2017-05-10T17:37:51-05:00 2016-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2015-07-01 274658935 MARTIN LUTHER KING JR-LOS ANGELES HEALTHCARE CORPORATION MART 4243388000 1680 E 120TH STREET LOS ANGELES CA 90059 MITCHELL T THOMAS CFO 4243388000 2017-05-09 1 RENIE BURBANK P00159653 4159561500 2015 2021-01-29 14:40:06Z MITCHELL T THOMAS 1680 E 120TH STREET LOS ANGELES CA 90059 213556284 0 X WWW.MLKCOMMUNITYHOSPITAL.ORG X 2010 CA THE SPECIFIC PURPOSE OF THIS CORPORATION IS TO ORGANIZE AND OPERATE A GENERAL ACUTE CARE HOSPITAL AND TO PROVIDE HIGH QUALITY HOSPITAL INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE AND SUCH ADDITIONAL HEALTH CARE SERVICES AS ARE DESIRABLE TO MEET THE NEEDS OF THE SOUTH LOS ANGELES COMMUNITY, WHICH INCLUDES INDIGENT, MEDI-CAL, MEDI-CAL MANAGED CARE, AND UNDERSERVED POPULATIONS, AMONG OTHERS, AND TO CONTRACT WITH, AMONG OTHERS, PUBLIC AND PRIVATE ENTITIES PROVIDING MANAGED CARE PROGRAMS FOR MEDI-CAL BENEFICIARIES IN LOS ANGELES COUNTY, PARTICULARLY SOUTH LOS ANGELES. 8 7 680 8 0 0 25118637 15849233 2367123 197291678 75708 4793 11883 410580 27573351 213556284 0 316530 0 0 19209953 57007764 0 0 0 33162141 134186697 52372094 191510991 -24798743 22045293 345353669 457621429 353297523 443520451 -7943854 14100978 X MARTIN LUTHER KING JR.-LOS ANGELES HEALTHCARE CORPORATION PROVIDES HIGH QUALITY HEALTH EDUCATION, PREVENTION, AND MEDICAL TREATMENT FOR A DIVERSE POPULATION. 0 0 174077970 316530 197291678 SCHEDULE OMARTIN LUTHER KING, JR. COMMUNITY HOSPITAL (MLKCH) IS A COMPLETELY NEW FACILITY REPLACING A PRIOR COUNTY FACILITY THAT WAS CLOSED DUE TO QUALITY OF CARE ISSUES IN 2007. MLKCH IS A UNIQUE PRIVATE-PUBLIC PARTNERSHIP. AS A PRIVATE, NON-PROFIT FREESTANDING 501(C)(3) CORPORATION, MLKCH LEASES A COMPLETELY NEW $280 MILLION HOSPITAL FACILITY FROM THE COUNTY OF LOS ANGELES. MLKCH WAS LICENSED BY THE CALIFORNIA DEPT. OF PUBLIC HEALTH ON APRIL 28, 2015 AND OPENED TO PATIENT CARE ON MAY 14, 2015.MLKCH ACHIEVE THE FOLLOWING MILESTONES DURING THE FISCAL YEAR ENDED JUNE 30, 2016:-ACCREDITED BY THE JOINT COMMISSION ON JUNE 30, 2015-OPENED ITS EMERGENCY DEPARTMENT ON JULY 7, 2015-BEGAN ACCEPTING RESCUE AMBULANCES ON AUGUST 11, 2015-STAGED A PHASED OPENING OF ITS INPATIENT FACILITIES SO THAT ALL INPATIENT BEDS WERE OPENED AND STAFFED BY DECEMBER 2015THE HOSPITAL CREDENTIALED OVER 200 PHYSICIANS AND HIRED OVER 1,000 EMPLOYEES AND CONTRACTORS TO MEET THE EXPECTED VOLUME OF PATIENTS. MLKCH'S SERVICE AREA IS ONE OF THE POOREST IN METROPOLITAN LOS ANGELES AND SUFFERS FROM A SEVERE SHORTAGE OF PHYSICIANS. AS A RESULT, EMERGENCY DEPARTMENT VOLUME HAS CONSISTENTLY EXCEEDED PROJECTIONS.AT ITS OPENING, MLKCH BEGAN WITH A SMALL VOLUME OF PATIENTS BUT AS COMMUNITY ACCEPTANCE AND WORD OFMOUTH SPREAD, THE HOSPITAL'S VOLUME HAS STEADILY INCREASED. FOR THE FISCAL YEAR ENDED JUNE 30, 2016, THEHOSPITAL'S PATIENT VOLUME WAS AS FOLLOWS:-4,590 ACUTE INPATIENT ADMISSIONS-18,499 ACUTE INPATIENT DAYS (AVERAGE DAILY CENSUS OF 50.4)-43,608 EMERGENCY DEPARTMENT VISITS-1,206 OUTPATIENT OBSERVATION VISITSMEDICAL STAFF COVERAGE INCREASED TO MEET THE NEEDS REQUIRED BY THE STEADILY INCREASING PATIENT VOLUME. MLKCH PROVIDES 24-7 COVERAGE BY HOSPITALISTS, INTENSIVISTS, LABORISTS, EMERGENCY PHYSICIANS, AND MANY OTHER HOSPITAL BASED PHYSICIANS SPECIALTIES. IN ADDITION TO OPENING THE FACILITY, THE HOSPITAL UNDERTOOK TWO MAJOR CAPITAL EXPANSION PROJECTS. APPROXIMATELY 50 ACUTE MEDICAL-SURGICAL INPATIENT BEDS WERE RECONFIGURED TO BE ABLE TO ACCOMMODATE TELEMETRY PATIENTS. IN ADDITION, $2.2 MILLION WAS EXPENDED TO SIGNIFICANTLY EXPAND THE HOSPITAL'S CLINICAL LABORATORY SO THAT IT COULD ACCOMMODATE A MUCH HIGHER VOLUME OF TEST. IN ADDITION, BACTERIOLOGY WAS ADDED AS A NEW SERVICES TO MINIMIZE THE NUMBER OF TESTS SEND TO OUTSIDE REFERENCE LABORATORIES. BY THE END OF FISCAL YEAR 2016, THE HOSPITAL'S EMERGENCY DEPARTMENT VOLUME WAS RUNNING APPROXIMATELY 6,000 VISITS PER MONTHS.MLKCH ACHIEVED ABOVE AVERAGE PATIENT SATISFACTION AND QUALITY SCORES. THE HOSPITAL'S LIKELY TO RECOMMEND" PRESS GANEY PATIENT SCORE WAS AT THE 80TH PERCENTILE AND CONSIDERABLY ABOVE-AVERAGE FOR A SAFETY NET HOSPITAL OF MLKCH'S SIZE AND MATURITY (80% OF PATIENTS GAVE US A RATING OF 9 OR 10 ON A SCALE OF 1-10). IN ADDITION, AN EMPLOYEE ENGAGEMENT SURVEY CONDUCTED IN MAY 2016, INDICATE STRONG EMPLOYEE SATISFACTION AT THE 82ND PERCENTILE.MLKCH IS A 'PAPERLESS' HOSPITAL WITH A STATE OF THE ART ELECTRONIC HEALTH RECORD (E.H.R.). AS EVIDENCE OF THIS ADVANCED TECHNOLOGY, MLKCH ACHIEVED HIMSS LEVEL 6 DURING THE FIRST YEAR OF OPERATIONS. ONLY 26% OF U.S. HOSPITALS TRACKED BY HIMSS HAVE ACHIEVED LEVEL 6. 174077970 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 171 0 1 680 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 0 CA X MITCHELL THOMAS CFO 4243388000 1680 E 120TH ST LOS ANGELES CA 90059 MANUAL A ABASCAL JD CHAIRMAN 6.00 2.00 X X 0 0 0 PAUL KING VICE CHAIRMAN 3.00 2.00 X X 0 0 0 MICHAEL MADDEN SECRETARY 3.00 0.00 X X 0 0 0 JAMES YOSHIOKA TREASURER 3.00 0.00 X X 0 0 0 GEORGINA R GARCIA RN BOARD MEMBER 3.00 0.00 X 0 0 0 ROBERT MARGOLIS MD BOARD MEMBER 3.00 2.00 X 0 0 0 IAN MORRISON BOARD MEMBER 3.00 0.00 X 0 0 0 ROBERT TRANQUADA MD BOARD MEMBER 3.00 0.00 X 0 0 0 DR ELAINE BATCHLOR CHIEF EXECUTIVE OFFICER 40.00 2.00 X 606719 0 12920 JOHN FISHER CHIEF MEDICAL OFFICER 40.00 0.00 X 355622 0 37972 SAJID AHMED CHF INFO/INNOVATION OFF'R 40.00 0.00 X 307594 0 37567 SUSAN SMITH VP HUMAN RESOURCES 40.00 0.00 X 236899 0 39087 MYRNA ALLEN CHF OPS OFF'R/CHF NURSING 40.00 0.00 X 302401 0 10879 MEDELL BRIGGS MALONSON CHF QUALITY IMPRVMT OFF'R 32.00 0.00 X 193159 0 34039 MITCHELL T THOMAS CHIEF FINANCIAL OFFICER 40.00 0.00 X 318111 0 0 JAMES ARRIC DIRECTOR IT APPLICATIONS 40.00 0.00 X 165247 0 12459 DANIEL A LUJAN SR. DIRECTOR IT OPERATIONS 40.00 0.00 X 145212 0 905 KENNETHA K GAINES DIR MATERNAL CHILD HEALTH 40.00 0.00 X 145417 0 34112 SARAH J STEVENS DIRECTOR CRITICAL CARE 40.00 0.00 X 171029 0 22952 ADRIANA VELASCO DIRECTOR MED SURGERY 40.00 0.00 X 172244 0 0 3119654 0 242892 35 0 1 0 CARETECH SOLUTIONS INC 901 WILSHIRE DR STE 100 TROY MI 48084 INFORMATION TECHNOLOGY 5253088 MCCARTHY BUILDING COMPANY 20401 SW BIRCH ST STE 300 NEW PORT BEACH CA 92660 CONSTRUCTION PROJECTS 4703991 PHILIPS HEALTHCARE 3000 MINUTEMAN RD ANDOVER MA 01810 HEALTHCARE PRODUCTS AND SERVICES 3955797 CYMETRIX CORPORATION 2875 MICHELLE DR STE 250 IRVINE CA 92606 REVENUE CYCLE SERVICES 3927917 THE CAMDEN GROUP 100 N SEPULVEDA BLVD STE 600 EL SEGUNDO CA 90245 HEALTHCARE MGMT AND CONSULTING 3309665 100 4887 15428195 416151 15849233 SUPPLEMENTAL FUNDING 541900 97828104 97828104 PATIENT SERVICE REVENUE 541900 81463574 81463574 INDIGENT CARE SERVICES 621110 18000000 18000000 197291678 4793 4793 OTHER INCOME 621110 410580 410580 410580 213556284 197291678 0 415373 X 316530 316530 2370556 2150758 219798 43036755 40824396 2212359 745244 700116 45128 7635422 7107232 528190 3219787 3041614 178173 1635729 1635729 206348 206348 66172549 61244872 4927677 305423 257296 48127 4056459 2889726 1166733 1768829 1238075 530754 291970 213353 78617 16113792 14502413 1611379 17423932 15557155 1866777 644379 547273 97106 HOSPITAL TAX FEE 8653310 7788220 865090 OTHER COSTS 7261072 6520373 740699 MEDICAL SUPPLIES 6025226 5932885 92341 MEDICAL SFTWR LICENSES 3627679 3245683 381996 191510991 174077970 17433021 0 4879696 8519940 30181887 183286 0 125279437 639304 1961466 2420625 7700007 321393296 19904067 306937565 301489229 220592 221913 74000 12266151 345353669 457621429 13962185 31092734 15327195 0 16800000 306458749 122379826 17549394 273247891 353297523 443520451 X -8049087 13983703 105233 117275 -7943854 14100978 345353669 457621429 22045293 -461 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 15886 15886 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA - 10.37% OF THE DUES PAID IS DIRECT LOBBYING EXPENSES. 241480000 7225260 234254740 13107424 780961 12326463 24072707 4177049 19895658 42733165 7720797 35012368 301489229 DUE TO MEDICAL STAFF 4350 COUNTY LEASE ACCRUED INTEREST 31920730 CAPITAL LEASE 241322811 273247891 X PART X, LINE 2: THE COMPANY 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. THERE WERE NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2016 OR 2015. THE COMPANY IS SUBJECT TO INCOME TAX EXAMINATION BY TAXING AUTHORITIES FOR ALL YEARS SINCE INCEPTION FOR FEDERAL AND STATE TAX FILINGS. 1 1 X 1 X 300.000000000000 1 X 1 0 1 1 1372734 1372734 0.00720 1372734 1372734 0.00720 25 98806 123089 123089 0.00060 48764 8421430 8421430 0.04400 1554 1554 0.00000 327773 327773 0.00170 25 147570 8873846 8873846 0.04630 25 147570 10246580 10246580 0.05350 1 9099510 0 7067850 8502623 -1434773 X 1 1 1 1 MARTIN LUTHER KING JR COMMUNITY HOSPITAL 1680 E 120TH STREET LOS ANGELES CA 90623 191230 X X X MARTIN LUTHER KING JR COMMUNITY HOSPIT 1 1 1 0 0 1 X 300.000000000000 300.000000000000 1 1 X X X X 1 X WWW.MLKCOMMUNITYHOSPITAL.ORG X WWW.MLKCOMMUNITYHOSPITAL.ORG X X X 1 X 1 X X X X X 1 X 0 0 MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: IN ADDITION TO THE CHNA, MLKCH HAS A COMMUNITY BENEFIT REPORT (CBR). THE CBR FOR FISCAL YEAR END JUNE 30, 2016 WAS DEVELOPED AND FILED WITH STATE OF CALIFORNIA AND WILL BE POSTED ON THE WEBSITE. WEBSITE 'COMMUNITY' PAGE LISTS MULTIPLE COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS. MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL PART V, SECTION B, LINE 2: THE COUNTY OF LOS ANGELES ("COUNTY") CONSTRUCTED THE NEW INPATIENT FACILITY AND ANCILLARY BUILDINGS AND THE HOSPITAL BEGAN OCCUPYING THE FACILITIES ON A DEVELOPMENT AND PREOPENING BASIS IN SEPTEMBER 2014. THE HOSPITAL OBTAINED LICENSURE TO OPERATE A 131-BED ACUTE CARE HOSPITAL BY THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH ON APRIL 28, 2015. MARTIN LUTHER KING, JR.-LOS ANGELES HEALTHCARE CORPORATION (MLK-LA) COMMENCED PATIENT CARE ON A LIMITED SCOPE BASIS ON MAY 14, 2015 UNTIL THEY RECEIVED ACCREDITATION BY THE JOINT COMMISSION. ON JUNE 30, 2015, MLK-LA RECEIVED FULL ACCREDITATION BY THE JOINT COMMISSION AND RECEIVED A LETTER FROM THE JOINT COMMISSION WHICH WAS SENT TO THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) ACKNOWLEDGING THE ACCREDITATION. THE HOSPITAL'S EMERGENCY DEPARTMENT OPENED ON JULY 7, 2015. THE HOSPITAL BECAME A FULL OPERATING HOSPITAL BEGINNING FISCAL YEAR 2016.PART V, SECTION B, LINE 3:PURSUANT TO 501(R) OF THE INTERNAL REVENUE CODE, MLK-LA IS REQUIRED TO MEET THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REQUIREMENTS ON OR BEFORE JUNE 30, 2017, WHICH IS THE LAST DAY OF THE SECOND TAXABLE YEAR THAT THE FACILITY OPERATED BY THE ORGANIZATION WAS LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL. FURTHER, MLK-LA'S ADOPTION OF AN IMPLEMENTATION STRATEGY BY GOVERNING BODY OF THE HOSPITAL TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA MUST BE MET ON OR BEFORE NOVEMBER 15, 2017. BOTH THE CHNA AND ADOPTION OF IMPLEMENTATION STRATEGY WILL BE COMPLETED IN ITS ENTIRETY BY THE REQUIRED DATES SET FORTH BY THE INTERNAL REVENUE CODE AND FINAL U.S. TREASURY REGULATIONS. MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: MLKCH IS IN THEIR EARLY STAGES OF SERVING PATIENTS. RESULTS OF CHNA ARE INCORPORATED IN THE ORGANIZATION'S STRATEGIC BUSINESS PLAN. MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL PART V, SECTION B, LINE 19D: NONE OF THESE ACTIONS OR OTHER SIMILAR ACTIONS WERE PERMITTED. PART V, SECTION B, LINE 14: LIMITS THE AMOUNTS THAT THE HOSPITAL WILL CHARGE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY ARE PROVIDED TO INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE TO AMOUNT GENERALLY RECEIVED BY THE HOSPITAL FOR COMMERCIALLY INSURED OR MEDICARE PATIENTS. CHARITY IS NOT CONSIDEREDTO BE A SUBSTITUTE FOR PERSONAL RESPONSIBILITY. PATIENTS ARE EXPECTED TO COOPERATE WITH MLK-LA'S PROCEDURES FOR OBTAINING CHARITY OR OTHER FORMS OF PAYMENT OR FINANCIAL ASSISTANCE AND TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR INDIVIDUAL ABILITY TO PAY. INDIVIDUALS WITH THE FINANCIAL CAPACITY TO PURCHASE HEALTH INSURANCE WILL BE ENCOURAGED TO DO SO, AS A MEANS OF ASSURING ACCESS TO HEALTH CARE SERVICES, FOR THEIR OVERALL PERSONAL HEALTH, AND FOR THE PROTECTION OF THEIR INDIVIDUAL ASSETS. PART I, LINE 7: THE COST ACCOUNTING SYSTEM USED ADDRESSES ALL PATIENT SEGMENTS INPATIENT, OBSERVATION, AND ANCILLARY SERVICES. THE INPATIENT COST WAS CALCULATED BASED ON THE PER DIEM RATE BY FACILITY LOCATION (I.E. ICU, NURSERY). THE ANCILLARY SERVICES WERE CALCULATED BASED ON A COST OF CARE RATE. PART I, LN 7 COL(F): ALL SELF-PAY ACCOUNTS, INCLUDING THOSE WRITTEN OFF TO BAD DEBT ARE DISCOUNTED TO THE HOSPITAL'S APPROXIMATE COST USING A COST-TO-CHARGE RATIO OF APPROXIMATELY 91% (I.E. APPROXIMATE COST EQUALS 9% OF CHARGES). PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH IMPROVEMENT ADVOCACY - THE ORGANIZATION PROVIDED COMMUNITY SERVICES FOCUSED ON HEALTH AND HEALING. THE SERVICES RANGED INCLUDED GENERAL HEALTH EDUCATION AS WELL AS POPULATIONS WITH OR AT RISK OF CHRONIC DISEASES, SENIORS AND POPULATIONS WITH HEALTH DISPARITIES. PROGRAMS INCLUDE HEALTH INITIATIVES THAT DELIVER HEALTH SCREENINGS,INFORMATION AND RESOURCES AVAILABLE TO NAVIGATE THE HEALTHCARE SYSTEM.OTHER - PARTNERED WITH HEALTH AND WELLNESS ASSOCIATIONS IN THE COMMUNITY AND PARTICIPATED IN HEALTH PANELS. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY).FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS AND NONCONTRACTED INSURANCE (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: DUE TO THE DEMOGRAPHICS AND PAYOR MIX OF THE HOSPITAL SERVICE AREA COMBINED WITH THE SEVERE PHYSICIAN SHORTAGE IN THE HOSPITAL'S SERVICE AREA, THE HOSPITAL'S EMERGENCY DEPARTMENT OPERATES AT A SIGNIFICANT LOSS. DIRECT OPERATING COSTS ARE MUCH HIGHER THAN REVENUE. PART III, LINE 9B: MLK-LA'S MANAGEMENT HAS DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, INCLUDING COLLECTIONS ACTION AND REPORTING TO CREDIT AGENCIES) THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR AGOVERNMENTAL PROGRAM OR FOR CHARITY FROM MLK-LA, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH MLK-LA. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, MLK-LA MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE COLLECTION EFFORTS. MLK-LA WILL NOT IMPOSE EXTRAORDINARY COLLECTIONS ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS WILL INCLUDE:1. VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT SOURCES OF THIRD-PARTY PAYMENT HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL;2. DOCUMENTATION THAT MLK-LA HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CARE PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITAL'S APPLICATION REQUIREMENTS;3. DOCUMENTATION THAT THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE ON A PRESUMPTIVE BASIS;4. DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. PART VI, LINE 2: NEEDS ASSESSMENT: THE ORGANIZATION ACTIVELY PARTICIPATES IN COMMUNITY EVENTS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THERE IS INFORMATION THAT IS POSTED IN THE MAIN PATIENT WAITING AREAS OF THE FACILITY, ALL PATIENTS ARE GIVEN WRITTEN INFORMATION UPON ADMISSION THAT DISCUSSES AVAILABILITY OF PROGRAMS AND PROVIDES CONTACT INFORMATION.PATIENT ACCESS COUNSELORS AVAILABLE, DEPARTMENT OF PUBLIC SERVICES ON SITE TO ASSIST THE PUBLIC. PART VI, LINE 4: COMMUNITY INFORMATION: MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL IS LOCATED IN SERVICE PLANNING AREA 6 (SPA 6) OF LOS ANGELES COUNTY. SPA 6 IS COMPRISED OF 1.35 MILLION PEOPLE. IT REPRESENTS THE COUNTY'S MOST VULNERABLE POPULATION, WITH HIGH RATES OF POVERTY AND UNEMPLOYMENT AND THE WORST HEALTH STATUS OUTCOMES. PART VI, LINE 5: COMMUNITY HEALTH PROMOTION: THE EMPLOYEES AND MEDICAL STAFF OF MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL WERE PROVIDING COMMUNITY SERVICES FOCUSED ON HEALTH AND HEALING. THESE SERVICES RANGED FROM PROVIDING HEALTH EDUCATION AT COMMUNITY EVENTS TO DESIGNING AND LAUNCHING PROGRAMS AIMED TO ADDRESS KEY COMMUNITY NEEDS, OFTEN IN COLLABORATION WITH OTHER COMMUNITY PARTNERS AND NON-PROFIT ORGANIZATIONS. 1 CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K STREET SUITE 800 SACRAMENTO CA 95814 941498697 316530 HOSPITAL FEE PROGRAM REQUIRED CONTRIBUTION UNDER PROGRAM 1 PART I, LINE 2: MLKCH MONITORS THE USE OF THE LA COUNTY FUNDS BY IDENTIFYING ALL QUALIFYING EXPENSES AND TRACKING EXPENSE TYPE CATEGORIES IN THE GENERAL LEDGER SYSTEM X X X X X 0 0 0 0 0 0 0 1 0 DR ELAINE BATCHLOR CHIEF EXECUTIVE OFFICER 427620 0 179000 0 99 0 2670 0 10250 0 619639 0 0 0 JOHN FISHER CHIEF MEDICAL OFFICER 295372 0 60250 0 0 0 2013 0 35959 0 393594 0 0 0 SAJID AHMED CHF INFO/INNOVATION OFF'R 221123 0 79000 0 7471 0 1697 0 35870 0 345161 0 0 0 SUSAN SMITH VP HUMAN RESOURCES 203936 0 32750 0 213 0 1617 0 37470 0 275986 0 0 0 MYRNA ALLEN CHF OPS OFF'R/CHF NURSING 144101 0 19000 0 139300 0 1892 0 8987 0 313280 0 0 0 MEDELL BRIGGS MALONSON CHF QUALITY IMPRVMT OFF'R 155117 0 35800 0 2242 0 1380 0 32659 0 227198 0 0 0 MITCHELL T THOMAS CHIEF FINANCIAL OFFICER 189005 0 0 0 129106 0 0 0 0 0 318111 0 0 0 JAMES ARRIC DIRECTOR IT APPLICATIONS 154507 0 10740 0 0 0 1070 0 11389 0 177706 0 0 0 KENNETHA K GAINES DIR MATERNAL CHILD HEALTH 134229 0 11188 0 0 0 785 0 33327 0 179529 0 0 0 SARAH J STEVENS DIRECTOR CRITICAL CARE 157492 0 13537 0 0 0 838 0 22114 0 193981 0 0 0 ADRIANA VELASCO DIRECTOR MED SURGERY 172244 0 0 0 0 0 0 0 0 0 172244 0 0 0 PART I, LINE 7 MANAGEMENT IS ELIGIBLE TO EARN AN ANNUAL INCENTIVE AMOUNT UNDER THE ORGANIZATION'S PERFORMANCE PROGRAM. THE PROGRAM INCLUDES ACHIEVING INDIVIDUAL AND ORGANIZATIONAL GOALS. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF FORM 990 WAS PROVIDED ELECTRONICALLY TO THE BOARD FOR THEIR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MLK-LA ADOPTED ITS CONFLICT OF INTEREST POLICY EARLY IN ITS EXISTENCE. ALL BOARD MEMBERS AND OFFICERS, INCLUDING THE CEO AND ALL INTERIM OFFICERS READ THE POLICY AND COMPLETED A CONFLICTS OF INTEREST DISCLOSURE STATEMENT FOR MEMBERS OF THE BOARD AND OFFICERS. POTENTIAL CONFLICTS, AS THEY ARE DISCLOSED, ARE BROUGHT BEFORE THE BOARD, DISCUSSED (AFTER THE PERSON WITH THE DISCLOSED POTENTIAL CONFLICT LEAVES THE BOARD MEETING), AND RESOLVED TO THE BOARD'S SATISFACTION. BOARD MEMBERS, OFFICERS, INTERIM TEAM MEMBERS CAN UPDATE THEIR CONFLICTS OF INTEREST DISCLOSURE AND CERTIFICATION FORM AT ANY TIME AND SUBMIT IT TO THE SECRETARY OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 AS A NEW START UP ENTITY, WHEN THE BOARD BEGAN THE PROCESS TO ENGAGE THE CEO THEY ENGAGED THE SERVICES OF A COMPENSATION FIRM TO ASSIST THEM IN DETERMINING THE COMPENSATION FOR SUCH AN INDIVIDUAL. BASED UPON RECENT SALARY SURVEYS PERFORMED BY INDUSTRY ORGANIZATIONS, THE COMPENSATION WAS SET FOR THE CEO. THE BOARD MADE THIS DETERMINATION AFTER CONSULTATION WITH THE COMPENSATION CONSULTING FIRM AND REVIEWING THE SALARY SURVEY DATA THEY PROVIDED. THE BOARD ALSO REVIEWED THE COMPENSATION FOR THE CIO, CFO, COO WITH EXTERNAL MARKET COMPENSATION INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE ON A QUARTERLY AND ANNUAL BASIS THROUGH OSHPD, THE CALIFORNIA AGENCY WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST IS NOT MADE AVAILABLE AT THIS TIME. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 61,244,872. MANAGEMENT AND GENERAL EXPENSES 4,927,677. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,172,549. MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION 1680 E 120TH STREET LOS ANGELES CA 90059 454433505 CHARITABLE FOUNDATION CA 501(C)(3) 7 MLKCH 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0