2017-11-15T12:02:08-06:00 2016-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2016-01-01 940760193 Community Hospital of the Monterey Peninsula COMM 8316254821 PO Box HH Monterey CA 93942 Matthew Morgan Vice President, Finance 8316254821 2017-11-13 1 Richard Croghan P00089862 4159561500 2017-11-13 73.189.125.157 2017-11-13 23:32:05 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 77D8D66CE2F074441361C0A43DEB59CA8CC3760F 2016 2018-03-14 21:41:22Z Steven Packer PO Box HH Monterey CA 93942 554357485 0 X www.chomp.org X 1928 CA TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY. 19 16 2381 422 2002902 -130930 3221962 3878064 513385964 556015407 179369 1601551 2502518 -7186025 519289813 554308997 30289822 1677970 0 0 278197167 283851460 0 0 0 174629236 196194268 483116225 481723698 36173588 72585299 533725411 633415545 384421583 434683769 149303828 198731776 TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY. 0 0 341796732 1677970 554339829 TO PROVIDE HEALTHCARE FOR THE GENERAL PUBLIC - 11,554 ADMISSIONS; 56,944 ADULT PATIENT DAYS; 330,956 OUTPATIENT VISITS; 7,425 SURGERIES; 56,146 EMERGENCY ROOM VISITS; 18,245 HOSPICE BENEFIT DAYS; AND 1,168 BIRTHS. 341796732 1 1 0 1 0 0 1 1 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 548 0 1 2381 1 1 1 0 0 0 0 0 0 0 0 0 X 19 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X Judi Sanderlin 8316254821 23845 WR HOLMAN HWY SUITE 105 MONTEREY CA 939405902 STEVEN PACKER MD PRESIDENT/CEO 42.00 13.00 X X 1005549 0 315494 FREDERICK M O'SUCH TRUSTEE 3.50 X 0 0 0 JANE PANATTONI Secretary 6.00 X X 0 0 0 John Mahoney Chair 14.00 X X 0 0 0 Michael D Lyon TRUSTEE 1.00 X 0 0 0 Patrick Welton MD Vice Chair 7.00 X X 0 0 0 Phil Wilhelm TRUSTEE 5.50 X 0 0 0 Robert M Kavner Trustee 13.00 X 0 0 0 John Ellison MD TRUSTEE 2.00 X 0 0 0 Michael Davis DO TRUSTEE 3.00 X 0 0 0 Stephen Schulte TRUSTEE 3.00 X 0 0 0 WILLIAM W LEWIS TRUSTEE 6.00 X 0 0 0 KATHLEEN BANG TRUSTEE 6.00 X 0 0 0 GENE HILL TRUSTEE 3.00 X 0 0 0 William Young TRUSTEE 3.50 X 0 0 0 Jean Kane Trustee 1.00 X 0 0 0 Stan Mckee Trustee 1.00 X 0 0 0 John O'Brien Trustee 2.00 X 0 0 0 Bill Warner TrUSTEE 2.00 X 0 0 0 Laura Zehm Vice President/CFO 42.00 13.00 X 672639 0 108362 STEVEN CABRALES VP Medical Affairs 55.00 X 551161 0 90989 Cynthia Peck Vice President 55.00 X 416572 0 71132 Terril Lowe VP Nursing 55.00 X 439172 0 82991 Tim Nylen Vice President 55.00 X 363143 0 39375 JARED STIVER ASST DIR THI 40.00 X 305340 0 56737 DAVID MISISCO PHYSICIST MASTERS 40.00 X 265753 0 58041 MATTHEW MORGAN CAO 50.00 X 296500 0 50970 Sabina Gaudoin Registered Nurse 40.00 X 276906 0 60555 Jennifer Ballesteros Registered Nurse 40.00 X 331508 0 31171 4924243 0 965817 835 0 1 0 MONTEREY PENINSULA RADIOLOGIST MEDICAL Group Inc PO Box HH mONTEREY CA 93942 radiologists 9004641 MONTEREY BAY EMERGENCY PHYSICIANS MEDICA Group PO Box HH MONTEREY CA 93942 emergency Department Group 8596827 Emergency Acute Care Med Corp PO Box HH MONTEREY CA 93942 emergency physician back-up 4439768 ORIGIN INC (DBA SHIFTWISE) 2501 SW 1ST AVENUE 200 PORTLAND OR 97201 CONTRACTED NURSING 4418323 Allscripts Healthcare LLC 24630 Network Place Chicago IL 606731246 IT Services 3697218 71 3878064 39665 3878064 OTHER PATIENT REVENUE 900099 324100498 322424920 1675578 MEDICARE/MEDICAID 900099 207016475 207016475 OTHER OPERATING REVENUE 900099 21821917 21821917 MOntage WELLNESS CENTER 900099 3076517 3076517 556015407 1650039 1650039 48488 -48488 -48488 -48488 OTHER INCOME 900099 1078332 327324 751008 Loss on Forgiveness of Loan - CHI 900099 -2527839 -2527839 Loss on Extinguishment of Debt 900099 -5736518 -5736518 -7186025 554308997 554339829 2002902 -5911798 1677970 1677970 4156577 4156577 169678522 140113425 29565097 20385263 16739932 3645331 76168406 61682073 14486333 13462692 10815792 2646900 599346 599346 234405 234405 242642 242642 7436326 7436326 12927398 12927398 3041068 3041068 4419608 4419608 29642338 4589440 25052898 2482969 2482969 Medical Supplies 76622188 76587491 34697 Physician Coverage 8710754 8710754 bad debts expense 6454446 6454446 43380780 6989083 36391697 481723698 341796732 139926966 0 9880872 9923044 54521897 64209727 81899492 95543383 2395845 2218466 24987632 30564449 751058309 481551639 278088315 269506670 81951358 161449806 533725411 633415545 51276778 55677507 30213 22186 110650000 110323615 14197479 31491540 208267113 237168921 384421583 434683769 X 149303828 198731776 149303828 198731776 533725411 633415545 X 72585299 -86673 -23070678 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 262110 262110 481461588 481723698 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 203038 23808 242642 262110 731598 250000 250000 250000 250000 1000000 1500000 X X 1 2.76 0 0 1 1 0.00 0 1 0 3494206 X 0 134796586 704076 9646031 738606 1019727 143388360 136954497 832369 -934052 75000 1631640 349588 134796586 131191891 875805 7255389 537716 1396470 434402 136954497 117974540 933845 16411731 100000 3561796 466429 131191891 107067033 992560 12424839 133924 1841967 534001 117974540 0.03230 0.27810 0.68960 1 1 1 5520450 5520450 393228784 191508379 201720405 330473912 282295685 48178227 21835163 7747575 14087588 269506670 OTHER INVESTMENTS 20580437 DUE FROM RELATED PARTIES 140850733 Bond Indenture 18636 161449806 accrued PROFESSIONAL LIABILITY 3405111 ACCRUED PENSION LIABILITY 149625488 POST-RETIREMENT HEALTH BENEFIT LIABILITY 37445891 WORKERS' COMPENSATION LIABILITY 15819011 INTEREST RATE SWAP 10676139 INTERCOMPANY PAYABLE 20197281 237168921 X Part II, Line 9: REPORTED ON BALANCE SHEET AS PART OF PROPERTY, PLANT AND EQUIPMENT. Part III, Line 4: ART COLLECTIONS PROMOTE THE HEALING ENVIRONMENT OF THE HOSPITAL Part V, Line 4: IMPROVEMENT OF PATIENT CARE, SPONSORED CARE UNDER CIRCUMSTANCES, OTHER COSTS TO IMPROVE THE AESTHETIC ENVIRONMENT, HOSPICE CARE, SCHOLARSHIPS, COMMUNITY BENEFIT GRANTS, AND EMPLOYEE WELLNESS AND INCENTIVE PROGRAMS. Part X, Line 2: MONTAGE, CHOMP, ASPIRE (EXCLUDING COASTAL), AND MMG HAVE BEEN DETERMINED TO BE EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA FRANCHISE TAX BOARD AND GENERALLY ARE NOT SUBJECT TO TAXES ON INCOME PURSUANT TO SECTION 501(C)(3) AND SECTION 23701(D) OF THE INTERNAL REVENUE CODE AND CALIFORNIA REVENUE AND TAXATION CODE, RESPECTIVELY. CCCMIC AND COASTAL ARE TAXABLE ENTITIES AND INCOME TAXES ARE ACCOUNTED FOR USING AN ASSET AND LIABILITY APPROACH THAT REQUIRES THE RECOGNITION OF DEFERRED TAX ASSETS AND LIABILITIES FOR THE EXPECTED FUTURE TAX CONSEQUENCES OF EVENTS THAT HAVE BEEN INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT AND TAX BASIS OF ASSETS AND LIABILITIES USING ENACTED TAX RATES IN EFFECT FOR THE YEAR IN WHICH THE DIFFERENCES ARE EXPECTED TO REVERSE. CCCMIC AND COASTAL HAVE NET CUMULATIVE LOSSES AND THE DEFERRED TAX ASSETS ASSOCIATED WITH THESE LOSSES HAVE BEEN FULLY RESERVED. THERE WERE NO TAX PROVISIONS RECORDED FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015. THE ORGANIZATION ASSESSES UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE PROVISIONS OF THE FASB ASC TOPIC 740-10, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE TAX BENEFIT 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. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2016 AND 2015. 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 2540153 2540153 0.00610 73164000 38541939 34622061 0.08300 24985673 12710956 12274717 0.02940 100689826 51252895 49436931 0.11850 13827 4717509 4717509 0.01130 2461 487215 487215 0.00120 25484102 4904117 20579985 0.04930 25 485160 485160 0.00120 16313 31173986 4904117 26269869 0.06300 16313 131863812 56157012 75706800 0.18150 1 205 4650 0 4650 0.00000 25 4550 57766 0 57766 0.00010 2 8555 436544 0 436544 0.00100 1 45 2650 0 2650 0.00000 75 65000 1589625 0 1589625 0.00380 12 99076 10207351 0 10207351 0.02450 6 5336 588368 0 588368 0.00140 122 182767 12886954 12886954 0.03080 1 6440798 1288160 126462899 191943293 -65480394 X 1 1 1 1 COMMUNITY HOSP OF THE MONTEREY PENINSULA 23625 HOLMAN HIGHWAY MONTEREY CA 93940 X X X COMMUNITY HOSP OF THE MONTEREY PENINSULA 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.CHOMP.ORG X 1 16 1 https://www.chomp.org/about-us/community-needs-assessment/#.Wd6H7VtSzn9 0 1 X 250.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X WWW.CHOMP.ORG X www.CHOMP.ORG X WWW.CHOMP.ORG X X X X X 1 X 0 1 X 0 0 COMMUNITY HOSP OF THE MONTEREY PENINSULA Part V, Section B, Line 5: The data collection effort consisted of a random sample of 1,000 individuals age 18 and older in the CHOMP Service Area, resulting in 170 surveys in Monterey, 116 in Carmel/Big Sur, 220 in Seaside, 188 in Marina 145 in Pacific Grove/Pebble Beach, and 161 in Salinas/Carmel Valley. Administration of the survey, data collection, and data analysis was conducted by an independent research firm.A key informant survey was conducted, and participants included 133 community stakeholders: physicians, public health representatives, other health professionals, social service providers, business leaders, and other community leaders. Participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. COMMUNITY HOSP OF THE MONTEREY PENINSULA Part V, Section B, Line 11: Identified areas for focus are incorporated into the hospital's operational planning. This includes collaboration with other community partners. Areas identified that were not selected for focus include chronic kidney disease, chronic pain and disabling conditions, dementia immunization and infectious diseases, injury and violence prevention, maternal/infant health and family planning, oral health, sexually transmitted disease, substance abuse, and tobacco abuse. The majority of these needs have other community organizations addressing the particular issue. In other areas, educational programs are already in place. Part I, Line 6a: Montage Health 94-2789696 Part I, Line 7: A ratio of cost to charges from Worksheet 2 was used on line (a). All other lines in this section either use directly attributable expenses from the general ledger or rely on estimates from our cost accounting system. The cost accounting system addresses all patient segments. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 64,545,446. Part II, Community Building Activities: COMMUNITY BUILDING ACTIVITIES ARE OFFERED IN DIRECT RESPONSE TO COMMUNITY NEED. COMMUNITY HEALTH IS PROMOTED BY ENSURING ADEQUATE PHYSICIAN AVAILABILITY IN THE AREA, MAKING HEALTH INFORMATION AVAILABLE TO PARTICIPATING PHYSICIANS AND ENSURING PROPER EMERGENCY PREPAREDNESS ON THE PENINSULA.THE HOSPITAL GOES ABOVE AND BEYOND REQUIREMENTS AS IT RELATES TO DISASTER PLANNING. INCLUDED ON PART II LINE 3 ARE A BASE HOSPITAL COORDINATOR AND EMERGENCY PREPAREDNESS EXPENSES. THE HOSPITAL SERVES AS THE KEY RESOURCE IN AREA DISASTER SUPPORT.THE HOSPITAL PROVIDES NUMEROUS INCENTIVES TO REDUCE TRAFFIC ON THE PENINSULA, AS FOUND ON LINE 4 IN PART II. FULL EMPLOYEE SHUTTLE SERVICE TO SURROUNDING COMMUNITIES AS WELL AS CARPOOL INCENTIVES COMPRISE A KEY BENEFIT TO THE LOCAL COMMUNITY.PART II, LINE 8 INCLUDES THE HOSPITAL'S PHYSICIAN RECRUITMENT PROGRAM WHICH IS FURTHER DESCRIBED BELOW:SINCE 1999, COMMUNITY HOSPITAL HAS ENGAGED IN PERIODIC ASSESSMENT OF THE ADEQUACY OF PHYSICIAN RESOURCES NEEDED TO MEET COMMUNITY HEALTHCARE NEEDS. THE FIRST STUDY DEMONSTRATED THAT THERE WERE UNMET NEEDS IN CERTAIN PHYSICIAN SPECIALTIES, AND THAT THE PROBLEM WOULD LIKELY WORSEN OVER THE NEXT SEVERAL YEARS. BECAUSE THE SHORTAGES DID, IN FACT, WORSEN IN THE INTERVENING YEARS, THE BOARD OF TRUSTEES ESTABLISHED A FORMAL PHYSICIAN RECRUITMENT PROGRAM IN 2001 TO PROVIDE SIGNIFICANT FINANCIAL SUPPORT AND A MORE AGGRESSIVE ORGANIZATIONAL COMMITMENT TO MEETING THESE COMMUNITY NEEDS AND IMPROVING ACCESS TO CARE FOR LOCAL RESIDENTS.THE PHYSICIAN RECRUITMENT PROGRAM INCLUDES ONGOING ASSESSMENT OF THE CHANGING NEEDS AND DEMOGRAPHICS OF THE HOSPITAL'S SERVICE AREA, CHANGING MARKET CONDITIONS, AND ACTIVE MEDICAL STAFF DEMOGRAPHICS AND PRACTICE PATTERNS. THE PROGRAM IS REGULARLY UPDATED TO REFLECT THIS ASSESSMENT DATA (AS WELL AS CHANGES IN APPLICABLE LAWS GOVERNING SUCH PROGRAMS), AND RECRUITMENT PRIORITIES ARE ESTABLISHED ANNUALLY BY HOSPITAL ADMINISTRATION AND MEDICAL STAFF LEADERSHIP. THE PROGRAM IS DESIGNED TO PROVIDE THE ASSISTANCE NECESSARY TO BRING PHYSICIANS IN SPECIALTIES WITH DEMONSTRATED LOCAL SHORTAGES TO THE HOSPITAL'S PRIMARY SERVICE AREA.THROUGH DECEMBER 2010, THE HOSPITAL HAD SUCCESSFULLY RECRUITED OVER 81 PHYSICIANS TO THE MONTEREY PENINSULA UNDER THE PROGRAM. ALL ARE REQUIRED TO PARTICIPATE IN THE MEDICARE, MEDI-CAL, AND CHAMPUS/TRICARE PROGRAMS, BECAUSE THE SHORTAGE OF PHYSICIANS ON THE MONTEREY PENINSULA WILLING TO DO SO IS PARTICULARLY ACUTE.CURRENT RECRUITMENT PRIORITIES INCLUDE: ADULT PRIMARY CARE (FAMILY AND INTERNAL MEDICINE), PEDIATRICS, ENDOCRINOLOGY, NEUROLOGY, PULMONARY MEDICINE/CRITICAL CARE, GENERAL AND VASCULAR SURGERY AS WELL AS OBSTETRICS.BECAUSE THE SHORTAGE OF PRIMARY CARE PHYSICIANS IS THE MOST ACUTE PHYSICIAN MANPOWER ISSUE AND UNMET HEALTHCARE NEED FACING THE HOSPITAL'S COMMUNITY, IN 2008 THE BOARD OF TRUSTEES TOOK OFFICIAL ACTION TO CREATE PENINSULA PRIMARY CARE, A NEW NONPROFIT SUBSIDIARY OF COMMUNITY HOSPITALFOUNDATION. PENINSULA PRIMARY CARE WAS SUBSEQUENTLY RENAMED MONTAGE MEDICAL GROUP.MONTAGE MEDICAL GROUP (MMG) OPENED ITS INITIAL SITE AT THE CROSSROADS IN CARMEL IN SEPTEMBER 2009. THIS SITE WAS SELECTED TO HELP ADDRESS A SIGNIFICANT UNMET NEED AMONG THE MEDICARE POPULATION IN THAT COMMUNITY. A SECOND OPENED IN 2011 IN MARINA. NOT ONLY IS THIS COMMUNITY UNDERSERVED IN PRIMARY CARE, BUT MARINA RESIDENTS ALSO VISIT AN EMERGENCY ROOM AT A MUCH HIGHER RATE THAN RESIDENTS OF OTHER LOCAL COMMUNITIES. AS A RESULT, THE SITE WILL INCLUDE AN URGENT CARE CENTER AS WELL AS X-RAY AND LABORATORYSERVICES. MONTAGE MEDICAL GROUP NOW OPERATES OUT OF SIX PHYSICAL LOCATIONS.THE GOAL IS TO RECRUIT ADDITIONAL PHYSICIANS TO PRACTICE IN OUR COMMUNITY, AS WELL AS PROVIDE A STABLE PRACTICE ENVIRONMENT FOR SOME EXISTING PHYSICIANS TO PREVENT THEIR LEAVING THE COMMUNITY. WE ANTICIPATE THAT EACH MMG SITE WILL REQUIRE AN ANNUAL SUBSIDY FROM COMMUNITY HOSPITAL OF APPROXIMATELY $1 MILLION WHEN FULLY OPERATIONAL. THOSE EXPENDITURES ARE NOT INCLUDED IN THIS COMMUNITY BENEFIT SECTION AS EXPENDITURES ORIGINATE FROM THE PARENT COMPANY, MONTAGE HEALTH.A MAJORITY OF THE HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND ARE INDEPENDENT.THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.THE ORGANIZATION INVESTS ALL SURPLUS FUNDS THAT ARE NOT PRESERVED FOR THE FUTURE INTO PHYSICAL PLANT UPGRADES, SERVICE AND FACILITY EXPANSION AND ENHANCED MEDICAL TECHNOLOGIES; ALL OF WHICH ARE INTENDED TO FURTHER BENEFIT THE COMMUNITY.NOT INCLUDED ANYWHERE ARE THE NEARLY 25,000 UNPAID HOURS CONTRIBUTED TO COMMUNITY BENEFIT ACTIVITIES. KEY CONTRIBUTORS INCLUDE AUXILIARY VOLUNTEERS, BOARD MEMBERS, PHYSICIANS AND HOSPITAL STAFF.PART II, LINE 9 INCLUDES THE ORGANIZATION'S DEVELOPMENT & SUPPORT OF CENTRAL COAST HEALTH CARE CONNECT, A HEALTH INFORMATION EXCHANGE DESIGNED TO NETWORK LOCAL PHYSICIANS WITH THE HOSPITAL, SHARING INFORMATION & IMPROVING CARE COORDINATION. Part III, Line 2: A RATIO OF COST TO CHARGES WAS USED ON LINE (2). ALL OTHER LINES IN THIS SECTION EITHER USE DIRECTLY ATTRIBUTABLE EXPENSES FROM THE GENERAL LEDGER OR RELY ON ESTIMATES FROM OUR COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS.BAD DEBT IS NET OF BOTH PAYMENTS AND DISCOUNTS. THE AMOUNT ATTRIBUTABLE TO INDIVIDUALS WHO MAY QUALIFY FOR CHARITY CARE IS BASED ON AN INTERNAL ESTIMATE. Part III, Line 3: Patients that would normally qualify for a charity care could end up with their accounts written off as bad debt because they won't complete the charity application. Part III, Line 4: CHOMP PROVIDES FOR ESTIMATED LOSSES ON ACCOUNTS RECEIVABLE BASED ON PRIORBAD DEBT EXPERIENCE AND GENERALLY DOES NOT CHARGE INTEREST ON PAST DUEBALANCES. PAST DUE STATUS IS BASED UPON THE DATE OF SERVICES PROVIDED.UNCOLLECTIBLE RECEIVABLES ARE CHARGED OFF WHEN DEEMED UNCOLLECTIBLE.RECOVERIES FROM PREVIOUSLY CHARGED-OFF ACCOUNTS ARE RECORDED WHENRECEIVED.CHOMP's allowance for doubtful accounts was 99% and 95% of self-paypatient accounts receivable at December 31, 2016 and 2015, respectively.The Organization's bad-debt write offs decreased from $10,006,000 to$4,187,000 in 2016, and self-pay accounts receivable increased$3,352,000 year to year. CHOMP had not changed its charity careor bad-debt collection policies during fiscal years 2016 or 2015.While CHOMP does maintain an allowance for doubtful accountsfrom third-party payers, it is immaterial to the total associated withself-pay patients. Part III, Line 8: THE MEDICARE SHORTFALL AT THE HOSPITAL IS A SUBSTANTIAL FIGURE. OURCOMMUNITY HAS A SIGNIFICANT MEDICARE POPULATION AND WE EXIST TOSERVE THAT COMMUNITY. IN OUR OPINION, 100% OF THE MEDICARESHORTFALL MEETS COMMUNITY BENEFIT CRITERIA BASED ON THEDEFINITION OF "COMMUNITY HEALTH IMPROVEMENT SERVICES" ASDEFINED IN THE 990 INSTRUCTIONS. THAT IS, "ACTIVITIES OR PROGRAMSCARRIED OUT OR SUPPORTED FOR THE EXPRESS PURPOSE OF IMPROVINGCOMMUNITY HEALTH THAT ARE SUBSIDIZED BY THE HEALTH CAREORGANIZATION." COSTS ASSIGNED TO MEDICARE PATIENTS ARE BASED ONTHE REPORTED AMOUNTS FOUND IN THE 2015 HOSPITAL COST REPORT.THOSE COSTS ARE ALLOCATED TO MEDICARE PATIENTS BASED ON THERATIOS DEVELOPED WITHIN THAT COST REPORT. Part III, Line 9b: Community Hospital of the Monterey Peninsula pursues a collection policy in keeping with best practices in the industry, California Hospital Association (CHA) recommendations, the Hospital Fair Pricing Policies Act, and all federal, state and local laws governing the collection of a patient debt. The hospital will clearly and conspicuously post and maintain signs notifying patients of the hospital's Sponsored Care and Discount Payment Programs, and the availability of funds from other programs to assist with payment of bills. The signs are placed in every registration site, the patient business office, the emergency department, the billing office, the admissions office, and other outpatient settings.Patient Business Services shall adhere to the following guidelines in the collection of any patient debt to the hospital stemming from medical services rendered at any site or in any department. Every patient will be accorded respect and treated with dignity at all times. These collection guidelines are established under the authority of the Patient Business Services Department, and debts will not be advanced for collection without review based on the Authorization process by dollar threshold. The decision to advance a debt for collection will be made on a case-by-case basis, following the policy and processes set forth below. The collection process may be automated if certain criteria are met. The decision to advance a debt for collection will be based on such factors as lack of payment, failure to apply for available programs, failure to respond to hospital requests, or failure to contact the hospital in response to a bill. At the discretion of the Patient Business Services and following the authorization process by dollar threshold below, a debt may be advanced for collection if payment in full is not received within 30 days of the initial bill, subject to the limitations stated below. Regardless of the age of a bill, the hospital will always be open to compromise regarding a debt.Collection is initially conducted by the hospital but may be advanced for collection by an external collection agency or legal action as set forth below. This collection policy governs all communications between the hospital and a patient concerning collection of amounts owed to the hospital.Policy applies to all patient types and all visit types.Collection procedures will vary depending on the type of visit, with sponsored care/discount eligible patients outlined below:1. Patient Has Applied or Qualified for the Hospital's Sponsored Care or Discount Payment Program. Patients who meet income and/or asset requirements may qualify for the hospital's Sponsored Care or Discount Payment Program. All efforts should be made to determine eligibility for these programs pre-service if possible, or as soon as practicable after services are provided. The hospital's Social Services Department or the Patient Business Services Department will review applications for Sponsored Care or Discount Payment Program eligibility in accordance with hospital policy. While the patient's application is pending, the hospital may send billing statements, but will not commence any collection activity. 2. Collecting for a Visit from a Patient who is Eligible for the Hospital's Sponsored Care or Discount Payment Program.Upon reaching a determination that the patient is eligible for the Sponsored Care or Discount Payment Program, the hospital will determine the amount owed by the patient in accordance with the hospital's Sponsored Care & Discount Payment Program Policy. If the patient is not able to pay the amount due in a lump sum, the patient will be offered the opportunity to negotiate and agree to a payment plan. The patient will be advised that the payments will be interest free provided they are timely made, but if the patient fails to make all scheduled payments during any 90-day period, the hospital may terminate the extended payment plan and the entire outstanding balance will be due, together with interest on the remaining balance at the maximum legal rate. If the patient chooses to enter into a payment plan, the Sponsored Care & Discount Payment Program Payment Plan should be completed and the patient should sign that Plan.If the patient has signed a Sponsored Care & Discount Payment Program Payment Plan, and the patient fails to timely make all scheduled payments during any 90-day period, the hospital may terminate the Payment Plan. Before terminating the Payment Plan, the hospital will contact the patient by telephone and in writing and inform the patient that the Payment Plan may be terminated due to default in scheduled payments. If the patient requests, the hospital will renegotiate the Payment Plan.The hospital will not report adverse information to a consumer credit reporting agency or begin a civil action against the patient for nonpayment before the Payment Plan is terminated.The hospital will not use the monetary asset information it obtained in determining eligibility for the Sponsored Care Program for collection activities. Information concerning income and monetary assets that are obtained as part of the eligibility determination are maintained separately from the patient's collection file.For a period of 150 days after the initial billing to the patient, the hospital will not report adverse information to a consumer credit reporting agency concerning, or commence a civil action against, a patient who lacks coverage or provides information that he or she may be eligible for the Sponsored Care or Discount Payment Program. If a patient is attempting to qualify for the Discount Payment or Sponsored Care Program and is attempting in good faith to settle an outstanding bill by negotiating a payment plan or making reasonable, regular payments on his/her bill, the hospital will not send the patient's visit to a collection agency unless the agency agrees to comply with the hospital's collection policy and the Hospital Fair Pricing Policies Act.The hospital will not use wage garnishments or liens on primary residences as a means of collecting unpaid hospital bills from patients who are eligible for the Discount Payment or Sponsored Care Program. If a patient appeals the hospital's decision concerning eligibility or level of benefits of the patient for either the Sponsored Care or Discount Payment Program, or appeals a coverage of determination of a third party, the hospital will not report adverse information to a consumer credit reporting agency concerning, or commence a civil action against, the patient provided the patient has filed an appeal in compliance with the hospital's Sponsored Care & Discount Payment Program Policy, or makes a reasonable effort to communicate with the hospital about the progress of any coverage appeal pending with a third party. The hospital will not begin the 150-day period referenced above until after the resolution of the patient's appeal is completed to afford the patient the full 150 days to make payment.Before beginning any collection activity against any patient, including those who are not eligible for the Sponsored Care or Discount Payment Programs, the hospital will provide the patient with a clear and conspicuous notice of the patient's rights under the Fair Pricing Policies Act, the Rosenthal Fair Debt Collection Practices Act, and the federal Fair Debt Collection Practices Act. The notice will state:"State and federal law require debt collectors to treat you fairly and prohibit debt collectors from making false statements or threats of violence, using obscene or profane language, and making improper communications with third parties, including your employer. Except under unusual circumstances, debt collectors may not contact you before 8:00 a.m. or after 9:00 p.m. In general, a debt collector may not give information about your debt to another person, other than your attorney or spouse. A debt collector may contact another person to confirm your location or enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission by telephone at 877-FTC-HELP (382-4357) or online at www.ftc.gov. Nonprofit credit counseling services may be available in the area.If you are uninsured or have high medical costs, please contact Community Hospital's Patient Business Services Department at (831) 625-4922 or (888) 625-4922 for information on discounts and programs for which you may be eligible, including the Medi-Cal program. If you have coverage, please tell us so that we may bill your plan."This notice will also be given in any document indicating that the commencement of collection activities may occur. Any amount collected from a patient in excess of the amount due under the hospital's Sponsored Care or Discount Payment Policy will be refunded to the patient, together with interest theron. Part VI, Line 2: In 2016, Community Hospital completed an updated and comprehensive assessment of our community's unmet healthcare needs. Professional Research Consultants (PRC) was retained to conduct a statistically valid telephone survey of 1,000 randomly selected local adults as well as facilitate group discussions with public health professionals from the community. All of the data was then compiled and benchmarked against the goals of the national Healthy People 2020 initiative sponsored by the U.S. Department of Health and Human Services. Part VI, Line 3: Patient Business Services and the Social Services department screen applicants for the sponsored care and discount programs. Completed applications, including required documentation, are submitted to Patient Business Services or Social Services for initial review and follow up. The patient/responsible party, and/or service department are notified of the final eligibility decision in writing. Should there be any dispute as to the decision made by the hospital on the eligibility or level of eligibility of the patient for either the sponsored care or discount payment program, an appeal of the decision may be made to the director of Patient Business Services. For patients in the Outpatient Immunology Services clinic, a nurse case manager may provide initial financial screening. Each patient room includes a brochure "Welcome to Community Hospital." This brochure includes information regarding our financial assistance program. In addition, Community Hospital publicly displays information on the general program in key service locations and provides information to every patient at the time of registration for services and enclosed with billing statements. Information on specialty programs (e.g., free baseline mammography through the Sherry Cockle Fund and rehabilitation services through the Thomas A. Work, Jr., Fund) are provided to patients who register for these specific services. Through its public web site, Community Hospital also publicizes the sponsored care and discount programs and illustrates the benefits of the program. A formal presentation about hospital billing practices and sponsored care requirements is provided to community groups on request by our Patient Business Services department. In addition, the hospital publicizes sponsored care for HIV/AIDS patients through regular reports to collaborating community organizations on the program usage and the population served.Financial counselors work in conjunction with a private vendor (Diversified Health Resources) to guide uninsured patients through the process of obtaining available government benefits, such as Medi-Cal or other state programs. These counselors also assist those patients through the qualification process. Part VI, Line 4: Community Hospital's primary service area is the Monterey Peninsula, health facility planning area (HFPA) #707. The Monterey Peninsula includes Carmel, Carmel Valley, Del Rey Oaks, Marina, Monterey, Pacific Grove, Pebble Beach, Sand City, Seaside, Big Sur, and unincorporated areas of Monterey County. Approximately 130,000 residents exist in the primary service area.Factors used in defining the community for community benefit planning purposes include: 1. Community reliance on Community Hospital's services. The hospital's market share of Peninsula resident discharges was approximately 78 percent in 2016. 2. Hospital reliance on the community. Residents of the Peninsula accounted for approximately 80 percent of the hospital's patients in 2016.3. Community benefit history and collaborative relationships with community organizations.4. Desires and perspectives of community groups with which the hospital collaborates.The socioeconomic characteristics of the Monterey Peninsula span a broad spectrum. Carmel and Pebble Beach are relatively affluent communities with substantial retired and senior populations. Big Sur and other unincorporated parts of the County are largely rural in character. The communities surrounding the former Fort Ord army base (Seaside, Marina, and Sand City) are less affluent and continuing to grow, with a younger population, more children, and significant racial and ethnic diversity. In spite of the socioeconomic variations, the Monterey Peninsula is a distinct sub-region of Monterey County with a well-defined sense of community. No federally-designated medically underserved areas or populations are present. Part VI, Line 5: The organization promote the health of the community in many ways, asoutlined in the Community Benefit report. CHOMP Board of Trustees iscomprised of volunteers from the community. The medical staff is open.CHOMP's sister organization, Community Health Innovations is dedicatedentirely to population health. Care managers throughout the communityassist in partnering patients with community resources. Part VI, Line 7, Reports Filed With States CA 1 American Cancer Society 945 South Main Street Suite 201 Salinas CA 93901 941170350 501(C)(3) 10000 2016 fundraising events; Relay for Life /Celebration of Life American Heart Association 1514 Moffett Street Suite J Salinas CA 939053342 135613797 501(C)(3) 10000 2016 heart & stroke fundraising event Big Sur International Marathon PO Box 222620 Carmel CA 939222620 770048388 501(C)(3) 10000 2016 5k marathon; community wellness Boys and Girls Clubs of Monterey County PO Box 97 Seaside CA 93955 941702753 501(C)(3) 10000 Healthy Lifestyles Initiative; clinical dietitian nutrition expertise Cal State University Monterey Bay 100 Campus Center Seaside CA 93955 770387459 501(C)(3) 6250 Minority Health celebration, 2016-2017 diversity events California Highway Adoption Company 1731 Massachusetts Avenue Riverside CA 92507 860871091 S-Corp 5775 Highway 68 litter removal Coast Property Owners Association PO Box 59 Big Sur CA 93920 770091132 501(C)(3) 50000 Support for Soberanes Fire Community Partnership for Youth PO Box 42 Monterey CA 93942 770310237 501(C)(3) 7500 2016 Passport Walk; healthy activities Healthcare Fdn of Northern & Central California 1215 K Street Suite 800 Sacramento CA 95814 861174825 501(C)(3) 105000 Medical Respite Program Monterey Bay Swim Club PO Box 1571 Monterey CA 93942 510155434 501(C)(3) 7500 swim scholarships Monterey County Health Department CSD 1615 Bunker Hill Way Suite 101 Salinas CA 93906 946000524 Monterey County 75000 provide primary care for uninsured/ underinsured patients at Seaside/Marina Monterey Peninsula Unified School District PO Box 1031 Monterey CA 93942 770320712 115(1) 60000 part-time nurse: 2015-2016 & 2016-2017 school year Monterey Rape Crisis Center PO Box 2630 Monterey CA 93942 942389889 501(C)(3) 10000 2017 fundraising event; rape prevention education for youth Multiple Sclerosis Quality of Life Project 519 B Hartnell Street Monterey CA 93940 320035866 501(C)(3) 7500 case management program, support services & education MY Museum 425 Washington Street Monterey CA 93940 770394488 501(C)(3) 20000 museum exhibit; exploring skeletal, nervous, muscular and vascular systems Rancho Cielo PO Box 6948 Salinas CA 93912 770555859 501(C)(3) 10000 lifestyle courses for 2016-17 academic year Community Hospital Properties Po Box HH Monterey CA 93942 942795922 501(C)(3) 1225000 General Support 14 3 Part I, Line 2: GRANT AMOUNTS ARE REVIEWED AND APPROVED BY AN EXECUTIVE FOR COMMUNITY HOSPITAL FOUNDATION. ACTUAL EXPENDITURES ARE REVIEWED AND APPROVED BEFORE TRANSFERRING THE GRANT PROCEEDS. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 STEVEN PACKER MD PRESIDENT/CEO 696682 0 270000 0 38867 0 285621 0 29873 0 1321043 0 0 0 Laura Zehm Vice President/CFO 492646 0 159120 0 20873 0 82819 0 25543 0 781001 0 0 0 STEVEN CABRALES VP Medical Affairs 413483 0 105820 0 31858 0 51150 0 39839 0 642150 0 0 0 Cynthia Peck Vice President 316110 0 87640 0 12822 0 45689 0 25443 0 487704 0 0 0 Terril Lowe VP Nursing 318913 0 95790 0 24469 0 51605 0 31386 0 522163 0 0 0 Tim Nylen Vice President 279297 0 44160 0 39686 0 26604 0 12771 0 402518 0 0 0 JARED STIVER ASST DIR THI 305340 0 0 0 0 0 16898 0 39839 0 362077 0 0 0 DAVID MISISCO PHYSICIST MASTERS 265753 0 0 0 0 0 32498 0 25543 0 323794 0 0 0 MATTHEW MORGAN CAO 239466 0 41108 0 15926 0 14702 0 36268 0 347470 0 0 0 Sabina Gaudoin Registered Nurse 263847 0 0 0 13059 0 32498 0 28057 0 337461 0 0 0 Jennifer Ballesteros Registered Nurse 313131 0 0 0 18377 0 18400 0 12771 0 362679 0 0 0 Part I, Line 1a HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE - CERTAIN EXECUTIVES ARE OFFERED AN EQUITY HOME SHARE OPTION WHEREBY THE HOSPITAL OWNS HALF OF THE EXECUTIVE'S RESIDENCE. THE PURPOSE OF THIS IS TO ASSIST THE EXECUTIVE WITH BUYING A HOME IN THIS EXPENSIVE AREA. THE COST OF REAL ESTATE IS OFTEN A BARRIER TO RECRUITMENT IN MONTEREY. THE VALUE IS REPORTED AS TAXABLE INCOME ON THE EMPLOYEE'S W-2. A ca STATEWIDE COMMUNITIES DEVELOP AUTHORITY 680164610 1307957B7 2012-09-28 34935000 REFUND BONDS ISSUED 7/10/03 0 0 0 B ca STATEWIDE COMMUNITIES DEVELOP AUTHORITY 680164610 2016-06-01 32550000 5/12/2011 0 0 0 C CA STATEWIDE COMMUNITIES DEVELOP AUTHORITY 680164610 1307953L9 2011-05-12 86414265 WELLNESS CENTER, HOSP ADMIN SERVICES, REFUND BONDS ISSUED 7/10/03 1 0 0 A 34935000 437362 34497638 2012 0 1 1 1 B 32550000 453050 0 0 0 1 C 86415173 1418224 29877277 54968924 150748 2011 1 0 0 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 1 B 1 0 0 0 0 0 C 0 0 0 1 1 1 Morgan StanleyGold 22.100000000000 0 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART II, Proceeds: Explanation of difference between line 3 and issue price in Part I: Investment earnings X 1 39665 Book Value 0 0 1 0 Form 990, Part VI, Section B, line 11b ALL BOARD MEMBERS ARE PROVIDED A DRAFT COPY OF THE 990 FOR REVIEW PRIOR TO IT BEING FILED. QUESTIONS/COMMENTS ARE ADDRESSED AS APPLICABLE PRIOR TO SUBMITTING THE FINAL RETURN. Form 990, Part VI, Section B, line 12c THE ORGANIZATION USES SELF DISCLOSURE TO REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section B, line 15 THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE OFFICERS' COMPENSATION. A CONSULTING FIRM IS ENGAGED TO PROVIDE COMPARABLE DATA. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IT ALSO MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON ITS OWN WEBSITE. Form 990, Part XI, line 9: UNREALIZED GAIN ON INTEREST RATE SWAPS 1,384,960. INCREASE IN MINIMUM PENSION -24,455,638. Montage WELLNESS CENTER LLC 23625 HOLMAN HIGHWAY MONTEREY CA 93940 273554386 HEALTH SERVICES CA 3076517 848781 COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA MONTEREY SALINAS HEALTHCARE COLLABORATIVE LLC 10 RAGSDALE DRIVE SUITE 102 MONTEREY CA 93940 473632762 HEALTH SERVICES CA 0 0 COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA COMMUNITY HOSPITAL PROPERTIES PO BOX HH MONTEREY CA 93942 942795922 SUPPORT SERVICES CA 501(c)(3) Line 12a, I Montage Health 1 COMMUNITY HOSPITAL ENDOWMENTS PO BOX HH MONTEREY CA 93942 942795423 SUPPORT SERVICES CA 501(c)(3) Line 12a, I Montage Health 1 Montage Health PO BOX HH MONTEREY CA 93942 942789696 SUPPORT SERVICES CA 501(c)(3) Line 10 N/A 0 Montage Medical Group po BOX HH MONTEREY CA 93942 264826604 HEALTHCARE SERVICES CA 501(c)(3) Line 3 Montage Health 0 Aspire Health Plan 23625 Holman Highway MoNTEREY CA 93940 461567681 Insurance Company CA 501(c)(4) Montage Health 0 Montage Health Foundation 23625 Holman Highway MoNTEREY CA 93940 812889645 SUPPORT SERVICES CA 501(c)(3) Line 7 Montage Health 1 San Carlos & 7th LLC 23625 HOLMAN HIGHWAY Monterey CA 93942 274672809 Real Estate CA Community Hospital of the Monterey Peninsula 14633 199518 0 1 0.50000 CYPRESS MEDICAL NETWORK INC po box hh monterey CA 93942 770438780 medical services CA COMMUNITY HOSPITAL OF MONTEREY PENINSULA C 1.00000 1 Central Coast Community Mutual Insurance Company 40 Main Street Suite 200 Burlington VT 05401 454016797 Insurance VT COMMUNITY HOSPITAL OF MONTEREY PENINSULA C 0.95000 1 0 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 0 Montage Wellness Center D 51308 bOOK VALUE ASPIRE HEALTH PLAN R 86245 BOOK VALUE