2015-11-16T15:20:24-06:00 2014-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2014-01-01 941458282 NORTHBAY HEALTHCARE GROUP NORT 7076463110 1200 B GALE WILSON BOULEVARD FAIRFIELD CA 94533 ARTHUR E DENIO VP/CFO 7076463110 2015-11-16 1 RENIE BURBANK P00159653 4159561500 2014 2016-04-25 22:37:26Z KONARD JONES 4500 BUSINESS CTR DR FAIRFIELD CA 94534 443050687 0 X WWW.NORTHBAY.ORG X 1954 CA THE PRIMARY PURPOSE OF THE CORPORATION IS TO PROVIDE HEALTH CARE SERVICES, WHICH INCLUDE HOSPITAL AND PHYSICIAN SERVICES, AND OPERATE FACILITIES AND/OR ASSETS NECESSARY TO IMPROVE THE HEALTH CARE STATUS OF THE PUBLIC IT SERVES. 9 4 2220 91 0 0 1222574 919820 393173560 431354926 2821459 4910118 1513039 4002278 398730632 441187142 311252 345304 0 0 172699505 193382895 0 0 0 195711409 199482905 368722166 393211104 30008466 47976038 356584887 399177862 162149352 154298200 194435535 244879662 X COMPASSIONATE CARE, ADVANCED MEDICINE, CLOSE TO HOME. 0 0 384790237 345304 431354926 SEE SCHEDULE O 384790237 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 578 0 1 2220 1 0 0 0 0 0 0 0 0 0 0 X 9 4 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ARTHUR E DENIO 7076463110 4500 BUSINESS CENTER DRIVE FAIRFIELD CA 94534 X ARCHIE HUMPHREY CHAIRMAN 1.00 1.00 X X 13860 0 0 MARK SIEVERS VICE CHAIRMAN 1.00 1.00 X X 13910 0 0 WAYNE SENALIK SECRETARY/TREASURER 2.00 2.00 X X 13860 0 0 DONALD DOYLE MD DIRECTOR 1.00 0.00 X 13696 0 0 THERESA HITE DIRECTOR 1.00 0.00 X 7921 0 0 GWENDOLYN RUNNELS DIRECTOR 1.00 0.00 X 0 0 0 DENISE SUIHKONEN DIRECTOR 1.00 0.00 X 13910 0 0 JAMES LONG MD DIRECTOR 1.00 0.00 X 0 0 0 WENDY WIGMORE DIRECTOR 1.00 0.00 X 7554 0 0 GARY PASSAMA CEO 13.00 27.00 X 0 901372 42594 DEBORAH SUGIYAMA NBHG PRESIDENT 36.00 4.00 X 0 826515 72989 ARTHUR DENIO VP & CFO 25.00 15.00 X 0 534413 44591 KATHLEEN RICHERSON V/P CHF NURSING OFF'R 40.00 0.00 X 0 409765 36069 ANTOINETTE NAVARRO CLINICAL COORDINATOR 49.00 0.00 X 278014 0 5764 JOANNE JACOB CLINICAL NURSE III 51.70 0.00 X 256735 0 20066 THERESA BARTOLI CLINICAL COORDINATOR 49.00 0.00 X 278716 0 27131 RHONDA MARTIN AVP NURSING OPERATIONS 40.00 0.00 X 288015 0 12554 SUSAN GORNALL DIR PERIOPERATIVE SRVCS 39.70 0.00 X 259353 0 15988 1445544 2672065 277746 616 0 1 0 LEE BURKHART LIU INC 5510 LINCOLN BLVD STE 250 LOS ANGELES CA 90094 ARCHITECTS 4828102 SOUND INPATIENT PHYSICIANS 1123 PACIFIC AVE TACOMA WA 98402 PHYSICIAN GROUP 3910479 EMERGENCY & ACUTE MEDICAL CORP 440 STEVENS AVE 150 SOLANA BEACH CA 92075 PHYSICIAN GROUP 3630297 SACSOLANO ANESTHESIA EXCHANGE 3315 WATT AVENUE SACRAMENTO CA 95821 ANESTHESIOLOGISTS 2580782 ACUTE CARE SURGERY MEDICAL GROUP INC PO BOX 502410 SAN DIEGO CA 921502410 PHYSICIAN GROUP 2580782 96 919820 184489 919820 PATIENT SERVICES 621400 383978973 383978973 CAPITATION REVENUE 621400 59967688 59967688 BAD DEBT PROVISION 621400 -12591735 -12591735 431354926 4394011 4394011 84875 32652 52223 52223 52223 2347000 1830893 516107 516107 516107 OTHER REV. FROM OPS 900099 3229634 3229634 AMORT. OF GAIN ON MOB 900099 474472 474472 NON-RECURRING REVENUE 900099 341181 341181 -95232 -95232 3950055 441187142 431354926 0 8912396 X 343387 343387 1917 1917 63297 63297 155841721 155105134 736587 4950013 4930200 19813 21640521 21558573 81948 10887343 10844673 42670 483519 483519 27602 27602 75403411 73868439 1534972 11328 11328 9680931 9622027 58904 715509 704246 11263 8562197 7939558 622639 317345 314806 2539 243377 226277 17100 2376141 2376141 9364296 9324510 39786 1203492 1203492 CORPORATE MGMT FEES 48485861 48485861 MEDICAL SUPPLIES 32989024 32988423 601 HOSPITAL EXPENSES 4021499 4021499 QUALITY ASSURANCE FEE 4012053 4012053 1585320 919746 665574 393211104 384790237 8420867 0 3044669 5053960 4817298 14041554 48419088 52092944 308386 13923 1444080 2558999 1632915 2757186 213272359 121110558 78500328 92161801 5638435 5640338 6850922 6758597 83432 20858 205845334 218077702 356584887 399177862 45598332 43209036 8539715 8644033 61463146 58067744 26815258 23798534 19732901 20578853 162149352 154298200 X 194374669 244820381 60866 59281 194435535 244879662 356584887 399177862 X 47976038 2449977 18112 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 27602 27602 0 PART II-B, LINE 1: NORTHBAY HEALTHCARE GROUP SUPPORTS CERTAIN INITIATIVES AND ISSUES THAT ARE HEALTHCARE RELATED AND CONSISTENT WITH ITS MISSION OF PROMOTING HEALTHCARE IN ITS COMMUNITY. EXPENDITURES INCURRED TO SUPPORT THESE INITIATIVES MAY BE CONSIDERED TO BE LOBBYING EXPENDITURES. AN INDIRECT EXPENDITURE OF THE HOSPITAL'S MEMBERSHIP DUES PAID TO AMERICAN HOSPITAL ASSOCIATION & CALIFORNIA HOSPITAL ASSOCIATION WERE USED FOR LOBBYING EXPENDITURES. 60863 15594 17168 11 59278 67746 15350 22233 60863 61960 21868 16082 67746 85700 18535 42275 61960 81291 19797 15388 85700 0.00000 0.00000 1.00000 0 0 9867153 9867153 57080211 28875345 28204866 8592852 5429523 3163329 110493007 79638691 30854316 27239136 7166999 20072137 92161801 FUNDED DEPRECIATION 215543662 DEFERRED FINANCING COSTS 1566571 LONG TERM WORKERS COMP RECEIVABLE 135510 LONG TERM MALPRACTICE RECEIVABLE 831959 218077702 HEALTH INSURANCE PRGM PAYABLE 9069889 DUE TO NORTHBAY HEALTH ADVANTAGE 524582 WORKERS COMP RESERVE 1413544 DUE TO NBMC 101788 NET DUE TO SDI 8907452 SWAP CONTRACTS 561598 20578853 441063000 -38305 -38305 441101305 85837 85837 441187142 389044000 -63247 -63247 389107247 4103857 4103857 393211104 PART V, LINE 4: THE FUNDS ARE USED TO FINANCIALLY ASSIST PATIENTS AND EMPLOYEES IN NEED WITH HOUSING, UTILITIES, MEDICATIONS, FOOD, MEDICAL EQUIPMENT, TRANSPORTATION, PERSONAL ITEMS, AND REGULAR LIFE EXPENSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENT REVENUE RECLASSIFIED FROM EXPENSES -63,247. AUDITED FINANCIAL STATEMENT ROUNDING ADJUSTMENT 818. RECLASSIFIED FROM OTHER CHANGES NET ASSETS 24,124. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FROM NBHC FOR OFFICERS COMPENSATION 63,297. CONTRIBUTIONS RECLASSIFIED FROM TEMP RESTRICTED NET ASSETS 22,540. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT REVENUE RECLASSIFIED TO STATEMENT OF REVENUE -63,247. PART XII, LINE 4B - OTHER ADJUSTMENTS: OFFICERS COMPENSATION PAID BY NORTHBAY HEALTHCARE CORPORATION 63,297. RECLASSIFICATION HOSPITAL EXPENSES FRM TEMP RESTRICTED NET ASSETS 4,021,499. RECLASSIFICATION HERO/EMPLOYEE EMERG FRM TEMP RESTRICTED NET ASSETS 17,168. AUDITED FINANCIAL STATEMENT ROUNDING ADJUSTMENT 1,893. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 10996379 10996379 0.02800 138295771 87233339 51062432 0.12990 478493 121987 356506 0.00090 149770643 87355326 62415317 0.15880 11922970 6116241 5806729 0.01480 632655 181180 451475 0.00110 37604 37604 0.00010 12593229 6297421 6295808 0.01600 162363872 93652747 68711125 0.17480 1 50 49740 49740 0.00010 1 10000 5280 5280 0.00000 12 2500 65900 65900 0.00020 2 24 25000 25000 0.00010 1 10000 31000 31000 0.00010 20 2000 20000 20000 0.00010 1 32 75000 3000 72000 0.00020 38 24606 271920 3000 268920 0.00080 1 12591734 0 65566808 105989112 -40422304 X 1 1 1 NORTHBAY PHYSICIANS SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.94000 0.06000 2 1 NORTHBAY MEDICAL CENTER 1200 B GALE WILSON BLVD FAIRFIELD CA 94533 WWW.NORTHBAY.ORG 110000093 X X X OUTPATIENT CLINICS A 2 VACAVALLEY HOSPITAL 1000 NUT TREE ROAD VACAVILLE CA 95687 WWW.NORTHBAY.ORG 110000093 X X X OUTPATIENT CLINICS B NORTHBAY HEALTHCARE GROUP 0 0 1 X X X X X X X X X X 13 1 1 0 1 X WWW.NORTHBAY.ORG X X 1 13 0 0 0 1 X 100.000000000000 500.000000000000 X X X X X 1 1 1 X X 1 X X 0 X X X X 1 X 0 0 NORTHBAY HEALTHCARE GROUP PART V, SECTION B, LINE 3J: NORTHBAY ADOPTS TWO ELEMENTARY SCHOOLS -- FAIRVIEW IN FAIRFIELD AND EUGENE PADAN IN VACAVILLE. AT CHRISTMAS TEACHERS SUBMIT CLASSROOM "WISH LISTS" FOR SUPPLIES AND PROGRAMS. CORPORATE SUPPORT INCLUDES SPONSORING 15 CLASSROOMS WHOSE NEEDS AMOUNTED TO $6,100 IN CLASSROOM SUPPLIES (COMPUTERS, PRINTERS, PAPER, PENCILS, ETC.). ANOTHER 64 CLASSROOMS (AT $360 EACH) WERE SPONSORED BY EMPLOYEE GROUPS. NORTHBAY HEALTHCARE GROUP PART V, SECTION B, LINE 5: FOCUS GROUPS WERE CONDUCTED AT FIVE COMMUNITY ORGANIZATIONS -- A CHURCH, A MIGRANT WORKER CENTER, A HOMELESS SHELTER, AN ETHNIC WOMEN'S CENTER AND A FAMILY RESOURCE CENTER. ADDITIONALLY, 11 KEY INFORMANTS (SOCIAL SERVICE AND COMMUNITY HEALTH CLINIC LEADERS) WERE ALSO INTERVIEWED. NORTHBAY HEALTHCARE GROUP PART V, SECTION B, LINE 6A: SUTTER SOLANO AND KAISER PERMANENTE VALLEJO/VACAVILLE NORTHBAY HEALTHCARE GROUP PART V, SECTION B, LINE 11: NORTHBAY DOES NOT YET HAVE THE EXPERTISE OR RESOURCES TO ADDRESS SUCH THINGS AS PERSONAL SAFETY, DENTAL CARE, EXERCISE/PLAY OPPORTUNITIES AND OTHER NEEDS BEYOND THE SCOPE OF HEALTHCARE DELIVERY PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: NORTHBAY MEDICAL CENTER PART V, SECTION B FACILITY REPORTING GROUP B FACILITY REPORTING GROUP B CONSISTS OF: - FACILITY 2: VACAVALLEY HOSPITAL 42 ABC CLINIC 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 "A BABY IS COMING" OUTPATIENT CLINIC ADULT DAY CENTER 3777 VACA VALLEY PARKWAY VACAVILLE CA 95688 ADULT DAY CENTER ALZHEIMERS RESOURCE CENTER 1010 NUT TREE ROAD VACAVILLE CA 95687 ALZHEIMERS RESOURCE CENTER ANTICOAGULATION SERVICES 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 94533 OUTPATIENT SERVICES BREAST CANCER CENTER PROGRAM 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 94533 OUTPATIENT CANCER CENTER CANCER CENTER PROGRAM 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 94533 OUTPATIENT CANCER CENTER CENTER FOR PAIN MANAGEMENT 1101 B GALE WILSON BLVD FAIRFIELD CA 945333552 OUTPATIENT PAIN CLINIC CENTER FOR WOMEN'S HEALTH 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT WOMEN'S HEALTH CLINIC COSMETIC REFLECTIONS 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT WOMEN'S HEALTH CLINIC COUMADIN CLINIC 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES CPC CLINIC - FAIRFIELD 2458 HILBORN ROAD FAIRFIELD CA 945333552 OUTPATIENT SERVICES CPC CLINIC - GREEN VALLEY 4520 BUSINESS CENTER DRIVE FAIRFIELD CA 945346888 OUTPATIENT PRIMARY CARE CLINIC CPC CLINIC - NTN 421 NUT TREE ROAD VACAVILLE CA 956874100 OUTPATIENT PRIMARY CARE CLINIC CPC CLINIC - VVHP 1010 NUT TREE ROAD VACAVILLE CA 956874100 OUTPATIENT PRIMARY CARE CLINIC EMPLOYEE HEALTH 2470 HILBORN ROAD FAIRFIELD CA 945333552 OUTPATIENT SERVICES ENDOCRINOLOGY 1010 NUT TREE ROAD VACAVILLE CA 956874100 OUTPATIENT SERVICES FUNCTIONAL MEDICINE 1010 NUT TREE ROAD VACAVILLE CA 956874100 OUTPATIENT SERVICES GASTROENTEROLOGY CLINIC 4520 BUSINESS CENTER DRIVE FAIRFIELD CA 945346888 OUTPATIENT SERVICES HOME HEALTH 4520 BUSINESS CENTER DRIVE FAIRFIELD CA 945346888 OUTPATIENT SERVICES HOSPICE & BEREAVEMENT 4520 BUSINESS CENTER DRIVE FAIRFIELD CA 945346888 OUTPATIENT SERVICES INFUSION CENTER 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES LACTATION SERVICES 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES NEUROSURGERY CLINIC 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES OCCUPATIONAL HEALTH 2470 HILBORN ROAD FAIRFIELD CA 945333552 OUTPATIENT OCCUPATIONAL HEALTH CLINIC OCCUPATIONAL HEALTH 1101 B GALE WILSON BLVD FAIRFIELD CA 945333552 OUTPATIENT OCCUPATIONAL HEALTH CLINIC ORTHOPAEDICS 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES ORTHOPAEDICS 1010 NUT TREE ROAD VACAVILLE CA 956874100 OUTPATIENT SERVICES PAIN MANAGEMENT 1101 B GALE WILSON BLVD FAIRFIELD CA 945333552 OUTPATIENT PAIN CLINIC SERVICES PEDIATRIC OT 1101 B GALE WILSON BLVD FAIRFIELD CA 945333552 OUTPATIENT SERVICES PERINATAL UNIT 5141 BUSINESS CENTER DR FAIRFIELD CA 945333552 OUTPATIENT SERVICES PHYSICAL THERAPY 1000 NUT TREE ROAD VACAVILLE CA 95687 OUTPATIENT SERVICES PHYSICALOCCUPATIONAL THERAPY 3250 RANCHO SOLANO PARKWAY FAIRFIELD CA 945333552 OUTPATIENT SERVICES - REHAB SER PHYSICALOCCUPATIONAL THERAPY 3446 BROWNS VALLEY ROAD VACAVILLE CA 956874100 OUTPATIENT SERVICES PSYCHIATRIC CLINIC 421 NUT TREE ROAD VACAVILLE CA 956874100 OUTPATIENT SERVICES RADIATION THERAPY SERVICES 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES SPECIALTY CARE 1860 PENNSYLVANIA AVENUE FAIRFIELD CA 945333552 OUTPATIENT SERVICES SPEECH PATHOLOGY 1200 B GALE WILSON BLVD FAIRFIELD CA 945333552 IN/OUTPATIENT SERVICES SPEECH THERAPY 1101 B GALE WILSON BLVD FAIRFIELD CA 945333552 OUTPATIENT THERAPY SERVICES SURGERY CENTER AT VACAVALLEY 1006 NUT TREE PARKWAY VACAVILLE CA 95687 OUTPATIENT SERVICES WOMEN'S HEALTH CENTER 1860 PENNSYLVANNIA AVE FAIRFIELD CA 94533 OUTPATIENT WOMEN'S HEALTH CLINIC WOMEN'S IMAGING 1101 B GALE WILSON BLVD FAIRFIELD CA 945333552 OUTPATIENT IMAGING SERVICES WOUND CARE CENTER 1010 NUT TREE ROAD VACAVILLE CA 956874100 IN/OUTPATIENT SERVICES PART I, LINE 7: FOR MEDICARE, THE MEDICARE COST REPORT AND ITS RULES OF ALLOWABLE COSTS WERE USED. FOR ALL OTHER PAYERS, A COST TO CHARGE RATIO WAS USED. THE COST TO CHARGE RATIO USED WAS DERIVED FROM IRS SCHEDULE H WORKSHEETS. PART II, COMMUNITY BUILDING ACTIVITIES: NORTHBAY HEALTHCARE COLLABORATES WITH OTHER LOCAL HEALTHCARE ORGANIZATIONS TO PROVIDE TRANSITIONAL HOUSING AND CARE MANAGEMENT FOR HOMELESS PATIENTS WITH CHRONIC MEDICAL AND MENTAL HEALTH CONDITIONS WHO ARE READY FOR HOSPITAL DISCHARGE WHO NEED FOLLOWUP CARE AND CASE MANAGEMENT.NORTHBAY HEALTHCARE IS A MAJOR CONTRIBUTOR TO SOLANO ECONOMIC DEVELOPMENT CORP., A PUBLIC-PRIVATE PARTNERSHIP THAT ATTRACTS AND RETAINS JOB-PRODUCING INDUSTRIES AND BUSINESSES IN OUR COMMUNITIES. IT HOLDS A SEAT ON THE BOARD OF DIRECTORS AND A TOP EXECUTIVE SERVES ON VARIOUS COMMITTEES TO NURTURE ECONOMIC DEVELOPMENT IN SOLANO COUNTY.FINANCIAL SUPPORT PROVIDED THE LEAVEN AFTER-SCHOOL MENTORING PROGRAM IN DISADVANTAGED NEIGHBORHOODS, POLICE ACTIVITIES LEAGUE CRIME-PREVENTION PROGRAMS, TWO HOMELESS SHELTERS (OPPORTUNITY HOUSE AND MISSION SOLANO), SOLANO KIDS INSURANCE PROGRAM, CHILD HAVEN FOR ABUSED AND NEGLECTED CHILDREN AND THE CALIFORNIA DENTAL ASSOCIATION'S CDA CARES PROGRAM THAT PROVIDED A FREE TWO-DAY DENTAL CLINIC FOR THE HOMELESS AND POOR AT THE COUNTY FAIRGROUNDS.NORTHBAY UNDERWRITES PROGRAMS FOR TWO LOCAL CHAMBERS OF COMMERCE -- LEADERSHIP TODAY. GRADUATES COMPLETE A YEARLONG PROGRAM THAT EXPOSES THEM TO THE INNER WORKINGS OF GOVERNMENT, SOCIAL SERVICES, LAW ENFORCEMENT, THE MILITARY AND HEALTH CARE IN THE LOCAL COMMUNITIES. NORTHBAY CONDUCTS HEALTH CARE DAY, BRINGING LEADERSHIP CANDIDATES TO OUR TWO HOSPITALS FOR AN ENTIRE DAY OF ORIENTATION ON THE DELIVERY, COST AND CHALLENGES OF THE LOCAL HEALTHCARE SYSTEM.SOLANO COALITION FOR BETTER HEALTH IS DIRECTED BY HIGH-LEVEL EXECUTIVES FROM ALL LOCAL HEALTH ORGANIZATIONS, SCHOOL DISTRICTS AND LOCAL POLICY-MAKERS. IT FACILITATES SOLUTIONS TO PROBLEMS RELATED TO ACCESS TO MEDICAL AND MENTAL HEALTH SERVICES THROUGH INDIRECT SERVICE INITIATIVES, FUND RAISING AND INFLUENCING POLICY DECISIONS.HEALTH EDUCATION SEMINARS AND WORKSHOPS ARE REGULARLY PROVIDED TO THE COMMUNITY, MOST ALL FREE OF CHARGE. PHYSICIANS AND PROVIDERS COVER A WIDE RANGE OF PREVENTIVE HEALTH TOPICS, FROM CANCER TO HEART DISEASE TO DIABETES AND ORTHOPEDIC INJURIES.NORTHBAY HEALTHCARE CONDUCTS A NURSE AMBASSADOR PROGRAM WHICH REACHED INTO LOCAL SCHOOLS TO DELIVER BOTH HEALTH EDUCATION, BUT ALSO WORKFORCE DEVELOPMENT, SEEKING YOUNG PEOPLE WHO ARE CONSIDERING A CAREER IN HEALTH CARE. MOST NOTABLY, THE PROGRAM ANNUALLY CONDUCTS NURSE CAMP, INVITING 32 HIGH SCHOOL JUNIORS AND SENIORS TO SPEND THREE DAYS WITH REGISTERED NURSES AND OTHER PROVIDERS OBSERVING A VARIETY OF SERVICES -- FROM THE EMERGENCY DEPARMENT TO SURGERY TO INPATIENT CARE AND LABORATORY SCIENCES. APPLICATIONS FROM STUDENTS INTERESTED IN PURSUING A HEALTHCARE CAREER FAR EXCEED THE NUMBER OF SLOTS AVAILABLE. THREE CURRENT NORTHBAY EMPLOYEES ARE GRADUATES OF NURSE CAMP IN PREVIOUS YEARS. PART III, LINE 4: COSTING METHOLOGY FOR BAD DEBT EXPENSE: GAAP IS USED TO CALCUATE BAD DEBT EXPENSE FOR THE FINANCIAL STATEMENTS, AND THEN THE OVERALL COST TO CHARGE RATIO IS APPLIED TO ARRIVE AT COST PERTAINING TO THE CHARGES ON THOSE PATIENT ACCOUNTS, OR PORTION THEREOF, WHICH HAVE BEEN DEEMED UNCOLLECTIBLE.IF A PAYMENT OR OTHER DISCOUNT HAD BEEN APPLIED TO A PATIENT ACCOUNT, THE AMOUNT OF GROSS CHARGES WRITTEN OFF AS A BAD DEBT WOULD HAVE BEEN REDUCED BY THAT AMOUNT, THEREBY EFFECTIVELY REDUCING BAD DEBT EXPENSE AND COST.IN CASES WHERE PATIENTS WERE NOT AVAILABLE TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND PRODUCE FINANCIAL DOCUMENTS, OUR COLLECTION AGENCIES USED TOOLS THAT SCREEN FOR PROPENSITY TO PAY AS A MEANS FOR ULTIMATELY DETERMINING THAT A PATIENT WOULD BE UNABLE TO PAY THEIR BILL.BAD DEBTS ARE INCLUDED AS COMMUNITY BENEFIT BECAUSE NORTHBAY HEALTHCARE GROUP PROVIDES SERVICES TO VULNERABLE POPULATIONS WHO ARE UNABLE TO PAY FOR THE SERVICES. THE HOSPITAL DOES NOT DENY EMERGENCY SERVICES TO ANYONE, AND EMERGENCY SERVICES COMPRISE THE MAJORITY OF THE HOSPITALS' BAD DEBTS COSTS.BAD DEBT EXPENSE FOOTNOTE: EFFECTIVE JANUARY 1, 2012, MANAGEMENT ADOPTED ASU NO. 2011-07, HEALTH CARE ENTITIES (TOPIC 954), PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES ("ASU 2011-07"), WHICH REQUIRES HEALTH CARE ENTITIES THAT RECOGNIZE SIGNIFICANT AMOUNTS OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THEY DO NOT ASSESS THE PATIENT'S ABILITY TO PAY, TO PRESENT THE PROVISION FOR BAD DEBTS RELATED TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) ON THEIR CONSOLIDATED STATEMENTS OF OPERATIONS. ALL PERIODS PRESENTED HAVE BEEN RECLASSIFIED IN ACCORDANCE WITH THE PROVISION OF ASU 2011-07.ACCOUNTS RECEIVABLE FOOTNOTE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM 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 ON A CONSOLIDATED BASIS. 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 WITH THIRD PARTY INSURANCE COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTABLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD PARTY 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 SELF-PAY PATIENTS (THOSE WITHOUT THIRD PARTY INSURANCE COVERAGE), AND RECEIVABLES REPRESENTING DEDUCTIBLES AND COPAYMENTS REQUIRED FROM PATIENTS BY THEIR INSURANCE PLANS, THE SYSTEM RECORDS A 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 DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS HISTORICALLY COLLECTED AFTER ALL REASONABLE COLLECTIONS HAVE BEEN EXHAUSTED IS THE ESTIMATED UNCOLLECTABLE RATE. THIS RATE IS APPLIED TO EXISTING ACCOUNTS TO RECORD AN ESTIMATE FOR UNCOLLECTABLE ACCOUNTS.THE SYSTEM'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 99% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2014 AND 2013. THE SYSTEM HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING THE YEARS ENDED DECEMBER 2014 AND 2013. THE SYSTEM DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD PARTY PAYORS. PART III, LINE 8: COSTING METHODOLOGY FOR MEDICARE: ALL OF THE MEDICARE SHORTFALL, WHERE THE COSTS FOR PATIENT CARE EXCEED THE REIMBURSEMENT THEREON, SHOULD BE TREATED AS A COMMUNITY BENEFIT. THROUGH SERVING THE SOLANO COUNTY POPULATION, WHICH INCLUDES A VERY LARGE PERCENTAGE IN THE 65 AND OLDER AGE GROUP, NORTHBAY HEALTHCARE OFFERS THE PEACE OF MIND THAT COMES WITH CONTINUITY OF CARE TO GIVE ITS COMMUNITY A HOSPITAL THAT IS NEAR THEIR HOME.THE AMOUNT OF MEDICARE ADVANTAGE PROGRAM COST FOR 2014 WAS $34,238,173 AND THE AMOUNT OF NET REVENUES RECEIVED FOR THIS MCR MANAGED CARE PROGRAM WAS $27,799,189, SHORTFALL OF 2014 IS $6,438,985. NONE OF THESE COSTS AND REVENUES ARE INCLUDED IN THE MEDICARE 2014 COST REPORT FIGURES.EXPENSES ARE DISALLOWED BASED ON PRIOR YEARS' COST REPORTS AUDITS AND STANDARD MEDICARE NON-REIMBURSABLE EXPENSES AS DIRECTED BY THE MEDICARE PROGRAM.FOR MEDICARE, THE MEDICARE COST REPORT AND IT RULES OF ALLOWABLE COSTS WERE USED. FOR OTHER PAYERS A COST TO CHARGE RATIO WAS USED. PART III, LINE 9B: COLLECTION PRACTICES: PATIENTS CAN QUALIFY FOR VARIED LEVELS OF FINANCIAL ASSISTANCE BASED UPON THEIR INCOME AS A PERCENTAGE OF THE FEDERAL POVERTY LEVEL. THE AMOUNT THAT A QUALIFIED PATIENT IS BILLED IS EITHER ZERO OR A PERCENTAGE OF THE MEDICARE FEE SCHEDULE DEPENDENT UPON THEIR INCOME. PART VI, LINE 2: NEEDS ASSESSMENT: IN PARTNERSHIP WITH THE SOLANO COALITION FOR BETTER HEALTH, A NEEDS ASSESSMENT WAS CONDUCTED. IT RESULTED IN A DETAILED LIST OF PRIORITY HEALTH NEEDS, INCLUDING A DESCRIPTION OF UNWANTED HEALTH OUTCOMES AND ASSOCIATED DRIVERS. THE NEEDS ASSESSMENT IS AVAILABLE ON THE WEBSITE, NORTHBAY.ORG PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: NORTHBAY HEALTHCARE POSTS NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IN ALL PATIENT REGISTRATION AREAS, IN PATIENT HANDBOOKS, AT ITS PATIENT BUSINESS SERVICES DEPARTMENT, AND ON ITS WEBSITE. NOTICES ARE POSTED IN ENGLISH AND SPANISH. PATIENTS ARE PROVIDED WITH INFORMATION REGARDING THE CHARITY CARE AND DISCOUNT POLICY AT THE POINT OF ACCESS. IF A PATIENT FEELS THAT THEY MAY BE ELIGIBLE UNDER THE POLICY, THEY SHALL BE REFERRED TO NORTHBAY FINANCIAL COUNSELING FOR FURTHER ASSISTANCE. A FINAL DETERMINATION WILL BE MADE WITHIN 30 DAYS OF A COMPLETE APPLICATION AND ALL REQUESTED DOCUMENTATION BEING SUBMITTED. ONCE A DECISION IS MADE FOR THE APPROVAL OR DENIAL OF FINANCIAL ASSISTANCE, A LETTER IS SENT TO THE PATIENT AS NOTIFICATION OF THE DECISION. PART VI, LINE 4: COMMUNITY INFORMATION: SOLANO COUNTY IS A RURAL EXPANSE OF 909.4 SQUARE MILES WITH A POPULATION OF 420,757 (U.S. CENSUS). THERE ARE THREE MAIN URBAN CENTERS: FAIRFIELD, VACAVILLE, AND VALLEJO/BENECIA. NORTHBAY MEDICAL CENTER IS LOCATED IN FAIRFIELD ALONG THE I-80 CORRIDOR BETWEEN THE CENTRAL BAY AREA AND THE STATE CAPITAL. NON-WHITE RESIDENTS ARE NOW A MAJORITY OF THE POPULATION, MAKING OUR CITIES SOME OF THE MOST ETHNICALLY DIVERSE IN CALIFORNIA. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH: NORTHBAY CONTINUALLY PROMOTES PUBLIC HEALTH THROUGH DOZENS OF PROGRAMS, FROM FREE PRENATAL CARE TO LOW-INCOME PREGNANT WOMEN, TO FREE HOSPICE AND BEREAVEMENT SERVICES. A SUBSIDIZED DEMENTIA DAY CARE FACILITY AND A TRANSITIONAL CARE FACILITY FOR THE HOMELESS WHO REQUIRE POST-DISCHARGE CONTINUITY OF CARE ARE ALSO PROVIDED. UP TO 30 PUBLIC EDUCATION PROGRAMS -- HEALTH FAIRS, FREE SCREENINGS, DRIVE-THROUGH FLU VACCINATIONS, INJURY PREVENTION DEMONSTRATIONS, DRUNKEN DRIVING DETERENCE PROGRAMS AT LOCAL SCHOOLS AND DIABETES AWARENESS -- ARE CONDUCTED EVERY YEAR IN COMMUNITY FACILITIES CLOSE TO THOSE WHO CAN BENEFIT FROM THEM. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942995085 501(C)(3) 307533 GENERAL SUPPORT NORTHBAY HEALTH ADVANTAGE 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942495998 501(C)(3) 20593 GENERAL SUPPORT 2 0 PART I, LINE 2: NORTHBAY HEALTHCARE GROUP GRANTS FUNDS TO PATIENTS AND OR THEIR FAMILIES IN NEED OF ASSISTANCE FOR PRESCRIPTIONS, DURABLE MEDICAL EQUIPMENT, TRANSPORTATION, ETC. EACH GRANT/ASSISTANCE REQUEST REQUIRES DOCUMENTATION AS TO THE USE OF THE FUNDS, AND THE DISBURSEMENT OF THOSE FUNDS MUST BE APPROVED BY THE NORTHBAY SOCIAL SERVICES STAFF AND HUMAN RESOURCES. NORTHBAY HEALTHCARE GROUP ALSO GRANTS FUNDS TO NORTHBAY HEALTHCARE FOUNDATION AND NORTHBAY HEALTH ADVANTAGE TO ASSIST WITH THEIR DAILY OPERATIONS. THERE IS NO SPECIFIC PROCEDURE IN PLACE FOR MONITORING THE USE OF GRANT FUNDS ISSUED TO NORTHBAY HEALTHCARE FOUNDATION OR NORTHBAY HEALTH ADVANTAGE. X X X X 0 1 0 0 0 0 1 0 0 GARY PASSAMA CEO 0 593001 0 185964 0 122407 0 26500 0 16094 0 943966 0 0 DEBORAH SUGIYAMA NBHG PRESIDENT 0 455827 0 113274 0 257414 0 48100 0 24889 0 899504 0 0 ARTHUR DENIO VP & CFO 0 373406 0 95811 0 65196 0 13185 0 31406 0 579004 0 0 KATHLEEN RICHERSON V/P CHF NURSING OFF'R 0 303561 0 65170 0 41034 0 20632 0 15437 0 445834 0 0 ANTOINETTE NAVARRO CLINICAL COORDINATOR 278014 0 0 0 0 0 5480 0 284 0 283778 0 0 0 JOANNE JACOB CLINICAL NURSE III 256735 0 0 0 0 0 5586 0 14480 0 276801 0 0 0 THERESA BARTOLI CLINICAL COORDINATOR 278716 0 0 0 0 0 5968 0 21163 0 305847 0 0 0 RHONDA MARTIN AVP NURSING OPERATIONS 251082 0 35574 0 1359 0 11451 0 1103 0 300569 0 0 0 SUSAN GORNALL DIR PERIOPERATIVE SRVCS 232155 0 24426 0 2772 0 8586 0 7402 0 275341 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE ORGANIZATION'S 457(F) PLAN: GARY J. PASSAMA - $85,554 DEBORAH A. SUGIYAMA - $260,472 ARTHUR E. DENIO - $44,319 KATHLEEN RICHERSON - $23,113 PART I, LINE 6 PART OF A SENIOR MANAGEMENT INCENTIVE PROGRAM AND MANAGEMENT ACCOUNTABILITIES WHICH INCLUDES SPECIFIC CRITERIA IN ORDER FOR THEM TO RECEIVE ADDITIONAL COMPENSATION. A CALIFORNIA MUNICIPAL FINANCE AUTHORITY 201563466 13048TQQ9 2013-10-24 61541322 TO FUND CAPITAL ACQUISITIONS & TO DEFEASE THE 1998 BONDS. 1 0 0 A 19581253 61541322 6000000 49266 1230826 1629363 33099880 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 X EQUIPMENT 1 184489 BOOK VALUE 0 0 0 0 FORM 990, PART III, LINE 4A EXEMPT PURPOSE ACHIEVEMENTS: NORTHBAY HEALTHCARE GROUP ("NBHG") IS ORGANIZED FOR THE PROMOTION OF HEALTH THROUGH THE OPERATION OF GENERAL ACUTE CARE HOSPITALS AND OTHER HEALTH RELATED ORGANIZATIONS AND ENTERPRISES. NBHG IS NOT ORGANIZED OR OPERATED FOR PECUNIARY GAIN. THE PROPERTY, ASSETS, AND PROFITS ARE DEDICATED IRREVOCABLY TO THE CHARITABLE PURPOSES SET FORTH IN THE ARTICLES OF INCORPORATION. IF DISSOLVED, ALL ASSETS WILL BE DISTRIBUTED TO THE NORTHBAY HEALTHCARE CORPORATION OR TO OTHER RELATED CHARITABLE ENTITIES. DIRECTOR QUALIFICATIONS INCLUDE COMMITMENT TO THE IMPROVEMENT AND DEVELOPMENT OF COMMUNITY HEALTHCARE IN SOLANO COUNTY. NORTHBAY MEDICAL CENTER & VACAVALLEY HOSPITAL - INPATIENT ACTIVITY: PATIENT DAYS: 37,000; DISCHARGES: 8,710; OBSTETRICAL DELIVERIES: 1,324; INPATIENT SURGICAL PROCEDURES: 4,076; CAPITATED MEMBER MONTHS: 651,457. NORTHBAY MEDICAL CENTER & VACAVALLEY HOSPITAL - OUTPATIENT ACTIVITY: TOTAL ER VISITS: 67,428; OUTPATIENT SURGERIES: 2,032. NORTHBAY MEDICAL GROUP - PRIMARY CARE MEDICAL CLINIC VISITS: 52,590; SPECIALTY CARE CLINIC VISITS: 93,267. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE UPDATED TO REFLECT NORTHBAY HEALTHCARE GROUP'S NEW MANAGEMENT STRUCTURE OF TWO DIVISION PRESIDENTS (PRESIDENT, AMBULATORY DIVISION AND PRESIDENT, HOSPITAL DIVISION) INSTEAD OF ONE NORTHBAY HEALTHCARE GROUP PRESIDENT. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND WILL BE PRESENTED TO THE BOARD OF DIRECTORS OF THE PARENT COMPANY, NORTHBAY HEALTHCARE CORPORATION. A HARDCOPY OF THE FORM 990 WILL BE SENT VIA US POSTAL SERVICE TO ALL VOTING MEMBERS FOR THEIR REVIEW AND COMMENTS AFTER FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUESTS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO SELF-MONITOR COMPLIANCE; IN ADDITION EACH OFFICER AND DIRECTOR MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 AN AD HOC COMPENSATION COMMITTEE OF THE SYSTEM BOARD REVIEWS EXECUTIVE COMPENSATION. THEY ARE ASSISTED BY INDEPENDENT CONSULTANTS. THE ORGANIZATION USES INDEPENDENT LOCAL SURVEYS AS A MEANS TO SUBSTANTIATE COMPENSATION DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE DIGITAL ASSURANCE CORPORATION WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENT ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART VI, LINE 4 REFERENCES TO PRESIDENT UPDATED TO REFLECT NORTHBAY HEALTHCARE GROUP'S NEW MANAGEMENT STRUCTURE OF TWO DIVISION PRESIDENTS (PRESIDENT, AMBULATORY DIVISION AND PRESIDENT, HOSPITAL DIVISION) INSTEAD OF ONE NORTHBAY HEALTHCARE GROUP PRESIDENT. FORM 990, PART VII AND PART IX, LINE 5 COMPENSATION FOR OFFICERS AND DIRECTORS: THE OFFICERS AND DIRECTORS ARE EMPLOYED AND COMPENSATED BY NORTHBAY HEALTHCARE CORPORATION (NBHC). NBHC REPORTS 100% OF THE INDIVIDUAL'S COMPENSATION ON W-2'S ISSUED BY NBHC. HOWEVER, SOME OF THESE EMPLOYEES ARE ASSIGNED DUTIES TO OTHER RELATED ORGANIZATIONS (SEE SCHEDULE R FOR ADDITIONAL INFORMATION REGARDING THE RELATED ORGANIZATIONS). AS A RESULT OF THESE ASSIGNMENTS, WAGE AND BENEFIT COSTS ARE ALLOCATED TO RELATED ORGANIZATIONS. THE WAGE AND BENEFIT COSTS ALLOCATED TO EACH ORGANIZATION ARE REPORTED ON FORM 990, PART IX, STATEMENT OF FUNCTIONAL EXPENSES FOR EACH INDIVIDUAL AS BEING COMPENSATED DIRECTLY FROM THE FILING ORGANIZATION AND THE BALANCE OF COMPENSATION IS REPORTED AS COMPENSATION FROM RELATED ORGANIZATIONS. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 73,868,439. MANAGEMENT AND GENERAL EXPENSES 1,534,972. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 75,403,411. FORM 990, PART XI, LINE 9: AUDITED FINANCIAL STATEMENT ROUNDING ADJUSTMENT 18,112. FORM 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT: THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. NORTHBAY HEALTHCARE CORPORATION 4500 BUSINESS CTR DR FAIRFIELD CA 94534 680046750 TO SUPPORT THE OPERATION OF NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-II N/A 0 NORTHBAY HEALTHCARE FOUNDATION 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942995085 PROVIDES FUNDRAISING FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-I NORTHBAY HEALTHCARE CORPORATION 0 NORTHBAY HEALTH ADVANTAGE 4500 BUSINESS CTR DR FAIRFIELD CA 94534 942495998 MANAGES REAL ESTATE FOR NORTHBAY HEALTHCARE GROUP & AFFILIATES CA 501(C)(3) 11-II NORTHBAY HEALTHCARE CORPORATION 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0