4A (Expenses $ 421025282 including grants of $ 272225) (Revenue $ 477295346)
SEE SCHEDULE O

VALLEY PRESBYTERIAN HOSPITAL
"PART V, SECTION B, LINE 5: VPH CONDUCTED INTERVIEWS AND SURVEYS WITH COMMUNITY STAKEHOLDERS TO OBTAIN INPUT ON HEALTH NEEDS, BARRIERS TO CARE AND RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED HEALTH NEEDS.INTERVIEWS:SIXTEEN (16) INTERVIEWS WERE COMPLETED IN JUNE AND JULY 2021. COMMUNITY STAKEHOLDERS IDENTIFIED BY THE HOSPITAL WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT INTERVIEWS. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE ""CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY"". THE IDENTIFIED STAKEHOLDERS WERE INVITED BY EMAIL TO PARTICIPATE IN THE PHONE INTERVIEW. APPOINTMENTS FOR THE INTERVIEWS WERE MADE ON DATES AND TIMES CONVENIENT TO THE STAKEHOLDERS. AT THE BEGINNING OF EACH INTERVIEW, THE PURPOSE OF THE INTERVIEW IN THE CONTEXT OF THE ASSESSMENT WAS EXPLAINED, THE STAKEHOLDERS WERE ASSURED THEIR RESPONSES WOULD REMAIN CONFIDENTIAL, AND CONSENT TO PROCEED WAS GIVEN. PLEASE REFERENCE ATTACHMENT 2 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT POSTED ON THE ORGANIZATION'S WEBSITE FOR A LIST OF INDIVIDUALS INTERVIEWED.SURVEY: VALLEY PRESBYTERIAN HOSPITAL CONDUCTED A COMMUNITY SURVEY. THE SURVEY WAS AVAILABLE IN AN ELECTRONIC FORMAT THROUGH A SURVEY MONKEY LINK, AND IN A PAPER COPY FORMAT. THE SURVEYS WERE AVAILABLE IN ENGLISH AND SPANISH. THE SURVEYS WERE AVAILABLE FROM JUNE 14 THROUGH AUGUST 30, 2021 AND DURING THIS TIME, 73 SURVEYS WERE COLLECTED (19 IN SPANISH AND 54 IN ENGLISH). VALLEY PRESBYTERIAN HOSPITAL DISTRIBUTED THE SURVEYS AT COMMUNITY MEETINGS AND THROUGH SOCIAL MEDIA. A WRITTEN INTRODUCTION EXPLAINED THE PURPOSE OF THE SURVEY AND ASSURED PARTICIPANTS THE SURVEY WAS VOLUNTARY, AND THEIR RESPONSES WOULD REMAIN ANONYMOUS. THE SURVEY ASKED FOR DEMOGRAPHIC INFORMATION ON THE SURVEY RESPONDENTS. THE SURVEY ASKED ABOUT COMMUNITY NEEDS AND BARRIERS, VULNERABLE POPULATIONS WHO ARE MOST IMPACTED BY THE COMMUNITY NEEDS AND ACCESSING HEALTH CARE SERVICES. FINALLY, THE SURVEY RESPONDENTS WERE ASKED TO PRIORITIZE THE MOST IMPORTANT COMMUNITY NEEDS."

VALLEY PRESBYTERIAN HOSPITAL
"PART V, SECTION B, LINE 11: IN 2021, VALLEY PRESBYTERIAN HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO COMPLY WITH FEDERAL AND STATE REGULATIONS GUIDING TAX-EXEMPT HOSPITALS. THE CHNA INCORPORATED DEMOGRAPHIC AND HEALTH DATA FOR THE COMMUNITIES SERVED BY THE HOSPITAL. SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED FROM SECONDARY DATA SOURCES AND KEY INFORMANT INTERVIEWS. HEALTH INDICATORS WERE CONSIDERED HIGH-RISK HEALTH NEEDS WHEN THEY EXCEEDED BENCHMARK DATA, SPECIFICALLY COUNTY OR STATE RATES OR HEALTHY PEOPLE 2030 OBJECTIVES. THE FOLLOWING SIGNIFICANT NEEDS WERE IDENTIFIED: ACCESS TO HEALTH CARE; ALZHEIMER'S DISEASE; BIRTH INDICATORS; CHRONIC DISEASES; COVID-19; DENTAL CARE; ECONOMIC INSECURITY; HOUSING AND HOMELESSNESS; MENTAL HEALTH; OVERWEIGHT AND OBESITY; PREVENTIVE PRACTICES; AND SUBSTANCE USE. OF THOSE SIGNIFICANT HEALTH NEEDS, VPH WILL ADDRESS THE FOLLOWING NEEDS THROUGH A COMMITMENT OF COMMUNITY BENEFIT PROGRAMS AND CHARITABLE RESOURCES: ACCESS TO CARE (INCLUDING PREVENTIVE PRACTICES AND TRANSPORTATION); HOUSING AND HOMELESSNESS; CHRONIC DISEASE (WITH AN EMPHASIS ON DIABETES); OVERWEIGHT AND OBESITY; AND MENTAL HEALTH.TO ADDRESS THE HEALTH NEED OF ""ACCESS TO CARE (INCLUDING PREVENTIVE PRACTICES AND TRANSPORTATION)"", VPH INTENDS TO ADDRESS THIS BY:1. PROVIDE FINANCIAL ASSISTANCE FOR HEALTH CARE SERVICES CONSISTENT WITH VPH'S FINANCIAL ASSISTANCE POLICY. IN ADDITION TO OFFERING FINANCIAL ASSISTANCE, THE HOSPITAL WILL HOST ENROLLMENT CAMPAIGNS AND ASSIST PATIENTS IN DETERMINING ELIGIBILITY AND ENROLLING IN LOW OR NO COST INSURANCE PROGRAMS, INCLUDING COVERED CA, THE STATE INSURANCE MARKETPLACE. 2. PROVIDE TRANSPORTATION TO HEALTH CARE SERVICES AT THE HOSPITAL AND LOCAL COMMUNITY HEALTH CENTERS TO SUPPORT AREA RESIDENTS WHO EXPERIENCE LACK OF TRANSPORTATION AS A BARRIER TO ACCESS HEALTH CARE SERVICES. 3. ADMINISTER THE VPH COMMUNITY GRANTS PROGRAM IN PARTNERSHIP WITH ESTABLISHED COMMUNITY ORGANIZATIONS TO IMPLEMENT PROGRAMS THAT INCREASE ACCESS TO CARE FOR UNDERSERVED POPULATIONS. 4. FACILITATE ACCESS TO FREE HEALTH SCREENINGS AND ASSIST WITH COMMUNITY RESOURCES. 5. PROVIDE OR FACILITATE ACCESS TO COVID-19 TESTING AND VACCINES, PNEUMONIA VACCINES AND FLU VACCINES TO THE MEDICALLY UNDERSERVED. 6. OFFER CULTURALLY COMPETENT PRENATAL CARE, FREE OF CHARGE TO COMMUNITY RESIDENTS. 7. HOST SEVERAL COMMUNITY HEALTH SYMPOSIUMS.THE ANTICIPATED IMPACT OF THESE ACTIONS WILL BE TO: INCREASE AVAILABILITY AND ACCESS TO HEALTH CARE AND PREVENTIVE CARE SERVICES; PROVIDE FINANCIAL ASSISTANCE TO QUALIFIED PATIENTS; REDUCE THE PERCENTAGE OF RESIDENTS WHO DELAY OBTAINING NEEDED PREVENTIVE SCREENINGS AND VACCINES; AID ACCESS TO HEALTH CARE SERVICES BY PROVIDING TRANSPORTATION ASSISTANCE; AND INCREASE KNOWLEDGE OF CHILDBIRTH AND PARENTING. VPH PLANS TO COLLABORATE WITH SEVERAL COMMUNITY HEALTH CLINICS AND NONPROFIT ORGANIZATIONS THAT SERVE RESIDENTS WITHIN VPH'S SERVICE AREA.TO ADDRESS THE HEALTH NEED OF ""CHRONIC DISEASE (WITH AN EMPHASIS ON DIABETES), VPH INTENDS TO TAKE THE FOLLOWING ACTIONS:1. PROVIDE SCREENINGS FOR CHRONIC DISEASES2. PROVIDE EDUCATION ON DIABETES PREVENTION AND TREATMENT, INCLUDING A FOCUS ON HEALTH EATING AND PHYSICAL ACTIVITY.3. ESTABLISH PARTNERSHIPS AND PROGRAMS WITH LOCAL SCHOOLS AND COMMUNITY CLINICS TO FOCUS ON DIABETES PREVENTION.4. CONTINUE THE VPH COMMUNITY GRANTS PROGRAM IN PARTNERSHIP WITH ESTABLISHED COMMUNITY ORGANIZATIONS TO IMPLEMENT PROGRAMS THAT FOCUS ON CHRONIC DISEASE INTERVENTIONS.THE ANTICIPATED IMPACT OF THESE ACTIONS WILL BE TO: INCREASE THE EARLY DIAGNOSIS OF PRE-DIABETES AND DIABETES; IMPROVE LINKAGES WITH SERVICES FOR TREATMENT OF CHRONIC DISEASES; AND INCREASE PUBLIC AWARENESS OF DIABETES PREVENTION. TO ADDRESS CHRONIC DIABETES, VPH WILL COLLABORATE WITH: THE AMERICAN DIABETES ASSOCIATION, FEDERALLY QUALIFIED HEALTH CENTERS, LOCAL SCHOOLS, AND COMMUNITY-BASED ORGANIZATIONS.TO ADDRESS ""HOUSING AND HOMELESSNESS"", VPH INTENDS TO TAKE THE FOLLOWING ACTIONS:1. COLLABORATIVELY ADDRESS HOUSING AND HOMELESSNESS ISSUES THROUGH SHARED RESOURCES. 2. CONTINUE THE VPH COMMUNITY GRANTS PROGRAM IN PARTNERSHIP WITH ESTABLISHED COMMUNITY ORGANIZATIONS TO IMPLEMENT PROGRAMS THAT FOCUS ON HOUSING AND HOMELESSNESS INTERVENTIONS. 3. ASSIST WITH LINKING HOMELESS PATIENTS TO EXTERNAL COMMUNITY RESOURCESTHE ANTICIPATED IMPACT OF THESE ACTIONS WILL BE TO: INCREASE PARTNERSHIPS TO ADDRESS HOUSING AND HOMELESSNESS ISSUES; FACILITATE TRANSPORTATION TO LOCAL COMMUNITY HOMELESS SERVICE CENTERS; AND IMPROVE LINKAGES WITH SERVICES FOR HOUSING AND HOMELESSNESS. TO ADDRESS THIS HEALTH NEED, VPH WILL COLLABORATE WITH COMMUNITY-BASED ORGANIZATIONS, THE SAN FERNANDO VALLEY/SANTA CLARITA COALITION, TRANSITIONAL HOUSING ORGANIZATIONS, RECUPERATIVE CARE ORGANIZATIONS, AND LOCAL SHELTERS.TO ADDRESS THE HEALTH NEED OF ""MENTAL HEALTH"", VPH INTENDS TO TAKE THE FOLLOWING ACTIONS:1. PROVIDE COMMUNITY HEALTH EDUCATION ON MENTAL HEALTH TOPICS, INCLUDING MEDITATION AND WELLNESS. 2. CONTINUE THE VPH COMMUNITY GRANTS PROGRAM IN PARTNERSHIP WITH ESTABLISHED COMMUNITY ORGANIZATIONS TO IMPLEMENT PROGRAMS THAT INCREASE ACCESS TO MENTAL HEALTH CARE SERVICES FOR UNDERSERVED POPULATIONS. 3. PROVIDE ACCESS TO MENTAL HEALTH CARE SERVICES THROUGH TELEMEDICINE SERVICES THAT REDUCE GEOGRAPHIC BARRIERS TO CARE.THE ANTICIPATED IMPACT OF THESE ACTIONS WILL BE TO: INCREASE ACCESS TO MENTAL HEALTH RESOURCES; INCREASE PUBLIC AWARENESS OF MENTAL HEALTH RESOURCES; AND BUILD COMMUNITY CAPACITY TO ADDRESS MENTAL HEALTH ISSUES. TO ADDRESS THIS HEALTH NEED, VPH WILL COLLABORATE WITH COMMUNITY-BASED ORGANIZATIONS AND FEDERALLY QUALIFIED HEALTH CENTERS.TO ADDRESS THE NEED OF ""OVERWEIGHT AND OBESITY"", VPH INTENDS TO TAKE THE FOLLOWING ACTIONS:1. PROVIDE COMMUNITY EXERCISE PROGRAMS. 2. CONTINUE THE VPH COMMUNITY GRANTS PROGRAM IN PARTNERSHIP WITH ESTABLISHED COMMUNITY ORGANIZATIONS TO IMPLEMENT PROGRAMS THAT ADDRESS OVERWEIGHT AND OBESITY IN THE COMMUNITY.THE ANTICIPATED IMPACT OF THESE ACTIONS WILL BE TO: INCREASE ACCESS TO HEALTH EATING AND PHYSICAL ACTIVITY OPPORTUNITIES; AND INCREASE PUBLIC AWARENESS OF THE BENEFIT OF HEALTHY WEIGHT AND PHYSICAL ACTIVITY. TO ADDRESS THIS HEALTH NEED, VPH WILL COLLABORATE WITH YOUTH PROGRAMS, COMMUNITY-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, AND SENIOR CENTERS.VPH WILL MONITOR AND EVALUATE THE PROGRAMS AND ACTIVITIES OUTLINED ABOVE. THE HOSPITAL HAS IMPLEMENTED A SYSTEM THAT TRACKS THE IMPLEMENTATION OF THE STRATEGIES AND DOCUMENTS THE ANTICIPATED IMPACT. THE VPH REPORTING PROCESS INCLUDES THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES, SUCH AS THE NUMBER OF PEOPLE REACHED/SERVED, INCREASES IN KNOWLEDGE OR CHANGES IN BEHAVIOR AS A RESULT OF COMMUNITY PROGRAMS, AND COLLABORATIVE EFFORTS TO ADDRESS HEALTH NEEDS. AN EVALUATION OF THE IMPACT OF THE HOSPITAL'S ACTIONS TO ADDRESS THESE SIGNIFICANT HEALTH NEEDS WILL BE REPORTED IN THE NEXT SCHEDULED COMMUNITY HEALTH NEEDS ASSESSMENT.TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, VPH WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA INCLUDING: ALZHEIMER'S DISEASE; BIRTH INDICATORS; DENTAL CARE; ECONOMIC INSECURITY; AND SUBSTANCE USE. SINCE VPH CANNOT ADDRESS ALL THE HEALTH NEEDS PRESENT IN THE COMMUNITY, IT WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT IT CAN MOST EFFECTIVELY ADDRESS GIVEN AREAS OF FOCUS AND EXPERTISE. THESE OTHER HEALTH NEEDS WILL BE ADDRESSED THROUGH REFERRALS TO COMMUNITY-BASED ORGANIZATIONS."

VALLEY PRESBYTERIAN HOSPITAL
PART V, SECTION B, LINE 16J: OTHER MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY WITHIN THE COMMUNITY SERVED IS THROUGH FINANCIAL COUNSELING IF IDENTIFIED AS UNDERINSURED.

PART V, LINE 16A, FAP WEBSITE:
HTTPS://WWW.VALLEYPRES.ORG/PATIENTS-VISITORS/FOR-PATIENTS/BILLING-INSURANCE-PAYMENTS-COST-OF-CARE/BILLING-PAYMENTS-COST-OF-CARE/CHARITY-CARE-FINANCIAL-ASSISTANCE/

PART V, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://WWW.VALLEYPRES.ORG/PATIENTS-VISITORS/FOR-PATIENTS/BILLING-INSURANCE-PAYMENTS-COST-OF-CARE/BILLING-PAYMENTS-COST-OF-CARE/CHARITY-CARE-FINANCIAL-ASSISTANCE/

PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
HTTPS://WWW.VALLEYPRES.ORG/PATIENTS-VISITORS/FOR-PATIENTS/BILLING-INSURANCE-PAYMENTS-COST-OF-CARE/BILLING-PAYMENTS-COST-OF-CARE/CHARITY-CARE-FINANCIAL-ASSISTANCE/

PART I, LINE 7:
THE ORGANIZATION IS UTILIZING A COST-TO-CHARGE RATIO TO DETERMINE AMOUNTS WITHIN SCHEDULE H, PART I, LINES 7A AND 7C; AMOUNTS REPORTED ON LINE 7E, 7F, AND 7I WERE ARRIVED AT UTILIZING COST ACCOUNTING METHODOLOGY.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY SUPPORT:HOSPITAL LEADERSHIP STAFF SUPPORTED COMMUNITY ORGANIZATIONS THROUGH PARTICIPATION ON COALITIONS, COMMUNITY BOARDS, COMMITTEES AND NETWORKS OF AGENCIES ADDRESSING COMMON ISSUES. EMPLOYEES ARE ALSO SUPPORTED BY THE HOSPITAL TO ENGAGE IN PLANNING, EDUCATION PRESENTATIONS, CONSORTIA, SUMMITS, AND MEETINGS WITH COMMUNITY GROUPS.COALITION BUILDING AND ADVOCACY:HOSPITAL REPRESENTATIVES SERVED ON A NUMBER OF COMMUNITY COMMITTEES AND BOARDS THAT ADDRESS HEALTH IMPROVEMENT AND COMMUNITY DEVELOPMENT. VPH ENGAGED IN ADVOCACY EFFORTS THAT SUPPORTED ACCESS TO HEALTH CARE.WORKFORCE DEVELOPMENT:VPH KNOWS THE IMPORTANCE OF CONNECTING WITH THE WORKFORCE OF THE FUTURE. THE HOSPITAL PARTICIPATED IN A VIRTUAL CAREER DAY TO PROVIDE INFORMATION ON HEALTH CARE CAREERS. STUDENTS LISTENED TO PANEL DISCUSSIONS FROM A VARIETY OF CLINICAL AND NON-CLINICAL LEADERS DISCUSSING THEIR EDUCATIONAL BACKGROUNDS, THEIR PERSONAL JOURNEYS THROUGH HEALTH CARE AND AN ACCOUNT OF WHAT A TYPICAL DAY ON THE JOB ENTAILS.

PART III, LINE 2:
IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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. 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 THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

PART III, LINE 3:
THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FAP WAS ESTIMATED UTILIZING RECORD REVIEWS. THE ENTIRE AMOUNT SHOULD BE CONSIDERED A COMMUNITY BENEFIT.

PART III, LINE 4:
"THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DOES NOT CONTAIN A SEPARATE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE FOOTNOTE THAT ADDRESSES ""PATIENT ACCOUNTS RECEIVABLE"" CAN BE FOUND ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS."

PART III, LINE 8:
THE COSTING METHODOLOGY WAS BASED ON THE 2021 MEDICARE COST REPORT COST-TO-CHARGE RATIO. IT IS THE HOSPITAL'S BELIEF THAT THE SHORTFALL REFLECTED ON PART III, LINE 7 SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN THE HOSPITAL'S COMMUNITY. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS.

PART III, LINE 9B:
THE HOSPITAL INITIALLY MAKES ALL REASONABLE EFFORTS TO OBTAIN FROM THE PATIENT OR HIS OR HER REPRESENTATIVE INFORMATION ABOUT WHETHER PRIVATE OR PUBLIC HEALTH INSURANCE OR SPONSORSHIP MAY FULLY OR PARTIALLY COVER THE CHARGES FOR CARE RENDERED BY THE HOSPITAL TO A PATIENT. ONCE ALL INSURERS HAVE ISSUED PAYMENT, AND THE ACCOUNT HAS BEEN REVIEWED BY A CLAIMS ADJUSTER, ANY REMAINING BALANCE IS OWED BY THE PATIENT. WHEN THE HOSPITAL IS NOT ABLE TO COLLECT OUTSTANDING PAYMENTS FROM A PATIENT OR AN INSURER THROUGH ITS OWN REASONABLE EFFORTS, IT MAY WORK WITH AN OUTSIDE COLLECTION AGENCY TO ASSIST IN OUTSTANDING PAYMENTS. FOR ANY PATIENT THAT IS UNINSURED OR HAS HIGH MEDICAL COSTS, AS DISCUSSED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE COLLECTION AGENCY OR ANY OTHER AGENT OF THE HOSPITAL SHALL NOT REPORT ADVERSE INFORMATION TO A CREDIT REPORTING AGENCY OR TAKE ANY LEGAL ACTION AGAINST THE PATIENT FOR NONPAYMENT LESS THAN 150 DAYS AFTER THE PATIENT WAS FIRST BILLED. THIS TIMELINE WILL BE EXTENDED IF THE PATIENT HAS APPEALED THE BILL AND THE APPEAL IS PENDING. THE HOSPITAL, COLLECTION AGENCY, OR ANY OTHER AFFILIATE OF THE HOSPITAL CANNOT USE WAGE GARNISHMENTS OR LIEN ON PERSONAL RESIDENCES AS A MEANS OF COLLECTIONS.ALTERNATIVELY, PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE IN FULL ARE GIVEN THE OPPORTUNITY TO MAKE MONTHLY PAYMENTS BASED ON THE BALANCE OWED WITH NO INTEREST. THE COLLECTIONS VENDOR WILL MAKE EVERY ATTEMPT TO HAVE THE ACCOUNT PAID IN FULL WITHIN THREE MONTHS FOR ACCOUNTS WITH SMALLER BALANCES, AND 12 MONTHS FOR ACCOUNTS WITH LARGER BALANCES. IF THE PATIENT AND THE COLLECTIONS VENDOR CANNOT AGREE ON A PAYMENT PLAN THE HOSPITAL SHALL CREATE A REASONABLE PAYMENT PLAN, CONSISTING OF MONTHLY PAYMENTS NOT MORE THAN 10% OF THE PATIENT'S FAMILY MONTHLY INCOME, EXCLUDING MONEY SPENT ON ESSENTIAL LIVING EXPENSES.

PART VI, LINE 5:
ADDITIONAL INFORMATION DESCRIBING HOW THE ORGANIZATION'S HOSPITAL FACILITIES FURTHER ITS EXEMPT PURPOSE INCLUDES: (I) THAT THE MAJORITY OF VPH'S BOARD MEMBERS ARE UNPAID COMMUNITY MEMBERS WHO RESIDE IN THE HOSPITAL SERVICE AREA; AND (II) ANY SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION TO FURTHER SUPPORT THE COMMUNITY.

PART VI, LINE 6:
N/A

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

PART VI, LINE 2:
THE ORGANIZATION ASSESSES THE HEALTH NEEDS OF THE COMMUNITY THROUGH ITS TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. INITIALLY, SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED THROUGH A REVIEW OF THE SECONDARY HEALTH DATA COLLECTED AND ANALYZED PRIOR TO THE INTERVIEWS AND SURVEYS. THE IDENTIFIED SIGNIFICANT HEALTH NEEDS INCLUDED: ACCESS TO HEALTH CARE; ALZHEIMER'S DISEASE; BIRTH INDICATORS; CHRONIC DISEASES; COVID-19; DENTAL CARE; ECONOMIC INSECURITY; HOUSING AND HOMELESSNESS; MENTAL HEALTH; OVERWEIGHT AND OBESITY; PREVENTIVE PRACTICES; AND SUBSTANCE ABUSE.THE IDENTIFIED SIGNIFICANT HEALTH NEEDS WERE PRIORITIZED WITH INPUT FROM THE COMMUNITY. INTERVIEWS WITH COMMUNITY STAKEHOLDERS AND A COMMUNITY SURVEY WERE USED TO GATHER INPUT ON THE SIGNIFICANT HEALTH NEEDS. THE FOLLOWING CRITERIA WERE USED TO PRIORITIZE THE HEALTH NEEDS: (I) THE PERCEIVED SEVERITY OF A HEALTH OR COMMUNITY ISSUE AS IT AFFECTS THE HEALTH AND LIVES OF THOSE IN THE COMMUNITY; (II) IMPROVING OR WORSENING OF AN ISSUE IN THE COMMUNITY; (III) AVAILABILITY OF RESOURCES TO ADDRESS THE NEED; AND (IV) THE LEVEL OF IMPORTANCE THE HOSPITAL SHOULD PLACE ON ADDRESSING THE ISSUE. EACH OF THE STAKEHOLDER INTERVIEWEES WAS SENT A LINK TO AN ELECTRONIC SURVEY (SURVEY MONKEY) IN ADVANCE OF THE INTERVIEW. ADDITIONALLY, THE LINK TO THE PRIORITIZATION SURVEY WAS MADE AVAILABLE TO COMMUNITY RESIDENTS. THE STAKEHOLDERS WERE ASKED TO RANK EACH IDENTIFIED HEALTH NEED. THE PERCENTAGE OF RESPONSES WERE NOTED AS THOSE THAT IDENTIFIED THE NEED AS HAVING SEVERE OR VERY SEVERE IMPACT ON THE COMMUNITY, HAD WORSENED OVER TIME, AND HAD A SHORTAGE OR ABSENCE OF RESOURCES AVAILABLE IN THE COMMUNITY. NOT ALL SURVEY RESPONDENTS ANSWERED EVERY QUESTION, THEREFORE, THE RESPONSE PERCENTAGES WERE CALCULATED BASED ON RESPONDENTS ONLY AND NOT ON THE ENTIRE SAMPLE SIZE. ACCESS TO HEALTH CARE, COVID-19, AND HOUSING AND HOMELESSNESS HAD THE HIGHEST SCORES FOR SEVERE IMPACT ON THE COMMUNITY IN THE SURVEY. HOUSING AND HOMELESSNESS, MENTAL HEALTH AND ECONOMIC INSECURITY HAD THE HIGHEST RANKINGS FOR WORSENED OVER TIME. HOUSING AND HOMELESSNESS, MENTAL HEALTH ACCESS TO HEALTH CARE AND ECONOMIC INSECURITY WERE RATED HIGHEST ON INSUFFICIENT RESOURCES AVAILABLE TO ADDRESS THE NEED.THE INTERVIEWEES AND COMMUNITY RESIDENTS WERE ALSO ASKED TO PRIORITIZE THE HEALTH NEEDS ACCORDING TO HIGHEST LEVEL OF IMPORTANCE IN THE COMMUNITY. THE TOTAL SCORE FOR EACH SIGNIFICANT HEALTH NEED (POSSIBLE SCORE OF 4) WAS DIVIDED BY THE TOTAL NUMBER OF RESPONSES FOR WHICH DATA WERE PROVIDED, RESULTING IN AN OVERALL SCORE FOR EACH HEALTH NEED. ACCESS TO HEALTH CARE, CHRONIC DISEASE AND PREVENTIVE PRACTICES WERE RANKED AS THE TOP THREE PRIORITY NEEDS IN THE SERVICE AREA.

PART VI, LINE 3:
THE HOSPITAL DISTRIBUTES A PLAIN LANGUAGE SUMMARY OF ITS FINANCIAL ASSISTANCE POLICIES AND OFFERS A CONFIDENTIAL APPLICATION FOR CHARITY CARE OR DISCOUNTED CARE PRIOR TO DISCHARGE. THE HOSPITAL ALSO DISTRIBUTES A WRITTEN NOTICE ABOUT THE AVAILABILITY OF THE HOSPITAL'S DISCOUNT PAYMENT AND CHARITY CARE POLICIES, ELIGIBILITY, AND CONTACT INFORMATION FOR A HOSPITAL EMPLOYEE WHO CAN PROVIDE FURTHER INFORMATION ABOUT THESE POLICIES.INFORMATION ABOUT FINANCIAL ASSISTANCE IS ALSO DISSEMINATED AND MADE WIDELY AVAILABLE THROUGH VARIOUS MEANS INCLUDING: (I) MAKING PAPER COPIES AVAILABLE IN PERSON OR BY MAIL UPON REQUEST AND WITHOUT CHARGE; (II) INFORMING AND NOTIFYING VISITORS THROUGH CONSPICUOUS PUBLIC DISPLAY, INCLUDING POSTING NOTICES IN AREAS SUCH AS THE EMERGENCY DEPARTMENT, BILLING OFFICE, ADMISSIONS OFFICE, AND OTHER OUTPATIENT SETTINGS; (III) INFORMING AND NOTIFYING THE COMMUNITY, SUCH AS BY DISTRIBUTING AN INFORMATION SHEET OR SUMMARY OF THE CHARITY CARE POLICY TO LOCAL PUBLIC AGENCIES AND NONPROFIT ORGANIZATIONS; AND (IV) MAKING AVAILABLE ON THE HOSPITAL'S WEB SITE THE CHARITY CARE POLICY AND A PLAIN LANGUAGE SUMMARY OF THE CHARITY CARE POLICY, AND THE CONFIDENTIAL APPLICATION FORM.ADDITIONALLY, FOR UNINSURED PATIENTS, THE PATIENT WILL BE PROVIDED AN ESTIMATE FOR THE PATIENT FINANCIAL RESPONSIBILITY THAT WILL BE DUE FOR THE TESTS/PROCEDURES TO BE PROVIDED OR, IN THE CASE OF AN INPATIENT ADMISSION, FOR THE ESTIMATED LENGTH OF STAY BASED UPON THEIR PRIMARY DIAGNOSIS. IF THE PATIENT IS UNABLE TO PAY THE ESTIMATE IN FULL OR MAKE PAYMENT ARRANGEMENTS, THE PATIENT WILL BE REFERRED TO FINANCIAL COUNSELING FOR A MEDI-CAL ELIGIBILITY SCREENING BASED ON THE PATIENT'S CONFIDENTIAL FINANCIAL INFORMATION.

PART VI, LINE 4:
"THE TOTAL POPULATION OF THE VALLEY PRESBYTERIAN HOSPITAL (VPH) SERVICE AREA IS 882,305. OF THE AREA POPULATION, 49.6% ARE MALE AND 50.4% ARE FEMALE. CHILDREN AND TEENS, AGES 0-17, MAKE UP 23.0% OF THE POPULATION, 65.6% ARE ADULTS, AGES 18-64, AND 11.4% OF THE POPULATION ARE SENIORS, 65 AND OLDER. IN THE SERVICE AREA, VAN NUYS 91402 HAS THE LARGEST PERCENTAGE OF YOUTH, AGES 0-17 (25.4%). CANOGA PARK HAS THE HIGHEST PERCENTAGE OF ADULTS, AGES 65 AND OLDER (13.9%). AMONG ADULTS IN THE SERVICE AREA, 6.6% IDENTIFY AS PART OF THE LESBIAN, GAY, BISEXUAL COMMUNITY.IN THE SERVICE AREA, 61.5% OF THE POPULATION ARE HISPANIC/LATINO; WHITES MAKE UP 23.1% OF THE POPULATION; ASIANS COMPRISE 9.3% OF THE POPULATION; AFRICAN AMERICANS ARE 4.1% OF THE POPULATION; AND NATIVE AMERICANS, HAWAIIANS, AND OTHER RACES COMBINED TOTAL 3.9% OF THE POPULATION. THE SERVICE AREA HAS A LARGER PERCENTAGE OF HISPANIC/LATINO INDIVIDUALS COMPARED TO THE COUNTY (48.5%) AND STATE (39%).IN THE SERVICE AREA, SPANISH IS SPOKEN AT HOME AMONG 53.9% OF THE POPULATION. ENGLISH ONLY IS SPOKEN IN THE HOME AMONG 30.5% OF THE POPULATION. OF THE POPULATION, 7.6% SPEAK AN INDO-EUROPEAN LANGUAGE, AND 6.9% OF THE POPULATION SPEAK AN ASIAN/PACIFIC ISLANDER LANGUAGE AT HOME. THE SERVICE AREA HAS A HIGHER PERCENTAGE OF THE POPULATION THAT SPEAKS SPANISH OR AN INDO-EUROPEAN LANGUAGE IN THE HOME WHEN COMPARED TO THE COUNTY AND THE STATE. WHEN EXAMINED BY SERVICE AREA ZIP CODE, PACOIMA (78.2%) AND VAN NUYS 91402 (66.6%) HAVE THE HIGHEST PERCENTAGE OF SPANISH SPEAKERS. WINNETKA (12.5%) AND VAN NUYS 91402 (11.9%) HAVE THE HIGHEST PERCENTAGE OF ASIAN/PACIFIC ISLANDER LANGUAGE SPEAKERS IN THE SERVICE AREA. THE HIGHEST PERCENTAGE OF INDO-EUROPEAN LANGUAGES SPOKEN AT HOME IS IN NORTH HOLLYWOOD 91605 (15.2%) AND VAN NUYS 91401 (14.6%). LINGUISTIC ISOLATION IS DEFINED AS THE POPULATION, AGES 5 AND OLDER, WHO SPEAKS ENGLISH ""LESS THAN VERY WELL"". IN THE SERVICE AREA, 30.6% OF THE POPULATION IS LINGUISTICALLY ISOLATED.IN THE SERVICE AREA, 2.7% OF THE POPULATION, 18 YEARS AND OLDER, ARE VETERANS. THIS IS LOWER THAN THE PERCENTAGE OF VETERANS FOUND IN THE COUNTY (3.3%) AND STATE (5.2%).THE COUNTY HEALTH RANKINGS RANK ORDER COUNTIES ACCORDING TO A VARIETY OF HEALTH FACTORS. SOCIAL AND ECONOMIC INDICATORS ARE EXAMINED AS A CONTRIBUTOR TO THE HEALTH OF A COUNTY'S RESIDENTS. THIS RANKING EXAMINES: HIGH SCHOOL GRADUATION RATES, UNEMPLOYMENT, CHILDREN IN POVERTY, SOCIAL SUPPORT, AND OTHERS. CALIFORNIA'S 58 COUNTIES WERE RANKED ACCORDING TO SOCIAL AND ECONOMIC FACTORS WITH 1 BEING THE COUNTY WITH THE BEST FACTORS TO 58 FOR THE COUNTY WITH THE POOREST FACTORS. FOR SOCIAL AND ECONOMIC FACTORS, LOS ANGELES COUNTY IS RANKED 34, SHOWING A DECREASE IN RANK FROM 29 IN 2018.THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ANNUALLY UPDATES OFFICIAL POVERTY POPULATION STATISTICS. IN 2019, THE FEDERAL POVERTY LEVEL (FPL) WAS AN ANNUAL INCOME OF $12,490 FOR ONE PERSON AND $25,750 FOR A FAMILY OF FOUR. AMONG RESIDENTS IN THE SERVICE AREA, 16.8% HAD INCOMES < 200% FPL IN THE SERVICE AREA. FAMILY INCOME HAS BEEN SHOWN TO AFFECT CHILDREN'S WELLBEING. COMPARED TO THEIR PEERS, CHILDREN IN POVERTY ARE MORE LIKELY TO HAVE PHYSICAL, BEHAVIORAL AND EMOTIONAL HEALTH PROBLEMS. IN OUR SERVICE AREA, 12.6% OF CHILDREN LIVE BELOW THE POVERTY LEVEL AND 26.6% OF CHILDREN ARE CATEGORIZED AS LOW-INCOME (< 200% FPL). IN THE SERVICE AREA, 14.5% OF SENIORS LIVE IN POVERTY, WHICH IS HIGHER THAN THE COUNTY RATE (13.2%) AND THE STATE RATE (10.2%).AMONG ADULTS IN OUR SERVICE AREA, 24.3% REPORTED AVOIDING GOVERNMENT BENEFITS DUE TO CONCERNS ABOUT DISQUALIFICATION FROM OBTAINING A GREEN CARD OR US CITIZENSHIP, AS COMPARED TO LOS ANGELES COUNTY AT 18.8%. ADDITIONALLY, 37.7% OF ADULTS BELOW 200% FPL CANNOT AFFORD FOOD AND 22.2% UTILIZE FOOD STAMPS. AMONG ELIGIBLE CHILDREN IN OUR SERVICE AREA, 24.9%, ACCESS WIC BENEFITS AS COMPARED TO LOS ANGELES COUNTY AT 41.9%. AMONG LOW-INCOME OLDER AND DISABLED ADULTS, 7.3% IN OUR SERVICE AREA ARE RECEIVING SUPPLEMENTAL SECURITY INCOME AS COMPARED TO LOS ANGELES COUNTY AT 10.5%.THE NATIONAL SCHOOL LUNCH PROGRAM IS A FEDERALLY ASSISTED MEAL PROGRAM THAT PROVIDES FREE, NUTRITIONALLY BALANCED LUNCHES TO CHILDREN WHOSE FAMILIES MEET ELIGIBILITY INCOME REQUIREMENTS. AMONG CHILDREN IN THE LOS ANGELES UNIFIED SCHOOL DISTRICT, 80.3% ARE ELIGIBLE FOR THE PROGRAM. ADDITIONALLY, AMONG HOUSEHOLDS WITH INCOMES LESS THAN 300% OF FEDERAL POVERTY LEVEL, 24.4% IN OUR SERVICE AREA WERE FOOD INSECURE.UTILIZING THE MOST AVAILABLE DATA, IN 2020 THE UNEMPLOYMENT RATE IN LOS ANGELES COUNTY WAS 12.8% AND 10.1% IN CALIFORNIA. PRELIMINARY DATA FOR THE MONTH OF FEBRUARY 2021 SHOWED AN UNEMPLOYMENT RATE OF 10.6% IN LOS ANGELES COUNTY. HIGH UNEMPLOYMENT CAN BE ATTRIBUTED IN PART TO THE COVID PANDEMIC."