEDS ASSESSMENT THE SYSTEM UPDATED ITS COMMUNITY NEEDS ASSESSMENT IN 2016. THE SYSTEM COORDINATED ITS HEALTH NEEDS ASSESSMENT WITH THOSE OF THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH, AND KAISER HEALTH PLAN, FOUNDATION HOSPITALS AND THE PERMANENTE MEDICAL GROUP. THE AREA-WIDE STUDY AND HEALTHCARE SURVEY CONSISTED OF AN ANALYSIS OF THE SOCIO-ECONOMIC PROFILE OF VENTURA COUNTY, THE HEALTH CARE STATUS AND NEEDS OF VENTURA COUNTY, THE STATUS OF HEALTHCARE DELIVERY AND SERVICES, COMMUNITY REPORTED HEALTH NEEDS AND COMMUNITY PRIORITIZATION AND IMPLEMENTATION STRATEGIES. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE PROGRAM BROCHURES EXPLAINING THE SYSTEM'S POLICY IS POSTED AND MADE AVAILABLE TO PATIENTS AT THE TIME OF ADMITTANCE. SIGNS ALERTING PATIENTS TO THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE PROMINENTLY DISPLAYED. AN INSERT REGARDING FINANCIAL ASSISTANCE ACCOMPANIES EACH INVOICE OF HOSPITAL SERVICES SENT TO EACH PATIENT. PART VI, LINE 4 COMMUNITY INFORMATION THE HEALTH SYSTEM'S TWO HOSPITALS ARE LOCATED IN THE CITY OF VENTURA AND THE CITY OF OJAI. THE HEALTH SYSTEM PROVIDES SERVICES THROUGH ITS HOSPITALS AND CENTERS FOR FAMILY HEALTH TO ALL OF WESTERN VENTURA COUNTY WHICH INCLUDES THE CITIES AND UNINCORPORATED AREAS SURROUNDING VENTURA, OJAI, SANTA PAULA, FILLMORE, OXNARD, PORT HUENEME AND CAMARILLO. THE POPULATION OF VENTURA COUNTY IS APPROXIMATELY 860,000 AND MADE OF UP 66.4% WHITE AND 33.6% OTHER RESIDENTS. THE COUNTY OF VENTURA PROVIDES COMMUNITY DATA THROUGH ITS WEBSITE HEALTH MATTERS IN VC AND CAN BE ACCESSED AT HTTP://WWW.HEALTHMATTERSINVC.ORG/INDEX.PHP FOR FURTHER INFORMATION. DEMOGRAPHIC VARIABLES SUCH AS AGE, RACE AND ETHNICITY ARE MEANINGFUL WHEN PLANNING FOR BOTH INPATIENT AND OUTPATIENT CARE IN ORDER TO ENSURE THAT PATIENT CARE SERVICES ARE SENSITIVE TO THE PROGRAM PLANNING NEEDS OF THE SERVICE AREA POPULATION. IT HAS LONG BEEN ESTABLISHED THAT THERE ARE SIGNIFICANT VARIANCES IN PHYSICAL AND BEHAVIORAL HEALTH PROBLEMS BETWEEN GROUPS BASED ON ETHNICITY, INCOME AND RESIDENCE. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH CMHS IS GOVERNED BY A BOARD OF DIRECTORS WHOSE MEMBERS ARE REPRESENTATIVE OF THE COMMUNITY, HOSPITAL AND MEDICAL STAFF LEADERSHIP. CONSISTENT WITH THE IRS "COMMUNITY BENEFIT STANDARD" A MAJORITY OF THE BOARD OF DIRECTORS ARE NEITHER EMPLOYEES, CONTRACTORS NOR FAMILY MEMBERS OF THE ORGANIZATION. CMHS HAS AN OPEN MEDICAL STAFF, EXTENDING STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL AREAS AND DEPARTMENTS OF ITS FACILITY. THE EMERGENCY DEPARTMENT AT BOTH COMMUNITY MEMORIAL HOSPITAL AND THE OJAI COMMUNITY HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HEALTH SYSTEM PROVIDES EMERGENCY SERVICES TO ALL PATIENTS, WITH OR WITHOUT INSURANCE, AND CONTRACTS WITH PHYSICIANS TO PROVIDE SPECIALTY EMERGENCY COVERAGE. THIS TEAM INCLUDES BOARD-CERTIFIED EMERGENCY PHYSICIANS, PHYSICIAN ASSISTANTS; BOARD CERTIFIED NURSES, EMERGENCY MEDICAL TECHNICIANS, RESPIRATORY THERAPISTS AND OTHER HIGHLY TRAINED EMERGENCY CARE PROFESSIONALS. ALL ARE DEDICATED TO PROVIDING TECHNOLOGICALLY ADVANCED AND LIFESAVING MEDICAL SERVICES. THE SYSTEM OFFERS FREE EDUCATIONAL SEMINARS TO THE PUBLIC COVERING A WIDE VARIETY OF HEALTH RELATED TOPICS SUCH AS DIABETES, CANCER, AND VASCULAR HEALTH. THE SYSTEM ALSO OFFERS A LARGE VARIETY OF CLASSES AND SUPPORT GROUPS THROUGH ITS CANCER RESOURCE CENTER, MATERNAL CHILD HEALTH, AND HEART AND VASCULAR HEALTH DEPARTMENTS. PART VI, LINE 6 N/A PART VI, LINE 7 State filing of community benefit report California 501(r) COMPLIANCE THE HOSPITAL IDENTIFIED AND CORRECTED CERTAIN GAPS IN ITS 501(R) COMPLIANCE. FOR MORE INFORMATION, SEE DISCLOSURES IN PART V, SECTION C, CORRESPONDING TO PART V, SECTION B, LINE 16H. false CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST SACRAMENTO CA 95814 941498697 501(c)(3) 256552 0 CA HOSP FEE PROGRAM 1 SCHEDULE I, PART I, LINE 2 DESCRIPTION OF PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS THE GRANTS MADE BY COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) ARE ONLY GIVEN TO 501(C)(3) AND GOVERNMENT ORGANIZATIONS. ONCE THE GRANT IS GIVEN, IT IS NOT MONITORED BY CMHS AND IS LEFT UP TO THE DISCRETION OF THE GRANTEE. X true false X X X X X true true false false false false false true false KIMBERLY BRIDGES ASSISTANT VP - CFH 169019 0 52788 0 5481 0 48373 0 3074 0 278735 0 0 0 EUGENE DAY DIRECTOR OF PHARMACY 236423 0 0 0 0 0 0 0 16381 0 252804 0 0 0 CYNTHIA DEMOTTE VP QUALITY 208722 0 60288 0 8597 0 55135 0 1974 0 334716 0 0 0 MICHAEL ELLINGSON VP MARKETING & DEVELOPMENT 226259 0 52788 0 611703 0 63351 0 474 0 954575 0 601338 0 CYNTHIA FAHEY CNO 252510 0 60288 0 10328 0 48655 0 474 0 372255 0 0 0 STANLEY FROCHTZWAJG CMO, INPATIENT 371631 0 60288 0 139640 0 98028 0 2572 0 672159 0 109551 0 WILFRED GARAND VP PLANNING & MANAGED CARE 256390 0 60288 0 7573 0 63406 0 0 0 387657 0 0 0 CARRIE GLENN Admin Director Medical ED 109071 0 0 0 171392 0 0 0 1765 0 282228 0 0 0 DAVID GLYER CFO 366574 0 120288 0 147684 0 96061 0 5172 0 735779 0 133590 0 DIANY KLEIN VP HUMAN RESOURCES 271350 0 82788 0 148261 0 70974 0 0 0 573373 0 126636 0 HAADY LASHKARI Chief Admin Ofcr Ojai/VP CMH 244550 0 75288 0 21355 0 80674 0 11517 0 433384 0 0 0 CARLOS LIMON JR PHARMACIST 223629 0 0 0 0 0 0 0 16381 0 240010 0 0 0 KEITH MCWILLIAMS Director-Information Systems 235084 0 0 0 0 0 0 0 13246 0 248330 0 0 0 EMILIE RAYMAN COMPLIANCE OFFICER 227740 0 45288 0 110819 0 57641 0 2572 0 444060 0 81878 0 RICHARD REISMAN VP AMBULATORY MEDICINE 308078 0 60230 0 7541 0 0 0 5172 0 381021 0 0 0 RONALD SANDIFER CIO 467796 0 0 0 0 0 0 0 0 0 467796 0 0 0 MARY SCHMITZ DIRECTOR OF DEVELOPMENT 229523 0 0 0 0 0 0 0 11286 0 240809 0 0 0 SAMUEL SMALL CHIEF OF MEDICAL EDUCATION 422363 0 60288 0 16246 0 0 0 4598 0 503495 0 0 0 ADAM THUNELL VP OPERATIONS 385331 0 120288 0 11742 0 122370 0 6517 0 646248 0 0 0 GARY K WILDE PRESIDENT & CEO 672803 0 225288 0 746881 0 457613 0 3917 0 2106502 0 682616 0 Form 990, SCHEDULE J, PART I, LINE 1A CERTAIN EXECUTIVES ON FORM 990, PART VII AND SCHEDULE J, PART II RECEIVE AN AUTOMOBILE ALLOWANCE. THE ALLOWANCE IS INCLUDED IN TAXABLE WAGES AND REPORTED ON THEIR W-2. Form 990, SCHEDULE J, Part I LINE 4A THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING 2017: CARRIE GLENN - $171,392 Form 990, SCHEDULE J, Part I LINE 4b ON APRIL 1, 2002, A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (THE 2002 SERP) WAS ESTABLISHED TO COVER SENIOR STAFF MEMBERS OF CMHS. FOR THE 2002 SERP, THE MONTHLY BENEFIT AT NORMAL RETIREMENT DATE (AGE 65) IS EQUAL TO THE AVERAGE MONTHLY COMPENSATION FOR THE THREE-YEAR PERIOD DURING WHICH COMPENSATION WAS THE HIGHEST, INCLUDING PERIODS BEFORE APRIL 1, 2002, AT THE FOLLOWING RATES: (I) 4% FOR THE CEO AND 2% FOR OTHER PARTICIPANTS THROUGH APRIL 4, 2004, AND (II) 5% FOR THE CEO, WHICH INCLUDES A CATCH UP PROVISION FOR A SERP BENEFIT FORFEITED FROM A PRIOR EMPLOYER AS A CONDITION OF HIS EMPLOYMENT AT CMH, AND 2% FOR OTHER PARTICIPANTS AFTER APRIL 4, 2004. PARTICIPANTS VEST AFTER TEN YEARS OF SERVICE AND THE ATTAINMENT OF AGE 60, INCLUDING SERVICE PRIOR TO THE EFFECTIVE DATE, OR ATTAINMENT OF AGE 65, WHICHEVER IS EARLIER. TOGETHER, THE 1990 SERP AND THE 2002 SERP ARE REFERRED TO AS SERPS. THE SERPS ARE FUNDED BASED ON AN ANNUAL VALUATION OF THE LIABILITY. THE BOARD OF DIRECTORS HAS DESIGNATED ASSETS TO BE SEGREGATED TO FUND THE SERPS. HOWEVER, THE ASSETS ARE NOT HELD IN TRUST OR OTHERWISE LEGALLY RESTRICTED TO FUND THE PLANS. THE FOLLOWING INDIVIDUALS RECEIVED A SERP PAYOUT DURING THE YEAR (AS NOTED ON SCHEDULE J, PART II, COLUMN F, ALL OF THESE PAYOUTS, EXCLUDING ACCRUALS FOR THE 2017 YEAR, WERE PREVIOUSLY REPORTED ANNUALLY ON SCHEDULE J, PART II, COLUMN C, IN PRIOR YEARS 990S): Michael Ellingson - $601,338 Diany Klein - $126,636 Gary K. Wilde - $682,616 Stanley Frochtzwajg - $109,551 David Glyer - $133,590 Emilie Rayman - $81,878 Form 990, SCHEDULE J, Part I LINE 7 BONUSES ARE AWARDED TO EXECUTIVES BASED UPON THEIR CONTRIBUTION TO THE OVERALL GOALS OF THE SYSTEM, THEIR ACHIEVEMENT OF INDIVIDUAL GOALS AND WITH REGARD TO REASONABLE COMPENSATION PRACTICES FOR COMPARABLE POSITIONS IN LIKE ORGANIZATIONS. THE COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS THE BONUSES AND MOVES FOR APPROVAL BY THE BOARD OF TRUSTEES. A CITY OF SAN BUENAVENTURA 956000807 797049AJ2 2011-08-17 350000 REPLACEMENT FACILITIES false false false A 0 0 349865548 48118471 161632717 0 0 0 0 140114360 0 0 false false false true A false false false false 0 false false false false A false false false false 0 false 0 false A false SCHEDULE K, PART II, LINE 3 ORIGINAL ISSUE DISCOUNT OF $134,452. SCHEDULE K, PART IV, LINE 2C THE REBATE COMPUTATION TO DETERMINE THAT NO REBATE IS DUE WAS COMPLETED ON 8/23/2017. SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 2053249 CONTRACTOR false X 4 47521 FMV false true false SCHEDULE M, PART I, COLUMN B THE NUMBER REPORTED IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART III, LINE 1 TO ESTABLISH, EQUIP AND MAINTAIN ONE OR MORE NONPROFIT HOSPITALS, MEDICAL CENTERS, INSTITUTIONS, CLINICS OR OTHER PLACES FOR THE RECEPTION AND CARE OF THE SICK, INJURED AND DISABLED, WITH PERMANENT FACILITIES THAT INCLUDE INPATIENT BED AND MEDICAL SERVICES; TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTS; AND TO PROVIDE ASSOCIATED SERVICES, OUTPATIENT CARE AND HOME CARE IN FURTHERANCE OF THIS CORPORATION'S CHARITABLE PURPOSES; TO PROMOTE AND CARRY ON EDUCATION ACTIVITIES RELATED TO THE CARE OF SICK, INJURED AND DISABLED; TO PROMOTE AND CARRY OUT SCIENTIFIC AND MEDICAL RESEARCH RELATED TO THE CARE OF THE SICK, INJURED AND DISABLED; AND TO PROMOTE OR CARRY OUT SUCH OTHER ACTIVITIES AS MAY BE DEEMED ADVISABLE FOR THE BETTERMENT OF THE GENERAL HEALTH OF THE COMMUNITIES SERVED. FORM 990, PART III, LINES 4A-4C COMMUNITY BENEFIT PLAN IT IS THE GOAL OF CMHS TO PROMOTE THE HEALTH OF THE COMMUNITY BY FOCUSING ON THE FOLLOWING FOUR AREAS: COMMUNITY EDUCATION OUTREACH 1. CONTINUE TO SPONSOR AND PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PUBLIC EXPOS AND OTHER MECHANISMS TO PROMOTE HEALTH SERVICES, HEALTH EDUCATION, AND PREVENTION THROUGHOUT THE COMMUNITY. HEALTH RELATED EDUCATION AND PREVENTION WILL BE FOCUSSED AROUND DIABETES, OBESITY, PRENATAL CARE, HEART HEALTH, AND HEALTHY LIVING AND NUTRITION. 2. PROVIDE INDIVIDUALS AND EMPLOYEES OF LOCAL BUSINESSES WITH THE HEARTAWARE HEART DISEASE DETECTION AND SCREENING PROGRAM. 3. CONTINUE TO PARTICIPATE IN THE STATE CPSP PROGRAM TO PROVIDE EDUCATIONAL RESOURCES TO LOW INCOME CHILDREN AND PREGNANT WOMEN. 4. PROVIDE COMMUNITY FORUMS IN VENTURA AND OJAI HIGHLIGHTING THE STATUS OF OUR HEALTH SYSTEM (THE HOSPITALS AND THE CENTERS FOR FAMILY HEALTH), NEW SERVICES AVAILABLE TO BENEFIT RESIDENTS OF THE COMMUNITY, AND COMMUNITY BENEFITS PROVIDED BY THE HEALTH SYSTEM. 5. DISTRIBUTE A HEALTH INFORMATION CARD TO INDIVIDUALS IN THE COMMUNITY TO ASSIST THEM IN KEEPING TRACK OF PERSONAL HEALTH INFORMATION THAT MAY BE VITAL WHEN ACCESSING THE HOSPITAL, AND, IN PARTICULAR, THE EMERGENCY DEPARTMENT. 6. ADD NEW DISEASE DETECTION AND SCREENING SERVICES FOCUSING ON DIFFERENT DISEASE CONDITIONS OF IMPORTANCE (MAJOR CHRONIC DISEASES). 7. CONTINUE TO PROVIDE AT LEAST 3,000 BLOOD PRESSURE CHECKS PER MONTH AT THE KIOSK IN THE PACIFIC VIEW MALL IN VENTURA. ACCESS TO CARE INCREASE ACCESS OF THE UNDERSERVED AND VULNERABLE POPULATION TO PRIMARY AND SECONDARY MEDICAL CARE IN VARIOUS GEOGRAPHIC LOCATIONS THROUGH THE CMHS SERVICE AREA. 1. CONTINUE TO OFFER A FREE PHYSICIAN REFERRAL SERVICE FOR MEMBERS OF THE PUBLIC PROVIDING AT LEAST 1,000 REFERRALS PER YEAR TO LOCAL PHYSICIANS AND OTHER HEALTH SERVICES. 2. CONTINUE EXPANSION OF EXISTING CENTERS FOR FAMILY HEALTH CLINICS AS WARRANTED BY THE GROWTH OF PATIENT VISITS. 3. CONTINUE TO PROVIDE ACCESS THROUGH THE CENTERS FOR FAMILY HEALTH CLINICS TO SIGNIFICANT NUMBERS OF MEDI-CAL AND UNINSURED INDIVIDUALS THROUGHOUT WESTERN VENTURA COUNTY. 4. CONTINUE TO PROVIDE GENERAL MEDICAL, SURGICAL, AND SPECIALTY PROFESSIONAL COVERAGE OF ER PATIENTS THROUGH THE "ER FUND". PROVIDE STIPENDS TO PHYSICIANS, AS NECESSARY, TO INSURE COVERAGE, ESPECIALLY FOR MEDICAL AND UNINSURED PATIENTS, BY ALL MEDICAL SPECIALTIES. 5. THROUGH THE CENTERS FOR FAMILY HEALTH, CONTINUE TO PROVIDE AN EXTENSIVE CHILDHOOD IMMUNIZATION PROGRAM. 6. ENGAGE SENIOR POPULATION IN DIALOGUE SURROUNDING HEALTH CARE OBJECTIVES AND ASSIST WITH CARE COORDINATION . 7. ENHANCE OUT-OF-AREA TRANSPORTATION SERVICES TO IMPROVE ACCESS TO CARE. 8. CONTINUE TO TRAIN RESIDENT PHYSICIANS THROUGH THE SYSTEM'S GRADUATE MEDICAL EDUCATION PROGRAM WITH FOCUS ON FAMILY AND INTERNAL MEDICINE. RESIDENTS WITH THE GME PROGRAM ARE PROVIDING FREE HEALTHCARE AND HEALTH EDUCATION IN MEDICALLY UNDERSERVED AREAS OF VENTURA COUNTY. UNCOMPENSATED AND UNDER FUNDED CARE 1. CONTINUE TO PROVIDE ACCESS TO A SIGNIFICANT NUMBER OF MEDI-CAL BENEFICIARIES ACROSS A BROAD RANGE OF MEDICAL SERVICES (MEASURED AS A PERCENTAGE OF GROSS REVENUE AND TOTALING AT LEAST 9%). 2.CONTINUE TO PROVIDE A SIGNIFICANT LEVEL OF SUBSIDIZED CARE THROUGH THE CENTERS FOR FAMILY HEALTH. SPONSORSHIP OF COMMUNITY RESOURCES 1. CONTINUE TO SUPPORT THE INTERIM PERMIT NURSING PROGRAM, WITH THE OBJECTIVE OF TRAINING AT LEAST TWENTY (20) RECENTLY GRADUATED NURSES TO BECOME COMPETENT CLINICAL NURSES. 2. CONTINUE TO ASSIST THE VENTURA COUNTY DISTRICT ATTORNEY'S OFFICE IN SUPPORTING VICTIMS OF DOMESTIC ABUSE THROUGH THE "PROJECT SAFE HARBOR" PROGRAM. 3. PROVIDE A ROTATION FOR TRAINING OB/GYN, ORTHOPEDIC SURGERY, INTERNAL MEDICINE, AND FAMILY MEDICINE PHYSICIAN RESIDENTS. 4. CONTINUE TO PROVIDE CHILDREN'S TOURS OF THE HOSPITALS. 5. CONTINUE TO PROVIDE DATA TO A NATIONAL TUMOR REGISTRY THAT SUPPORTS A KNOWLEDGE BASE THAT ENHANCES THE CARE OF CANCER PATIENTS IN OUR COMMUNITY. 6. CONTINUE TO PROVIDE A CANCER CENTER THAT INCLUDES SUPPORT GROUPS TO HELP PATIENTS AND THEIR FAMILIES DEAL WITH THEIR CONDITION AT NO COST. Form 990, Part VI, Line 2 Family or business relationships JOHN RUSSELL AND MARTIN POPS HAD A BUSINESS RELATIONSHIP FOR PART OF 2017. Form 990, Part VI, Line 11b PROCESS USED TO REVIEW FORM 990 FORM 990 WAS PREPARED BY ERNST & YOUNG LLP AND COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) FINANCE WITH INPUT FROM THE SYSTEM'S PLANNING AND MANAGED CARE OFFICE. FORM 990 WAS REVIEWED BY THE CEO, CFO, CORPORATE COMPLIANCE OFFICER AND AUDIT COMMITTEE. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING THE FORM 990 WITH THE IRS. Form 990, Part VI, Line 12c DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY AND COLLECTED FROM DIRECTORS, OFFICERS AND KEY EMPLOYEES ON AN ANNUAL BASIS. SUCH STATEMENTS PROVIDE DISCLOSURE OF FINANCIAL INTERESTS AND TRANSACTIONS WHERE CONFLICT OF INTEREST IS A POSSIBILITY, AND SHALL ASSIST IN THE AVOIDANCE OF POTENTIAL CONFLICT OF INTEREST IN CHOOSING NEW DIRECTORS, AND OTHER MATTERS INVOLVING OFFICERS, DIRECTORS, AND KEY EMPLOYEES. IT IS THE POLICY OF CMHS THAT REQUIRES DIRECTORS TO DISQUALIFY HIMSELF/HERSELF FROM MAKING A DECISION WHERE HE/SHE HAS A CONFLICT OF INTEREST. THE SYSTEM'S CHIEF CORPORATE OFFICER HAS OVERSIGHT OF THIS PROCESS AND DETERMINES WHETHER A CONFLICT OF INTEREST IS PRESENT. FORM 990, PART VI, QUESTIONS 15A AND 15B PROCESS FOR DETERMINING COMPENSATION IN 2016 AND 2017, THE ORGANIZATION USED AN INDEPENDENT CONSULTANT TO SURVEY EXECUTIVE COMPENSATION. NATIONWIDE SURVEYS WERE USED TO COMPARE THE COMPENSATION OF THE HEALTH SYSTEM'S EXECUTIVE STAFF TO THE 50TH PERCENTILE OF THOSE SURVEYED AND BY ORGANIZATIONAL SIZE AND SCOPE. THE BOARD COMPENSATION COMMITTEE IS RESPONSIBLE FOR ENGAGING THE INDEPENDENT COMPENSATION CONSULTANT AND FOR DETERMINING THE COMPENSATION OF THE CEO. THE COMPENSATION FOR ALL OTHER EXECUTIVES IS DETERMINED BY THE CEO AND SUBJECT TO THE APPROVAL BY THE BOARD COMPENSATION COMMITTEE. THE RECOMMENDATION OF THE BOARD COMPENSATION COMMITTEE IS THEN APPROVED BY THE BOARD OF DIRECTORS. THIS PROCESS IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST COMPLETED APRIL 2017. FORM 990, PART VI, QUESTIONS 16A AND 16B JOINT VENTURES CMHS HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS. FORM 990, PART VI, QUESTION 19 PUBLIC DISCLOSURE OF CERTAIN DOCUMENTS THE AUDITED FINANCIAL STATEMENTS, FORM 990 TAX RETURNS, GOVERNING AND ORGANIZATIONAL DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE THROUGH THE ADMINISTRATIVE OFFICES AND ARE PROVIDED UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSSETS CHANGE IN PENSION LIABILITY $1,587,417 CHANGE IN PLEDGE RECEIVABLE BALANCE $( 20,017) ACAOV CONTRIBUTED CAPITAL $ 315,388 ----------- TOTAL $1,882,788 ACCOUNTABLE CARE ALLIANCE OF VENTURA LL 147 N BRENT STREET VENTURA CA 93003 462843182 MGMT SVCS CA 2400 41225 CMHS COMMUNITY MEMORIAL PHYSICIANS SERVICES 147 N BRENT STREET VENTURA CA 93003 463142917 MGMT SVCS CA 0 165447 CMHS VENTURA ORTHOPEDIC CO-MANAGEMENT COMPANY 147 N BRENT STREET VENTURA CA 93003 453483342 MGMT SVCS CA 0 0 CMHS COMMUNITY MEMORIAL HEALTHCARE FOUNDATION 147 N BRENT STREET VENTURA CA 93003 953847251 FUNDRAISING CA 501(c)(3) 7 CMHS true GROSSMAN IMAGING CENTER OF CMH 2001 N SOLAR DRIVE SUITE 135 OXNARD CA 93030 311512002 IMAGING CENTER CA NA Related 25579 225087 false 0 false 0.51000 VENTURA CARDIOVASCULAR CO-MANAGEMENT CO 147 N BRENT STREET VENTURA CA 93003 273227049 MANAGEMENT SERVIC CA NA Related 151720 196502 false 0 true 0.50000 BUENAVISTA MEDICAL PROPERTIES LTD 168 N BRENT STREET VENTURA CA 93003 770275364 RENTAL CA NA BUENAVISTA MEDICAL PROPERTIES INC 147 N BRENT STREET VENTURA CA 93003 770298516 REAL ESTATE CA NA C Corp 188231 423466 1.00000 true CALIFORNIA HEART INSTITUTE 147 N BRENT STREET VENTURA CA 93003 770276145 BILLING SERVICES CA NA C Corp 264712 195768 1.00000 true true false true true false false false false false true false false true true true false true false true GROSSMAN IMAGING CENTER a 121663 ACCRUAL METHOD GROSSMAN IMAGING CENTER d 3529213 ACCRUAL METHOD GROSSMAN IMAGING CENTER j 157224 ACCRUAL METHOD COMMUNITY MEMORIAL HEALTHCARE FDN c 275542 ACCRUAL METHOD COMMUNITY MEMORIAL HEALTHCARE FDN q 200544 ACCRUAL METHOD FORM 990, SCHEDULE R, PART III INFORMATION FOR RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS ORGANIZATION NAME: GROSSMAN IMAGING CENTER OF CMH, LLC ORGANIZATION EIN: 37-1512002 U.S. ADDRESS: 2001 N. SOLAR DR., SUITE 135, OXNARD, CA 93030 ORGANIZATION NAME: VENTURA CARDIOVASCULAR CO-MANAGEMENT CO. LLC ORGANIZATION EIN: 27-3227049 U.S. ADDRESS: 147 NORTH BRENT STREET, VENTURA, CA 93003 ORGANIZATION NAME: BUENAVISTA MEDICAL PROPERTIES, LTD. ORGANIZATION EIN: 77-0275364 U.S. ADDRESS: 168 NORTH BRENT STREET, VENTURA, CA 93003