2025-06-12T08:41:58-05:00 2024-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-07-01 941049467 ORCHARD HOSPITAL ORCH 5308469021 240 SPRUCE STREET GRIDLEY CA 95948 AMY MICHELI CEO 5308469021 2025-06-05 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-06-05 2023 2025-03-06 01:10:19Z AMY MICHELI 240 SPRUCE STREET GRIDLEY CA 95948 33716224 0 X WWW.ORCHARDHOSPITAL.COM X 1949 CA OUR MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. ACHIEVING THIS REQUIRES CLEAR PRIORITIES, SUPPORTIVE LEADERSHIP AND STAFF AND COMMUNITY COLLABORATION, WHICH WILL BE ENGRAINED IN OUR HERO VALUES. 7 7 309 8 0 0 460111 494477 30119719 33050968 147861 120547 282176 50232 31009867 33716224 0 0 0 0 17503307 17381744 0 0 22791 15078353 16782837 32581660 34164581 -1571793 -448357 16956952 19345636 8998689 11729454 7958263 7616182 X OUR MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. ACHIEVING THIS REQUIRES CLEAR PRIORITIES, SUPPORTIVE LEADERSHIP AND STAFF AND COMMUNITY COLLABORATION, WHICH WILL BE ENGRAINED IN OUR HERO VALUES OF:VALUES AT ORCHARD HOSPITAL, OUR GOVERNANCE AND DECISION MAKING WILL ALWAYS BE BASED UPON INTEGRITY, RESPECT, INNOVATIVE PROCESSES, ETHICAL FOUNDATIONS AND CONTINUAL SELF IMPROVEMENT.H - HONESTY AND INTEGRITY WE WILL MAKE DECISIONS WITH HONESTY AND INTEGRITY THAT WILL ENSURE ORCHARD HOSPITAL'S FUTURE. E - ENGAGED AND EMPOWERED STAFF WE WILL HIRE STAFF THAT ARE ENGAGED AND EMPOWERED TO MAKE A POSITIVE DIFFERENCE IN THE LIVES OF OUR PATIENTS AND EACH OTHER. R - RESPONSIVE WE WILL RESPOND TO THE NEEDS OF OUR COMMUNITY BY IMPLEMENTING PROGRAMS THAT ALIGN WITH OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA).O - OUTCOMES-DRIVEN WE WILL BE RECOGNIZED FOR HAVING EXCELLENT OUTCOMES FOR THE SERVICES WE PROVIDE AT ORCHARD HOSPITAL. 0 0 24128512 0 33057964 THE HOSPITAL IS AN ACUTE CARE FACILITY THAT OPERATES A 24-BED CRITICAL ACCESS HOSPITAL (CAH) WHICH PROVIDES HEALTHCARE SERVICES TO THE CITY OF GRIDLEY AND THE SURROUNDING COMMUNITY. THE HOSPITAL PROVIDED 6,099 DAYS OF INPATIENT SERVICES. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. DETAILS ON THE COSTS INCURRED AND BENEFIT PROVIDED IS FURTHER DESCRIBED IN SCHEDULE H ATTACHED. 24128512 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 72 0 309 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X AMY MICHELI 5308469021 240 SPRUCE STREET GRIDLEY CA 95948 CLARK S REDFIELD CHAIRPERSON 2.00 X X 0 0 0 DAGO CANDELARIO VICE CHAIR 2.00 X X 0 0 0 BENJAMIN TAYLOR BOARD CFO/TREASURER 2.00 X X 0 0 0 JATINDER KULLAR SECRETARY 2.00 X X 0 0 0 EDWIN A BECKER BOARD MEMBER 2.00 X 0 0 0 JOE CUNHA BOARD MEMBER 2.00 X 0 0 0 MAGGIE DAUGHERTY BOARD MEMBER 2.00 X 0 0 0 STEVEN STARK CEO (THRU AUG 2024) 18.00 22.00 X 581782 0 22837 AMY MICHELI CEO 40.00 1.00 X 0 0 0 EDUARDO GONZALEZ CFO 40.00 X 91730 0 485 VIKTOR LIMANSKIY MEDICAL PRACTITIONER 40.00 X 288581 0 2849 MARALEE BOWERS MEDICAL PRACTITIONER 40.00 X 190693 0 21960 DANA STROME PHYSICIANS ASSISTANT 40.00 X 190888 0 1859 NATALIE LADINE CMO (THRU JAN 2024) 40.00 X 165395 0 19292 ALISHA STOTTSBERRY EMERGENCY ROOM MANAGER 40.00 X 161558 0 15894 CHRIS ROBERTS FORMER CFO (THRU AUG 2023) 40.00 X 129844 0 10959 1800471 0 96135 40 1 1 0 REHABVISIONS 11623 ARBOR STREET OMAHA NE 68144 OUTSOURCED PT/OT/ST 537510 FOCUS MEDICAL IMAGING 215 EAST LAS TUNAS DR SAN GABRIEL CA 91776 OUTSOURCED IMAGING/INTERPRETATION 437900 CELLUCCI-CHWALIK CYNTHIA 1849 IRON POINT RD STE 160 FOLSOM CA 95630 PHYSICIAN 365850 ISHIMOTO MDGREG 791 CALIFORNIA ST GRIDLEY CA 95948 PHYSICIAN 321623 DONNER DAVID MD 3272 STRATHMORE DR VENTURA CA 93003 PHYSICIAN 284500 18 357216 133011 4250 494477 PATIENT SERVICE REVENUE 621400 27285493 27285493 340B/PHARMACY REVENUE 456110 5388317 5388317 377158 377158 33050968 120547 120547 6996 0 6996 6996 6996 DIETARY INCOME 900099 43236 43236 43236 33716224 33057964 0 163783 X 1119373 1119373 13198307 10056940 3118576 22791 290976 174355 116621 1712491 990510 721981 1060597 603002 457595 53358 53358 29656 29656 2294 2294 7541769 5698511 1843258 266 266 674451 262130 412321 687500 687500 666653 567356 99297 29047 12791 16256 37283 17030 20253 159341 37269 122072 544706 544706 299435 299435 BAD DEBT EXPENSE 3552008 3552008 MEDICAL SUPPLIES & DRUG 1643255 1643255 REPAIRS & MAINTENANCE 539509 428392 111117 LICENSES & FEES 92107 12146 79961 230199 72817 157382 34164581 24128512 10013278 22791 1025513 1548174 8509849 9649028 444006 513407 127158 170497 14649624 10890241 3247785 3759383 2470018 2530391 1132623 1174756 16956952 19345636 5119581 5168645 63011 0 1402732 1311970 2413365 5248839 8998689 11729454 X 7958263 7616182 7958263 7616182 16956952 19345636 -448357 106276 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2294 2294 0 PART II-B, LINE 1: THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. THE ASSOCIATIONS USED A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. 106951 106951 5273394 2987223 2286171 9269279 7903018 1366261 3759383 RIGHT-OF-USE-ASSET, OPERATING 557661 DUE FROM RELATED PARTIES 242915 DUE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 374180 1174756 DUE TO RELATED PARTIES 4140741 OPERATING LEASE OBLIGATIONS 563277 CAPITAL LEASE OBLIGATIONS 544821 5248839 1 1 X 1 X 350.000000000000 1 X 1 1 1 1 1 1 74466 74466 0.00240 11355163 8501014 2854149 0.09140 11429629 8501014 2928615 0.09380 5882 5882 0.00020 5882 5882 0.00020 11435511 8501014 2934497 0.09400 1 2923467 11486248 11515021 -28773 X 1 1 1 1 ORCHARD HOSPITAL 240 SPRUCE STREET GRIDLEY CA 95948 WWW.ORCHARDHOSPITAL.COM 230000007 X X X X ORCHARD HOSPITAL 1 0 0 1 X X X X X X X X X X 21 1 1 1 1 X HTTPS://ORCHARDHOSPITAL.COM/COMMUNITY-NEEDS-ASSESSMENT/ X X 1 21 1 HTTPS://ORCHARDHOSPITAL.COM/COMMUNITY-NEEDS-ASSESSMENT/ 0 1 X 350.000000000000 200.000000000000 X 1 1 X X X 1 X HTTPS://WWW.ORCHARDHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.ORCHARDHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.ORCHARDHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 ORCHARD HOSPITAL PART V, SECTION B, LINE 3J: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT ALSO DESCRIBES THE FOLLOWING ITEMS:-THE HOSPITAL'S IMPLEMENTATION PLAN, WHICH IDENTIFIES AND PRIORITIZES THE NEEDS OF THE COMMUNITY AND LAYS OUT A STRATEGY TO ADDRESS EACH COMMUNITY NEED-LIST OF PARTICIPATING ORGANIZATIONS FOR COMMUNITY INPUT-LIST OF QUESTIONS ASKED TO EACH COMMUNITY MEMBER ADDRESSING THE MOST IMPORTANT FACTORS FOR A HEALTHY COMMUNITY, THE GREATEST NEEDS AFFECTING CHILDREN'S HEALTH, AND THE MOST IMPORTANT HEALTH FACTORS AND RISKY BEHAVIORS FACING THE COMMUNITY. -COMMUNITY HEALTH SURVEY WHICH LISTS SPECIFIC QUESTIONS ABOUT THE HEALTH, FAMILY, AND LIFESTYLE OF THE INTERVIEWEE AS WELL AS THE INTERVIEWEE'S VIEW OF THE COMMUNITY'S HEALTH.-LIST OF HEALTH AGENCIES AND THEIR CONTACT INFORMATION REFERENCE CHART TO SUPPORT THE INFORMATION REPORTED ON SCHEDULE H. ORCHARD HOSPITAL PART V, SECTION B, LINE 5: THE LIST OF SIGNIFICANT HEALTH NEEDS INFORMED PRIMARY DATA COLLECTION. THE PRIMARY DATA COLLECTION PROCESS WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS TO ADDRESS NEEDS, AND DISCOVER GAPS IN RESOURCES. COMMUNITY FOCUS GROUPS AND STAKEHOLDER INTERVIEWS WERE USED TO GATHER INPUT AND PRIORITIZE THE SIGNIFICANT HEALTH NEEDS. ORCHARD HOSPITAL STAFF SPOKE WITH REPRESENTATIVES FROM PUBLIC HEALTH, LAW ENFORCEMENT AGENCIES, NEIGHBORING HOSPITALS, AND CLINIC SYSTEMS IN ORDER TO GATHER INSIGHT AND FEEDBACK FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. PARTICIPANTS WERE ASKED TO SHARE THEIR PROFESSIONAL AND PERSONAL THOUGHTS AND EXPERIENCES REGARDING ACCESS TO HEALTH CARE, OBSTACLES AND BARRIERS TO QUALITY HEALTH CARE AND ABILITY TO LIVE HEALTHY LIVES. ORCHARD HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL WORKED COLLABORATIVELY WITH THE FOLLOWING HOSPITALS AND PUBLIC HEALTH ENTITY TO COMPLETE THE DATA GATHERING PROCESS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT:-ENLOE MEDICAL CENTER-FEATHER RIVER HOSPITAL ADVENTIST HEALTH-OROVILLE HOSPITAL-BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH ORCHARD HOSPITAL PART V, SECTION B, LINE 6B: SEE SCHEDULE H, PART V, LINE 6A. ORCHARD HOSPITAL PART V, SECTION B, LINE 7D: NOTIFICATION TO THE PUBLIC THAT THE ORCHARD HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT WAS AVAILABLE FOR REVIEW ON THE ORCHARD HOSPITAL WEBSITE. NOTIFICATION TO ALL OF OUR EMPLOYEES WAS MADE THROUGH A FACILITY WIDE MASS EMAIL. EMAIL INCLUDED A LINK TO THE REPORT ON OUR WEBSITE AND AN ATTACHMENT (PDF) OF THE REPORT. ORCHARD HOSPITAL PART V, SECTION B, LINE 11: SIGNIFICANT NEEDS WERE IDENTIFIED THROUGH A REVIEW OF THE SECONDARY HEALTH DATA AND VALIDATION THROUGH COMMUNITY STAKEHOLDER SURVEYS. THE SIGNIFICANT NEEDS IDENTIFIED ARE AS FOLLOWS:- ACCESS TO CARE- MENTAL HEALTH ISSUES- SUBSTANCE USE DISORDERS- CHRONIC DISEASES (DIABETES, AGING PROBLEMS, HEART DISEASE, LUNG DISEASE, STROKE)- LOW CRIME/SAFE NEIGHBORHOODS- ADVERSE CHILDHOOD EXPERIENCES AND CHILDHOOD MALTREATMENT- OVERWEIGHT & OBESITY FROM 2023-2025, ORCHARD HOSPITAL WILL ADDRESS THE FOLLOWING HEALTH NEEDS THROUGH A COMMITMENT OF COMMUNITY PROGRAMS AND RESOURCES. ORCHARD HOSPITAL PART V, SECTION B, LINE 16J: THE HOSPITAL'S WEBSITE HIGHLIGHTS THE HOSPITAL'S COMMITMENT TO PROVIDING QUALITY CARE TO PATIENTS IN THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. VISITORS TO THE WEBSITE AND THE HOSPITAL ARE INFORMED OF THE AVAILABILITY OF THE SERVICES OF FINANCIAL COUNSELORS TO ASSIST THEM IN OBTAINING FINANCIAL ASSISTANCE. THE UNCOMPENSATED CARE (CHARITY CARE) POLICY IS COMMUNICATED TO HOSPITAL PATIENTS THROUGH POSTED SIGNS IN THE HOSPITAL BUSINESS OFFICE AND ADMITTING AREAS AND THROUGH MESSAGES ON BILLING STATEMENTS TO PATIENTS. IN FINANCIAL CLASSES ASSOCIATED WITH SELF-PAY ACCOUNTS OR ASSOCIATED WITH SPONSORED ACCOUNTS WITH DEDUCTIBLE OR CO-PAYMENT RESPONSIBILITIES, UNINSURED, AND/OR LOW-INCOME PATIENTS ARE REFERRED TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL MAKES PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY AND THE APPLICATION FORM AVAILABLE UPON REQUEST AND WITHOUT CHARGE. 2 1 - ORCHARD HOSP MEDICAL SPECIALTY CENTER 284 SPRUCE STREET GRIDLEY CA 95948 RURAL HEALTH CLINIC 2 - ORCHARD HOSP MED SPECIALTY CTR-OROVILLE 2990 ORO DAM BLVD STE A OROVILLE CA 95965 RURAL HEALTH CLINIC PART I, LINE 3C: HTTPS://WWW.ORCHARDHOSPITAL.COM/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE PART I, LINE 7: THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES DERIVED FROM WORKSHEET 2, FOR AMOUNTS REPORTED IN THE TABLE (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, MEDICAID PROVIDER TAXES, TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING EXPENSES). 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 $ 2,923,467. PART III, LINE 2: THE COSTING METHODOLOGY USED BY THE HOSPITAL INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE. PART III, LINE 3: THE HOSPITAL DID NOT TRACK THE AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING THE YEAR. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS AND UNINSURED PATIENT DISCOUNTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON HISTORICAL LOSS EXPERIENCE AND CONSIDERING RECEIVABLES FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE FOR. 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 AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES HISTORICAL LOSS EXPERIENCE ON REVENUE FROM ALL PAYORS AND CONSIDERS TRENDS IN THE AGING OF RECEIVABLES. BASED ON THESE FACTORS, THE ORGANIZATION ESTIMATES THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. 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 AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: NONE OF THE MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS IS TREATED AS CHARITY CARE OR A COMMUNITY BENEFIT. ONLY THOSE PATIENTS THAT MET THE FINANCIAL ASSISTANCE POLICY REQUIREMENTS ARE CONSIDERED CHARITY CARE PATIENTS. MEDICARE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR PURSUANT TO THE FACILITY'S DESIGNATION AS "CRITICAL ACCESS HOSPITAL." PART III, LINE 9B: ALL COLLECTION ACTIVITY CEASES WHEN A PATIENT IS DECLARED ELIGIBLE FOR UNCOMPENSATED CARE OR QUALIFIES FOR GOVERNMENT PROGRAMS. PART VI, LINE 2: SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED FROM SECONDARY DATA USING THE SIZE OF THE PROBLEM (RELATIVE PORTION OF POPULATION AFFLICTED BY THE PROBLEM) AND THE SERIOUSNESS OF THE PROBLEM (IMPACT AT INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS). TO DETERMINE SIZE OR SERIOUSNESS OF THE PROBLEM, THE HEALTH NEED INDICATORS THAT WERE IDENTIFIED IN THE SECONDARY DATA WERE MEASURED AGAINST BENCHMARK DATA; SPECIFICALLY, COUNTY RATES, STATE RATES AND/OR HEALTHY PEOPLE OBJECTIVES. INDICATORS RELATED TO THE HEALTH NEEDS THAT PERFORMED POORLY AGAINST ONE OR MORE OF THESE BENCHMARKS MET THIS CRITERION TO BE CONSIDERED A HEALTH NEED. THE LIST OF SIGNIFICANT HEALTH NEEDS INFORMED PRIMARY DATA COLLECTION. THE PRIMARY DATA COLLECTION PROCESS WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS TO ADDRESS NEEDS, AND DISCOVER GAPS IN RESOURCES. COMMUNITY FOCUS GROUPS AND STAKEHOLDER INTERVIEWS WERE USED TO GATHER INPUT AND PRIORITIZE THE SIGNIFICANT HEALTH NEEDS.THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY AND COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.ORCHARDHOSPITAL.COM/IMAGES/CHNA2022.PDF. ANY ADDITIONAL HEALTH CARE NEEDS OF THE COMMUNITY ARE EVALUATED AS THEY COME UP, BASED ON CHANGES IN THE COMMUNITY. PART VI, LINE 3: FINANCIAL ASSISTANCE CONTACT INFORMATION IS MADE AVAILABLE ON THE HOSPITAL WEBSITE, POSTED IN BUSINESS SERVICE AREA, IN ADMISSIONS, AND ON BILLING STATEMENTS. FINANCIAL COUNSELORS DISCUSS WITH PATIENTS THE AVAILABILITY OF CARE. A COUNTY ELIGIBILITY PERSON IS ON-SITE FOR THREE DAYS A WEEK TO HELP PATIENTS SIGN UP FOR MEDICAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY (FAP) IS MADE AVAILABLE TO ANY PATIENTS WHO REQUEST A COPY. AN APPLICATION FOR ELIGIBILITY DETERMINATION FOR UNCOMPENSATED CARE IS PROVIDED UPON DISCHARGE. IF INSURANCE IS INADEQUATE, THE FAP IS DISCUSSED WITH THOSE PATIENTS. PART VI, LINE 4: THE HOSPITAL PRIMARILY SERVICES THE TOWNS OF BIGGS, GRIDLEY AND RICHVALE WHICH ARE LOCATED IN BUTTE COUNTY, CA AND THE TOWN OF LIVE OAK WHICH IS LOCATED IN SUTTER COUNTY, CA. THE POPULATION OF GRIDLEY, BIGGS, AND RICHVALE AMOUNTS TO OVER 10,500. THE 2020 CENSUS DATA SHOWS THAT THE MEDIAN HOUSEHOLD INCOME FOR BUTTE COUNTY IS $52,537 WHICH IS LOWER THAN THE STATE AND NATION. APPROXIMATELY 17.3% OF BUTTE COUNTY RESIDENTS ARE AT OR BELOW POVERTY LEVEL. APPROXIMATELY 22% OF BUTTE COUNTY RESIDENTS ARE RECEIVING MEDICAID. APPROXIMATELY 86.06% OF PATIENTS SEEN AT THE HOSPITAL ARE MEDICARE OR MEDICAID INSURED. THE HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL IN GRIDLEY, AS WELL AS ALONG THE HIGHWAY 99 CORRIDOR BETWEEN SACRAMENTO AND RED BLUFF. PART VI, LINE 5: THE HOSPITAL IS DEDICATED TO UNDERSTANDING AND MEETING THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. AS A PART OF THIS COMMITMENT, MOST OF THE BOARD MEMBERS LIVE IN THE COMMUNITY AND ARE NOT EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE HOSPITAL. THE HOSPITAL IS ALSO DEDICATED TO PROVIDING THE FINEST HEALTHCARE TO THE COMMUNITY. THEREFORE, IF THERE ARE ANY SURPLUS FUNDS, THE HOSPITAL REINVESTS THOSE FUNDS INTO THE FACILITY OF EQUIPMENT. X X X 0 1 0 0 0 0 0 0 0 STEVEN STARK CEO (THRU AUG 2024) 581782 0 0 0 0 0 1315 0 21522 0 604619 0 0 0 VIKTOR LIMANSKIY MEDICAL PRACTITIONER 287581 0 1000 0 0 0 1199 0 1650 0 291430 0 0 0 MARALEE BOWERS MEDICAL PRACTITIONER 189693 0 1000 0 0 0 790 0 21170 0 212653 0 0 0 DANA STROME PHYSICIANS ASSISTANT 189888 0 1000 0 0 0 726 0 1133 0 192747 0 0 0 NATALIE LADINE CMO (THRU JAN 2024) 165395 0 0 0 0 0 670 0 18622 0 184687 0 0 0 ALISHA STOTTSBERRY EMERGENCY ROOM MANAGER 158558 0 3000 0 0 0 604 0 15290 0 177452 0 0 0 CHRIS ROBERTS FORMER CFO (THRU AUG 2023) 129844 0 0 0 0 0 723 0 10236 0 140803 0 0 0 PART I, LINE 4B STEVEN STARK, CEO, RECEIVED $165,058 IN NONQUALIFIED PLAN DISTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO THE CFO WHO REVIEWS THE FORM, SCHEDULES, AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS DISTRIBUTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE FORM 990. ONCE MANAGEMENT IS SATISFIED WITH THE FORM 990, THE CFO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST STATEMENT IS COMPLETED BY THE BOARD OF DIRECTORS ON A PERIODIC BASIS. ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE ARE CONSIDERED DURING THE DECISION-MAKING PROCESS FOR ALL TRANSACTIONS. ANY DIRECTOR INVOLVED IN A POTENTIAL CONFLICT OF INTEREST IS EXCLUDED FROM VOTING ON THAT DECISION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD USES COMPARABILITY DATA THAT INCLUDES THE CALIFORNIA HOSPITAL ASSOCIATION ANNUAL SURVEY TO DETERMINE THE COMPENSATION AMOUNT. IF ANY BOARD MEMBER HAS A CONFLICT OF INTEREST REGARDING COMPENSATION, THE BOARD MEMBER DOES NOT PARTICIPATE IN THE DECISION-MAKING PROCESS OR VOTE. THE DECISION IS DOCUMENTED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. REQUESTED INFORMATION IS PRINTED AND AVAILABLE TO THE INTERESTED PARTY AT THE OFFICE. FORM 990, PART IX, LINE 11G THERAPIST SERVICES: PROGRAM SERVICE EXPENSES 558,102. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 558,102. OTHER MEDICAL CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 785,126. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 785,126. OTHER SERVICES: PROGRAM SERVICE EXPENSES 792,810. MANAGEMENT AND GENERAL EXPENSES 1,843,258. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,636,068. PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 3,562,473. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,562,473. ORCHARD HOSPITAL FOUNDATION 240 SPRUCE STREET GRIDLEY CA 95948 680474996 SUPPORT CA 501(C)(3) LINE 12A, I ORCHARD HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 ORCHARD HOSPITAL FOUNDATION C 357216 CASH