4A (Expenses $ 449773970 including grants of $ 27806970) (Revenue $ 477439390)
MARIN GENERAL HOSPITAL DBA MARINHEALTH MEDICAL CENTER IS A 327-BED INDEPENDENT HOSPITAL WITH DEEP ROOTS IN THE COMMUNITY. WE HAVE BEEN MEETING THE HEALTHCARE NEEDS OF THE NORTH BAY SINCE FIRST OPENING OUR DOORS AS MARIN GENERAL HOSPITAL IN 1952. AS MARIN'S ONLY FULL-SERVICE, ACUTE CARE HOSPITAL, WE PROVIDE COMPREHENSIVE CARE ACROSS ALL MAJOR SERVICE LINES. OUR LEVEL III TRAUMA CENTER AND EMERGENCY DEPARTMENT RECEIVE 70% OF THE COUNTY'S AMBULANCE TRAFFIC, AND WE PROVIDE LIFE-SAVING CARE FOR OUR STROKE AND HEART ATTACK PATIENTS. WE ALSO OFFER THE ONLY HOSPITAL-BASED LABOR & DELIVERY UNIT IN MARIN. ADDITIONAL SERVICES PROVIDED INCLUDE: BEHAVIORAL HEALTH; CANCER CARE; CRITICAL CARE; EMERGENCY & TRAUMA; IMAGING & RADIOLOGY; STROKE CARE; SPINE & BRAIN CARE; AND SURGERY & PROCEDURES, AMONGST MANY OTHER SPECIALTIES.AS A DISTRICT HOSPITAL, OWNED BY MARIN HEALTHCARE DISTRICT, WE ANSWER ONLY TO THE COMMUNITY WE SERVE. THIS GIVES US THE FLEXIBILITY TO PLAN CARE THAT TRULY MEETS OUR COMMUNITY'S NEEDS. BUILDING ON A DECADES-LONG RELATIONSHIP, MARINHEALTH AND UCSF HEALTH FORMED A STRATEGIC ALLIANCE IN 2019 THAT EXPANDS ACCESS TO HIGH-QUALITY CLINICAL CARE IN MARIN COUNTY AND THROUGHOUT THE NORTH BAY.

MARIN GENERAL HOSPITAL DBA MARINHEALTH
PART V, SECTION B, LINE 5: A BROAD RANGE OF COMMUNITY MEMBERS PROVIDED COMMUNITY INPUT THROUGH KEY INFORMANT INTERVIEWS, GROUP INTERVIEWS, AND FOCUS GROUPS. INDIVIDUALS WITH THE KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE CONSULTED. THESE INDIVIDUALS INCLUDED REPRESENTATIVES FROM HEALTH DEPARTMENTS, SCHOOL DISTRICTS, LOCAL NON-PROFITS, AND OTHER REGIONAL PUBLIC AND PRIVATE ORGANIZATIONS AS WELL AS COMMUNITY LEADERS, CLIENTS OF LOCAL SERVICE PROVIDERS, AND OTHER INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND SUB-POPULATIONS THAT FACE UNIQUE BARRIERS TO HEALTH (E.G., RACE/ETHNIC MINORITY POPULATIONS, INDIVIDUALS EXPERIENCING HOMELESSNESS). INTERVIEWS WERE CONDUCTED WITH 31 KEY INFORMANTS BETWEEN 8/30/2018 10/15/2018 WITH REPRESENTATIVES FROM: THE MARIN FOOD POLICY COUNCIL, CANAL ALLIANCE, CITY OF SAN RAFAEL, MARIN TRANSIT, MARIN COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, RX SAFE MARIN, NATIONAL ALLIANCE OF MENTAL ILLNESS MARIN, NORTH MARIN COMMUNITY SERVICES, COSTAL HEALTH ALLIANCE, MARIN CITY HEALTH AND WELLNESS CENTER, MARIN COMMUNITY CLINICS, ROTACARE CLINIC OF SAN RAFAEL, MARIN ECONOMIC FORUM, SAN RAFAEL CHAMBER OF COMMERCE, NOVATO CHAMBER OF COMMERCE, LATINO COUNCIL OF MARIN, NORTH BAY LEADERSHIP COUNCIL, MARIN CENTER FOR INDEPENDENT LIVING, BUCKELEW PROGRAMS, WHISTLESTOP, CASA ALLEGRA, MARIN VENTURES, MARIN IHSS PUBLIC AUTHORITY, RITTER CENTER, HOMEWARD BOUND, ST. VINCENT DE PAUL SOCIETY, MARIN HOUSING AUTHORITY, WHOLE PERSON CARE, AND DOWNTOWN STREETS TEAM. IN ADDITION, THREE FOCUS GROUPS WERE HELD ON 9/5/2018, 9/21/2018, AND 10/2/2018; FOCUS GROUPS WERE CONDUCTED IN ENGLISH AND SPANISH, ENGAGING 22 COMMUNITY MEMBERS.

MARIN GENERAL HOSPITAL DBA MARINHEALTH
PART V, SECTION B, LINE 6A: MHMC CONDUCTED ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN CONJUNCTION WITH HEALTHY MARIN PARTNERSHIP, WHICH INCLUDES ALL ACUTE-CARE HOSPITALS IN MARIN COUNTY: MARINHEALTH MEDICAL CENTER, KAISER FOUNDATION HOSPITAL - SAN RAFAEL, AND SUTTER HEALTH - NOVATO COMMUNITY HOSPITAL.

MARIN GENERAL HOSPITAL DBA MARINHEALTH
PART V, SECTION B, LINE 6B: THE ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES WHO ARE MEMBERS OF HEALTHY MARIN PARTNERSHIP, WITH WHICH MARINHEALTH MEDICAL CENTER CONDUCTED ITS 2019 CHNA INCLUDE: MARIN COUNTY HEALTH & HUMAN SERVICES, HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA NORTH BAY LEADERSHIP COUNCIL, MARIN COUNTY OFFICE OF EDUCATION, MARIN COMMUNITY FOUNDATION, AND SAN RAFAEL CHAMBER OF COMMERCE.

MARIN GENERAL HOSPITAL DBA MARINHEALTH
PART V, SECTION B, LINE 11: WITH THE 2020-2022 IMPLEMENTATION STRATEGY, MARINHEALTH MEDICAL CENTER WILL ADDRESS THE HEALTH NEEDS OF: ACCESS TO HEALTHCARE; HEALTHY EATING AND ACTIVE LIVING; HOUSING AND HOMELESSNESS; MENTAL HEALTH/SUBSTANCE USE; AND VIOLENCE/INJURY PREVENTION THROUGH A COMMITMENT OF COMMUNITY BENEFIT PROGRAMS AND CHARITABLE RESOURCES.ACCESS TO CARE: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED FINANCIAL ASSISTANCE FOR UNINSURED/UNDERINSURED AND LOW-INCOME RESIDENTS; (II) PROVIDED TRANSPORTATION SERVICES FOR PERSONS WHO LACKED TRANSPORTATION TO ACCESS HEALTH CARE SERVICES; (III) REACHED 1,164 INDIVIDUALS WITH COMPASSIONATE DISCHARGE SERVICES AND PRESCRIPTIONS; (IV) SUPPORTED PRIMARY CARE AND SPECIALTY CARE SERVICES FOR THE UNINSURED AT MARINHEALTH MEDICAL NETWORK CLINICS; (V) SUPPORTED OPERATION ACCESS IN THEIR WORK TO PROVIDE DONATED OUTPATIENT SURGICAL AND SPECIALTY CARE FOR THE UNINSURED AND UNDERSERVED. MARINHEALTH MEDICAL CENTER WAIVED HOSPITAL CHARGES AND PROVIDED GRANT FUNDS FOR OPERATION ACCESS CLIENTS, ENABLING 248 UNINSURED INDIVIDUALS TO RECEIVE 368 NEEDED SURGICAL AND/OR DIAGNOSTIC SERVICES, HELPING TO RESTORE THEIR QUALITY OF LIFE. IN ADDITION, THROUGH OPERATION ACCESS MARINHEALTH-AFFILIATED PHYSICIAN VOLUNTEERS PROVIDED 29 SURGICAL PROCEDURES AND DIAGNOSTIC SERVICES FOR 27 UNINSURED INDIVIDUALS; (VI) PROVIDED FREE EDUCATION, COUNSELING, AND SUPPORT TO 856 BREASTFEEDING MOTHERS; (VII) PROVIDED OUTPATIENT CARE COORDINATION AND TRANSITIONS OF CARE THROUGH THE SUPPORTIVE CARE CENTER, ADDRESSING BARRIERS TO CARE FOR VULNERABLE PATIENTS AND THEIR CAREGIVERS; (VIII) ASSISTED 17,015 INDIVIDUALS WITH HEALTH INSURANCE ENROLLMENT IN PARTNERSHIP WITH MARIN COMMUNITY CLINICS; (IX) IDENTIFIED 486 COVID-19 CASES IN PARTNERSHIP WITH CANAL ALLIANCE; (X) PROVIDED 929 UNDUPLICATED INDIVIDUALS WITH DENTAL SERVICES IN PARTNERSHIP WITH PETALUMA HEALTH CENTER DBA COASTAL HEALTH ALLIANCE; AND (XI) PROVIDED A MOBILE CARE TEAM WITH A VAN EQUIPPED WITH COVID TESTING CAPABILITY AND PERSONAL PROTECTIVE EQUIPMENT, WHICH PROACTIVELY VISITED NURSING HOMES FOR EDUCATION, TESTING PATIENTS, TESTING STAFF, AND PROVIDING THEM WITH PROPER USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE). HEALTHY EATING AND ACTIVE LIVING: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) DISTRIBUTED THE FREE HEALTH CONNECTION E-NEWSLETTER AND QUARTERLY EDUCATIONAL PODCASTS TO THE PUBLIC AND PROVIDED EDUCATION ON HEALTHY EATING AND ACTIVE LIVING; (II) FACILITATED A CAREGIVER CLASS THAT EDUCATED 30 COMMUNITY CAREGIVERS WHO WORKED WITH PERSONS WITH DIABETES AND OTHER CHRONIC DISEASES; (III) PROVIDED FREE ADVICE TO THE PUBLIC ON NUTRITION NEEDS THROUGH REGISTERED DIETITIAN NUTRITIONISTS; (IV) THROUGH THE BRADEN DIABETES CENTER, PROVIDED FREE DIABETES SUPPORT GROUPS, COMMUNITY EDUCATION, AND SCREENINGS. IN 2021, 278 COMMUNITY MEMBERS PARTICIPATED EITHER IN-PERSON OR VIRTUALLY; (V) THROUGH THE INTEGRATIVE WELLNESS CENTER, PROVIDED EDUCATION, SUPPORT GROUPS, NUTRITION CLASSES, AND QI GONG EVENTS FREE TO THE PUBLIC. IN 2021, MORE THAN 1,880 COMMUNITY MEMBERS WERE SERVED; (VI) DELIVERED 25,885 ORGANIC, MEDICALLY TAILORED MEALS TO INDIVIDUALS WITH A SERIOUS ILLNESS AND THEIR FAMILY MEMBERS IN PARTNERSHIP WITH CERES COMMUNITY PROJECT.HOUSING AND HOMELESSNESS: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 1,180 INDIVIDUALS EXPERIENCING HOMELESSNESS WITH QUALITY HEALTH CARE SERVICES, INCLUSIVE OF MEDICAL, MENTAL HEALTH, AND ALCOHOL/DRUG TREATMENT SERVICES IN PARTNERSHIP WITH RITTER CENTER, A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) THAT ASSISTS MARIN'S LOW-INCOME AND HOMELESS POPULATION; (II) IN PARTNERSHIP WITH NORTH MARIN COMMUNITY SERVICES, 419 HOUSEHOLDS RECEIVED FINANCIAL ASSISTANCE; 1,255 OLDER ADULTS, CHILDREN, AND FAMILIES REMAINED HOUSED THROUGH FINANCIAL ASSISTANCE FOR EVICTION PREVENTION; (III) PROVIDED 77 INDIVIDUALS EXPERIENCING HOMELESSNESS WITH A STABLE ENVIRONMENT TO RECUPERATE AND RECEIVE WRAPAROUND SUPPORT SERVICES TO PROMOTE ECONOMIC INDEPENDENCE, HOUSING STABILITY AND ESTABLISH A MEDICAL HOME IN PARTNERSHIP WITH HOMEWARD BOUND. THIS RESULTED IN PREVENTING 945 AVOIDABLE HOSPITAL DAYS; (IV) PROVIDED 206 LOW-INCOME INDIVIDUALS WITH FREE ACUTE MEDICAL CARE AND MEDICATIONS IN PARTNERSHIP WITH ROTACARE BAY AREA CLINIC, THE ONLY FREE CLINIC IN MARIN COUNTY SERVING THE ADULT POPULATION.MENTAL HEALTH AND SUBSTANCE USE: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED ACCREDITED HOSPITAL INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH CARE SERVICES, INCLUDING PARTIAL HOSPITALIZATION AND A CO-OCCURRING BEHAVIORAL HEALTH AND SUBSTANCE USE; (II) IN PARTNERSHIP WITH THE HUCKLEBERRY TEEN YOUTH PROGRAM, BUCKELEW PROGRAMS, COMMUNITY INSTITUTE FOR PSYCHOTHERAPY, AND NORTH MARIN COMMUNITY SERVICES, MORE THAN 1,000 YOUTH AND ADULTS WERE PROVIDED BILINGUAL, CULTURALLY SENSITIVE MENTAL HEALTH COUNSELING SESSIONS; (III) FORTY-EIGHT SENIORS RECEIVED COGNITIVE BEHAVIORAL THERAPY, HEALTHY IDEAS BEHAVIORAL ACTIVATION AND LINKAGES TO OTHER SERVICES, AS NEEDED, IN PARTNERSHIP WITH JEWISH FAMILY AND CHILDREN'S SERVICES. IN ADDITION,18 FAMILY MEMBERS AND CAREGIVERS WERE PROVIDED THERAPY AND LINKAGES TO COMMUNITY RESOURCES; (IV) PROVIDED TRANSPORTATION FOR SENIORS IN THE BEHAVIORAL HEALTH PROGRAM TO INCREASE ACCESS TO CARE; (V) IN PARTNERSHIP WITH COMMUNITY ACTION MARIN, 4,500 COMMUNITY MEMBERS WERE ABLE TO ACCESS SUPPORT THROUGH A WARMLINE IN ENGLISH AND SPANISH; (VI) IN PARTNERSHIP WITH SAN GERONIMO VALLEY COMMUNITY CENTER, HELD A LET'S TALK SPEAKER SERIES FOCUSING ON SUBSTANCE USE, TEEN DEVELOPMENT AND PARENTING; AND (VII) SUPPORTED MARIN CITY COMMUNITY DEVELOPMENT CORPORATION, A SUBSTANCE USE RECOVERY-ORIENTED MENTAL HEALTH PROGRAM FOR THOSE WITH SERIOUS MENTAL ILLNESS, INCLUDING TRANSITIONAL AGE YOUTH.VIOLENCE AND INJURY PREVENTION: IN RESPONSE TO THIS NEED, IN 2021 MARINHEALTH MEDICAL CENTER: (I) PROVIDED 186 WEST MARIN SENIORS WITH CASE MANAGEMENT SERVICES, HOME-DELIVERED MEALS AND FREQUENT CONTACT VIA PHONE, FACETIME AND ZOOM; (II) HOSTED 2,500 YOUTH PARTICIPATED IN HEALTH EDUCATION, SUBSTANCE USE PREVENTION, AND SEXUAL VIOLENCE PREVENTION WORKSHOPS WITH HUCKLEBERRY YOUTH PROGRAMS; (III) PROVIDED 5,000 INDIVIDUALS AND FAMILIES WITH SUPPORT SERVICES TO PREVENT AND ADDRESS SUBSTANCE USE, MENTAL HEALTH, ISOLATION, SEXUAL HEALTH AND TRAUMA WITH SAN GERONIMO VALLEY COMMUNITY CENTER; (IV) HOSTED 750 BOY SCOUTS THROUGH THE AMERICAN COLLEGE OF SURGEON'S STOP THE BLEED TRAINING, WHICH ENCOURAGES BYSTANDERS TO BECOME TRAINED, EQUIPPED, AND EMPOWERED TO HELP IN A BLEEDING EMERGENCY BEFORE PROFESSIONAL HELP ARRIVES.MARINHEALTH MEDICAL CENTER HAS CHOSEN TO CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN THE ORGANIZATION'S AREAS OF FOCUS AND EXPERTISE. KNOWING THAT THERE ARE NOT SUFFICIENT RESOURCES TO ADDRESS ALL OF THE COMMUNITY HEALTH NEEDS, MARINHEALTH MEDICAL CENTER CHOSE TO ADDRESS THOSE HEALTH NEEDS THAT HAVE THE POTENTIAL FOR THE LARGEST IMPACT. TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, MARINHEALTH MEDICAL CENTER WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA: ECONOMIC SECURITY, EDUCATION, MATERNAL AND INFANT HEALTH, ORAL HEALTH, AND SOCIAL CONNECTIONS.

PART I, LINE 3C:
TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINE (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: 1) SPECIAL CIRCUMSTANCES CHARITY CARE: A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, INELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE HOSPITAL'S CHARITY CARE ELIGIBILITY CRITERIA. 2) CATASTROPHIC CHARITY CARE: FULL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 10% OF PATIENT'S FAMILY INCOME.3) UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. 4) PROMPT PAYMENT DISCOUNT: ADDITIONAL DISCOUNT FOR PATIENTS RECEIVING THE UNINSURED DISCOUNT OF AT LEAST 10% WHO PAYS ESTIMATED BILL PRIOR TO DISCHARGE.

PART I, LINE 7:
A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS ON LINES 7B, AND 7C. COST ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS ON LINES 7A, 7E, 7F, AND 7I.

PART III, LINE 2:
THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON SCHEDULE H, PART III, LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.

PART III, LINE 4:
"MHMC'S AUDITED FINANCIAL STATEMENTS DOES NOT HAVE A SEPARATE BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE FOOTNOTE WHICH ADDRESSES ""PATIENTS ACCOUNTS RECEIVABLE, NET"" CAN BE FOUND ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS."

PART III, LINE 8:
THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H, PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT AS MEDICARE RATES ARE NON-NEGOTIABLE AND SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. BY CONTINUING TO TREAT PATIENTS ELIGIBLE TO MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. ADDITIONALLY, IRS REV. RUL. 69-545 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.ALL MEDICARE REVENUES AND COSTS WERE INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.

PART III, LINE 9B:
THE MEDICAL CENTER INCLUDES AN EXTENDED PAYMENT PLAN TO ALLOW PAYMENT OF THE DISCOUNTED PRICE OVER TIME. THE MEDICAL CENTER AND THE PATIENT MAY NEGOTIATE THE TERMS OF THE PAYMENT PLAN. THE MEDICAL CENTER WILL NOT CHARGE INTEREST ON THE EXTENDED PAYMENT PLAN DEBT. AN EXTENDED PAYMENT PLAN MAY BE NEGOTIATED WITH THE PATIENT IF THE PATIENT FAILS TO MAKE ALL CONSECUTIVE PAYMENTS DURING A 90-DAY PERIOD. PRIOR TO DECLARING AN EXTENDED PAYMENT PLAN INOPERABLE THE PATIENT MUST BE: 1. CONTACTED OR ATTEMPTED TO BE CONTACTED BY TELEPHONE (LAST KNOWN NUMBER)2. GIVEN NOTICE IN WRITING THAT THE PLAN MAY BE INOPERABLE (LAST KNOWN ADDRESS)3. INFORMED THAT THERE IS AN OPPORTUNITY TO RE-NEGOTIATE THE PAYMENT PLAN.UNTIL THE PAYMENT PLAN IS DECLARED INOPERABLE, NO REPORT MAY BE MADE TO A CONSUMER CREDIT REPORTING AGENCY AND NO CIVIL ACTION MAY COMMENCE. ANY ADVANCING OF DEBT FOR COLLECTION OR REPORTING REQUIRES THE APPROVAL OF EACH PATIENT BY THE DIRECTOR OF PATIENT FINANCIAL SERVICES. ADVANCING OF DEBT COLLECTION SHALL OCCUR AFTER 150 DAYS OF AN INOPERABLE PAYMENT PLAN. CREDIT REPORTING SHALL NOT OCCUR UNTIL AFTER 150 DAYS OF THE PAYMENT PLAN BEING INOPERABLE.IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING MARINHEALTH MEDICAL CENTER'S CHARITY CARE ELIGIBILITY CRITERIA, THE PATIENT ACCOUNT MAY BE CONSIDERED CHARITY CARE, EVEN IF THEY WERE ORIGINALLY CLASSIFIED FOR COLLECTION OR AS A BAD DEBT. COLLECTION AGENCY PATIENT ACCOUNTS MEETING CHARITY CARE CRITERIA SHOULD BE RETURNED TO MARINHEALTH MEDICAL CENTER'S BILLING OFFICE AND REVIEWED FOR CHARITY CARE ELIGIBILITY.

PART VI, LINE 2:
IN ADDITION TO THE TRIENNIAL CHNA, HEALTH NEEDS ARE MONITORED AS FOLLOWS: (I) MARIN HEALTHCARE DISTRICT BOARD MEETINGS, WHICH INCLUDE PUBLIC COMMENTS AND WHICH THE HOSPITAL CEO ATTENDS AND SHARES COMMUNITY INPUT WITH HOSPITAL STAFF AS APPROPRIATE; (II) HOSPITAL BOARD MEMBERS ARE ALL COMMUNITY RESIDENTS AND SHARE COMMUNITY HEALTH CONCERNS WHEN APPROPRIATE; AND (III) COMMUNITY COMMENTS ON THE TRIENNIAL CHNA AND IMPLEMENTATION STRATEGY ARE COLLECTED ON THE HOSPITAL WEBSITE AND ARE MONITORED BY THE COMMUNITY RELATIONS DEPARTMENT.

PART VI, LINE 4:
"MARINHEALTH MEDICAL CENTER IS LOCATED AT 250 BON AIR ROAD, GREENBRAE, CA 94904. THE HOSPITAL SERVICE AREA COMPRISES ALL OF MARIN COUNTY AND INCLUDES THE CITIES OF: BELVEDERE, CORTE MADERA, FAIRFAX, LARKSPUR, MILL VALLEY, NOVATO, ROSS, SAN ANSELMO, SAN RAFAEL, SAUSALITO, TIBURON, AND THE COASTAL TOWNS OF STINSON BEACH, BOLINAS, POINT REYES, INVERNESS, MARSHALL, AND TOMALES. THE SERVICE AREA WAS DETERMINED FROM THE COMMUNITIES THAT REFLECT A MAJORITY OF PATIENT ADMISSIONS. MARIN COUNTY IS NORTH OF SAN FRANCISCO BY WAY OF THE GOLDEN GATE BRIDGE. THE COUNTY INCLUDES VAST AREAS OF OPEN SPACE, INCLUDING NATIONAL PROTECTED AREAS (SUCH AS MUIR WOODS NATIONAL MONUMENT), STATE AND LOCAL PROTECTED AREAS (SUCH AS MARIN COUNTY DEPARTMENT OF PARKS AND OPEN SPACE), AND STATE PARKS (SUCH AS MOUNT TAMALPAIS). MUCH OF MARIN'S POPULATION LIVES ALONG THE HIGHWAY 101 CORRIDOR, CREATING AN URBAN ENVIRONMENT IN THE EASTERN-CENTRAL PART OF THE COUNTY AND A MORE RURAL ENVIRONMENT ALONG THE COAST AND THE HIGHWAY 1 CORRIDOR IN WEST MARIN. MARIN HAS CONSISTENTLY BEEN RANKED BY THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS AS ONE OF THE HEALTHIEST COUNTIES IN CALIFORNIA. FOR 9 OUT OF THE PAST 10 YEARS, MARIN HAS EARNED THE TOP SPOT ON THIS LIST. THERE IS MUCH TO CELEBRATE REGARDING THE POSITIVE HEALTH OUTCOMES IN OUR COUNTY YET CLEAR INEQUITIES STILL EXIST, ILLUSTRATING THAT NOT ALL MARIN COUNTY RESIDENTS ARE ABLE TO ACHIEVE POSITIVE HEALTH OUTCOMES.MARIN COUNTY IS HOME TO 260,814 RESIDENTS. WITH A MEDIAN AGE OF 46.141 AND A HIGH PERCENTAGE OF OLDER ADULTS, MARIN COUNTY IS ONE OF THE ""OLDEST"" COUNTIES IN THE BAY AREA. PERSONS OVER THE AGE OF 60 ARE ESTIMATED TO NUMBER 72,684, COMPRISING 28% OF THE COUNTY'S TOTAL POPULATION. BY 2030, PERSONS OVER 60 WILL ACCOUNT FOR AT LEAST 33% OF THE POPULATION. STATEWIDE, PERSONS OVER 60 ACCOUNT FOR 18% OF THE POPULATION. YOUTH, 19 AND UNDER, MAKE UP 22% OF MARIN'S POPULATION. DUE TO THE HIGH COST OF LIVING IN MARIN COUNTY, FAMILIES WITH YOUNG CHILDREN FACE SIGNIFICANT CHALLENGES. ALMOST ONE-FOURTH (23%) OF MARIN COUNTY CHILDREN ARE LIVING AT OR BELOW 199% OF THE FEDERAL POVERTY LEVEL ($50,000 FOR A FAMILY OF 4). FAMILIES MUST MAKE DIFFICULT DECISIONS ABOUT PAYING FOR HOUSING, PAYING FOR FOOD, AND PAYING FOR QUALITY CHILDCARE AND EDUCATION FOR THEIR CHILDREN. IN MARIN COUNTY, 51% OF THE POPULATION IS FEMALE AND 49% IS MALE.THE MAJORITY OF THE POPULATION IN MARIN COUNTY IS NON-HISPANIC WHITE (71.9%); 15.6% OF THE POPULATION IS HISPANIC/LATINO; 5.6% OF THE POPULATION IS ASIAN; AND 2.3% OF THE POPULATION IS BLACK/AFRICAN AMERICAN. THE REMAINING 4.6% OF THE POPULATION IS MULTIPLE RACES, OTHER RACES, NATIVE ALASKANS, NATIVE HAWAIIANS AND NATIVE AMERICANS."

PART VI, LINE 3:
"A) CHARITY CARE INFORMATION PROVIDED AT PATIENT INTAKE: EXCEPT IN THE CASE OF EMERGENCY SERVICES, MARINHEALTH MEDICAL CENTER SHALL PROVIDE PATIENTS WITH INFORMATION REGARDING CHARITY CARE AND DISCOUNT PAYMENTS DURING THE PATIENT INTAKE PROCESS. MARINHEALTH MEDICAL CENTER SHALL ALSO PROVIDE PATIENTS WITH CONTACT INFORMATION FOR A MARINHEALTH MEDICAL CENTER EMPLOYEE OR OFFICE FROM WHICH THE PATIENT MAY OBTAIN FURTHER INFORMATION ABOUT CHARITY CARE AND DISCOUNT PAYMENTS. THE INFORMATION PROVIDED SHALL BE IN THE PRIMARY LANGUAGE(S) OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. A LANGUAGE IS A PRIMARY LANGUAGE OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA IF 5% OR MORE OF MARINHEALTH MEDICAL CENTER'S LOCAL POPULATION SPEAKS THE LANGUAGE. B) CHARITY CARE INFORMATION PROVIDED AT ALL OTHER TIMES: MARINHEALTH MEDICAL CENTER SHALL PROVIDE PATIENTS WITH INFORMATION REGARDING CHARITY CARE AND DISCOUNT PAYMENTS DURING THE INTAKE PROCESS, OR AT ANY OTHER TIME UPON PATIENT REQUEST. MARINHEALTH MEDICAL CENTER SHALL PROVIDE UNINSURED PATIENTS WITH THE MARINHEALTH MEDICAL CENTER CHARITY CARE APPLICATION FORM, THE ""STATEMENT OF FINANCIAL CONDITION,"" IMMEDIATELY UPON PATIENT REQUEST. THE INFORMATION PROVIDED SHALL BE IN THE PRIMARY LANGUAGE(S) OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. A LANGUAGE IS A PRIMARY LANGUAGE OF MARINHEALTH MEDICAL CENTER'S SERVICE AREA IF 5% OR MORE OF MARINHEALTH MEDICAL CENTER'S LOCAL POPULATION SPEAKS THE LANGUAGE. C) PUBLIC NOTICE AND POSTING: PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE THROUGH THIS POLICY SHOULD BE MADE BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION. NOTICES MUST BE POSTED IN AT LEAST THE EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMITTING OFFICES, AND MEDICAL CENTER OUTPATIENT SERVICE SETTINGS. POSTED NOTICES SHALL BE IN LANGUAGES REFLECTING THAT SPOKEN IN THE SERVICE AREA IS 5% OR MORE OF THE POPULATIONS SPEAK THIS LANGUAGE. POSTED NOTICES SHALL CONTAIN THE FOLLOWING INFORMATION: 1) A STATEMENT INDICATING THAT MARINHEALTH MEDICAL CENTER HAS A FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS WHO MAY NOT BE ABLE TO PAY THEIR BILL AND THAT THIS POLICY PROVIDES FOR FULL OR PARTIAL CHARITY CARE WRITE-OFF.2) IDENTIFICATION OF A MEDICAL CENTER CONTACT PHONE NUMBER THAT THE PATIENT CAN CALL TO OBTAIN MORE INFORMATION ABOUT THE POLICY AND ABOUT HOW TO APPLY FOR ASSISTANCE.D) INCLUDE POLICY INFORMATION ON BILLS AND STATEMENTS SENT TO PATIENTS INDICATING:1) IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR QUALIFY FOR CHARITY CARE OR DISCOUNT PAYMENT FROM MARINHEALTH MEDICAL CENTER. THE INCOME REQUIREMENTS SHALL BE STATED ON THE NOTICE.2) NOTIFICATION TO THE PATIENT THAT EMERGENCY PHYSICIANS ARE REQUIRED TO HAVE A DISCOUNT POLICY TO UNINSURED AND HIGH MEDICAL COST PATIENTS WHICH MAY HAVE DIFFERENT ELIGIBILITY CRITERIA THAN THAT OF THE MEDICAL CENTER BUT AT LEAST AT 350% OF THE FPL. 3) A MEDICAL CENTER PHONE NUMBER THAT PATIENTS MAY CALL FOR FURTHER INFORMATION. 4) POSTING NOTICE OF THE AVAILABILITY OF ASSISTANCE AND A CONTACT PHONE NUMBER ON MARINHEALTH MEDICAL CENTER'S WEB SITE. 5) PROVIDING UNINSURED PATIENTS A DOCUMENT OUTLINING THE TYPES OF FINANCIAL ASSISTANCE AVAILABLE."

PART VI, LINE 5:
MARINHEALTH MEDICAL CENTER IS THE ONLY FULL-SERVICE ACUTE CARE HOSPITAL IN THE COUNTY AND THE ONLY HOSPITAL WITH AN OBSTETRICAL SERVICE OR IN PATIENT BEHAVIORAL HEALTH SERVICE. IT SERVES AS THE TRAUMA CENTER FOR MARIN COUNTY AND SURROUNDING AREAS. THE BOARD OF DIRECTORS IS COMPOSED OF UNCOMPENSATED COMMUNITY RESIDENTS. ALL FUNDS ARE USED TO IMPROVE HEALTH CARE SERVICES, MAINTAIN UP-TO-DATE FACILITIES, AND SUPPORT TRAINING PROGRAMS FOR HEALTH PROFESSIONALS IN AREAS SUCH AS NURSING, PHARMACY, RADIOLOGY, RESPIRATORY THERAPY, REHABILITATION SERVICES AND BEHAVIORAL HEALTH. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS.

PART VI, LINE 6:
MARIN HEALTHCARE DISTRICT IS THE GENERAL MEMBER OF MARINHEALTH MEDICAL CENTER; MARIN HEALTHCARE DISTRICT IS RESPONSIBLE FOR PROMOTING THE HEALTH AND WELFARE OF THE RESIDENTS OF MARIN COUNTY, INCLUDING MAINTAINING COUNTY-WIDE ACCESS TO CARE THROUGH THE MARIN HEALTHCARE DISTRICT HEALTH CENTERS. IN ADDITION, MARINHEALTH MEDICAL CENTER OPERATES IN CONJUNCTION WITH MARINHEALTH MEDICAL NETWORK, WHICH IS A MEDICAL FOUNDATION OFFERING A WIDE RANGE OF PHYSICIANS AND PROVIDERS.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA