4A (Expenses $ 254624913 including grants of $ 1332334) (Revenue $ 312454453)
PATIENT SERVICES TO INCLUDE 91,484 PATIENT DAYS, 158,495 OUTPATIENT VISITS, AND 214,401 VISITS TO THE CENTERS FOR FAMILY HEALTH (THE HEALTH CARE SYSTEM'S OUTPATIENT CARE CLINICS). SEE SCHEDULE O.

4B (Expenses $ 808305 including grants of $ 0) (Revenue $ 0)
COMMUNITY OUTREACH PROGRAMS TO INCLUDE: FREE BREAST CANCER SCREENING FOR WOMEN AGES 35 TO 50 MEETING LOW INCOME GUIDELINES; FREE CERVICAL CANCER SCREENING FOR WOMEN AGES 25 TO 60 MEETING LOW INCOME GUIDELINES; FREE BLOOD PRESSURE CHECKS; CANCER RESOURCE CENTER AND SUPPORT GROUPS; HEART-AWARE PROGRAM THAT PROVIDES FREE RISK EVALUATION, PREVENTATIVE INFORMATION AND RESOURCES; CARING NEWSLETTER, A SEMI-ANNUAL PUBLICATION ISSUED TO 70,000 LOCAL HOUSEHOLDS COVERING THE HEALTH SYSTEM'S SERVICES AND PROGRAMS.

PART V, SECTION B, LINE 3
CHNA COMMUNITY REPRESENTATIVES IN CONDUCTING ITS 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, THE SYSTEM OBTAINED DIRECT COMMUNITY INPUT THROUGH FOCUS GROUP MEETINGS AND LEADERSHIP COMMITTEES. FOCUS GROUP SESSIONS WERE ATTENDED BY COMMUNITY LEADERS AND WERE CONDUCTED IN OJAI ON OCTOBER 2, 2013 AND SAN BUENAVENTURA ON OCTOBER 9, 2013.

PART V, SECTION B, LINE 7
CHNA NEEDS IDENTIFIED BUT NOT ADDRESSED THE ORGANIZATION HAS NOT MET ALL OF THE NEEDS IDENTIFIED IN ITS COMMUNITY NEEDS ASSESSMENT. BEHAVIORAL HEALTH AND SUBSTANCE ABUSE ARE AREAS THAT ARE NOT SERVED BY THE ORGANIZATION. THESE AREAS ARE SUPPORTED BY COMMUNITY RESOURCES IN WEST VENTURA AND OJAI.

PART V, SECTION B, LINE 14G
COMMUNITY PUBLICITY MEASURES CMHS PUBLICIZES A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL IF INTERESTED. MOREOVER, CMHS HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THE SIGNAGE DISPLAYED.

PART I, LINE 7G
SUBSIDIZED HEALTH SERVICES NO AMOUNT ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES ARE ON PART I, LINE 7G. PART I, LINE 7 COSTING METHOD USED IS COST-TO-CHARGE USING WORKSHEET 2.

PART I, LINE 7B
"UNREIMBURSED MEDICAID THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE ON JANUARY 1, 2010. AMENDING LEGISLATION, TO CONFORM TO CHANGES REQUESTED BY THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) DURING THE APPROVAL PROCESS, WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA AND BECAME EFFECTIVE SEPTEMBER 8, 2010. THE PRIMARY LEGISLATION (AB 1383) AND AMENDING LEGISLATION (AB 1653) CONTAIN TWO COMPONENTS. THE QUALITY ASSURANCE FEE ACT GOVERNS THE ""HOSPITAL FEE"" OR ""QUALITY ASSURANCE FEE"" (QA FEE) PAID BY PARTICIPATING HOSPITALS. THE MEDI-CAL HOSPITAL PROVIDER STABILIZATION ACT GOVERNS SUPPLEMENTAL MEDI-CAL PAYMENTS (SUPPLEMENTAL PAYMENTS) MADE TO PROVIDERS FROM THE FUND. HOSPITAL PARTICIPATION IS MANDATORY WITH LIMITED EXCEPTIONS. THE CALIFORNIA HEALTH FOUNDATION AND TRUST ESTABLISHED A GRANT FUND TO SUPPORT CHARITABLE ACTIVITIES OF VARIOUS HOSPITAL AND HEALTH SYSTEMS IN CALIFORNIA, INCLUDING MEASURES TO ALLEVIATE LOSSES POTENTIALLY RESULTING FROM THE ADMINISTRATION OF THE PROGRAM. AB 1653, THE PROGRAM THAT COVERED THE PERIOD OF APRIL 1, 2009 THROUGH DECEMBER 31, 2010, WAS APPROVED BY CMS IN DECEMBER 2010. THE AMENDED LEGISLATION ALLOWED THE CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES (DHCS) TO BEGIN ASSESSING FEES AND MAKE SUPPLEMENTAL PAYMENTS TO HOSPITALS. IN APRIL 2011, SB 90 WAS SIGNED INTO LAW, WHICH CREATED THE PROVIDER FEE PROGRAM FOR THE PERIOD JANUARY 1, 2011 THROUGH JUNE 30, 2011. THE PROGRAM WAS APPROVED BY CMS IN DECEMBER 2011. THE SYSTEM MADE PAYMENTS TO THE DHCS FOR THE QA FEE IN THE AMOUNT OF $12,846,567 AND $11,609,495 IN 2013 AND 2012, RESPECTIVELY. THE SYSTEM MADE CALIFORNIA HEALTH FOUNDATION AND TRUST PLEDGE PAYMENTS IN THE AMOUNT OF $1,299,769 AND $1,123,678 IN 2013 AND 2012, RESPECTIVELY, AND THE PLEDGE PAYMENTS WERE RECORDED WITHIN QA FEE IN OPERATING EXPENSES WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE SYSTEM RECEIVED SUPPLEMENTAL PAYMENTS OF $20,869,783 AND $31,965,076 OVER THE COURSE OF THE PROGRAM IN 2013 AND 2012, RESPECTIVELY. THE SYSTEM RECORDED THE SUPPLEMENTAL PAYMENTS AS OPERATING REVENUE WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE NET QA FEE PAYMENTS RECEIVED OR ACCRUED DURING 2013 REPORTED ON LINE 7B IS $6,723,447, WHICH CONSISTS OF REVENUE OF $20,869,783 AND FEE EXPENSE OF 14,146,336. WHEN THE NET QA FEE PAYMENTS ARE EXCLUDED FROM THE CALCULATION, THE TOTAL FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT PERCENTAGE ON LINE 7K IS 6.92%."

PART II
COMMUNITY BUILDING ACTIVITIES PHYSICIAN RECRUITING

PART III, LINE 4
THE SYSTEM USED WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, TO DETERMINE THE COST OF ITS BAD DEBT EXPENSE. BAD DEBT FOOTNOTE FROM AUDITED FINANCIAL STATEMENTS: IN JULY 2011, THE FASB ISSUED ASU NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE PROVISIONS OF ASU 2011-07 REQUIRE CERTAIN HEALTH CARE ENTITIES TO PRESENT THE PROVISION FOR BAD DEBTS RELATED TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE STATEMENT OF OPERATIONS RATHER THAN AS AN OPERATING EXPENSE. THIS NEW GUIDANCE IS EFFECTIVE FOR FISCAL YEARS AND INTERIM PERIODS WITHIN THOSE FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2011, WITH EARLY ADOPTION PERMITTED. THE SYSTEM EARLY ADOPTED THE PROVISIONS OF ASU 2011-07 AS OF JANUARY 1, 2011, AND RETROSPECTIVELY APPLIED THE PRESENTATION REQUIREMENTS TO ALL PERIODS PRESENTED. THE CHANGE IN PRESENTATION AND ADDITIONAL DISCLOSURES, AS REQUIRED BY ASU 2011-07, ARE REFLECTED IN THE SYSTEM'S CONSOLIDATED STATEMENTS OF OPERATIONS AND NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM MANAGES PATIENT ACCOUNT RECEIVABLES BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR CONTRACTUAL DISCOUNTS AND UNCOLLECTIBLE AMOUNTS. THESE ALLOWANCES ARE BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS FOR EACH MAJOR PAYOR SOURCE, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD SERVICES ARE PROVIDED RELATED TO SELF-PAY PATIENTS, INCLUDING BOTH UNINSURED PATIENTS AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THEIR BALANCE. SIGNIFICANT CHANGES IN PAYER MIX, BUSINESS OFFICE OPERATIONS, GENERAL ECONOMIC CONDITIONS, AND HEALTH CARE COVERAGE PROVIDED BY FEDERAL OR STATE GOVERNMENTS OR PRIVATE INSURERS MAY HAVE A SIGNIFICANT IMPACT ON THE SYSTEM'S ESTIMATES AND SIGNIFICANTLY AFFECT THE SYSTEM'S LIQUIDITY, RESULTS OF OPERATIONS, AND CASH FLOWS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. THE SYSTEM DISCOUNTS UNINSURED SELF-PAY PATIENT CHARGES BY 40% AND CLASSIFIES ACCOUNTS PENDING MEDI-CAL APPROVAL AS SELF-PAY ACCOUNTS IN ITS ACCOUNTS RECEIVABLE AGING REPORT AND APPLIES THE STANDARD UNINSURED DISCOUNT. THE NET ACCOUNT BALANCE IS FURTHER SUBJECT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RESERVE POLICY. SHOULD THE ACCOUNT QUALIFY FOR MEDI-CAL COVERAGE, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND RECLASSIFIED TO MEDI-CAL ACCOUNTS RECEIVABLE WITH THE APPROPRIATE CONTRACTUAL DISCOUNT RATE APPLIED. SHOULD THE ACCOUNT NOT QUALIFY FOR MEDI-CAL COVERAGE BUT QUALIFIES AS CHARITY CARE UNDER THE SYSTEM'S CHARITY CARE POLICY, THE PREVIOUSLY RECORDED UNINSURED DISCOUNT IS REVERSED AND THE ENTIRE ACCOUNT BALANCE IS RECORDED AS A CHARITY CARE DEDUCTION. THE SYSTEM'S COMBINED ALLOWANCE FOR DOUBTFUL ACCOUNTS, UNINSURED DISCOUNTS, AND CHARITY CARE COVERED APPROXIMATELY 96% AND 95% OF THE SYSTEM'S COMBINED UNINSURED AND SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2013 AND DECEMBER 31, 2012, RESPECTIVELY. THE SYSTEM'S ALLOWANCE FOR BAD DEBT WAS $28,817,866 AND $29,417,343 AT DECEMBER 31, 2013 AND 2012, RESPECTIVELY. THE SYSTEM'S PROVISION FOR PATIENT BAD DEBTS INCREASED TO $13,692,937 FROM $12,077,613 FOR THE YEARS ENDED DECEMBER 31, 2013 AND DECEMBER 31, 2012, RESPECTIVELY.

PART III, LINE 8
SHORTFALL TREATMENT AS COMMUNITY BENEFIT THE ENTIRE SHORTFALL OF MEDICARE EXPENSES OVER MEDICARE REIMBURSEMENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE COSTS ATTRIBUTABLE TO SERVICE MEDICARE PATIENTS. THE SYSTEM IS REIMBURSED FOR SERVICES PROVIDED TO PATIENTS UNDER CERTAIN PROGRAMS ADMINISTERED BY GOVERNMENTAL AGENCIES, WHICH INCLUDES THE MEDICARE PROGRAM. THE MEDICARE PROGRAM CONSISTS OF 28.9% OF THE SYSTEMS NET REVENUE FOR 2013. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FROM THE MEDICARE PROGRAM, AND THE MEDICARE PROGRAM DOES NOT COVER THE COSTS OF TREATING THE SYSTEM'S MEDICARE PATIENTS, ALTHOUGH THE QUALITY OF CARE AND ACCESS TO CARE IS THE SAME FOR ALL PATIENTS, REGARDLESS OF PAYER SOURCE. UNREIMBURSED COST UNDER THE MEDICARE PROGRAM IS A TRUE LOSS TO THE SYSTEM AND THE LOSS IS REFLECTED IN THE SYSTEMS FINANCIAL STATEMENTS. AS SUCH, MEDICARE LOSSES SHOULD BE CONSIDERED A COMMUNITY BENEFIT PROVIDED BY THE SYSTEM. THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED IN SCHEDULE H WAS USED.

PART III, LINE 9B
COLLECTION PRACTICES THE PATIENT'S ABILITY TO PAY IS EVALUATED UPON ADMISSION. A PATIENT FINANCIAL SERVICES STAFF ASSISTS PATIENTS WITH APPLYING FOR LOCAL, STATE AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT. IN THE EVENT THAT NO THIRD PARTY PAYMENT SOURCE IS AVAILABLE, PATIENTS ARE PROVIDED WITH INFORMATION ON THE SYSTEM'S FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE AND CHARITY CARE IS BASED ON A SLIDING SCALE FEE SCHEDULE UTILIZING THE CURRENT UNITED STATES FEDERAL POVERTY GUIDELINES. INFORMATION FROM THE APPLICANT'S FINANCIAL APPLICATION AND SUPPORTING DOCUMENTATION IS USED TO DETERMINE THE AMOUNT OF THE QUALIFIED FINANCIAL ASSISTANCE TO BE GRANTED. THE SYSTEM HAS A WRITTEN COLLECTION POLICY TO PROVIDE FOR AN EQUITABLE PROCESS BY WHICH A PATIENT AND/OR RESPONSIBLE PARTY CAN MAKE A PAYMENT OR PAYMENT ARRANGEMENT PRIOR TO OR AT THE TIME OF SERVICE. THE SYSTEM WILL PROACTIVELY DETERMINE THE PATIENT'S ABILITY TO PAY. A DEPOSIT, BASED UPON SELF-PAY LIABILITY IS COLLECTED PRIOR TO ADMISSION OR AT THE TIME OF SERVICE. FOR PATIENTS WHO ARE UNABLE TO PAY THEIR ESTIMATED LIABILITY AT THE TIME OF SERVICE, THE SYSTEM WILL OFFER A FINANCING OPTION. PATIENTS WHO MEET CHARITY OR INDIGENT GUIDELINES WILL BE REFERRED TO A FINANCIAL ADVOCATE FOR FINANCIAL AID.

PART IV, LINE 1
MANAGEMENT COMPANIES AND JOINT VENTURES GROSSMAN IMAGING CENTER OF CMF, LLC BUENAVISTA MEDICAL PROPERTIES, LTD VENTURA CARDIOVASCULAR CO-MANAGEMENT COMPANY, LLC

PART VI, LINE 2
NEEDS ASSESSMENT THE SYSTEM UPDATED ITS COMMUNITY NEEDS ASSESSMENT IN 2013. THE SYSTEM UTILIZED THE SERVICES OF A NATIONAL PUBLIC OPINION RESEARCH AND STRATEGY FIRM TO CONDUCT THE SURVEY. THE AREA-WIDE STUDY AND HEALTHCARE SURVEY CONSISTED OF AN ANALYSIS OF THE SOCIO-ECONOMIC PROFILE OF VENTURA COUNTY, THE HEALTH CARE STATUS AND NEEDS OF VENTURA COUNTY, THE STATUS OF HEALTHCARE DELIVERY AND SERVICES, COMMUNITY REPORTED HEALTH NEEDS AND COMMUNITY PRIORITIZATION AND IMPLEMENTATION STRATEGIES.

PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE PROGRAM BROCHURES EXPLAINING THE SYSTEM'S POLICY IS POSTED AND MADE AVAILABLE TO PATIENTS AT THE TIME OF ADMITTANCE. SIGNS ALERTING PATIENTS TO THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE PROMINENTLY DISPLAYED. AN INSERT REGARDING FINANCIAL ASSISTANCE ACCOMPANIES EACH INVOICE OF HOSPITAL SERVICES SENT TO EACH PATIENT.

PART VI, LINE 4
COMMUNITY INFORMATION THE HEALTH SYSTEM'S TWO HOSPITALS ARE LOCATED IN THE CITY OF VENTURA AND THE CITY OF OJAI. THE HEALTH SYSTEM PROVIDES SERVICES THROUGH ITS HOSPITALS AND CENTERS FOR FAMILY HEALTH TO ALL OF WESTERN VENTURA COUNTY WHICH INCLUDES THE CITIES AND UNINCORPORATED AREAS SURROUNDING VENTURA, OJAI, SANTA PAULA, FILLMORE, OXNARD, PORT HUENEME AND CAMARILLO. THE POPULATION OF VENTURA COUNTY IS APPROXIMATELY 38.0% HISPANIC, 54.2% WHITE AND 7.8% OTHER. THE MEDIAN HOUSEHOLD INCOME FOR VENTURA COUNTY IS $80,618 AND THE MEDIAN HOUSEHOLD INCOME FOR OJAI/OAKVIEW IS $92,382 AND OXNARD IS $52,263. DEMOGRAPHIC VARIABLES SUCH AS AGE, RACE AND ETHNICITY ARE MEANINGFUL WHEN PLANNING FOR BOTH INPATIENT AND OUTPATIENT CARE IN ORDER TO ENSURE THAT PATIENT CARE SERVICES ARE SENSITIVE TO THE PROGRAM PLANNING NEEDS OF THE SERVICE AREA POPULATION. IT HAS LONG BEEN ESTABLISHED THAT THERE ARE SIGNIFICANT VARIANCES IN PHYSICAL AND BEHAVIORAL HEALTH PROBLEMS BETWEEN GROUPS BASED ON ETHNICITY, INCOME AND RESIDENCE. THERE ARE 4 HOSPITALS IN CMHS PRIMARY SERVICE AREA.

PART VI, LINE 5
"PROMOTION OF COMMUNITY HEALTH CMHS IS GOVERNED BY A BOARD OF DIRECTORS WHOSE MEMBERS ARE REPRESENTATIVE OF THE COMMUNITY, HOSPITAL AND MEDICAL STAFF LEADERSHIP. CONSISTENT WITH THE IRS ""COMMUNITY BENEFIT STANDARD"" A MAJORITY OF THE BOARD OF DIRECTORS ARE NEITHER EMPLOYEES, CONTRACTORS NOR FAMILY MEMBERS OF THE ORGANIZATION. CMHS HAS AN OPEN MEDICAL STAFF, EXTENDING STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL AREAS AND DEPARTMENTS OF ITS FACILITY. THE EMERGENCY DEPARTMENT AT BOTH COMMUNITY MEMORIAL HOSPITAL AND THE OJAI COMMUNITY HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HEALTH SYSTEM PROVIDES EMERGENCY SERVICES TO ALL PATIENTS, WITH OR WITHOUT INSURANCE, AND CONTRACTS WITH PHYSICIANS TO PROVIDE SPECIALTY EMERGENCY COVERAGE. THIS TEAM INCLUDES BOARD-CERTIFIED EMERGENCY PHYSICIANS, PHYSICIAN ASSISTANTS; BOARD CERTIFIED NURSES, EMERGENCY MEDICAL TECHNICIANS, RESPIRATORY THERAPISTS AND OTHER HIGHLY TRAINED EMERGENCY CARE PROFESSIONALS. ALL ARE DEDICATED TO PROVIDING TECHNOLOGICALLY ADVANCED AND LIFESAVING MEDICAL SERVICES. THROUGH ITS HEALTHY WOMEN'S PROGRAM, CMHS PROVIDES FOR FREE BREAST AND CERVICAL CANCER SCREENING FOR UNINSURED AND UNDER-INSURED PATIENTS WHO LACK THE RESOURCES TO PAY FOR THESE SERVICES. THROUGH THIS PROGRAM, CMHS IS ABLE TO OFFER BREAST CANCER SCREENING AND TREATMENT, AND CERVICAL CANCER SCREENING AND VACCINATIONS TO WOMEN IN THE COMMUNITY WHO LACK ACCESS TO THESE EARLY DETECTION AND LIFE SAVING EXAMS. THE SYSTEM OFFERS FREE EDUCATIONAL SEMINARS TO THE PUBLIC COVERING A WIDE VARIETY OF HEALTH RELATED TOPICS SUCH AS DIABETES, CANCER, AND VASCULAR HEALTH. THE SYSTEM ALSO OFFERS A LARGE VARIETY OF CLASSES AND SUPPORT GROUPS THROUGH ITS CANCER RESOURCE CENTER, MATERNAL CHILD HEALTH, AND HEART AND VASCULAR HEALTH DEPARTMENTS."

PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA.