2012-11-09T15:21:16-06:00 2011-12-31 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2011-01-01 941044474 LODI MEMORIAL HOSPITAL ASSOCIATION INC LODI 2093343411 975 S FAIRMONT AVENUE LODI CA 95240 JOSEPH P HARRINGTON 2093343411 2012-11-06 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-02-24 21:20:13Z LODI MEMORIAL HOSPITAL JOSEPH P HARRINGTON 975 S FAIRMONT AVENUE LODI CA 95240 207015927 0 X WWW.LODIHEALTH.ORG X 1945 CA PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY 16 13 1561 174 17206 0 1319172 882450 190415653 195604502 1816794 1717581 25718 14293 193577337 198218826 227340 41241 0 0 83665000 86376106 0 0 200027 114579701 114207849 198472041 200625196 -4894704 -2406370 291588430 283619824 175568655 175027439 116019775 108592385 X AS A NOT-FOR-PROFIT, HEALTH-CARE DELIVERY SYSTEM, LODI MEMORIAL HOSPITAL IS DEDICATED TO:- IMPROVING COMMUNITY HEALTH;- PROVIDING QUALITY AND TIMELY HEALTH-CARE SERVICES, RANGING FROM HEALTH PROMOTION AND EDUCATION TO DIAGNOSTICS, ACUTE-INPATIENT CARE, REHABILITATION SERVICES AND HOME CARE;- EXPANDING COMMUNITY ACCESS TO CARE. 0 0 155865972 41241 191019237 LODI MEMORIAL HOSPITAL IS A NON-PROFIT, ACUTE CARE HOSPITAL PROVIDING HIGH QUALITY SERVICES THAT PROMOTE HEALTH AND REHABILITATION, PREVENT DISEASE, AND TREAT AND CARE FOR THE SICK AND INJURED. HOSPITAL STAFF, MEDICAL STAFF AND THE GOVERNING BOARD ARE DEDICATED TO TREATING ALL PATIENTS AND VISITORS AS INDIVIDUALS WITH EQUAL DIGNITY, RESPECT AND QUALITY OF CARE.LODI MEMORIAL HOSPITAL TREATS AND PROVIDES CARE TO ITS PATIENTS THROUGH INPATIENT AND OUTPATIENT SERVICES. INPATIENTS RECEIVE CARE THROUGH MEDICAL-SURGICAL, PERI-OPERATIVE, PERI-NATAL, PEDIATRIC, INTENSIVE CARE, SUB-ACUTE, AND ACUTE-PHYSICAL REHABILITATION SERVICES.OUTPATIENT CARE INCLUDES 24-HOUR EMERGENCY, DIAGNOSTIC SERVICES, SURGERY, REHABILITATION AND EDUCATION.LODI MEMORIAL HOSPITAL IDENTIFIES THE HEALTH-CARE AND HEALTH MAINTENANCE NEEDS AND PREFERENCES OF THE COMMUNITY IT SERVES. DIAGNOSTIC, REHABILITATIVE, EDUCATIONAL, TREATMENT AND PREVENTATIVESERVICES ARE DEVELOPED AS APPROPRIATE FOR A HOSPITAL OF THIS SIZE AND ROLE.LODI MEMORIAL HOSPITAL, CONSISTENT WITH ITS NON-PROFIT STATUS, DEVELOPS FINANCIAL RESOURCES TO ADEQUATELY SUPPORT HEALTH MAINTENANCE AND PATIENT-CARE SERVICES; CHARITY CARE FOR THOSE UNABLE TO PAY, WORKING CAPITAL NEEDS; AND CAPITAL REQUIREMENTS OF PLANT, EQUIPMENT AND ENVOLVING TECHNOLOGY. EVERY EFFORT IS MADE TO KEEP COSTS AFFORDABLE FOR PATIENTS WHILE CONTINUOUSLY STRIVING TO IMPROVE THE QUALITY OF SERVICE. 7426574 0 4578562 LODI MEMORIAL COMMUNITY CLINICS ARE LICENSED UNDER THE DEPARTMENT OF PUBLIC HEALTH SERVICES REGULATIONS, AND ARE OWNED AND OPERATED BY THE LODI MEMORIAL HOSPITAL ASSOCIATION, INC., A NOT-FOR-PROFIT ENTITY AND WILL PROVIDE MEDICAL CARE TO ANY AGE. A COMMUNITY CLINIC UNIT OFFERS SERVICES DURING POSTED HOURS OF BUSINESS, WITH AT LEAST ONE PHYSICIAN EXPERIENCED IN THE COMMUNITY CLINIC PRACTICE. SPECIALTY CONSULTATION WILL BE AVAILABLE BY PHONE OR REFERRAL TO MEMBERS OF THE MEDICAL STAFF. IN 2011, THERE WERE THREE (3) COMMUNITY CLINICS LICENSED AND OPERATIONAL. 163292546 1 1 0 1 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 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 278 0 1 1561 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X CYNTHIA BUTLER INTERIM CFO 2093343411 975 S FAIRMONT AVE FINANCE DEPT LODI CA 95240 ADDINGTON RON 2.00 X 0 0 0 AGUIRE ELIZABETH 2.00 X 0 0 0 CRABTREE STEVE 2.00 X 0 0 0 CUMMINS WILLIAM LEE 2.00 X 0 0 0 DILLON CECIL 5.00 X X 0 0 0 MILANO ELVIRA MD 2.00 X 0 0 0 HALEY PAUL 2.00 X 0 0 0 KIRST JEFF 2.00 X 0 0 0 KHAN TAJ 2.00 X 0 0 0 MCCAFFREY ROBERT DR 2.00 X X 0 0 0 MURDACA ANNETTE 2.00 X X 0 0 0 OLSON DEBBIE 2.00 X 0 0 0 SORBERA THOMAS MD 40.00 X 295420 0 8468 FERREE CHRISTEEN 2.00 X 0 0 0 PHELPS DAN 2.00 X 0 0 0 GILL PARAMPAL MD 2.00 X 153000 0 0 HARRINGTON JOSEPH P 50.00 X 323437 0 8721 KREUTNER RONALD K 50.00 X 207369 0 10490 MORENO DEBBE JOYCE 50.00 X 188388 0 12257 SEY MARK 50.00 X 165971 0 8721 SCHNEIDER PAMELA 50.00 X 157165 0 8721 FREUNDEDMUND A MD 40.00 X 278695 0 8468 CONNOLY JOHN PATRICK MD 40.00 X 323175 0 0 MULLEN KENNETH MD 28.00 X 218421 0 1068 LAVIOLA STEVEN MD 40.00 X 321898 0 3024 YAO WEIPING MD 40.00 X 228848 0 6443 2861787 0 76381 171 0 1 0 HARBISON MAHONEY HIGGINS BUILDERS INC 15 BUSINESS PARY WAY SUITE 100 SACRAMENTO CA 95828 CONSTRUCTION CONTRACTOR 7014119 QUANTUM HEALTHCARE MEDICAL ASSOCIATES I PO BOX 634850 CINCINNATI OH 45263 PHYSICIAN PROFESSIONAL SERVICES 2029722 PREMIER ANESTHESIA 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 PHYSICIAN PROFESSIONAL SERVICES 1909229 HEALTHCARE RESOURCE GROUP INC 12610 E MIRABEAU PARKWAY STE 800 SPOKANE VALLEY WA 99216 BILLING & COLLECTIONS 1083080 GE HEALTHCARE 3000 N GRANDVIEW BLVD WAUKESHA WI 53188 BIOMEDICAL MAINTENANCE SERVICE 938313 40 18495 215977 647978 882450 PATIENT SERVICE REVENU 621400 187751334 187751334 GAIN FR TRINITY PLAZA 621400 2753085 2753085 CAPITATION FEES 621990 1341989 1341989 GAIN FROM ADVANCED IMA 621400 10184 10184 LOSS FR ENDOSCOPY CENT 621400 -611890 -611890 4359800 4359800 195604502 760712 760712 176732 176732 184978 191395 -6417 -6417 -6703 286 7331495 2054348 6571993 2033713 759502 20635 780137 780137 MANAGEMENT FEES - VITA 541610 16920 16920 OTHER REVENUE 900099 3790 3790 20710 198218826 195597799 17206 1721371 41241 41241 1548128 1179028 369100 658747 501690 157057 71907528 54716780 17129363 61385 6548754 4974671 1557346 16737 5712949 4340855 1358927 13167 192921 192921 821159 246084 575075 64778 64778 25930 19748 6182 111588 111588 18913696 14383839 4502933 26924 80177 45019 14094 21064 21519100 16380792 5128089 10219 1329122 1012236 316886 10674352 8109610 2538754 25988 137838 104975 32863 79048 60202 18846 11758880 8955360 2803520 998649 755693 236573 6383 BAD DEBTS 43251984 43251984 HOSP MEDI-CAL QLTY ASSU 3358578 3358578 DUES, SUBSCRIPTIONS, BO 389492 291478 91249 6765 BUSINESS TAXES & LICENS 211052 160734 50318 289505 209028 69082 11395 200625196 163292546 37132623 200027 133015 155990 13186059 13244488 6098458 4074495 29812330 33074425 85790 69307 2947433 3359243 5338143 8774412 247337335 76190935 173461721 171146400 40664787 32946803 8554824 10714457 11305870 6059804 291588430 283619824 23173431 28407383 148625000 145880000 3770224 740056 175568655 175027439 X 114726597 107663766 1293178 928619 116019775 108592385 291588430 283619824 X -2406370 -5021020 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25930 25930 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO CALIFORNIA HOSPITAL ASSOCIATION & THE HOSPITAL COUNCIL OF NORTHERN CALIFORNIA ARE CONSIDERED TO BE FOR LOBBYING ACTIVITIES. 3655763 3655763 863558 126972088 29949611 97886035 5210954 937038 4273916 103173557 44266440 58907117 7461415 1037846 6423569 171146400 CONDITIONAL ASSET RETIREMENT 740056 740056 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: WE FOLLOW FASB GUIDANCE RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THESE GUIDELINES PRESCRIBE A COMPREHENSIVE MODEL FOR RECOGNIZING, MEASURING, PRESENTING AND DISCLOSING IN THE CONSOLIDATED FINANCIAL STATEMENTS TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN. THEY ALSO PROVIDE ACCOUNTING GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. AS OF DECEMBER 31, 2011, WE ARE NOT AWARE OF ANY UNCERTAIN TAX POSITIONS FOR ANY YEARS OPEN UNDER FEDERAL OR STATE OF CALIFORNIA STATUTES OF LIMITATIONS. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 1 1264 2971077 2971077 0.01890 14 43013 30469262 21750601 8718661 0.05540 15 44277 33440339 21750601 11689738 0.07430 10 28388 3278007 82655 3195352 0.02030 324975 202076 122899 0.00080 11 29758 7970877 5838983 2131894 0.01350 175288 175288 0.00110 21 58146 11749147 6123714 5625433 0.03570 36 102423 45189486 27874315 17315171 0.11000 2 269797 269797 0.00170 2 269797 269797 0.00170 1 4714466 1650063 44906705 50864257 -5957552 X 1 1 1 TRINITY PLAZA SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.94000 0.00000 0.06000 2 ENDOSCOPY CENTER OF LODI LLC AMBULATORY SURGERY CENTER 0.98000 0.00000 0.02000 3 ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC DIAGNOSTIC IMAGING CENTER (WITH MRI) 0.51000 0.00000 0.49000 4 LODI SURGICAL VENTURES LLC MAJORITY OWNER OF LLC OPERATING AMBULATORY SURGERY CENTERS 0.60780 0.00000 0.00000 1 1 LODI MEMORIAL HOSPITAL

975 S FAIRMONT AVE LODI CA 95240

X X X GENERAL ACUTE CARE BEDS = 190 2 LODI MEMORIAL HOSPITAL - WEST

800 LOWER SACRAMENTO ROAD ACUTE PHYS LODI CA 95242

X X ACUTE PHY REHAB = 24 BEDS LODI MEMORIAL HOSPITAL 1 1 1 300.000000000000 1 350.000000000000 1 X X X 1 1 X X X X X X 1 0 1 X 0 0 8 TRINITY PLAZA SURGICAL CENTER LLC

10200 TRINITY PARKWAY SUITE 101 STOCKTON CA 95219

AMBULATORY SURGERY CENTER ENDOSCOPY CENTER OF LODI LLC

840 S FAIRMONT AVE SUITE 1 LODI CA 95240

AMBULATORY SURGERY CENTER ADV IMAGING CENTER AT LODI MEM HOSP LLC

999 S FAIRMONT AVENUE SUITE 110 LODI CA 95240

DIAGNOSTIC IMAGING OUTPATIENT CENTER LODI MEMORIAL COMMUNITY CLINIC - TRINITY

10200 TRINITY PARKWAY SUITE 102 STOCKTON CA 95219

COMMUNITY CLINIC LODI MEMORIAL COMM CLINIC - MILLSBRIDGE

1901 KETTLEMAN LANE SUITE 200 LODI CA 95242

COMMUNITY CLINIC LODI MEMORIAL COMMUNITY CLINIC - VINE

1235 W VINE ST SUITE 22 LODI CA 95240

COMMUNITY CLINIC LODI MEMORIAL HOSP HOME HEALTH AGENCY

800 S LOWER SACRAMENTO RD LODI CA 95242

HOME HEALTH AGENCY LODI OUTPATIENT SURGERY CENTER

521 S HAM LANE LODI CA 95242

AMBULATORY SURGICAL CENTERS PART I, LINE 7: COST IS ASSIGNED UTILIZING OUR INTERNAL COST ACCOUNTING SYSTEM (ECLIPSYS). COST IS ESTIMATED BY UTILIZING RELATIVE VALUE UNITS ASSIGNED TO EACH PRODUCT (I.E. CHARGEABLE TEST, SUPPLY, OR PROCEDURE). EACH PRODUCT'S RELATIVE VALUE IS ESTIMATED BY EACH DEPARTMENT DIRECTOR BASED ON RESOURCES EXPENDED FOR EACH DEPARTMENT PRODUCT. DEPARTMENT COSTS ARE ALLOCATED TO EACH PRODUCT BASED ON ACCUMULATED RELATIVE VALUES. EACH PATIENT ACCUMULATES PRODUCTS DURING THEIR VISIT. THE TOTAL COST FOR EACH PATIENT REPRESENTS THE SUM OF ALL THE PRODUCTS PROVIDED TO THEM DURING THEIR VISIT OR INPATIENT STAY. THE ABOVE IS THE CACULATION FOR HOSPITAL CHARGES. FOR COMMUNITY CLINICS, HOSPITAL BASED CLINICS, HOSPITAL BASED HOME HEALTH AGENCY AND TWO SURGERY CENTER JOINT VENTURES A COST TO CHARGE RATIO WAS CALCULATED BASED ON THE DIRECT COSTS OF THESE LINES OF BUSINESS. 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 $ 43251984. PART II: THE HOSPITAL PROVIDES MANY COMMUNITY-BUILDING ACTIVITIES TO INCREASE ACCESS TO PRIMARY-CARE SERVICES AND REDUCE THE NUMBER OF PATIENTS WHO PRESENT THEMSELVES TO THE EMERGENCY DEPARTMENT SEEKING CARE FOR MEDICAL CONDITIONS OR INJURIES THAT COULD HAVE EASILY BEEN TREATED AT THE ONSET BY A PRIMARY-CARE PHYSICIAN. THE FOLLOWING WERE LAUNCHED AND ARE NOW SUSTAINED BY THE HOSPITAL TO ADDRESS THE NEED FOR ACCESS TO CARE: A FREE CLINIC; THREE HOSPITAL BASED PRIMARY-CARE CLINICS, AN OBSTETRIC CLINIC AND A PEDIATRIC CLINIC; TWO PRIMARY-CARE COMMUNITY CLINICS AND ONE SPECIALTY COMMUNITY CLINIC. THE CLINICS ALSO KEEP LOCAL PHYSICIANS PRACTICING MEDICINE IN THE AREA. MANY PHYSICIANS WOULD HAVE RETIRED OR MOVED OUT OF THE AREA TO PRACTICE IN A HEALTH SYSTEM IF THE HOSPITAL HAD NOT AGREED TO EMPLOY THEM OR MANAGE THEIR PRACTICES. SO THAT ADULTS CAN WORK WHILE THEIR CHILDREN AND PARENTS ARE SAFELY AND LOVINGLY CARED FOR DURING THE DAY, THE HOSPITAL OFFERS AN AFFORDABLE CHILD-CARE CENTER AND AN ADULT-DAY-CARE CENTER. ADDITIONALLY, THE HOSPITAL PROVIDES NURSE TRAINING, SALARIES AND SUPPORT FOR NINE PARISH-NURSE PROGRAMS SO THAT PEOPLE IN THEIR CHURCHES HAVE ACCESS TO HEALTH EDUCATION, PREVENTION AND OTHER SUPPORTIVE SERVICES. TO PREVENT DISEASE AND INJURY AND ENCOURAGE WELLNESS, HEALTH NEWSLETTERS ARE MAILED TO 85,000 SERVICE-AREA HOUSEHOLDS AND MADE AVAILABLE ON THE HOSPITAL WEB SITE THREE TIMES A YEAR. SAN JOAQUIN COUNTY IS AMONG THE MOST DIFFICULT COUNTIES IN THE STATE WHEN IT COMES TO RECRUITING PHYSICIANS TO PRACTICE MEDICINE, AND THE HOSPITAL DEVOTES SIGNIFICANT FINANCIAL AND HUMAN RESOURCES TO THAT EFFORT. PART III, LINE 4: FINANCIAL STATEMENT NOTE 18. "UNCOMPENSATED CARE AND COMMUNITY BENEFIT COSTS: OUR POLICY IS TO PROVIDE SERVICE TO ALL WHO REQUIRE IT, REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, WE PROVIDE SUBSTANTIAL AMOUNTS OF UNCOMPENSATED CARE. WHEN THIS CARE IS PROVIDED TO PATIENTS WHO LACK FINANCIAL RESOURCES AND THEREFORE ARE DEEMED MEDICALLY INDIGENT, IT IS CLASSIFIED AS CHARITY CARE. WHEN IT IS PROVIDED TO PATIENTS WHO HAVE THE MEANS TO PAY, BUT DECLINE TO DO SO, IT IS CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS. SOME UNDETERMINED PORTION OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS REPRESENTS CARE TO INDIGENT PATIENTS WHO WE HAVE BEEN UNABLE TO IDENTITY AS CHARITY. NEITHER CHARITY CARE NOR THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS REFLECTED IN NET PATIENT SERVICE REVENUES. IN ADDITION, WE PROVIDE SERVICES TO POOR AND UNDERSERVED PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, INCLUDING PATIENTS INSURED UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS THAT ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND FREQUENTLY THE PAYMENTS ARE LESS THAN THE COSTS OF RENDERING THE SERVICES."COSTING METHODOLOGY:UTILIZING THE PREVIOUS COSTING METHODOLOGY AS OUTLINED IN RESPONSE TO PART I LINE 7, ALL PATIENTS ARE ASSIGNED A PAYOR CLASS (I.E. CHARITY, SELF PAY, MEDICARE, MEDI-CAL, MANAGED CARE). THE COST BY PAYOR IS A SUMMATION OF ALL PATIENTS IN THE ASSIGNED PAYOR CLASS. COMMUNITY BENEFIT RATIONALE: UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGIBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE. OFTEN THE INFORMATION GATHERED IN THE MEDICAID APPLICATION WILL MAKE THIS DETERMINATION "AUTOMATIC." IF ADDITIONAL INFORMATION IS REQUIRED WE ATTEMPT TO CONTACT THE PATIENT.THE AMOUNTS WRITTEN OFF AS BAD DEBT (ASSIGNED TO A COLLECTION AGENCY) ARE NET OF ANY APPLICABLE PAYMENTS OR DISCOUNTS. ANY PAYMENTS RECEIVED AFTER AN ACCOUNT IS ASSIGNED TO A COLLECTION AGENCY REDUCE THE BAD DEBT EXPENSE IN THE PERIOD RECEIVED.OF THE TOTAL UNINSURED PATIENTS SEEN IN 2011: 32% QUALIFIED FOR CHARITY CARE AND 62% WERE WRITTEN OFF TO BAD DEBTS. WE ESTABLISHED IN THE 3RD QUARTER OF 2011 TO WRITE OFF "PRESUMPTIVE" CHARITY CARE - FOR THE UNINSURED HOMELESS OR UNEMPLOYED BEFORE COMPLETING CHARITY CARE APPLICATION PROCESS. THIS INCREASED OUR CHARITY CARE BY 34% COMPARED TO 2011. IT IS DIFFICULT TO ASCERTAIN HOW MANY UNINSURED WRITTEN OFF TO BAD DEBTS WOULD QUALIFY FOR CHARITY CARE. ALL BAD DEBT WRITE OFFS ARE SENT TO A COLLECTION AGENCY. IF AN ACCOUNT QUALIFIES FOR CHARITY CARE AFTER SENT TO AN AGENCY, NO FURTHER COLLECTION ACTIVITY IS PURSUED AND THE "BAD DEBT" ACCOUNT IS WRITTEN OFF IN FULL - WE HAVE NOT TRACKED THESE IN THE PAST AS PART OF OUR CHARITY CARE EXPENSE BUT ESTIMATE AT LEAST 35% OF OUR BAD DEBT COSTS REPRESENT CHARITY CARE. PART III, LINE 8: THE COSTS OF PROVIDING CARE TO MEDICARE RECIPIENTS OFTEN EXCEED THE GOVERNMENT'S REIMBURSEMENT FOR THESE SERVICES. FOR COST ASSIGNED TO MEDICARE PATIENTS, PLEASE SEE RESPONSE IN PART III, LINE 4.FEE REIMBURSED CHARGES FOR LABORATORY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY WITH INCIDENTAL CHARGES FOR SUPPLIES AND DRUGS WERE OBTAINED FROM THE MEDICARE PS&R. COST TO CHARGE RATIOS (CCR) FROM THE FILED COST REPORT WERE UTILIZED TO CALCULATE MEDICARE COSTS. MEDICARE REVENUES FOR THESE SERVICES WERE $1,553,853; COSTS WERE $1,389,711THE COST ACCOUNTING SYSTEM IS USED FOR HOSPITAL CHARGES - ALL INPATIENT, OUTPATIENT, EMERGENCY AND URGENT CARE - FOR ALL PAYORS. A COST TO CHARGE RATIO WAS USED FOR SEGMENTS THAT ARE NOT YET INCLUDED IN THE COST ACCOUNTING SYSTEM: PRIMARILY HOSPITAL BASED CLINICS, COMMUNITY CLINICS, HOME HEALTH AND OUR RURAL HEALTHCARE CLINIC. 96.4% OF OUR CONSOLIDATED GROSS REVENUES ARE CAPTURED IN THE COST ACCOUNTING SYSTEM. PART III, LINE 9B: UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE. PART V, SECTION A: THESE TWO LOCATIONS ARE LICENSED TOGETHER AS ONE HOSPITAL. LODI MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: THE FINANCIAL ASSISTANCE (CHARITY CARE) POLICY CHARGES THE PATIENT 10% OF GROSS CHARGES IF THEIR POVERTY LEVEL IS BETWEEN 300% AND 350% OF THE FEDERAL GUIDELINES. THE 10% OF GROSS CHARGES APPROXIMATES THE HOSPITAL'S REIMBURSEMENT FROM MEDICARE AND IS THE MAXIMUM CHARGED TO INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: EVERY THREE YEARS LODI MEMORIAL HOSPITAL ASSESSES COMMUNITY HEALTH NEEDS BY 1)CONSULTING WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY CONSTITUENCIES TO REVIEW THE NEEDS OF EACH CONSTITUENCY; 2)REVIEWING SERVICE-AREA MORBIDITY AND MORTALITY HEALTH DATA PROVIDED BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES; 3)COMPILING SOCIO-ECONOMIC DATA TO DETERMINE WHERE THE GREATEST NEEDS EXIST WITHIN THE HOSPITAL-SERVICE AREA; AND 4)ASKING AREA RESIDENTS TO COMPLETE A HEALTH SURVEY REGARDING THEIR PERSONAL HEALTH AND NOTIONS ABOUT GOOD HEALTH. ONCE THE DATA IS COLLECTED, IT IS REVIEWED AND ASSESSED BY THE HOSPITAL'S COMMUNITY ADVISORY BOARD, BOARD OF DIRECTORS AND HOSPITAL MANAGERS TO DETERMINE WHAT SERVICES AND GAP AREAS MAY NEED ENHANCING OR ADDRESSING TO IMPROVE HEALTH WITHIN THE REALM OF THE HOSPITAL'S RESOURCES TO DO SO. PART VI, LINE 3: SIGNS ARE PROMINENTLY POSTED IN THE ADMISSIONS, EMERGENCY AND BILLING DEPARTMENTS OF THE HOSPITAL, IN ADDITION TO ALL THE HOSPITAL CLINICS, TO ADVISE PATIENTS AND VISITORS THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND HOW TO WORK WITH HOSPITAL STAFF TO OBTAIN IT. THE SAME INFORMATION IS INCLUDED IN PATIENT-ADMISSION PACKETS AND POSTED ON THE HOSPITAL WEB SITE. HOSPITAL CASE MANAGERS ARE VIGILANT OF PATIENTS NEEDING FINANCIAL ASSISTANCE AND FOLLOW UP WITH THOSE IN NEED. FINANCIAL ASSISTANCE INCLUDES APPLYING FOR MEDICAID AS WELL AS CHARITY CARE. PART VI, LINE 4: NEARLY ALL OF THE INDIVIDUALS SEEKING CARE FROM LODI MEMORIAL HOSPITAL RESIDE IN ONE OF FIVE COUNTIES: SAN JOAQUIN, SACRAMENTO, SOLANO, AMADOR, AND CALAVERAS. ABOUT HALF OF THE HOSPITAL'S PATIENTS RESIDE WITHIN A FIVE-MILE RADIUS OF THE HOSPITAL IN SAN JOAQUIN COUNTY. GEOGRAPHICALLY, THE HOSPITAL SITS AT THE NORTHERN END OF THE SAN JOAQUIN VALLEY WHERE THE RESIDENTS ARE AMONG THE POOREST AND LEAST EDUCATED OF ALL THE STATE'S COUNTIES. IN ADDITION, SAN JOAQUIN COUNTY HAS AMONG THE WORST UNEMPLOYMENT RATES IN THE STATE'S COUNTIES; NEARLY TWO IN 10 RESIDENTS ARE UNEMPLOYED. ALSO SAN JOAQUIN COUNTY IS GROUND-ZERO FOR THE MORTGAGE CRISIS IN THIS COUNTRY. THE COUNTY IS ALSO AMONG THE MOST VIOLENT IN WHICH TO LIVE IN THE COUNTRY DUE TO SIGNIFICANT GANG ACTIVITY AND POVERTY. HOSPITAL PATIENTS REPRESENT DIVERSITY: ABOUT 30 PERCENT ARE HISPANIC, WITH MANY OF THOSE PATIENTS BEING MONOLINGUAL SPANISH SPEAKERS. ANOTHER THREE PERCENT ARE PAKISTANI, MANY OF WHOM SPEAK ONLY URDU OR PASHTU. ADDITIONALLY THERE IS A SIGNIFICANT POPULATION OF HOSPITAL PATIENTS WHO ARE GREATER THAN 80 YEARS OF AGE. THE MAJOR HEALTH ISSUES OF THE COUNTY ARE HEART DISEASE, STROKE, CANCER, DIABETES AND OBESITY. PART VI, LINE 5: THE HOSPITAL CONDUCTS MYRIAD ACTIVITIES TO PROMOTE COMMUNITY HEALTH. THOSE ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO HEALTH FAIRS WITH FREE MEDICAL SCREENINGS FOR HIGH CHOLESTEROL, HIGH-BLOOD PRESSURE, DIABETES AND LOW-OXYGEN SATURATION LEVELS; REFERRALS TO FREE CLINICS OR LOCAL PHYSICIANS FOR THOSE WITH HIGH VALUES; A VARIETY OF LINKED VIDEOS TO THE HOSPITAL WEB PAGE, FACEBOOK PAGE, YOUTUBE PAGE, AND TWITTER RELATED TO HEALTH EDUCATION AND PREVENTION; A WELLNESS PROGRAM FOR HOSPITAL EMPLOYEES THAT IS ROOTED IN EXERCISE AND NUTRITION SO THAT EMPLOYEES MAY LEAD BY EXAMPLE; A MONTHLY NUTRITION COLUMN IN THE LOCAL NEWSPAPER; HOSPITAL STAFF SERVING ON THE BOARDS OF REGIONAL NGOS; DONATIONS OF MATERIALS AND EQUIPMENT TO NGOS; EMPLOYEE DONATIONS OF FOOD AND CLOTHING TO THE NEEDY; AND THE HOSPITAL IS THE SECOND LARGEST YEAR-ROUND EMPLOYER IN LODI SO THAT EMPLOYEES MAY REINVEST THEIR EARNINGS IN THE LOCAL ECONOMY. THE HOSPITAL HAS ALSO ADOPTED THE MOST IMPOVERISHED, LARGEST AND MOST DIVERSE SCHOOL IN THE LOCAL SCHOOL DISTRICT TO HELP EDUCATE STUDENTS, PARENTS AND TEACHERS IN PREVENTION. IN THAT EFFORT THE HOSPITAL HOSTS AT THE SCHOOL HEALTH AND EDUCATION FAIRS; PARTICIPATES IN CLASSROOM TEACHING AND HEALTH DEMONSTRATIONS; AND PARTICIPATES IN CAREERS FAIRS AT THE SCHOOL. DUE TO HAND-WASHING EDUCATION ALONE, THE SCHOOLS ABSENTEE RATES HAVE DECLINED DRAMATICALLY. FOR STUDENTS TO LEARN, THEY MUST BE IN SCHOOL; AND FOR SCHOOLS TO RECEIVE STATE FUNDING, THEY MUST MAINTAIN THEIR ATTENDANCE. PART VI, LINE 6: N/A REPORTS FILED WITH STATES PART VI, LINE 7 CA 1 CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST STE 800 SACRAMENTO CA 95814 941498697 501(C)(3) 24613 HOSPITAL QA FEE PROGRAM PLEDGES 1 0 X X X X 0 1 0 0 0 0 0 0 0 SORBERA THOMAS MD 295420 0 0 0 0 0 0 0 8468 0 303888 0 0 0 GILL PARAMPAL MD 153000 0 0 0 0 0 0 0 0 0 153000 0 0 0 HARRINGTON JOSEPH P 317437 0 0 0 6000 0 0 0 8721 0 332158 0 0 0 KREUTNER RONALD K 202819 0 0 0 4550 0 0 0 10490 0 217859 0 0 0 MORENO DEBBE JOYCE 184188 0 0 0 4200 0 0 0 12257 0 200645 0 0 0 SEY MARK 161771 0 0 0 4200 0 0 0 8721 0 174692 0 0 0 SCHNEIDER PAMELA 157165 0 0 0 0 0 0 0 8721 0 165886 0 0 0 FREUNDEDMUND A MD 253109 0 25586 0 0 0 0 0 8468 0 287163 0 0 0 CONNOLY JOHN PATRICK MD 323175 0 0 0 0 0 0 0 0 0 323175 0 0 0 MULLEN KENNETH MD 204060 0 14361 0 0 0 0 0 1068 0 219489 0 0 0 LAVIOLA STEVEN MD 321898 0 0 0 0 0 0 0 3024 0 324922 0 0 0 YAO WEIPING MD 215268 0 13580 0 0 0 0 0 6443 0 235291 0 0 0 PART I, LINE 4B LMH HAS A 457(F) SERP WHICH IS LIMITED TO SELECT MEMBERS OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. PARTICIPANTS ARE SELECTED BY THE BOARD OF DIRECTORS OR AN AUTHORIZED OFFICER. THE AMOUNT OF THE DEFERRED COMPENSATION UNDER THE PLAN FOR A PARTICIPANT FOR A PLAN YEAR SHALL BE SPECIFIED IN THE PARTICIPANT'S PARTICIPATION AGREEMENT OR, IF NOT SO SPECIFIED, THE AMOUNT DETERMINED BY THE EMPLOYER FOR SUCH PLAN YEAR IN THE EMPLOYER'S SOLE AND ABSOLUTE DISCRETION. A PARTICIPANT BECOMES FULLY VESTED IN THE PARTICIPANT'S ACCOUNT UPON THE EARLIEST OF NORMAL RETIREMENT, DATE OF DEATH OR DATE OF DISABILITY WHILE STILL AN EMPLOYEE, DATE OF TERMINATION OR DEMOTION BY THE EMPLOYER IF THE EVENT OCCURS WITHIN THE TWELVE MONTH PERIOD FOLLOWING A CHANGE IN CONTROL, THE EMPLOYER'S INVOLUNTARY TERMINATION OF THE PARTICIPANT'S EMPLOYMENT WITHOUT CAUSE. IF THE PARTICIPANT CEASES TO BE AN EMPLOYEE PRIOR TO BECOMING FULLY VESTED, THE EMPLOYEE SHALL NOT BE ENTITLED TO ANY BENEFIT UNDER THIS PLAN. ANY AMOUNTS CREDITED TO A PARTICIPANT'S ACCOUNT THAT ARE NOT VESTED AT THAT TIME SHALL BE FORFEITED. DISTRIBUTIONS UNDER THE PLAN COMMENCE WITHIN 90 DAYS FOLLOWING VESTING AND NOT LATER THAN MARCH 15 OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR OF VESTING. NO PLAN CONTRIBUTIONS AND NO PAYMENTS WERE MADE FROM THE PLAN DURING THE YEAR. CALIFORNIA STATEWIDE COMMUNITES DEVELOPMENT AUTHORITY 680164610 2007-12-01 150629537 SEE SUPPLEMENTAL INFORMATION 0 0 0 4120000 155146986 11157662 18234618 1547800 5651669 116147397 2407841 2011 0 0 0 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 X SCHEDULE K SUPPLENTAL INFORMATION THE DIFFERENCE OF $4,517,449 BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND THE TOTAL PROCEEDS OF ISSUE IN PART II, LINE 3 IS DUE TO THE CUMULATIVE INVESTMENT EARNINGS (2007-2011) ON PROJECT FUNDS AND RESERVE FUNDS. PART I; COLUMN F: DESCRIPTION OF PURPOSE: TO CONSTRUCT AND EQUIP: GENERAL ACUTE CARE ADDITION & NEW EMERGENCY DEPT. TO ALSO REMODEL WITH NEW EQUIPMENT: KITCHEN AND CAFETERIA. HASHIMOTO HARVEY MD LINE OF CREDIT, PHYSICIAN PRACTICE SUPPORT X 120000 69307 0 1 1 69307 MAUREEN MCCAFFREY DAUGHTER OF ROBERT MCCAFFREY, BOARD MEMBER 114019 EMPLOYEE OF LODI MEMORIAL HOSPITAL 0 P GILL OBSTETRICS AND GYNECOLOGY >5% OWNED PARTNERSHIP BY PARAMPAL GILL, CURRENT BOARD MEMBER 328800 PHYSICIAN PROFESSIONAL SERVICE-OB CLINIC 0 FORM 990, PART VI, SECTION A, LINE 6 ASSOCIATION MEMBERSHIP IS OPEN TO ANYONE FOR A ONE-TIME, LIFETIME FEE OF $100. MEMBERS PARTICIPATE IN THE ANNUAL ELECTION OF BOARD MEMBERS WHO DIRECT THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS PARTICIPATE IN THE ANNUAL ELECTION OF BOARD MEMBERS WHO DIRECT THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 11 THE DRAFT OF THE FORM 990 IS PRESENTED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF LODI MEMORIAL HOSPITAL TO REVIEW. THE REVIEWED DRAFT COPY IS THEN PROVIDED ELECTRONICALLY TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD, COMMITTEES, OFFICERS AND MANAGEMENT ARE REQUIRED TO REVIEW, ATTEST AND DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS ON AN ANNUAL BASIS. IN ADDITION, IT IS VERBALLY REQUESTED AT EVERY BOARD MEETING FOR ALL MEMBERS TO DECLARE IF THEY HAVE A CONFLICT OF INTEREST ON ANY AGENDA ITEM AND TO ABSTAIN FROM VOTING ON SAID ITEM. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE, WHO REVIEWS THE CEO'S PERFORMANCE AND COMPENSATION AT LEAST ANNUALLY WHOSE SPECIFIC RESPONSIBILITIES INCLUDE: SCHEDULING AND COMPLETING AN ANNUAL REVIEW OF THE CEO'S PERFORMANCE, REVIEWING AND ESTABLISHING PERFORMANCE CRITERIA FOR THE CEO, AN ANNUAL REVIEW OF THE CEO'S JOB DESCRIPTION, SOLICITING INPUT FROM OTHER SOURCES ON CEO PERFORMANCE, ANNUALLY REVIEWING MARKET AREA COMPENSATION AND BENEFITS FOR HOSPITAL CEOS TO DETERMINE FAIR MARKET VALUE COMPENSATION, ANNUALLY PROVIDE VERBAL AND WRITTEN FEEDBACK TO CEO ON PERFORMANCE. THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE THAT ALSO ESTABLISHES A COMPENSATION PHILOSOPHY FOR CEO AND SENIOR MANAGEMENT, REVIEWS AND APPROVES THE CEO RECOMMENDATION FOR CAO, CAN, CFO AND VP COMPENSATION AND REVIEWS AND APPROVES MANAGEMENT COMMITTEE INCENTIVE COMPENSATION. IN ADDITION, LODI MEMORIAL HOSPITAL (LMH) PARTICIPATES IN AN ANNUAL COMPENSATION SURVEY SPONSORED BY THE CALIFORNIA HOSPITAL ASSOCIATION, THE HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA AND THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA. LMH SUBMITS THEIR WAGE AND SALARY DATA TO AN INDENDENDENT THIRD PARTY WHICH PRODUCES A REPORT BY JOB TITLE AND JOB DESCRIPTION THAT COMPARES SALARIES BY REGION WITHIN CALIFORNIA FOR ALL HOSPITALS WHO PARTICIPATE IN THE SURVEY. FORM 990, PART VI, SECTION C, LINE 19 AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -636,918. INCOME OF SUBSIDIARY - VITAL 85,760. INCOME OF SUBSIDIARY - LRHS -144,265. BOOK/TAX K-1 DIFFERENCES -4,325,597. TOTAL TO FORM 990, PART XI, LINE 5: -5,021,020. 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