2014-08-15T19:27:28-05:00 2013-09-30 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2012-10-01 941502014 SOUTHERN MONTEREY COUNTY MEMORIAL HOSP DBA GEORGE L MEE MEMORIAL HOSPITAL SOUT 8313856000 300 CANAL STREET KING CITY CA 93930 SUSAN M CHILDERS 8313856000 2014-08-15 1 RENIE BURBANK P00159653 4159561500 2012 2015-11-30 17:44:51Z SUSAN M CHILDERS 300 CANAL STREET KING CITY CA 93930 85398964 0 X WWW.MEEMEMORIAL.COM X 1964 CA THE HOSPITAL PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. 8 5 573 40 0 0 380220 137746 72904784 77968534 -897657 -494935 4660125 7257324 77047472 84868669 69261 82672 0 0 38449203 36042245 0 0 0 35739084 37432262 74257548 73557179 2789924 11311490 38184501 41786045 48424164 40714218 -10239663 1071827 THE HOSPITAL PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. 0 0 55793026 82672 77968534 THE HOSPITAL, IS A 119-BED LICENSED FACILITY THAT PROVIDES COMPREHENSIVE MEDICAL CARE TO THE LOCAL COMMUNITY AND OUTLYING AREAS WITHIN A 50-MILE RADIUS. TYPES OF CARE OFFERED ARE ACUTE, LONG-TERM, AND RURAL HEALTH CLINIC SERVICES. OVER THE FISCAL YEAR, TOTAL PATIENT DAYS WERE 25,455, AND TOTAL PATIENTS TREATED WERE 45,000. 55793026 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 0 0 0 0 1 180 0 1 573 1 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CA X MICHAEL FRENCH 8313857162 300 CANAL STREET KING CITY CA 93930 X BUTTGEREIT JANET 2.00 X X 0 0 0 BORZINI ROGER 2.00 X X 0 0 0 BUMBALOUGH PAULETTE 2.00 X 0 0 0 EDDINGTON ROBERT 2.00 X 0 0 0 NASH SARAH 2.00 X 0 0 0 ZARO MD CHRISTINA 2.00 X 109400 0 12000 SCHINDELHEIM MD ROY 2.00 X X 210641 0 43494 SMITH LEX 50.00 X X 295209 0 31494 CHILDERS SUSAN 50.00 X 230374 0 31494 SALAMACHA RENA 50.00 X 129988 0 42997 WONG KAREN 50.00 X 156540 0 14358 SILVA NANCY 40.00 X 164198 0 0 LAI JOY 40.00 X 146545 0 14358 ROBEY LAURA 40.00 X 143082 0 31494 FARRELL IAN 40.00 X 139656 0 14358 DIESH VIJAY 40.00 X 120596 0 14358 1846229 0 250405 52 0 1 0 XTEND HEALTHCARE PO BOX 1709 HENDERSONVILLE TN 37077 PATIENT AR BILLING & COLLECTIONS AGENCY 1797444 MONTEREY ANESTHESIA PROFESSIONALS 1522 CONSTITUTION BLVD 123 SALINAS CA 93905 MEDICAL SERVICES 1306945 UKATU CHIDI MD 10521 RUTHELEN STREET LOS ANGELES CA 90047 MEDICAL SERVICES 709147 BRADFORD LETITIA MD 7485 RUSH RIVER SUITE 710-323 SACRAMENTO CA 95831 MEDICAL SERVICES 567231 TRAN DAN MD 17212 MARINA VIEW PLACE HUNTINGTON BEACH CA 92649 MEDICAL SERVICES 410950 25 137746 137746 PATIENT SERVICE REV. 621400 77968534 77968534 77968534 6544 6544 47125 22316 24809 24809 24809 6500 507979 -501479 -501479 -501479 WRITE-OFF LIABILITY 900099 5880568 5880568 OTHER OPERATING INCOME 900099 1153295 0 1153295 REBATES/REFUNDS 900099 71730 0 71730 126922 126922 7232515 84868669 77968534 0 6762389 X 82672 82672 1423665 410319 1013346 21849928 21132284 717644 291067 262239 28828 10470882 9868551 602331 2006703 1890128 116575 203769 32549 171220 407965 41054 366911 127200 10000 117200 13973575 11289439 2684136 5111989 5084309 27680 1444972 1412905 32067 242274 219106 23168 70210 59313 10897 1337610 1337610 2004683 1703981 300702 829396 788633 40763 BAD DEBT EXPENSE 10952215 10952215 726404 167934 558470 73557179 55793026 17764153 0 173163 972570 11212843 11566094 790563 787837 496807 725106 45167709 22538161 23015411 22629548 12518 12518 2483196 5092372 38184501 41786045 16647346 9027500 10140139 9878302 15967823 15618715 1253442 922031 4415414 5267670 48424164 40714218 X -10239663 1071827 -10239663 1071827 38184501 41786045 11311490 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 512182 512182 26844198 10883096 15961102 14833153 11023068 3810085 2978176 631997 2346179 22629548 OTHER RECEIVABLES 4361975 ASSETS LIMITED AS TO USE 5785 OTHER ASSETS 32596 THIRD PARTY SETTLEMENTS 692016 5092372 ACCRUED INTEREST PAYABLE 276601 SELF INSURED HEALTH CARE CLAIMS 1380876 LITIGATION RESERVE 1014354 ASSEMBLY BILL 97 CLAWBACK LIAB 2185539 PROFESSIONAL FEES 42000 INCURRED CLAIMS PAYABLE 368300 5267670 X 74474418 -10918046 -10918046 85392464 -523795 -523795 84868669 63187954 582990 582990 62604964 10952215 10952215 73557179 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL ASSESSES UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH THE PROVISIONS OF THE FASB ACCOUNTING STANDARD CODIFICATION ("ASC") TOPIC 740-10, INCOME TAXES. THE HOSPITAL RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE THAN 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 HOSPITAL RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT SEPTEMBER 30, 2013 AND 2012, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF SERVICE LEAGUE REVENUE 34,169. RECLASSIFICATION OF BAD DEBT EXPENSE FROM NET PATIENT REVENUE -10,952,215. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF LOSS ON DISPOSAL OF ASSETS -501,479. RECLASSIFICATION OF RENTAL EXPENSES TO REVENUE -22,316. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASSIFICATION OF LOSS ON DISPOSAL OF ASSETS 501,479. RECLASSIFICATION OF SERVICE LEAGUE EXPENSES 59,195. RECLASSIFICATION OF RENTAL EXPENSES TO STATEMENT OF REVENUE 22,316. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF BAD DEBT EXPENSE FROM NET PATIENT REVENUE 10,952,215. 1 1 X 1 X 1 X 1 0 1 1 3016290 3016290 0.04100 27 66550 27864711 27020694 844017 0.01150 27 66550 30881001 27020694 3860307 0.05250 7 8767 98765 59873 38892 0.00050 7 8767 98765 59873 38892 0.00050 34 75317 30979766 27080567 3899199 0.05300 1 8767 82672 59873 22799 0.00030 4 12803 12803 0.00020 2 3290 3290 0.00000 7 8767 98765 59873 38892 0.00050 1 10952215 6855909 8399419 15761658 -7362239 X 1 1 1 1 GEORGE L MEE MEMORIAL HOSPITAL

300 CANAL STREET KING CITY CA 93930

X X X GEORGE L MEE MEMORIAL HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X X X 1 X X 1 X X X X X 1 X 0 0 5 KING CITY CLINIC

210 CANAL STREET KING CITY CA 93930

OUTPATIENT CLINIC SPECIALTY CLINIC

400 CANAL STREET SUITE B KING CITY CA 93930

OUTPATIENT CLINIC FAMILY MEDICAL CENTER

400 CANAL STREET SUITE A KING CITY CA 93930

OUTPATIENT CLINIC THE WOMEN'S CENTER

400 CANAL STREET SUITE C KING CITY CA 93930

OUTPATIENT CLINIC GREENFIELD CLINIC

467 S EL CAMINO REAL GREENFIELD CA 93927

OUTPATIENT CLINIC PART I, LINE 7: COST TO CHARGE RATIO WAS USED TO CALCULATE THE COMMUNITY BENEFIT EXPENSE ON PART I, LINE 7B. PART II: ONLY HOSPITAL IN THE SOUTHERN PART OF THE COUNTY FOR A 50 MILE RADIUS SERVING A LARGE AGRICULTURAL AREA WITH MANY MEDICALLY INDIGENT AND UNDOCUMENTED RESIDENTS.PROVIDES MANY SERVICES FOR THE COMMUNITY: ED, ICU, OR, OBSTETRICAL & DELIVERY, DIALYSIS, IMAGING, LAB, PHARMACY & PHYSICAL/REHAB. THE ONLY SNF TO DP/SNF IN THE AREA. PROVIDES TWO RURAL HEALTH CLINICS FOR THE PSA. MMH HAS AN OPEN MEDICAL STAFF. THE BOARD IS PRIMARILY COMPRISED ON COMMUNITY MEMBERS. MMH PROMOTES COMMUNITY HEALTH BY OFFERING MULTIPLE HEALTH FAIRS AND PROVIDES MEALS TO ELIGIBLE ADULTS THROUGH THE COUNTY SENIOR NUTRITION PROGRAM. PART III, LINE 4: METHODOLOGY USED: BASED ON INFLATED MEDICARE RATES APPLIED TO GROSS CHARGES.RATIONALE: THAT PORTION OF GROSS CHARGES THAT WOULD NORMALLY BE ADJUSTED FOR CONTRACTUAL ALLOWANCES IF THIS UNINSURED OR UNDER-INSURED GROUP COULD ACCESS CONTRACTUAL DISCOUNTS & THEN APPLYING A COST TO CHARGE RATIO TO ARRIVE AT THE HOSPITAL'S COST OF PROVIDING THAT CARE.NET PATIENT ACCOUNTS RECEIVABLE/BAD DEBTS EXPENSE FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: PATIENT ACCOUNTS RECEIVABLE CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES, AND PRIVATE PATIENTS. THE HOSPITAL'S PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCES FOR BOTH CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THESE ALLOWANCES. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE 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 (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PAYMENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL 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 THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS INCREASED FROM 27% OF GROSS PATIENT ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2012, TO 31% OF GROSS PATIENT ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2013. THE HOSPITAL HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2013 OR 2012. PART III, LINE 8: SHORTFALL EXPLANATION: UNFUNDED COSTS FOR DIRECT PATIENT CARE.COSTING METHODOLOGY: CALCULATED COST TO CHARGE RATIO APPLIED UNIFORMILY TO ALL PAYERS. PART III, LINE 9B: COLLECTION PRACTICES FOR QUALIFIED PATIENTS:IT IS THE POLICY OF GEORGE L. MEE MEMORIAL HOSPITAL TO PROVIDE EXCELLENT CUSTOMER SERVICE TO ALL PATIENTS, AND ASSIST ALL UNINSURED PATIENTS WITH OBTAINING COVERAGE FROM GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICARE, MEDI-CAL, AND CENTRAL COAST ALLIANCE FOR HEALTH, AND HEALTHY FAMILIES. IF SUCH COVERAGE IS NOT AVAILABLE TO THE PATIENT, THE HOSPITAL WILL PROVIDE APPROPRIATE HEALTHCARE TO THE PATIENT, AND THE HOSPITAL WILL PROVIDE FINANCIAL ASSISTANCE BASED ON THE CURRENT FEDERAL POVERTY LEVEL, AND PER THE HOSPITAL'S POLICY, IN ACCORDANCE WITH CALIFORNIA STATE LAW, EMTALA, AND MEDICARE REGULATIONS. FURTHER, SELF-PAY PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE BASED ON INCOME WILL BE PROVIDED WITH SEVERAL OPTIONS FOR PAYMENT OF THEIR BILLS. IT IS THE HOSPITAL'S POLICY TO:- ASSIST ALL UNINSURED PATIENT WITH OBTAINING COVERAGE FROM GOVERNMENT-SPONSORED PROGRAMS SUCH AS MEDICARE, MEDI-CAL, CENTRAL COAST ALLIANCE FOR HEALTH, AND HEALTHY FAMILIES.- PROVIDE ALL MEDICALLY NECESSARY HEALTH CARE SERVICES AT NO COST TO ELIGIBLE PATIENTS WHOSE FAMILY'S INCOME IS BELOW 100% OF THE CURRENT FEDERAL POVERTY LEVEL.- PROVIDE ALL MEDICALLY NECESSARY HEALTH CARE SERVICES AT A 50% DISCOUNT TO ELIGIBLE PATIENTS WHOSE FAMILY'S INCOME IS BETWEEN 101% AND 133% OF THE CURRENT FEDERAL POVERTY LEVEL. FOR THE SERVICES PROVIDED TO A PATIENT MEETING THESE CRITERIA, EXPECTED PAYMENT SHALL NOT EXCEED THE GREATER OF THE AMOUNT THAT WOULD BE EXPECTED FROM MEDICARE, MEDI-CAL, CENTRAL COAST ALLIANCE FOR HEALTH, OR HEALTHY FAMILIES FOR THE SAME SERVICES.- PROVIDE ALL MEDICALLY NECESSARY HEALTH CARE SERVICES AT A 35% DISCOUNT TO ELIGIBLE PATIENTS BETWEEN 133% AND 200% OF THE CURRENT FEDERAL POVERTY LEVEL. FOR THE SERVICES PROVIDED TO A PATIENT MEETING THESE CRITERIA, EXPECTED PAYMENT SHALL NOT EXCEED THE GREATER OF THE AMOUNT THAT WOULD BE EXPECTED FROM MEDICARE, MEDI-CAL, CENTRAL COAST ALLIANCE FOR HEALTH, OR HEALTHY FAMILIES FOR THE SAME SERVICES.- PROVIDE INTEREST-FREE PAYMENT PLANS FOR ELIGIBLE PATIENTS UNDER THIS POLICY.- FORGO REPORTS TO CREDIT BUREAUS, REFERRAL OF ACCOUNTS TO COLLECTION AGENCIES, LIENS AGAINST PROPERTY OR WAGE GARNISHMENTS FOR ELIGIBLE PATIENTS WHO ARE MEETING AN AGREED-UPON PAYMENT PLAN.- PROVIDE ADEQUATE NOTICE OF THIS POLICY IN ALL ADMITTING AND RECEPTION AREAS.- OFFER FREE FINANCIAL COUNSELING TO ALL UNINSURED PATIENTS FOR FINANCIAL MATTERS RELATED TO THEIR HOSPITAL BILLS.- FOR ALL UNINSURED PATIENTS ABOVE 100% OF THE CURRENT FEDERAL POVERTY LEVEL, SEVERAL PAYMENT OPTIONS WILL BE PRESENTED, AS FOLLOWS:A. PROMPT PAY DISCOUNT: OFFER A 25% DISCOUNT IF THE ACCOUNT IS PAID IN FULL AT TIME OF SERVICE.B. PAYMENT PLAN: OFFER A 15% DISCOUNT IF THE PATIENT SIGNS AN AGREEMENT REPRESENTING THAT HE/SHE WILL MEET A PAYMENT PLAN THAT WILL PAY THE BALANCE IN FULL WITHIN 6 MONTHS AT NO INTEREST.C. CCS EARLY-OUT: IF THE PATIENT REJECTS EACH OF THE ABOVE OPTIONS, THE ACCOUNT WILL BE SENT TO CCS FOR "EARLY-OUT" COLLECTIONS FOR 90 DAYS. THIS "EARLY-OUT" PROCESS DOES NOT INCLUDE REPORTS TO CREDIT BUREAUS. AT THE END OF THE 90 DAYS, THE ACCOUNT WILL BE RETURNED TO THE HOSPITAL TO BE REVIEWED FOR POTENTIAL BAD DEBT WRITE-OFF AND COLLECTIONS REPORTING. GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: DIRECT INTERVIEWS WITH CLERGY COUNCIL, CHAMBER OF COMMERCE, ROTARY CLUB, CITY COUNCIL AND COMMUNITY FOCUS GROUPS. GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: - INVASIVE CARDIOLOGY - REFERRED TO OTHER HOSPITALS- GASTROENTEROLOGY - WORKING ON IMPLEMENTATION OF GI SERVICES- MENTAL HEALTH - WORKING WITH COUNTY BEHAVIORAL HEALTH SERVICES- KIDNEY, LIVER & HEART TRANSPLANTS - REFERRED TO OTHER HOSPITALS- CANCER/ONCOLOGY - REFERRED TO OTHER HOSPITALS GEORGE L. MEE MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: MEANS USED TO DETERMINE THE AMOUNTS BILLED TO UNINSURED INDIVIDUALS FOR EMERGENCY CARE:FOR ALL UNINSURED PATIENTS ABOVE 100% OF THE CURRENT FEDERAL POVERTY LEVEL, SEVERAL PAYMENT OPTIONS WILL BE PRESENTED, AS FOLLOWS:A. PROMPT PAY DISCOUNT: OFFER A 25% DISCOUNT IF THE ACCOUNT IS PAID IN FULL AT TIME OF SERVICE.B. PAYMENT PLAN: OFFER A 15% DISCOUNT IF THE PATIENT SIGNS AN AGREEMENT REPRESENTING THAT HE/SHE WILL MEET A PAYMENT PLAN THAT WILL PAY THE BALANCE IN FULL WITHIN 6 MONTHS AT NO INTEREST.C. CCS EARLY-OUT: IF THE PATIENT REJECTS EACH OF THE ABOVE OPTIONS, THE ACCOUNT WILL BE SENT TO CCS FOR "EARLY-OUT" COLLECTIONS FOR 90 DAYS. THIS "EARLY-OUT" PROCESS DOES NOT INCLUDE REPORTS TO CREDIT BUREAUS. AT THE END OF THE 90 DAYS, THE ACCOUNT WILL BE RETURNED TO THE HOSPITAL TO BE REVIEWED FOR POTENTIAL BAD DEBT WRITE-OFF AND COLLECTIONS REPORTING. PART VI, LINE 2: NEEDS ASSESSMENT: THE ORGANIZATION ENGAGED CAROL DAVIS WITH STRATEGY CONNECTIONS TO CONDUCT A THOROUGH COMMUNITY NEEDS ASSESSMENT THAT HAS ALSO PROVIDED ANNUAL MARKET & BUSINESS PLAN UPDATES FOR OUR STRATEGIC PLANS.CAROL CONDUCTED IN-DEPTH INTERVIEWS WITH CARE PROVIDERS, COMMUNITY STAKEHOLDERS AND REVIEW/ANALYSIS OF MARKET DEMOGRAPHICS ALONG WITH HISTORIC SERVICES PROVIDED. MMH ALSO REVIEWS SERVICES PROVIDED BY OTHER FACILITIES OUTSIDE OF THE IMMEDIATE MARKET SERVICE AREA. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UPON PRESENTATION TO OUR ADMITTING PROCESS, ONCE THE PATIENT IDENTIFIES THEY ARE WITHOUT INSURANCE, WE INFORM/EDUCATE THEM ABOUT THEIR OPTIONS WITH GOVERNMENT PROGRAMS AND PROVIDE CONTACT INFORMATION TO ACCESS THOSE PROGRAMS. ADDITIONALLY, WE PROVIDE THE PATIENT WITH OUR POLICIES RELATED TO CHARITY AND A CHARITY APPLICATION SHOULD THEY WISH TO PURSUE THAT ASSISTANCE. WE ALSO MAKE THESE AVAILABLE TO THE GENERAL PUBLIC THROUGH OUR WEBSITE: HTTP://MEEMEMORIAL.COM/FOR-OUR-PATIENTS/PATIENT-RIGHTS PART VI, LINE 4: COMMUNITY INFORMATION: THE PRIMARY SERVICE AREA (PSA) IS SOUTHERN MONTEREY COUNTY AND THE SALINAS VALLEY COMPRISED OF THE FOLLOWING COMMUNITIES: KING CITY, GREENFIELD, SAN ARDO, LOCKWOOD, JOLON, SAN LUCAS & BRADLEY. THE SERVICE AREA IS SOUTH OF SALINAS, CA BY 45 MILES AND NORTH OF PASO ROBLES BY 45 MILES.THE POPULATION SIZE OF THE PSA IS ROUGHLY 40,000 WITH THE MEDIAN AGE OF 28.5 (32.5% OF 0-17 OF THE AGE GROUP, 41.6% FOR 18-44, 18.9% FOR 45-64 & 7.1% OF THE POPULATION OVER 65 YEARS OF AGE). MEDIAN HOUSEHOLD INCOME (2014) IS $51,773. RACIAL & ETHNIC DISTRIBUTION IS AS FOLLOWS: 81.2% HISPANIC OR LATINO, 14.9% WHITE & 3.9% FROM OTHER RACES. REPORTS FILED WITH STATES PART VI, LINE 7 CA LINE I COST-TO-CHARGE RATIO. 0 COUNTY OF MONTEREY 1000 SOUTH MAIN ST SUITE 301 SALINAS CA 93901 946000524 82672 CASH VALUE NUTRITIONAL PROGRAM FOR THE ELDERLY 1 1 X X X 0 0 0 0 0 0 0 0 0 SCHINDELHEIM MD ROY 210641 0 0 0 0 0 0 0 43494 0 254135 0 0 0 SMITH LEX 254978 0 40231 0 0 0 0 0 31494 0 326703 0 0 0 CHILDERS SUSAN 209174 0 21200 0 0 0 0 0 31494 0 261868 0 0 0 SALAMACHA RENA 129988 0 0 0 0 0 0 0 42997 0 172985 0 0 0 WONG KAREN 156540 0 0 0 0 0 0 0 14358 0 170898 0 0 0 SILVA NANCY 164198 0 0 0 0 0 0 0 0 0 164198 0 0 0 LAI JOY 146545 0 0 0 0 0 0 0 14358 0 160903 0 0 0 ROBEY LAURA 143082 0 0 0 0 0 0 0 31494 0 174576 0 0 0 FARRELL IAN 139656 0 0 0 0 0 0 0 14358 0 154014 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 INTERNAL STAFF GATHERS, REVIEWS & COMPILES INFORMATION PROVIDED TO THE TAX PREPARER. TAX PREPARER GUIDES AND ADVISES CLIENT ON ANY ISSUE IN QUESTION. TAX PREPARER COMPLETES THE TAX DOCUMENTS AND SUBMITS TO CLIENT FOR FINAL APPROVAL/SIGNATURE. THE BOARD & EXECUTIVE TEAM REVIEW WITH THE TAX PREPARER AT A REGULARLY SCHEDULED BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C MONTEREY COUNTY MEMORIAL HOSPITAL HAS A CORPORATE POLICY ON CONFLICT OF INTEREST. THIS POLICY APPLIES TO ALL INTERESTED PERSONS WHO ARE AS FOLLOWS: A. TRUSTEES B. MEMBER OF SENIOR MANAGEMENT THE BOARD OF TRUSTEES, THE CEO, AND CFO WILL CONTINUOUSLY MONITOR AND EVALUATE ANY AND ALL TRANSACTIONS OF INTERESTED PARTIES WITH THE HOSPITAL. IF THE CURRENT OR PAST TRANSACTION POSE A POTENTIAL RISK OF BEING A CONFLICT OF INTEREST TO THE HOSPITAL, THESE ITEM(S) WILL BE BROUGHT TO THE ATTENTION OF THE CEO, BOARD CHAIRMAN, AND OR FULL BOARD OF TRUSTEES. AFTER DISCLOSURE OF A POTENTIAL CONFLICT OF INTEREST TO THE BOARD, THE INTERESTED BOARD MEMBER WOULD LEAVE THE BOARD MEETING WHILE THE CONFLICT OF INTEREST IS DISCUSSED AND/OR VOTED ON. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. PROVIDED, HOWEVER, IF THE INTERESTED PERSON IS AN ADMINISTRATIVE STAFF EMPLOYEE AND THE CONTEMPLATED TRANSACTION IS AT THE ADMINISTRATIVE LEVEL, THE DECISION SHALL BE MADE BY THE HOSPITAL CEO. ANY BOARD MEMBER HAVING A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER MUST DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT. BOARD MEMBERS SHOULD ALWAYS ABSTAIN FROM VOTING ON ANY ISSUES OF A POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS ESTABLISHED THROUGH COMPARISON TO REGIONAL SALARY SURVEY INFORMATION AND PERFORMANCE USE EVALUATIONS. THE BOARD APPROVES ALL COMPENSATION AGREEMENTS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A ROY SCHINDELHEIM, MD, DEVOTES 2 HOUR PER WEEK FOR HIS SERVICES AS A VICE CHAIRMAN OF THE BOARD OF DIRECTORS. HE DOES NOT RECEIVE COMPENSATION OR BENEFITS AS A BOARD MEMBER. DR. SCHINDELHEIM PROVIDES SERVICES AS A PHYSICIAN TO THE HOSPITAL. HE DEVOTES 40 HOURS PER WEEK AND THE COMPENSATION AND BENEFITS ARE FOR HIS SERVICES AS A PHYSICIAN. CHRISTINA ZARO, MD, CHIEF OF STAFF, DEVOTES 2 HOUR PER WEEK FOR HER SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS. SHE DOES NOT RECEIVE COMPENSATION OR BENEFITS AS A BOARD MEMBER. DR. ZARO, PROVIDES SERVICES AS A PHYSICIAN TO THE HOSPITAL. SHE DEVOTES 20 HOURS PER WEEK AND THE COMPENSATION AND BENEFITS ARE FOR HER SERVICES AS A PHYSICIAN. OTHER FEES FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 11,289,439. MANAGEMENT AND GENERAL EXPENSES 2,684,136. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,973,575. AUDIT COMMITTEE AND OVERSIGHT FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES INCLUDES: PROFESSIONAL FEES - MEDICAL THERAPIST & OTHER : $6,910,829 PURCHASED SERVICES - MEDICAL : $ 278,079 PURCHASED SERVICES - MGMT SRVCS, COLLECTION & OTHER: $4,137,871 CONTRACT LABOR - MEDICAL THERAPIST & OTHER : $1,623,392 CONTRACT LABOR - REGISTRY NURSING PERSONNEL : $ 405,896 REPAIR & MAINTENANCE SERVICES : $ 617,508