4A (Expenses $ 343756293 including grants of $ 0) (Revenue $ 356091465)
RIDEOUT MEMORIAL HOSPITAL CONSISTS OF TWO CAMPUSES DURING THIS TAX YEAR:- RIDEOUT MEMORIAL HOSPITAL (RMH) LOCATED IN MARYSVILLE, CA IS A 221-LICENSED-BED ACUTE CARE FACILITY WHICH INCLUDES A TRAUMA LEVEL-3 EMERGENCY DEPARTMENT, A STATE-OF-THE-ART CARDIAC UNIT AND A FREESTANDING CANCER CENTER WHICH IS AN AFFILIATION BETWEEN THE FREMONT RIDEOUT HEALTH GROUP AND UC-DAVIS HEALTH SYSTEM. THE EMERGENCY DEPARTMENT, LOCATED INSIDE RMH IS THE ONLY EMERGENCY ROOM BETWEEN SOUTHERN BUTTE COUNTY AND SACRAMENTO. - FREMONT MEDICAL CENTER (FMC) LOCATED IN YUBA CITY, CA IS A 46-LICENSED-BED ACUTE CARE FACILITY WHICH INCLUDES PERINATAL AND PEDIATRIC CARE. THIS FACILITY WAS CLOSED IN MAY 2017.

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: RIDEOUT MEMORIAL HOSPITAL, - Facility 2: FREMONT MEDICAL CENTER

Facility Reporting Group - A Part V, Section B, line 5:
As a not-for-profit healthcare organization with a mission to help others, RH cares about people while we care for people. In addition, the Quality Council, a subcommittee of the RH Board of Directors, comprised of physicians, board members, hospital executive leaders, quality professionals and front-line staff review quality data as it relates to the patient population served and makes recommendations and allocates resources for quality improvement initiatives focusing on the processes and outcomes of care. RH representatives are active in community groups and collaboratives, including United Way, American Cancer Society, American Red Cross Northeastern California, Sutter and Yuba County Public Health, Cancer Care Network and UC Davis Health System, among others. These committees and programs, along with our Board of Directors, set the pace for assessing the communities' needs in regard to health care.The Community Action Committee (CAC) was formed in 1995 from members of the RH Board of Directors, RH Foundation Board of Directors, administration and staff, and community members (including representation from physicians, educators, migrant farm representatives and business people). It is charged with assessing the needs of the community and developing a plan of action to prioritize and meet those needs. The committee gathers information and facts from a variety of sources from within RH and through community members, government and community agencies to develop the overall plan. Rideout Health (RH) and Sutter Surgical Hospital - North Valley (SSHNV), two hospitals serving portions of both Sutter and Yuba counties in northern California share the same service area and jointly conducted the recent assessment. RH is located in Marysville, California and is a part of the Rideout Health System. SSHNV is located in Yuba City, California, and is owned in partnership with physician owners and Sutter Medical Foundation. The CHNA was conducted over a period of ten months, beginning in July 2015, and concluded in May 2016. Many dedicated community health experts and members of various social service organizations serving the most vulnerable members of the community gave their time and expertise as key informants to help guide and inform the findings of the assessment. Many community residents also participated and volunteered their time and told us what it was like to live in the community with limited or no access to healthcare and the basic resources needed to live a healthy life.

Facility Reporting Group - A Part V, Section B, line 6a:
Sutter Surgical Hospital - North Valley

Facility Reporting Group - A Part V, Section B, line 11:
"The identified significant health needs for the Communities of Concern are listed below in prioritized order:1. Access to Quality Primary Care Health Services and Prescription Drugs - The highest priority significant health need for the Communities of Concern was access to quality primary care health services and prescription drugs. Primary care resources include community clinics, pediatricians, family practice physicians, internists, nurse practitioners, pharmacists, telephone advice nurses, and similar. Primary care services are typically the first point of contact when an individual seeks healthcare. These services are the front line in the prevention and treatment of common diseases and injuries in a community.2. Access to Affordable, Healthy Food - The second highest priority significant health need was access to affordable, healthy foods. Eating a healthy diet is important for one's overall health and wellbeing. When access to healthy foods is challenging for community residents, many turn to unhealthy foods that are convenient, affordable, and readily available. Communities experiencing social vulnerability and poor health outcomes often are overloaded with fast food and other establishments where unhealthy food is sold.3. Access to Mental, Behavioral, and Substance Abuse Services -The third highest priority significant health need was access to mental, behavioral, and substance abuse services. Individual health and wellbeing are inseparable from individual mental and emotional outlook. Coping with daily life stressors is challenging for many people, especially when other social, familial, and economic challenges also occur. Adequate access to mental, behavioral, and substance abuse services help community members to obtain additional support when needed.4. Access to Specialty Care -The fourth highest priority significant health need for RH/SSHNV Communities of Concern was access to specialty care. Specialty care services are those devoted to a particular branch of medicine and focus on the treatment of a particular disease. Primary and specialty care go hand-in-hand, and without access to specialists such as endocrinologists, cardiologists, and gastroenterologists, community residents are often left to manage chronic diseases such as diabetes and high blood pressure on their own.5. Access to Health Education and Health Literacy - The fifth highest priority significant health need for the HSA was access to health education and health literacy. Knowledge is important for individual health and wellbeing, and health education interventions are powerful tools to improve community health. When community residents lack adequate information on how to prevent, manage, and control their health conditions, those conditions tend to worsen. Health education around infectious disease control (e.g. STI prevention, influenza shots) and intensive health promotion and education strategies around the management of chronic diseases (e.g. diabetes, hypertension, obesity, and heart disease) are important for community health improvement.6. Access to Transportation and Mobility - The sixth highest priority significant health need for RH/SSHNV Communities of Concern was access to transportation and mobility. Having access to transportation services to support individual mobility is a necessity of daily life. Without transportation, individuals struggle to attain their basic needs, including those that promote and support a healthy life.7. Additional Identified Health Need - Collaboration and Coordination among Community Services and Programs -When community health needs are viewed from a requisite perspective, or those things required to improve the health of the community, the idea that enhanced collaboration and coordination among organizations, programs, and services would lead to better health outcomes for community residents appears logical. All but one key informant identified this as a priority health need for the RH/SSHNV HSA.To review the full CHNA report, please visit: http://www.frhg.org/Community-Health-Needs-Assessment.aspxRH Has Chosen to Further Address the Health Heeds Through the Resources and Programs Identified Below:1. RH Clinic continues to recruit primary care physicians and physician assistants to help with patient load. A ""Community Pharmacy Needs Plan"" is under design. Challenges include: Lack of availability of low cost medications; Getting prescriptions to the right pharmacies; Helping patients understand medications - and the need to continue them until seen by primary care. The Pharmacy Plan includes: Managed Medicaid plan formularies to ensure that patients can fill medications at low cost; Low cost $4 meds at Walmart or Costco; 340B program; Home delivery; Low costs convenience. A process is being set-up with pharmacies to deliver to hospital/ED discharge prescriptions.2. The RH Community Garden provides free fresh vegetables to indigent populations in communities living in ""food deserts"" nearby. An Access to Affordable, Healthy Food plan is under design, including: Food insecurity screenings; Y-S Food Bank - obtained resource reference material; a referral form; Case Management and Nursing staff meetings are being held; ICD-10 Coding; Patients are being referred to the food bank and other distribution centers in the patients geographic area; Leadership is volunteering once a month at the local Food Bank; A RH leader will join the Food Bank board of directors.3. The Mental Health Emergency Stabilization Outpatient Unit has been integrated into the RH Emergency Department and functions in collaboration with Sutter Yuba Mental Health, utilizing county mental health and emergency psychiatry professionals, emergency telepsychiatry, ED staff, and crisis nursing.4. RH Clinic has opened or enhanced additional Specialty Care clinics including the Rideout Urology Clinic, The Rideout Neurology Clinic and the Rideout General Surgery Clinic including Bariatric surgery. 5. We are educating and empowering our patients through our enhanced Community Health Education program: Rideout Healthy. Classes include: Tobacco Cessation, Maternity, Childbirth, Child Safety, Diabetes, Healthy Eating, Cancer Wellness and Hospice Grief Classes, Regional Health Fairs and for youngsters, our free Rideout Healthy Kids school assemblies for K-8th grade students in Yuba, Sutter and Colusa counties.6. RH Foundation assists cancer center patients, senior care and hospice care patients with transportation needs and more by providing provisions such as gas cards, bus passes, food cards and more to help indigent or low income patients with their travel needs.7. RH coordinates with the Sutter and Yuba County Health agencies and local low-income health providers to distribute health information and assist with health services included at no cost.RH's ""Rideout Healthy"" program offers free community health education classes to all community members focused on the benefits of eating healthy, exercise, and emotional well-being. At RH we strive to give people the resources and encouragement they need to live the healthiest lives possible.- In 2014 the ""Rideout Healthy Kids"" program began. This program provides health education to elementary and middle school children in an interactive musical theater performance and a comedy show. An evaluation of specific outcomes of this program included the following:- In 2014 the program was delivered to over 22,000 YubaSutter school system students- In 2015 the Rideout Healthy Kids program was expanded to neighboring Colusa County- In 2016/17, the Rideout Healthy Kids program shared the message of healthy eating/esteem at 20 - K-8 School assemblies in Yuba and Sutter counties. Portions of the musical assembly script were reworked to bring RHK's messaging up-to-date, and to include current trends which will appeal to students K-8th grades- Teacher evaluations were conducted after each program was delivered to assess observed behavioral changes and increased awareness in the students that attended the program. A sample of evaluations was selected at random (n=22) to demonstrate the impact of the program. This analysis revealed that 64% of teachers surveyed reported observing an increased awareness of healthy eating habits and 59% reported observing an increased awareness of exercise and activity habits in the students that attended the program.- RH developed a series of new health education classes and delivers these monthly throughout the calendar year. Topics include nutrition, diabetes management and grief/health coping- The RH Teen Leadership Council participate in seasonal activities that are sanctioned by the Rideout Health Foundation including help with community health events, the community garden and job shadowing healthcare professionals"

Facility Reporting Group - A Part V, Section B, line 20e:
The Rideout Health System will make every effort to notify the patients of the financial liability prior to service, or at the time of service. All patients will be requested to sign the Conditions of Admission which informs the patient in summary of their financial responsibility. Any patient who requests assistance with payment for services will be directed to the Financial Counseling or Patient Financial Services Departments depending on their in-house or discharge status. The Financial Counseling Department will assist patients who are currently in-house or preregistered with collection of any insurance deductibles, co-pays, co-insurance or share-of-costs as well as obtaining payment arrangements. Assist the patient with financial assistance and or other programs that may be available. The Patient Financial Services Department will assist all patients post discharge with collection of any insurance deductibles, co-pays or share-of-costs as well as obtaining payment arrangements, assisting with MediCal or other eligible application and application to the Hospital's Financial Assistance Program for patients without another payment source. Prior to an account being referred to bad debt, it may be placed on a payment arrangement plan if the monthly payment amount requested and agreed to by the patient and or patient representative falls within Rideout Health payment arrangement guidelines. Collection Guidelines1. Following completion of outpatient services or discharge as an inpatient, the Credit and Collections Representative will verify resolution to understand financial counseling issues. If open issues exist, the representative will work with the patient and/or Financial Counselor as appropriate to complete. 2. For outpatient services other than surgery, emergency room, cancer center and cardiac cath lab; follow up will be driven by statements only.3. For inpatient services, surgery, emergency room, cancer center and cardiac cath lab; follow up will be driven by statements and a minimum of one phone contact.4. The first contact attempt should be made within the first 30 days after date of service or date of discharge is possible.5. Credit and Collections follow-up process and billing cycle a. The self-pay patient will receive 6 patient statements:i. Initial statement will be generated on day 30 of the billing cycleii. Subsequent patient statements are generated on days: 60, 90, 120 (alpha split)b. Collection calls begin when the following aging criteria is met:i. 45 daysii. 75 daysiii. 115 daysAfter a period of 120 days, if the account is deemed uncollectible, the Hospital will place the account in bad debt and refer to an outside collection agency.Bad Debt Qualification Criteria1. An account may be referred to collections if it meets one or more of the following criteria:a. Self-pay balance not paid 120 days after bill date and when all reasonable follow up efforts have been exhausted.b. Patient or Guarantor advises PFS Collections staff that they have no intention of paying the bill.c. Patient communication via mail and or phone is unsuccessful due to bad patient/account information.

Facility Reporting Group - A Part V, Section B, line 24:
ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT IS FAP-ELIGIBLE AND COMPLETES THE REQUIRED DOCUMENTATION, THE CHARGES ARE EITHER REDUCED OR WRITTEN-OFF TO CHARITY CARE.

Part I, Line 6a:
RIDEOUT MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT IS INCLUDED IN THE COMMUNITY BENEFIT REPORT PREPARED BY FREMONT RIDEOUT HEALTH GROUP. THE COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND ON OUR WEBSITE WWW.FRHG.ORG. IT CAN ALSO BE REQUESTED THROUGH THE STATE (OSHPD ADDRESS PROVIDED BELOW).OSHPD HEALTHCARE INFORMATION RESOURCE CENTER400 R STREET, ROOM 250; SACRAMENTO, CA 95811-6213TELEPHONE (916) 326-3802FAX (916) 324-9242

Part I, Line 7:
Actual costs are used - cost to charge ratio methodology

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 $ 13,816,669.

Part III, Line 2:
ACTUAL COSTS ARE USED - COST TO CHARGE RATIO METHODOLOGY.

Part III, Line 3:
Rideout Memorial Hospital does not currently make an estimate for Bad Debt attributable to patients under financial assistance. These accounts are included in the total bad debt reserve. These costs are not reported as community benefit. Once patients have been determined to qualify for FAP, the accounts are discounted as charity care, and are then included in our community benefit figures.

Part III, Line 4:
Footnote relating to bad debt expense - See note 6 on page 24 of the audited financial statements.Footnote relating to allowance for doubtful accounts - See note 1 on page 11 of the audited financial statements.

Part III, Line 8:
The Medicare shortfall is fully treated as community benefit in the organization's community benefit report.Actual costs are used - cost to charge ratio methodology

Part III, Line 9b:
The financial counseling department will assist patients who are currently in-house with collection of any insurance deductibles, co-pays, or share-of-costs as well as obtaining payment arrangements, assisting with Medi-Cal or CMSP application, and application to the hospital's financial assistance program for patients without another payment source.

Part VI, Line 2:
The community action committee, a cross-section of clinical and non-clinical hospital staff, regularly review health care needs of the community. Participants are asked for suggestions on new classes, programs and services. FRHG representatives are active in community groups and collaboratives, including united way, American Cancer Society and Sutter and Yuba County Public Health Departments and UC Davis health system. These committees and programs, along with the board of directors, set the pace for assessing the communities' needs in regard to health care.

Part VI, Line 3:
The financial counseling department will assist patients who are currently in-house with collection of any insurance deductibles, co-pays, or share-of-costs as well as obtaining payment arrangements, assisting with Medi-Cal or CMSP application, and application to the hospital's financial assistance program for patients without another payment source. Financial counselors and credit & collection employees will perform uncompensated care financial screening and means testing. A patient may be granted either full or partial financial relief depending upon their financial situation. All uninsured patients who cannot afford treatment will be assessed at time of admission/registration to determine if they have unexplored insurance benefits or are eligible for publicly funded programs.

Part VI, Line 5:
- RIDEOUT MEMORIAL HOSPITAL ADDRESSES THE FOLLOWING COMMUNITY NEEDS: ACCESS TO INPATIENT AND OUTPATIENT CARE FOR INDIVIDUALS WITHOUT A MEDICAL PROVIDER; EDUCATION AND SCREENING PROGRAMS FOR SPECIAL POPULATIONS AND HEALTH CONDITIONS; COMMUNITY FLU VACCINATION CLINICS; SPECIAL SUPPORT SERVICES FOR HOSPICE PATIENTS, FAMILIES AND THE COMMUNITY; SUPPORT OF COMMUNITY NON-PROFIT ORGANIZATIONS; EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS; AND COLLABORATION WITH LOCAL SCHOOLS THROUGH OUR TEEN LEADERSHIP COUNCIL PROGRAM TO PROMOTE INTEREST IN HEALTH CARE CAREERS. ADDITIONAL STEPS WERE TAKEN DURING THE CURRENT YEAR TO INCREASE PATIENT ACCESS TO MEDICAL CARE FACILITIES BY ESTABLISHING A NUMBER OF CLINICS IN THE COMMUNITY. RIDEOUT MEMORIAL HOSPITAL REGULARLY OFFERS HEALTH SCREENINGS TO THE PUBLIC AT LITTLE OR NO CHARGE THROUGH HEALTH FAIRE AND PROSTATE SCREENINGS THROUGH THE CANCER CENTER AT RIDEOUT. THE RIDEOUT MEMORIAL HOSPITAL ALSO OFFERS LOW COST MAMMOGRAM PROGRAMS DURING PINK OCTOBER. THESE SCREENINGS MAY INCLUDE: CHOLESTEROL, GLUCOSE, BLOOD PRESSURE HEIGHT AND WEIGHT WITH BMI (BODY MASS INDEX), PROSTATE SCREENING, AND LOW COST MAMMOGRAMS.- RIDEOUT MEMORIAL HOSPITAL PROUDLY SUPPORTS MANY LOCAL ORGANIZATIONS, IN COLLABORATION WITH AGENCIES SUCH AS PEACH TREE CLINIC, AMPLA HEALTH CARE, SUTTER COUNTY HEALTH ACS, YUBA COUNTY HEALTH DEPARTMENT TO PROVIDE SERVICES AND SUPPORT GROUPS. - RIDEOUT MEMORIAL HOSPITAL IS ACTIVELY INVOLVED IN THE ECONOMIC DEVELOPMENT COMMITTEE FOR YUBA COUNTY, EXECUTIVE STEERING COMMITTEE FOR THE CITY OF MARYSVILLE, AND REPRESENTATION IN ROTARY SERVICE CLUBS IN BOTH YUBA CITY AND MARYSVILLE.- RIDEOUT MEMORIAL HOSPITAL'S COMMUNITY HEALTH EDUCATION PROGRAM PROVIDES A VARIETY OF CLASSES, SEMINARS, SUPPORT GROUPS AND EVENTS TO HELP THE RESIDENTS OF THE YUBASUTTER COMMUNITIES TO IMPROVE AND MAINTAIN THEIR HEALTH AND LIFESTYLE.

Part VI, Line 7, Reports Filed With States
CA

Part VI, Line 4:
Rideout Health serves the Sacramento Valley and Sierra Nevada foothill region comprised of Yuba and Sutter counties, with a combined population of 171,533, according to a 2016 California Department of Finance estimate. Yuba and Sutter counties' population growth has outpaced the growth rate in California over the past two decades, and is projected to continue. Of the total population of the two counties, 26.7 percent are children (under the age of 18), and 13.8 percent are seniors (65 or older). The senior population is expected to more than double from 2010 to 2035.This region of abundant natural resources grapples with several socioeconomic challenges, including a poverty rate 34 percent higher than all of California, which can create significant community health challenges. According to the U.S. Census Bureau, incomes in both counties are below the statewide average, and the poverty rate is higher than the statewide average. Median per capita income for Yuba County was just $20,471 in 2017, 32 percent below the statewide average of $30,318. Sutter County was at $23,689, 22 percentage points behind the rest of the state. The combined poverty rate of the two counties is 19.2 percent, compared to all of California at 14.3 percent.According to the United States Bureau of Labor Statistics, in the 20 years from 1990 to 2010, the unemployment rate for the Yuba-Sutter region was at a high of 19.5 percent in 2010 and a low of 8.8 percent in 2000. While the region's economy has improved, the annual average unemployment rate in 2016 was 9.2 percent, compared to 5.4 percent statewide, according to the California Employment Development Department.According to the University of Wisconsin and Robert J. Wood Foundation County Health Rankings, Yuba County ranked 44th worst out of 58 counties in California for overall health and Sutter County ranked 30th win 2016. According to the California Department of Public Health, Yuba County has the third highest rate of death from all causes in California, and Sutter County has the 22nd highest mortality rate. Yuba County has the third highest, and Sutter County the sixth highest, rate of death due to coronary disease.The percentage of Yuba County residents with a disability is twice the statewide average. Yuba County has adisability rate of 14.5 percent in people under the age of 65, and Sutter County has a disability rate of 9.3 percent. The statewide average is 6.8 percent.More Yuba and Sutter County residents now have health insurance due to the Affordable Care Act. Prior to the ACT, the percentage of residents without health insurance was higher in Yuba and Sutter counties than the national average, according to the U.S. Census Bureau's Small Area Health Insurance Estimates. According to the Census Bureau, 21.5 percent of Sutter County residents and 19.1 percent of Yuba County residents were without health insurance for all 12 months of 2009, compared to the California uninsured rate of 20.1 percent, and the national uninsured rate of 16.3 percent. An estimated 10,000 additional individuals in Yuba and Sutter counties became Medi-Cal Certified Eligible in 2014 with the implementation of the ACT, and the percentage of individuals without health insurance has dropped to 14 percent in each county. However, many still struggle to find Medi-Cal providers.Rideout Health provides community benefits to the communities we serve - demonstrating our commitment to the health of residents in our service area. We provide programs and activities that provide treatment or promote health and healing as a response to identified community needs in such a way as to improve residents' access to health care services, enhance the health of the community, and advance medical or health knowledge. RH's community benefit includes education, charity care, subsidized health services, community health improvement activities and more. RH creates access to health care in our region for individuals and families who struggle against poverty, disability and isolation.