4A (Expenses $ 461041433 including grants of $ 0) (Revenue $ 524013403)
EMANATE HEALTH MEDICAL CENTER (EHMC) OPERATES TWO ACUTE CARE HOSPITALS, QUEEN OF THE VALLEY HOSPITAL (QVH) AND INTER-COMMUNITY HOSPITAL (ICH), IN THE EAST SAN GABRIEL VALLEY OF LOS ANGELES COUNTY. EHMC PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE FOR THE COMMUNITIES SURROUNDING THE TWO MEDICAL HOSPTALS. QVH AND ICH PROVIDE CARE FOR AN AVERAGE OF _284_ PATIENTS PER DAY. COMBINED ADJUSTED PATIENT DAYS WAS 149,095. EMERGENCY ROOM & OUTPATIENT VISITS TOTALED 185,481. EHMC PROVIDED TRADITIONAL CHARITY CARE AT COST TOTALING $5,199,018, UNREIMBURSED MEDI-CAL PROGRAM COST TOTALING $62,623,590 AND OTHER COMMUNITY BENEFIT COST TOTALING $2,216,988.DURING 2021, EHMC RECORDED A NET SUPPLEMENTAL PAYMENTS OF $51,233,947 FROM THE CALIFORNIA HOSPITAL FEE PROGRAM FOR THE HOSPITAL SERVICES TO MEDI-CAL FEE-FOR-SERVICE AND MEDI-CAL MANAGED CARE PATIENTS COVERED FOR THE PERIOD FROM JANUARY 1, 2021 TO DECEMBER 31, 2021.

PART V, SECTION A:
EMANATE HEALTH MEDICAL CENTER (EHMC) OPERATES TWO ACUTE CARE HOSPITALS, QUEEN OF THE VALLEY HOSPITAL (QVH) AND INTER-COMMUNITY HOSPITAL (ICH). QVH IS LOCATED AT 1115 SOUTH SUNSET AVENUE, WEST COVINA, CA 91790. ICH IS LOCATED AT 210 W. SAN BERNARDINO ROAD, COVINA, CA 91723.

EHMC - QVH AND ICH
PART V, SECTION B, LINE 5: COMMUNITY INPUT:COMMUNITY INPUT WAS PROVIDED BY A BROAD RANGE OF COMMUNITY MEMBERS THROUGH THE USE OF KEY INFORMANT INTERVIEWS, FOCUS GROUPS, AND/OR SURVEYS. INDIVIDUALS WITH KNOWLEDGE, INFORMATION, AND/OR EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE CONSULTED, INCLUDING REPRESENTATIVES FROM STATE, LOCAL OR OTHER REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENTS (OR EQUIVALENT DEPARTMENT OR AGENCY) AS WELL AS LEADERS; REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS; AND REPRESENTATIVES FROM LOCAL SCHOOLS, PUBLIC SERVICE ORGANIZATIONS AND BUSINESSES. FOCUS GROUPS WERE CONDUCTED IN ENGLISH AND SPANISH AS NEEDED. FOR A COMPLETE LIST OF INDIVIDUALS WHO PROVIDED INPUT DURING THE CHNA PROCESS, SEE APPENDIX C OF THE CHNA REPORT. PRIMARY DATA WERE COLLECTED AS DESCRIBED ABOVE FROM A VARIETY OF STAKEHOLDERS THROUGH PHONE INTERVIEWS AND FOCUS GROUPS TO IDENTIFY THE MOST SEVERE HEALTH NEEDS AND DRIVERS IN THE EMANATE HEALTH (EH) SERVICE AREA AS WELL AS GEOGRAPHIC DISPARITIES, SUB-POPULATION DISPARITIES AND COMMUNITY ASSETS AND RESOURCES AVAILABLE TO ADDRESS THE IDENTIFIED HEALTH NEEDS AND DRIVERS. SIX FOCUS GROUPS AND TEN PHONE INTERVIEWS WERE CONDUCTED TO COLLECT PRIMARY DATA FROM OVER 50 STAKEHOLDERS THAT INCLUDED COMMUNITY REPRESENTATIVES, HEALTH EXPERTS, LOCAL GOVERNMENT REPRESENTATIVES, LOCAL BUSINESS OWNERS, AND SOCIAL AND HEALTH SERVICE PROVIDERS. PRIMARY DATA WERE INPUTTED INTO MICROSOFT EXCEL DATABASE TO ASSIST IN ORGANIZING THE DATA, CODING AND IDENTIFYING MAJOR THEMES, AND COLLECTING QUOTES. METHODOLOGY FOR INTERPRETATION AND ANALYSIS OF PRIMARY DATA:THE CENTER FOR NONPROFIT MANAGEMENT (CNM) USED A THREE-STEP PROCESS FOR ANALYZING AND INTERPRETING PRIMARY DATA: 1) ALL INFORMATION GATHERED DURING FOCUS GROUPS AND INTERVIEWS WERE ENTERED INTO MICROSOFT EXCEL, 2) SPREADSHEET DATA WERE REVIEWED MULTIPLE TIMES USING CONTENT ANALYSIS TO BEGIN SORTING AND CODING THE DATA, AND 3) THROUGH THE CODING PROCESS, THEMES, CATEGORIES AND QUOTES WERE IDENTIFIED. STEPS TWO AND THREE ARE REPEATED AS OFTEN AS NECESSARY TO RECOGNIZE AS MANY CONNECTIONS AND PATTERNS WITHIN THE DATA AS POSSIBLE. THIS APPROACH PROVIDES A SYSTEMATIC WAY TO IDENTIFY BROAD THEMES WITHIN A LARGE SET OF QUALITATIVE DATA AND BEGIN CODING AND CATEGORIZING DATA AROUND THOSE THEMES (E.G., ACCESS TO CARE, POVERTY, CULTURAL BARRIERS). RESPONSES WERE REVIEWED AND CODED SO THAT COMMON THEMES PULLED FROM THE DATA CAN BE COMBINED WITH QUANTITATIVE DATA TO FORM CONCLUSIONS.

EHMC - QVH AND ICH
PART V, SECTION B, LINE 6A: THE CURRENT CHNA WAS COMPLETED THROUGH COLLABORATION BETWEEN EMANATE HEALTH (WHICH INCLUDES EMANATE HEALTH MEDICAL CENTER AND EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL), CITY OF HOPE, HUNTINGTON HOSPITAL, METHODIST HOSPITAL AND KAISER FOUNDATION HOSPITAL, BALDWIN PARK, CA.

EHMC - QVH AND ICH
"PART V, SECTION B, LINE 11: EMANATE HEALTH'S CHNA 2020-2023 IMPLEMENTATION PLAN'S AREAS OF FOCUS ARE CHRONIC DISEASES/HEALTHY BEHAVIORS; MENTAL HEALTH; HOMELESSNESS; AND ACCESS TO CARE. DUE TO THE 2020-2021 COVID-19 PANDEMIC, SEVERAL OF THE STRATEGIES AND ACTIVITIES WERE PUT ON HOLD DURING THE STAY-AT-HOME MANDATE AND THE CHALLENGES UNDERWENT BY THE HOSPITALS. HOWEVER, EMANATE HEALTH AND ITS COMMUNITY PARTNERS WORKED DILIGENTLY TO IMPLEMENT PART OF THE GOALS AND ACTIVITIES OUTLINED IN THE IMPLEMENTATION PLAN.CHRONIC DISEASES/HEALTH BEHAVIORSSTROKE DISEASE COVID-19 BRIEF THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION REPORTS THAT FOOTHILL PRESBYTERIAN HOSPITAL (FPH) HAS EARNED THE 2020 GET WITH THE GUIDELINES - STROKE GOLD PLUS QUALITY ACHIEVEMENT AWARD AND ALSO QUALIFIED FOR RECOGNITION FOR THE TARGET: TYPE 2 DIABETES HONOR ROLL. THE AWARDS RECOGNIZE FPH'S COMMITMENT AND SUCCESS IN IMPLEMENTING A HIGH STANDARD OF STROKE CARE BY ENSURING THAT THEIR STROKE PATIENTS RECEIVE TREATMENT THAT MEETS NATIONALLY ACCEPTED, EVIDENCE-BASED STANDARDS AND RECOMMENDATIONS. QUEEN OF THE VALLEY HOSPITAL RECEIVED THE GOLD PLUS QUALITY AWARD WITH THE HONOR ELITE DISTINCTION, AS WELL AS THE TARGET: TYPE 2 DIABETES HONOR ROLL. CONGRATULATIONS TO THE DOCTORS, NURSES AND OTHER STAFF ON EMANATE HEALTH'S STROKE TEAM FOR YOUR HARD WORK IN ACHIEVING THIS RECOGNITION.MENTAL HEALTH & HOMELESSNESS-WORKED AND PARTNERED WITH LOS ANGELES SERVICES AUTHORITY AND UNITED WAY FOR A ""HOMELESS PATIENT NAVIGATOR"" TRAINED INDIVIDUAL WHO WOULD VISIT HOSPITALS' HOMELESS PATIENTS AND AT-RISK FOR HOMELESSNESS PATIENTS PRIOR TO THEIR DISCHARGE. THE ROLE OF THE NAVIGATOR IS TO CONDUCT AN ASSESSMENT OF THE PATIENT'S HEALTH AND PSYCHOSOCIAL NEEDS TO CONNECT THEM WITH THE NEEDED SERVICES; I.E. IDENTIFY SHELTER OR HOUSING RESOURCES FOR THE PATIENT BEING DISCHARGED; FOOD ATTAINMENT; FOLLOW-UP MEDICAL APPOINTMENTS AND PRESCRIPTIONS; EMPLOYMENT, ETC. THE NAVIGATOR HAS BEEN GRANTED SPECIAL ACCESS TO THE LA COUNTY RESOURCE SYSTEM AND WORKS UNDER THE HOSPITAL SOCIAL SERVICES LEADERSHIP. -IN PARTNERSHIP WITH FIRST 5 LA'S WELCOME BABY PROGRAM, 1,345 PREGNANT AND POST-PARTUM WOMEN RECEIVED DEPRESSION AND RISK-SCREENING ASSESSMENTS. IT WAS IDENTIFIED THAT 239 WOMEN HAD SIGNS OF DEPRESSION. HOSPITAL LIAISONS CONDUCTED 1,283 BRIDGES FOR NEWBORN ASSESSMENTS WHICH INCLUDE INFORMATION ON DETERMINANTS OF HEALTH FOR THE FAMILY. OF THOSE, 125 WOMEN WERE REFERRED FOR MENTAL HEALTH SERVICES. THE NEW GAD-7 GENERALIZED ANXIETY DISORDER ASSESSMENT WAS ADMINISTERED TO 2,068 WOMEN. ALL SERVICES WERE PROVIDED VIRTUALLY. -IN PARTNERSHIP WITH THE HEALTH CONSORTIUM OF THE SAN GABRIEL VALLEY'S INTEGRATION COMMITTEE, WEBINARS WERE PROVIDED TO THE COMMUNITY BY EXPERT PRESENTERS. 1. THE INTERSECTION OF DIABETES AND DEPRESSION; THIS WEBINAR PRESENTED INFORMATION ON ETHNIC DISPARITIES, THE BI-DIRECTIONAL RELATIONSHIP AND A SUMMARY OF BEST/BETTER PRACTICES TO IMPROVE QUALITY OF CARE. A SECOND WEBINAR WAS OFFERED ON AN INTRODUCTION TO RACE EQUITY IN BEHAVIORAL HEALTHCARE (DEC 2020). THIS PRESENTATION PROVIDED PARTICIPANTS WITH A FOUNDATIONAL UNDERSTANDING OF KEY RACIAL EQUITY TERMS AND CONCEPTS FROM A BEHAVIORAL HEALTH PERSPECTIVE. IT ALSO EXPLORED RACISM AND RACIAL TRAUMA AND THE IMPORTANCE OF APPLYING A RACIAL EQUITY LENS/ANTI-RACIST APPROACH TO ADVANCE SOCIAL JUSTICE."

PART V, SECTION B, LINE 7A CHNA REPORT:
THE CHNA REPORT IS AVAILABLE ON THE HOSPITAL'S WEBSITE HTTPS://WWW.EMANATEHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS/ PLEASE NOTE THAT THE ABOVE LINK IS CASE SENSITIVE. PLEASE USE LOWER CASE LETTERS.

PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY:
THE IMPLEMENTATION STRATEGY IS AVAILABLE ON THE HOSPITAL'S WEBSITE THE HOSPITAL FACILITY'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY (SEE SECTION VIII OF THE 2021 CALIFORNIA COMMUNITY BENEFIT REPORT) POSTED ON WEBSITE BELOW HTTPS://WWW.EMANATEHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS/PLEASE NOTE THAT THE ABOVE LINK IS CASE SENSITIVE. PLEASE USE LOWER CASE LETTERS.

PART V, SECTION B, LINE 11:
FOR THE 2019-2021 CHNA CYCLE, A COLLABORATIVE OF NONPROFIT HOSPITALS LOCATED IN THE SAN GABRIEL VALLEY OF LOS ANGELES COUNTY, CALIFORNIA (THE SPA 3 HOSPITAL COLLABORATIVE) COMMITTED TO PARTICIPATE IN A JOINT CHNA DATA COLLECTION PROCESS. THE INTENT WAS TO FACILITATE THE DEVELOPMENT OF A COORDINATED EFFORT TO COLLABORATIVELY ADDRESS PRIORITY HEALTH NEEDS THROUGH THEIR JOINT IMPLEMENTATION STRATEGIES MOVING FORWARD. THE SPA 3 HOSPITAL COLLABORATIVE AGREED TO SHARE AMONG ALL PARTICIPATING HOSPITALS THE PRIMARY DATA COLLECTED THROUGH THE CHNA CYCLE. ADDITIONALLY, THE HOSPITALS IDENTIFIED A LIMITED LIST OF SUBPOPULATIONS THEY WANTED TO TARGET THROUGH QUALITATIVE DATA COLLECTION EFFORTS (BOTH INDIVIDUAL INTERVIEWS AND FOCUS GROUPS). TOGETHER, THE SPA 3 HOSPITAL COLLABORATIVE AGREED ON A CORE SET OF QUESTIONS TO BE ASKED ACROSS ALL INTERVIEWS AND FOCUS GROUPS, AND DEVELOPED A LIST OF TOPICS OF INTEREST SPECIFIC TO EACH INTERVIEW OR FOCUS GROUP THAT WOULD LEAD TO A MORE DETAILED UNDERSTANDING OF THE SPECIFIC HEALTH NEEDS OF THE TARGET GROUP REPRESENTED IN THE ENGAGEMENT. THE NEW FEDERAL CHNA REQUIREMENTS HAVE PROVIDED AN OPPORTUNITY TO REVISIT THE NEEDS ASSESSMENT AND STRATEGIC PLANNING PROCESSES WITH AN EYE TOWARD ENHANCED COMPLIANCE AND TRANSPARENCY AND LEVERAGING EMERGING TECHNOLOGIES. THE INTENTION IS TO DEVELOP AND IMPLEMENT A TRANSPARENT, RIGOROUS, AND WHENEVER POSSIBLE, COLLABORATIVE APPROACH TO UNDERSTANDING THE NEEDS AND ASSETS IN OUR COMMUNITIES. FROM DATA COLLECTION AND ANALYSIS TO THE IDENTIFICATION OF PRIORITIZED NEEDS AND THE DEVELOPMENT OF AN IMPLEMENTATION STRATEGY, THE INTENT WAS TO DEVELOP A RIGOROUS PROCESS THAT WOULD YIELD MEANINGFUL RESULTS. REVIEW AND COMPILATION OF SECONDARY DATA WAS CONDUCTED THROUGH MULTIPLE SOURCES THAT PROVIDE ACCESS TO PUBLICLY AVAILABLE INDICATORS INCLUDING SOCIAL AND ECONOMIC FACTORS, HEALTH BEHAVIORS, PHYSICAL ENVIRONMENT, CLINICAL CARE, AND HEALTH OUTCOMES. PRIMARY DATA WERE COLLECTED THROUGH KEY INFORMANT INTERVIEWS, FOCUS GROUPS AND SURVEYS. THIS CONSISTED OF REACHING OUT TO LOCAL PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS AND RESIDENTS TO IDENTIFY ISSUES THAT MOST IMPACTED THE HEALTH OF THE COMMUNITY. THE CHNA PROCESS ALSO INCLUDED AN IDENTIFICATION OF EXISTING COMMUNITY ASSETS AND RESOURCES TO ADDRESS THE HEALTH NEEDS. IN CONJUNCTION WITH THIS REPORT, EMANATE HEALTH HAS DEVELOPED AN IMPLEMENTATION STRATEGY FOR THE PRIORITY HEALTH NEEDS THE HOSPITAL WOULD ADDRESS. THESE STRATEGIES ARE BUILT ON EMANATE HEALTH'S ASSETS AND RESOURCES, AS WELL AS EVIDENCE-BASED STRATEGIES, WHEREVER POSSIBLE.

PART V, LINE 16A, CHARITY CARE/FAP:
HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/EMANATE-HEALTH-SITE-360/MEDIA/1850/A009-CHARITY-CARE-2020-ENGLISH.PDFHOW AMOUNTS GENERALLY BILLED (AGB) IS CALCULATED HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/EMANATE-HEALTH-SITE-360/MEDIA/1366/EMANATE-HEALTH-AMOUNTS-GENERALLY-BILLED-AGB-2019-ENGLISH.PDFPLEASE NOTE THAT THE ABOVE LINKS ARE CASE SENSITIVE. PLEASE USE LOWER CASE LETTERS.

PART V, LINE 16B APPLICATION FORM URL:
HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/EMANATE-HEALTH-SITE-360/MEDIA/1380/EMANATE-HEALTH-FINANCIAL-ASSISTANCE-APPLICATION-ENGLISH.PDFPLEASE NOTE THAT THE ABOVE LINK IS CASE SENSITIVE. PLEASE USE LOWER CASE LETTERS.

PART V, LINE 16C PLAIN LANGUAGE SUMMARY PAGE:
HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/EMANATE-HEALTH-SITE-360/MEDIA/1365/EMANATE-HEALTH-FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SUMMARY-2019-ENGLISH.PDFPLEASE NOTE THAT THE ABOVE LINK IS CASE SENSITIVE. PLEASE USE LOWER CASE LETTERS.

PART I, LINE 3C:
ELIGIBILITY CRITERIA AND AMOUNTS CHARGED TO PATIENTS.SERVICES ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP) WILL BE MADE AVAILABLE TO THE PATIENT ON A SLIDING FEE SCALE, IN ACCORDANCE WITH FINANCIAL NEED, AS DETERMINED IN REFERENCE TO FEDERAL POVERTY LEVELS (FPL) IN EFFECT AT THE TIME OF DETERMINATION.-PATIENTS WITH MONETARY ASSETS OR INCOME LEVEL AT 350% OR LESS OF THE FPL, WILL HAVE THE ENTIRE HOSPITAL BILL WRITTEN OFF REGARDLESS OF NET WORTH OR SIZE OF BILL;-PATIENTS WITH MONETARY ASSETS OR INCOME LEVEL BETWEEN 350% AND 500% OF THE FPL, WILL HAVE A PORTION OF THE HOSPITAL BILL WRITTEN OFF, BASED UPON THE SLIDING SCALE SET FORTH BELOW REGARDLESS OF NET WORTH OR SIZE OF BILL:351% - 400% = 75% WRITE-OFF401% - 450% = 50% WRITE-OFF451% - 500% = 25% WRITE OFF-PATIENTS WITH HOSPITAL BILL THAT EXCEEDS THE PATIENT'S MONETARY ASSETS OR NET WORTH MAY QUALIFY AND BE COVERED UNDER THIS POLICY USING THE GUIDELINES BELOW:- PATIENTS WITH MONETARY ASSETS OR NET INCOME LEVELS BETWEEN 351% AND 400% OF THE FPL, THE AMOUNT OF THE HOSPITAL BILL THAT EXCEEDS THE PATIENT'S NET WORTH WILL BE WRITTEN-OFF; - PATIENTS WITH MONETARY ASSETS OR INCOME IS OVER THE 401% OF THE FPL, PORTION OF THE HOSPITAL BILL THAT EXCEEDS THE PATIENT'S NET WORTH MAY BE: - WRITTEN-OFF UPON APPROVAL OF THE VP OF REVENUE CYCLE OR HIS/HER DESIGNEE; OR - ARRANGED FOR PAYMENT WITH THE PATIENT THROUGH MONTHLY PAYMENT PLAN. FOR PURPOSES OF DETERMINING MONETARY ASSETS OR INCOME, THE REVIEW SHALL NOT INCLUDE THE:A. RETIREMENT OR DEFERRED COMPENSATION PLANS QUALIFIED UNDER THE INTERNAL REVENUE CODE, OR NON-QUALIFIED DEFERRED COMPENSATION PLANS;B. FIRST TEN THOUSAND DOLLARS ($10,000) OF A PATIENT'S MONETARY ASSETS;C. FIFTY PERCENT (50%) OF A PATIENT'S MONETARY ASSETS OVER THE FIRST $10,000.

PART I, LINE 6A:
THE SOLE MEMBER OF THIS ORGANIZATION IS EMANATE HEALTH, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. EMANATE HEALTH PREPARED AN ANNUAL WRITTEN COMMUNITY BENEFIT REPORT THAT DESCRIBES THE HOSPITAL'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY THE HOSPITAL.

PART I, LINE 7:
"MANY GOVERNMENT PROGRAMS (MEDI-CAL AND MEDICARE) AND OTHER THIRD PARTY COVERAGE PROGRAMS HAVE BEEN ESTABLISHED TO PROVIDE FOR OR DEFRAY THE HEALTHCARE COSTS FOR THE INDIVIDUALS WHO ALSO MAY BE CONSIDERED NEEDY. IN THE CASE WHERE ARRANGEMENTS FOR PAYMENT TO THE HOSPITAL REQUIRE THE HOSPITAL TO ACCEPT THE PAYMENT AMOUNT AS PAYMENT IN FULL, THE BALANCES OF THESE ACCOUNTS WRITTEN OFF ARE ATTRIBUTABLE TO CONTRACTUAL ADJUSTMENTS AND WILL NOT BE CONSIDERED CHARITY CARE. IN CASES WHERE THESE PROGRAMS REQUIRE THE PATIENTS TO PAY CO-PAYMENTS OR DEDUCTIBLES AND THE PATIENTS DO NOT HAVE THE ABILITY TO PAY; THESE AMOUNTS WILL BE CONSIDERED CHARITY CARE.CHARITY DETERMINATION WILL BE GRANTED ON ""ALL, PARTIAL, OR NOTHING BASIS"". THERE IS A CATEGORY OF PATIENTS WHO QUALIFY FOR MEDI-CAL, BUT DO NOT RECEIVE PAYMENT FOR THEIR ENTIRE STAY. UNDER THE CHARITY POLICY DEFINITION, THESE PATIENTS ARE ELIGIBLE FOR CHARITY CARE WRITE-OFFS. IN ADDITION, THE HOSPITAL SPECIFICALLY INCLUDES AS CHARITY THE CHARGES RELATED TO DENIED STAYS, DENIED DAYS OF CARE, AND NON-COVERED SERVICES. THESE ""TREATMENT AUTHORIZATION REQUEST"" DENIALS AND ANY LACK OF PAYMENT FOR NON-COVERED SERVICES PROVIDED TO MEDI-CAL PATIENTS ARE TO BE CLASSIFIED AS CHARITY. THESE PATIENTS ARE RECEIVING THE SERVICES AND THEY DO NOT HAVE THE ABILITY TO PAY FOR IT. IN ADDITION, MEDICARE PATIENTS WHO HAVE MEDI-CAL COVERAGE FOR THEIR CO-INSURANCE/DEDUCTIBLES, FOR WHICH MEDI-CAL DOES NOT MAKE PAYMENT AND MEDICARE DOES NOT ULTIMATELY PROVIDE BAD DEBT REIMBURSEMENT WILL ALSO BE INCLUDED AS CHARITY. THESE INDIGENT PATIENTS ARE RECEIVING A SERVICE FOR WHICH A PORTION OF THE RESULTING BILL IS NOT BEING REIMBURSED.THE ABOVE CHARITY WRITE-OFFS ARE CONVERTED INTO CHARITY COST USING THE COST TO CHARGE RATIO WHICH WAS DERIVED FROM WORKSHEET 2 OF THE INSTRUCTIONS TO THE IRS SCHEDULE H, ""RATIO OF PATIENT CARE COST-TO-CHARGES.""INCLUDED IN PART I, LINE 7B ARE NET SUPPLEMENTAL MEDI-CAL PAYMENTS OF $51,233,947 FROM THE CALIFORNIA HOSPITAL FEE PROGRAM (""PROGRAM""). CALIFORNIA LEGISLATION ESTABLISHED THE PROGRAM TO IMPOSE A QUALITY ASSURANCE FEE ON CERTAIN GENERAL ACUTE CARE HOSPITALS IN ORDER TO MAKE SUPPLEMENTAL AND GRANT PAYMENTS AND INCREASED CAPITATION PAYMENTS (SUPPLEMENTAL PAYMENTS) TO HOSPITALS UP TO THE AGGREGATE UPPER PAYMENT LIMIT FOR VARIOUS PERIODS. SEVERAL PIECES OF LEGISLATION HAVE BEEN ENACTED TO CREATE THE PROGRAM FOR VARIOUS PERIODS OF TIME.THE PROGRAM IS DESIGNED TO MAKE SUPPLEMENTAL INPATIENT AND OUTPATIENT MEDI-CAL PAYMENTS TO PRIVATE HOSPITALS, INCLUDING ADDITIONAL PAYMENTS FOR CERTAIN FACILITIES THAT PROVIDE HIGH-ACUITY CARE AND TRAUMA SERVICES TO THE MEDI-CAL POPULATION. THE PROGRAM PROVIDES A MECHANISM FOR INCREASING PAYMENTS TO HOSPITAL THAT SERVE MEDI-CAL PATIENTS, WITH NO IMPACT ON THE STATE'S GENERAL FUND. SOME OF THESE PAYMENTS ARE MADE DIRECTLY BY THE STATE, WHILE OTHERS ARE MADE BY MEDI-CAL MANAGED CARE PLANS, WHICH WILL RECEIVE INCREASED CAPITATION RATES FROM THE STATE IN AMOUNTS EQUAL TO THE SUPPLEMENTAL PAYMENTS. OUTSIDE OF THE LEGISLATION, THE CALIFORNIA HOSPITAL ASSOCIATION (CHA) HAS CREATED A PRIVATE PROGRAM, OPERATED BY THE CALIFORNIA HEALTH FOUNDATION AND TRUST (CHFT), WHICH WAS ESTABLISHED TO ALLEVIATE DISPARITIES POTENTIALLY RESULTING FROM THE IMPLEMENTATION OF THE PROGRAMS.THERE ARE TWO PROGRAMS THAT HAD ACTIVITY IN 2021 AND 2020: A 30-MONTH HOSPITAL FEE PROGRAM COVERING THE PERIOD FROM JANUARY 1, 2017 THROUGH JUNE 30, 2019, AND A 30-MONTH HOSPITAL FEE PROGRAM COVERING THE PERIOD FROM JULY 1, 2019 THROUGH DECEMBER 31, 2021. EMANATE HEALTH MEDICAL CENTER (EHMC) PROVIDED APPROXIMATELY 39,000 DAYS OF QUALITY HEALTH CARE SERVICES TO MEDI-CAL BENEFICIARIES ANNUALLY.EHMC IS ONE OF THE LARGEST PROVIDERS OF CARE TO MEDI-CAL ENROLLEES IN SOUTHERN CALIFORNIA. DUE TO DEEP FUNDING CUTS TO THE MEDI-CAL PROGRAM, AS WELL AS HISTORICAL LOW LEVELS OF REIMBURSEMENT AND HIGH RATE OF DENIALS, THE HOSPITAL FEE PROGRAM HAS BEEN CRITICAL IN HELPING EHMC TO CONTINUE PROVIDING QUALITY HEALTH CARE SERVICES TO THE POOREST AND MOST VULNERABLE POPULATION IN THE COMMUNITY. THE PROGRAM REMAINS CRUCIAL IN MAINTAINING MEDI-CAL SERVICES AND CHARITY PROVIDED BY OUR HOSPITAL TO THE COMMUNITY'S LOW INCOME POPULATION, AND IT IS VITAL TO EHMC THAT FUTURE SIMILAR PROGRAMS BE APPROVED AND IMPLEMENTED.PART I, LINE 7F:HEALTH PROFESSION EDUCATION - IN AN EFFORT TO CREATE A HEALTHY COMMUNITY IN THE EAST SAN GABRIEL VALLEY AREA, EMANATE HEALTH HAS OFFERED A NUMBER OF SPECIAL EVENTS, LECTURES AND CLASSES TO HELP EDUCATE THE COMMUNITY TO IMPROVE THEIR HEALTH, SCHOLARSHIPS FOR NURSING STUDENTS AND OTHER HEALTH RELATED PROGRAMS THAT EDUCATE HEALTH PROFESSIONALS IN THE BROADER COMMUNITY. IN NOVEMBER 2016, THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) OFFICIALLY ANNOUNCED ITS APPROVAL TO ACCREDIT A FAMILY MEDICINE RESIDENCY PROGRAM AT EMANATE HEALTH. IN ADDITION, EMANATE HEALTH OFFICIALLY ENTERED INTO AN AFFILIATION WITH USC'S KECK SCHOOL OF MEDICINE AND ITS DEPARTMENT OF FAMILY MEDICINE. THIS AFFILIATION PROVIDES OPPORTUNITIES FOR MEDICAL RESEARCH AND EDUCATIONAL OPPORTUNITIES FOR THE SCHOOL'S STUDENTS, WHILE ALSO ALLOWING EMANATE HEALTH PHYSICIANS WHO FUNCTION AS VOLUNTARY FACULTY TO OUR RESIDENTS TO ALSO BECOME VOLUNTARY FACULTY FOR USC'S DEPARTMENT OF FAMILY MEDICINE. THE TEN FIRST-YEAR RESIDENT POSITIONS IN OUR CHARTER CLASS STARTED TRAINING AT OUR HOSPITALS AND AT EAST VALLEY COMMUNITY HEALTH CENTER IN JULY - 2017, AND THE NUMBER OF RESIDENTS INCREASED TO 30 POSITIONS IN 2021."

PART I, LINE 7G:
"THE AMOUNT INCLUDED IN THIS LINE IS THE NET COST OF THE SUBSIDIZED HEALTH SERVICES PROGRAM CALLED ""NEONATAL SLEEP APNEA"" WHICH TREATMENT INCORPORATES STUDIES THAT FURTHER SCIENCE'S UNDERSTANDING OF THE APNEA ILLNESS IN NEWBORNS."

PART III, LINE 2:
STATEMENT REGARDING COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III - REGARDING CARE OF THE POOR AND COMMUNITY BENEFIT REPORT:EMANATE HEALTH HAS A POLICY TO TREAT EMERGENCY PATIENTS REGARDLESS OF ABILITY TO PAY. A PATIENT IS CLASSIFIED AS A CHARITY PATIENT IN ACCORDANCE WITH CERTAIN ESTABLISHED POLICIES OF THE CORPORATION. ESSENTIALLY, THESE POLICIES DEFINE CHARITY SERVICES AS THOSE SERVICES FOR WHICH NO PAYMENT IS ANTICIPATED BECAUSE OF INABILITY TO PAY. EMANATE HEALTH PROVIDES PROGRAMS AND ACTIVITIES THAT CONTRIBUTE TO CHARITY CARE, CARE OF THE POOR, AND COMMUNITY BENEFIT. THESE PROGRAMS AND ACTIVITIES SERVE A MAJORITY OF PERSONS WHO ARE BENEFICIARIES OF MEDI-CAL AND COUNTY/STATE PROGRAMS FOR THE MEDICALLY INDIGENT. ALSO INCLUDED ARE ACTIVITIES THAT IMPROVE THE COMMUNITY'S HEALTH STATUS, AND EDUCATE OR PROVIDE SOCIAL SERVICES TO THE ELDERLY AND CHILDREN. EMANATE HEALTH USES 3 CATEGORIES TO CLASSIFY CARE OF THE POOR AND COMMUNITY BENEFIT: CATEGORY 1: TRADITIONAL CHARITY CARE - CARE OF THE POOR INCLUDES SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED. THIS WRITE-OFF IS ARRANGED BEFORE THE CARE IS GIVEN WHEN POSSIBLE. IF THERE IS ANY SUBSIDY DONATED FOR THESE SERVICES, THAT AMOUNT IS DEDUCTED FROM THE GROSS AMOUNT. CATEGORY 2: UNPAID COST OF PUBLIC PROGRAMS - THIS AMOUNT REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PATIENTS IN THE MEDI-CAL PROGRAM AND ENROLLED IN HMO AND PPO PLANS UNDER CONTRACT WITH THE MEDI-CAL PROGRAM. CATEGORY 3: COMMUNITY BENEFIT - SERVICES THAT ARE BENEFICIAL TO THE BROADER COMMUNITY, IE., OTHER NEEDY POPULATIONS THAT MAY NOT QUALIFY AS POOR BUT THAT NEED SPECIAL SERVICES AND SUPPORT. EXAMPLES INCLUDE THE ELDERLY, SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH AIDS. THEY ALSO INCLUDE THE COST OF HEALTH PROMOTION AND EDUCATION, AND HEALTH CLINICS AND SCREENINGS. CHARITY AMOUNT IS INCLUDED IN PART I, LINE 7.STATEMENT REGARDING BAD DEBT EXPENSE:THE POLICY OF EMANATE HEALTH IS TO PROVIDE OUR UNINSURED AND UNDERINSURED PATIENTS THE SAME ALLOWANCES PROVIDED TO ITS MANAGED CARE CONTRACTORS. THAT IS, THOSE PATIENTS SHALL HAVE APPLIED TO THEIR ACCOUNTS APPROPRIATE ALLOWANCES AND PER DIEM RATES. EMANATE HEALTH IS TO FOLLOW UP ON AND COLLECT ALL SELF PAY ACCOUNT BALANCES, AS WELL AS, WHERE THIRD PARTY BENEFITS EXIST, ALL PATIENT CO-PAYS AND DEDUCTIBLES, EITHER AT THE TIME OF SERVICE, OR WHEN THEY BECOME DUE. THIS SHALL BE ACCOMPLISHED IN A FAIR, CARING AND COMPASSIONATE MANNER. THE RESULTING NET REALIZABLE BALANCE ON THESE ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL COLLECTION EFFORTS AND FOLLOW UP ATTEMPTS HAVE BEEN MADE. EMANATE HEALTH RECOGNIZES BAD DEBT EXPENSE BASED UPON ITS HISTORICAL EXPERIENCE.

PART III, LINE 8:
MEDICARE COST REPORT WAS USED TO REPORT THE MEDICARE REVENUE AND MEDICARE ALLOWABLE COSTS. THE MEDICARE RAC (RECOVERY AUDIT CONTRACTORS) AMOUNT RETRACTED BY MEDICARE IN THE CURRENT YEAR FOR THE SERVICES PROVIDED TO THE MEDICARE PATIENTS IN THE PRIOR YEARS WAS NOT OFFSET AGAINST THE MEDICARE REVENUE IN THE CURRENT YEAR. MEDICARE ALLOWABLE COSTS TEND TO UNDERSTATE THE ACTUAL COSTS WHICH INCLUDED CERTAIN COST DISALLOWANCES AND NON-REIMBURSABLE COST CENTERS SUCH AS NON-ALLOWABLE PHYSICIAN FEES, CAFETERIA COSTS, MANAGED CARE OUT-OF-AREA MEDICAL CLAIMS, HOME OFFICE'S MANAGEMENT FEES ADJUSTMENT, MAMMOGRAPHY CLINIC, NON-ALLOWABLE MEALS, HOME OFFICE BUILDING COSTS, AND OTHER NON-ALLOWABLE EXPENSES. IF THE ESTIMATED ADDITIONAL ALLOCATED DISALLOWABLE MEDICARE COSTS OF $10,526,000 WERE INCLUDED IN LINE 5 AND LINE 6 RESPECTIVELY, THE SHORTFALL ON LINE 7 WOULD BE $(7,451,415).

PART III, LINE 9B:
EMANATE HEALTH OFFERS THE FOLLOWING COVERAGE OPTIONS WHICH ARE ALWAYS EXPLORED IN ASSESSING PATIENTS' ABILITY TO PAY:A) LINKAGE TO AVAILABLE STATE AID SUCH AS: (I) MEDI-CAL, (II) CALIFORNIA CHILDREN SERVICES, (III) COVERED CALIFORNIA, (IV) OTHERB) PATIENTS UNDER AGE TWENTY ONE YEARS, WHO ARE SELF PAY, SHALL BE REFERRED TO THE ONSITE MEDI-CAL ELIGIBILITY WORKER OR TO EITHER OF OUR CONTRACTED VENDORS FOR COMPLETION OF A MEDI-CAL APPLICATION AND/OR THE ON SITE GEM (GET ELIGIBILITY MOVING) PROGRAM.C) ALL OBSTETRICAL PATIENTS WHO ARE SELF PAY AND UNABLE TO MEET THEIR FINANCIAL OBLIGATION SHALL BE REFERRED TO THE ONSITE MEDI-CAL ELIGIBILITY WORKER OR TO EITHER OF OUR CONTRACTED VENDORS FOR COMPLETION OF A MEDI-CAL APPLICATION AND/OR THE ON SITE GEM PROGRAM.FOR THOSE PATIENTS WHO QUALIFY FOR CHARITY CARE ACCORDING TO EMANATE HEALTH'S CHARITY CARE POLICY, THE PATIENT ACCOUNTS WOULD BE WRITTEN OFF TO CHARITY AND THE PATIENTS WOULD NOT BE BILLED.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

PART III, LINE 4:
TEXT OF THE FOOTNOTE TO THE CONSOLIDATED FINANCIAL STATEMENTS REGARDING BAD DEBT EXPENSE:PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION EMANATE EXPECTS TO BE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS IN EXCHANGE FOR PROVIDING PATIENT CARE. PROVIDING PATIENT CARE SERVICES IS CONSIDERED A SINGLE PERFORMANCE OBLIGATION, SATISFIED OVER TIME, IN BOTH THE INPATIENT AND OUTPATIENT SETTING. GENERALLY, EMANATE BILLS THE PATIENTS AND THIRD-PARTY PAYORS SEVERAL DAYS AFTER SERVICES ARE PERFORMED AND/OR WHEN THE PATIENT IS DISCHARGED FROM THE FACILITY. REVENUE FOR INPATIENT ACUTE CARE SERVICES IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL EXPECTED, OR ACTUAL, CHARGES. EMANATE MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE. AS ALL EMANATE'S PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR, EMANATE ELECTED TO APPLY THE OPTIONAL EXEMPTION PROVIDED IN ACCOUNTING STANDARDS CODIFICATION (ASC) 606, REVENUE FROM CONTRACTS WITH CUSTOMERS, AND, THEREFORE, IS NOT REQUIRED TO DISCLOSE THE AGGREGATE AMOUNT OF THE TRANSACTION PRICE ALLOCATED TO PERFORMANCE OBLIGATIONS THAT ARE UNSATISFIED OR PARTIALLY SATISFIED AT THE END OF THE REPORTING PERIOD, WHICH ARE PRIMARILY RELATED TO INPATIENT ACUTE CARE SERVICES AT THE END OF THE REPORTING PERIOD. THE PERFORMANCE OBLIGATIONS FOR THESE CONTRACTS ARE GENERALLY COMPLETED WHEN THE PATIENTS ARE DISCHARGED, WHICH GENERALLY OCCURS WITHIN DAYS OR WEEKS OF THE END OF THE REPORTING PERIOD. FOR PATIENTS COVERED BY THIRD-PARTY PAYORS, EMANATE DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THOSE THIRD-PARTY PAYORS. EMANATE DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE.LAWS AND REGULATIONS CONCERNING GOVERNMENT PROGRAMS, INCLUDING MEDICARE AND MEDICAID, ARE COMPLEX AND SUBJECT TO VARYING INTERPRETATIONS. EMANATE IS SUBJECT TO RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS, AND INVESTIGATIONS. IN ADDITION, THE CONTRACTS EMANATE HAS WITH COMMERCIAL PAYORS ALSO PROVIDE FOR A RETROACTIVE AUDIT AND REVIEW OF CLAIMS. SETTLEMENTS WITH THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE CONSIDERED VARIABLE CONSIDERATION AND ARE INCLUDED IN THE DETERMINATION OF THE ESTIMATED TRANSACTION PRICE FOR PROVIDING PATIENT CARE. THESE SETTLEMENTS ARE ESTIMATED BASED ON THE TERMS OF THE PAYMENT AGREEMENT WITH THE PAYOR, CORRESPONDENCE WITH THE PAYOR, AND EMANATE'S HISTORICAL SETTLEMENT ACTIVITY, ATTEMPTING TO ENSURE THAT A SIGNIFICANT REVENUE REVERSAL WILL NOT OCCUR WHEN THE FINAL AMOUNTS ARE SUBSEQUENTLY DETERMINED. ESTIMATED SETTLEMENTS ARE ADJUSTED IN FUTURE PERIODS AS NEW INFORMATION BECOMES AVAILABLE, OR AS YEARS ARE SETTLED OR ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, AND INVESTIGATIONS. GENERALLY, PATIENTS COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH IS REFERRED TO AS THE PATIENT PORTION. EMANATE ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT FROM STANDARD CHARGES IN ACCORDANCE WITH ITS POLICIES. CONSISTENT WITH EMANATE'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, EMANATE HAS DETERMINED THAT IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES, SUCH AS COPAY AND DEDUCTIBLES. THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS EXPECTED TO BE COLLECTED BASED ON EMANATE'S COLLECTION HISTORY WITH THOSE PATIENTS IS RECORDED AS IMPLICIT PRICE CONCESSIONS, OR AS A DIRECT REDUCTION TO NET PATIENT SERVICE REVENUE. SUBSEQUENT ADJUSTMENTS THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT OR PAYOR'S ABILITY TO PAY ARE RECOGNIZED AS BAD DEBT EXPENSE. WITH THE ADOPTION OF ASC 606, BAD DEBT EXPENSE IS INCLUDED WITHIN OTHER EXPENSE IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS, RATHER THAN AS A DEDUCTION TO ARRIVE AT REVENUE. BAD DEBT EXPENSE FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020 WAS NOT MATERIAL FOR EMANATE. EMANATE ESTIMATES THE TRANSACTION PRICE FOR THE PATIENT PORTION AND UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY ASSISTANCE: THE HOSPITAL EMPLOYS A VARIETY OF METHODS TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY POSTING ITS CHARITY CARE POLICIES IN PUBLIC PLACES AND PROVIDING PATIENTS WITH WRITTEN NOTICE ABOUT THEIR FINANCIAL OPTIONS, INCLUDING THE AVAILABILITY OF DISCOUNTS, PAYMENT PLANS AND PUBLIC INSURANCE PROGRAMS SUCH AS MEDI-CAL, HEALTHY KIDS, HEALTHY FAMILIES, ACCESS FOR INFANTS AND MOTHERS PROGRAM AND OTHER OPTIONS. SINCE 1991, EMANATE HEALTH'S GEM (GET ENROLLMENT MOVING PROJECT) HAS BEEN A LEADER IN THE SAN GABRIEL VALLEY IN CONNECTING FAMILIES AND INDIVIDUALS WITH ACCESS TO FREE OR LOW-COST HEALTH INSURANCE, AS WELL AS REFERRALS TO OTHER HEALTH ACCESS PROGRAMS FOR THE UNINSURED. THE GEM PROJECT PARTNERS WITH PROMOTORAS (BILINGUAL HEALTH PROMOTERS), SCHOOLS, CHILD-CARE AGENCIES, CHURCHES, FAMILY RESOURCE CENTERS, CLINICS, COMMUNITY BASED ORGANIZATION, ETC. TO IDENTIFY UNINSURED CHILDREN AND ADULTS, AND PROVIDE INSURANCE ENROLLMENT SERVICES IN THE GEM OFFICE AND AT THE OFF-SITE COMMUNITY LOCATIONS. IN ADDITION, THE HOSPITAL HAS OUTREACH PROGRAMS TO LOW INCOME VULNERABLE POPULATIONS VIA DOOR-TO-DOOR, COMMUNITY SITES AND EVENTS. EMANATE HEALTH ALSO SUPPORTS ECHO (EVERY CHILD'S HEALTH OPTION) PROGRAM WHICH PROVIDES URGENT AND SPECIALTY CARE TO UNINSURED CHILDREN.

PART VI, LINE 2:
"2019 NEEDS ASSESSMENT THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) ENACTED ON MARCH 23, 2010, INCLUDED NEW REQUIREMENTS FOR NONPROFIT HOSPITALS IN ORDER TO MAINTAIN TAX EXEMPT STATUS. THE PROVISION WAS THE SUBJECT OF FINAL REGULATIONS PROVIDING GUIDANCE ON THE REQUIREMENTS OF SECTION 501(R) OF THE INTERNAL REVENUE CODE. INCLUDED IN THE NEW REGULATIONS IS A REQUIREMENT THAT ALL NONPROFIT HOSPITALS MUST CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND DEVELOP AN IMPLEMENTATION STRATEGY (IS) EVERY THREE YEARS. WHILE EMANATE HEALTH HAS CONDUCTED CHNAS FOR MANY YEARS TO IDENTIFY NEEDS AND RESOURCES IN OUR COMMUNITIES AND TO GUIDE OUR COMMUNITY BENEFIT PLANS, THESE NEW REQUIREMENTS HAVE PROVIDED AN OPPORTUNITY TO REVISIT OUR NEEDS ASSESSMENT AND STRATEGIC PLANNING PROCESSES WITH AN EYE TOWARD ENHANCING COMPLIANCE AND TRANSPARENCY AND LEVERAGING EMERGING TECHNOLOGIES. THE CHNA PROCESS UNDERTAKEN IN 2019 AND DESCRIBED IN THIS REPORT WAS CONDUCTED IN COMPLIANCE WITH CURRENT FEDERAL REQUIREMENTS. SUMMARY OF COMMUNITY IDENTIFIED NEEDS HEALTH OUTCOMES AND DRIVERS ALSO KNOWN AS SOCIAL DETERMINANTS OF HEALTH ARE INTERCONNECTED AND CAN NEGATIVELY OR POSITIVELY IMPACT INDIVIDUAL HEALTH. THEY INCLUDE SOCIAL AND ECONOMIC FACTORS THAT OFTEN CONTRIBUTE TO THE ABILITY OR INABILITY OF CERTAIN POPULATIONS OR GROUPS TO ACCESS THE NECESSARY CARE NEEDED TO DIAGNOSE, TREAT AND PREVENT POOR HEALTH. THEREFORE, IT IS IMPORTANT THAT THESE FACTORS BE TAKEN INTO CONSIDERATION WHEN DEVELOPING HEALTH STRATEGIES AND PROGRAMS TO ADDRESS HEALTH NEEDS. THE FOLLOWING IS A LIST OF 10 IDENTIFIED COMMUNITY NEEDS (HEALTH OUTCOMES AND SOCIAL DETERMINANTS OF HEALTH) THAT RESULTED FROM THE ANALYSIS OF PRIMARY AND SECONDARY DATA, OBSERVATIONS OF DISPARITIES, AND REVIEW OF THE PREVIOUS 2016 EMANATE HEALTH CHNA FINDINGS. ACCESS TO CARE CANCER CHRONIC DISEASES (HEART DISEASE & STROKE, DIABETES) ECONOMIC AND FOOD INSECURITY EXERCISE, NUTRITION, AND WEIGHT (OBESITY) HOMELESSNESS AND HOUSING INSTABILITY MENTAL HEALTH ORAL HEALTH SENIOR SERVICES SUBSTANCE ABUSE/TOBACCO USE SUMMARY OF NEEDS ASSESSMENT METHODOLOGY AND PROCESS IDENTIFICATION THE 2019 CHNA NEEDS ASSESSMENT METHODOLOGY AND PROCESS INVOLVED A MIXED-METHODS APPROACH THAT INCLUDED THE COLLECTION OF BOTH SECONDARY DATA AND PRIMARY DATA. SECONDARY DATA INDICATORS ON A VARIETY OF HEALTH, SOCIAL, ECONOMIC, AND ENVIRONMENTAL TOPICS WERE COLLECTED BY ZIP CODE, SERVICE PLANNING AREA (SPA)1, COUNTY, AND STATE LEVELS (AS AVAILABLE). IN MOST CASES, VALUES PRESENTED FOR THE EMANATE HEALTH SERVICE AREA WERE CALCULATED BY AGGREGATING VALUES OF SMALLER GEOGRAPHIC UNITS (E.G., ZIP CODES, CENSUS TRACTS) WHICH FALL WITHIN THE SERVICE AREA BOUNDARY. WHEN ONE OR MORE GEOGRAPHIC UNITS ARE NOT ENTIRELY ENCOMPASSED BY A SERVICE AREA, THE MEASURE IS AGGREGATED PROPORTIONALLY. THE OPTIONS FOR WEIGHING ""SMALL AREA ESTIMATIONS"" ARE BASED ON TOTAL AREA, TOTAL POPULATION, AND DEMOGRAPHIC GROUP POPULATION. PRIMARY DATA COLLECTION CONSISTED OF REACHING OUT TO LOCAL PUBLIC HEALTH EXPERTS, COMMUNITY LEADERS, AND RESIDENTS TO IDENTIFY ISSUES THAT MOST AFFECTED THE HEALTH OF THE COMMUNITY. THE CHNA PROCESS ALSO INCLUDED AN IDENTIFICATION OF EXISTING COMMUNITY ASSETS AND RESOURCES TO ADDRESS THE IDENTIFIED HEALTH NEEDS. IN ORDER TO BE INCLUDED IN THE LIST OF IDENTIFIED HEALTH NEEDS, A HEALTH OUTCOME OR DRIVER HAD TO MEET TWO REQUIREMENTS: IT HAD TO BE MENTIONED IN THE PRIMARY DATA COLLECTION MORE THAN ONCE AND A SECONDARY DATA INDICATOR ASSOCIATED WITH THE HEALTH OUTCOME AND/OR DRIVER NEEDED TO PERFORM POORLY AGAINST A DESIGNATED BENCHMARK (COUNTY AVERAGE, STATE AVERAGE, OR HEALTHY PEOPLE 2020 GOAL). PRIORITIZATION THE PRIORITIZATION THAT IS OUTLINED IN THIS REPORT IS BASED ON THE COMMUNITY KEY INFORMANT INTERVIEWS AND FOCUS GROUP INPUT. IT IS COMPLEMENTED WITH THE SERVICE AREA DATA RESOURCES AND WAS UPDATED UPON THE CONDUCT OF A COMMUNITY-INVOLVED PRIORITIZATION PROCESS IN JANUARY 2020. COMMUNITY ASSETS AND RESOURCES COMMUNITY ASSETS AND RESOURCES TO ADDRESS THE EMERGING HEALTH NEEDS WERE IDENTIFIED THROUGH FOCUS GROUPS AND INTERVIEWS IN THE IDENTIFICATION PHASE OF THE PROCESS. STAKEHOLDERS WERE ASKED TO SHARE NAMES OF COMMUNITY ORGANIZATIONS, PROGRAMS, AND OTHER RESOURCES THEY KNEW OF AND/OR HAD EXPERIENCE WITH TO ADDRESS THE SPECIFIC HEALTH NEEDS. THESE INCLUDED HOSPITALS, CLINICS, HEALTH CENTERS, ASSOCIATIONS, COMMUNITY-BASED ORGANIZATIONS, FAITH-BASED ORGANIZATIONS, UNIVERSITIES, PUBLIC INITIATIVES AND HOTLINES. FOLLOWING THE IDENTIFICATION OF ASSETS, INTERNET RESEARCH WAS CONDUCTED TO VALIDATE EACH ASSET AND RESOURCE AND COLLECT UP-TO-DATE INFORMATION FOR EACH."

PART VI, LINE 4:
COMMUNITY INFORMATION: EMANATE HEALTH MEDICAL CENTER (EHMC) SERVES AN URBAN COMMUNITY OF NEARLY ONE MILLION PEOPLE IN THE SAN GABRIEL VALLEY AND HAS TWO HOSPITALS: EHMC - INTER-COMMUNITY HOSPITAL IN COVINA AND EHMC - QUEEN OF THE VALLEY HOSPITAL IN WEST COVINA. FOLLOWING IS A SUMMARY OF THE MAJOR DEMOGRAPHICS OF THE HOSPITAL'S SERVICE AREA -- POPULATION BY AGE: 12% AGE 0-9, 10% AGE 10-17, 64% AGE 18-64 AND 14% AGE 65+; MEDIAN HOUSEHOLD INCOME $70,892; POVERTY LEVEL: APPROXIMATELY ONE IN EIGHT PEOPLE IN THE LOS ANGELES COUNTY SERVICE PLANNING AREA (SPA) 3 - SAN GABRIEL VALLEY SERVICE AREA POPULATION LIVES BELOW 200% OF THE FEDERAL POVERTY LEVEL (37% OVERALL AND 41% OF CHILDREN 18 YEARS AND YOUNGER). THERE ARE 4,479 HOMELESS PEOPLE IN SPA 3 - SAN GABRIEL VALLEY, MANY OF WHOM STRUGGLE WITH MENTAL ILLNESS (26%) AND SUBSTANCE ABUSE PROBLEMS (14%) OR ARE PHYSICALLY DISABLED (21%). PAYER MIX BASED ON EHMC'S INPATIENT DAYS SERVED: MEDI-CAL AND MEDI-CAL MANAGED CARE 37.3%, MEDICARE AND MEDICARE MANAGED CARE 44.9%, MANAGED CARE 16.2%, AND SELF-PAY 1.7%. APPROXIMATELY 11 OTHER HOSPITALS ARE SERVICING THE AREAS.

PART VI, LINE 5:
PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL PROVIDES A WIDE RANGE OF PATIENT CARE SERVICES THROUGH ITS TWO CAMPUSES AS FOLLOWS:EHMC - QUEEN OF THE VALLEY HOSPITAL LOCATED IN WEST COVINA IS A 325-BED FULLY ACCREDITED NONPROFIT, CATHOLIC HEALTH CARE FACILITY FOUNDED IN 1962 BY THE IMMACULATE HEART COMMUNITY.KEY SERVICES: -FAMILY BIRTH & NEWBORN CENTER (A 40-BED PERINATAL SERVICES AND A 40-BED NICU) - MORE DELIVERIES ARE MADE AT THIS HOSPITAL THAN ANY HEALTH CARE FACILITY IN THE EAST SAN GABRIEL VALLEY WITH APPROXIMATELY 3,400 DELIVERIES ANNUALLY AND APPROXIMATELY 500 BABIES HAVE BEEN CARED FOR IN THE LEVEL IIIB NEWBORN INTENSIVE CARE UNIT EACH YEAR. -THE GELERIS FAMILY CANCER CENTER - OFFERING COMPLETE EDUCATION, DIAGNOSIS, TREATMENT AND SUPPORT SERVICES. PATIENTS ARE KEPT APPRISED OF ONGOING CLINICAL CANCER TRIALS AND MAY PARTICIPATE, WHEN ELIGIBLE.-QUEEN'S MAMMOGRAPHY CENTER - PROVIDING LOW-COST MAMMOGRAPHY SCREENING AND BREAST HEALTH EDUCATION.-STATE-OF-THE-ART MRI, CAT SCAN AND LITHOTRIPSY SERVICES-12-BED INTENSIVE CARE UNIT.-6-BED CARDIAC CARE UNIT.-37-BED DEFINITIVE OBSERVATION UNIT.-12-BED REHABILITATION UNIT.-40-BED NEONATAL-200-BED MEDICAL/SURGICAL SERVICES.-18-BED PEDIATRICS UNIT - A CERTIFIED CHILD LIFE SPECIALIST IS ON STAFF TO PROVIDE EDUCATION, SUPPORT AND THERAPEUTIC INTERVENTIONS THAT ADDRESS THE PSYCHOSOCIAL AND EMOTIONAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES.-EMANATE HEALTH CENTERS FOR REHABILITATION SERVICES - OFFERING SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY SERVICES FOR CHILDREN AND ADULTS-EMERGENCY DEPARTMENT IS ONE OF THE BUSIEST IN SOUTHERN CALIFORNIA, WITH NEARLY 54,000 VISITS IN 2021-ROBOTIC SURGERY PROGRAM FEATURING THE DA VINCI SI SURGICAL SYSTEM.EHMC - INTER-COMMUNITY HOSPITAL HAS BEEN PROVIDING HEALTH CARE SERVICES TO THE COMMUNITY SINCE 1922. THE NONPROFIT 191-BED FACILITY IN COVINA PROVIDES HIGH-QUALITY HEALTH CARE TO THE EAST SAN GABRIEL VALLEY WITH A WIDE RANGE OF MEDICAL, SURGICAL AND SPECIALTY SERVICES. KEY SERVICES: -EMANATE HEALTH HEART CENTER - OFFERING THE ONLY OPEN HEART SURGERY PROGRAM IN THE EAST SAN GABRIEL VALLEY -CARDIAC CATH LAB - PROVIDING THE LATEST TREATMENTS AND ADVANCEMENTS FOR PATIENTS SUFFERING FROM CARDIAC DISEASE -DIAGNOSTIC CARDIOLOGY AND NUCLEAR MEDICINE DEPARTMENTS -CARDIAC REHABILITATION PROGRAM -14-BED CARDIAC CARE UNIT. -8-BED INTENSIVE CARE UNIT. -54-BED DEFINITIVE OBSERVATION UNIT. -24-BED ORTHO/SURG UNIT. -38-BED MEDICAL/SURGICAL SERVICES. -30-BED MENTAL HEALTH UNIT. -23-BED SKILLED NURSING UNIT. -RADIATION ONCOLOGY AND INPATIENT CANCER UNIT. -MAMMOGRAPHY SCREENING CENTER WITH 3D MAMMOGRAPHY TECHNOLOGY. -WOUND CARE - COMPREHENSIVE CARE FOR PATIENTS WITH WOUNDS THAT WON'T HEAL, INCLUDING A STATE-OF-THE-ART HYPERBARIC CHAMBER -EMERGENCY DEPARTMENT WITH NEARLY 33,000 VISITS IN 2021.-CHEST PAIN EMERGENCY UNIT -EMANATE HEALTH CENTERS FOR REHABILITATION SERVICES - OFFERING SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY SERVICES FOR CHILDREN AND ADULTS -INFORMATION CENTER FOR PHYSICIAN, HOSPITAL AND COMMUNITY OUTREACH REFERRALS -CANCER RESOURCE CENTER THE HOSPITAL IS GOVERNED BY A 20-MEMBER BOARD OF DIRECTORS COMPRISED OF PHYSICIANS, BUSINESS AND COMMUNITY LEADERS. THE BOARD HAS THE OVERALL RESPONSIBILITY FOR THE MANAGEMENT OF THE HOSPITAL. TO CARRY OUT THIS RESPONSIBILITY, THE GOVERNING BODY PROVIDES FOR THE EFFECTIVE FUNCTIONING OF ACTIVITIES RELATED TO: DELIVERY OF PATIENT CARE, PERFORMANCE IMPROVEMENT, PATIENT SAFETY, RISK MANAGEMENT, MEDICAL STAFF CREDENTIALING, FINANCIAL MANAGEMENT, STRATEGIC PLANNING AND COMMUNITY BENEFIT.EMANATE HEALTH MEDICAL CENTER'S MEDICAL STAFF CONSISTED OF 698 PHYSICIANS, OF WHICH 332 ARE MEMBERS OF ITS ACTIVE STAFF (DEFINED AS ADMITTING MORE THAN TWELVE PATIENTS PER YEAR). 75.4% OF THE TOTAL MEDICAL STAFF MEMBERS AND 81.3% OF THE ACTIVE MEDICAL MEMBERS WERE BOARD-CERTIFIED IN THEIR RESPECTIVE SPECIALTIES.THE SURPLUS FUNDS HELD BY THE HOSPITAL ARE USED TO FULFILL ITS MISSION AS AN INTEGRATED HEALTH CARE ORGANIZATION COMMITTED TO PROVIDING QUALITY HEALTH CARE SERVICES IN A COMPASSIONATE ENVIRONMENT FOR THE PEOPLE IN THE SURROUNDING COMMUNITIES BY OFFERING OUTREACH EDUCATION AND CHARITY CARE, INVESTING IN ADVANCED MEDICAL TECHNOLOGY AND MODERNIZING HOSPITAL FACILITIES.

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AFFILIATED HEALTH CARE SYSTEM: EMANATE HEALTH, THE SOLE CORPORATE MEMBER OF EHMC, EMANATE HEALTH FOOTHILL PRESBYTERIAN HOSPITAL (FPH), EMANATE HEALTH HOSPICE (HOSPICE), AND EMANATE HEALTH FOUNDATION (FOUNDATION), PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT DESCRIBES SPECIFIC OUTREACH PROGRAMS AND SERVICES THAT SUPPORT AND PROVIDE CHARITY CARE AND EDUCATION AND PROMOTE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES SERVED BY EHMC AND ITS AFFILIATE ORGANIZATIONS.FPH OPERATES A GENERAL ACUTE CARE HOSPITAL WITH 105 LICENSED BEDS, LOCATED IN GLENDORA, CALIFORNIA, AND PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE SURROUNDING COMMUNITIES.HOSPICE, LOCATED IN WEST COVINA, CALIFORNIA, OPERATES A 10 LICENSED BED SKILLED NURSING FACILITY AND IN HOME SERVICES FOR TERMINALLY ILL PATIENTS AND A HOME HEALTH AGENCY DOING BUSINESS AS EMANATE HEALTH HOME CARE. FOUNDATION PERFORMS THE FUND-RAISING AND TRUST ADMINISTRATION ACTIVITIES RELATED TO EMANATE HEALTH AND ITS AFFILIATES.EMANATE HEALTH IS AN ORGANIZATION RECOGNIZED FOR ITS OUTSTANDING COMMUNITY OUTREACH EFFORTS AND ACCOMPLISHMENTS. AN ORGANIZATION DEDICATED TO CREATING INNOVATIVE PARTNERSHIPS AMONG THE NUMEROUS HEALTH AND SOCIAL SERVICE ORGANIZATIONS IN OUR VALLEY, WITH CLOSE TO 100 PARTICIPATING AGENCIES IN DIVERSE COLLABORATIVE RELATIONSHIP DEVOTED TO PROMOTING COMMUNITY HEALTH AND WELL-BEING.SOME HIGHLIGHTS INCLUDE EMANATE HEALTH'S PARTNERSHIP NURSING PROGRAM, WHICH IS BASED ON THE CONCEPT THAT THROUGH WORKING PARTNERSHIPS BETWEEN FAITH COMMUNITIES, COMMUNITY ORGANIZATIONS AND MEDICAL PROFESSIONALS, HEALTH AND WELLNESS ISSUES CAN BE SIGNIFICANTLY IMPROVED. GET ENROLLMENT MOVING PROGRAM (GEM), VOLUNTEERS AND EMANATE HEALTH STAFF MEMBERS WORK TOGETHER TO RECRUIT ELIGIBLE FAMILIES AND ENROLL THEM IN MEDI-CAL, HEALTHY KIDS, COVERED CALIFORNIA, AND OTHER HEALTH ACCESS PROGRAMS. GEM ALSO CALLS ENROLLED INDIVIDUALS THREE SEPARATE TIMES TO CONFIRM ENROLLMENT, ENSURE UTILIZATION OF SERVICES AND TROUBLE SHOOT, AND TO PROVIDE ASSISTANCE AT RENEWAL TIME. GEM IS A PROJECT OF EMANATE HEALTH AND IT IS SUPPORTED BY FUNDING FROM THE L.A. COUNTY OF PUBLIC HEALTH DEPARTMENT AND FIRST 5 LA. GEM PROMOTORAS DE SALUD/HEALTH PROMOTERS IS A PEER OUTREACH AND EDUCATION NEIGHBORHOOD-BASED INITIATIVE WITH THE PURPOSE OF TEACHING AND CONNECT COMMUNITY RESIDENTS WITH HEALTH INSURANCE OPTIONS. AS LEADERS IN THEIR COMMUNITY, THEY VISIT HOMES DOOR-TO-DOOR TO IDENTIFY NEEDS FOR INFORMATION AND SERVICES. EMANATE HEALTH'S DIABETES PROGRAM PROVIDES FREE DIABETIC FOOT SCREENINGS FOR PATIENTS AND RESIDENTS EVERY MONTH. FREE DIABETES TEST STRIPS ARE PROVIDED FREE OF CHARGE TO PATIENTS THROUGH A PARTNERSHIP WITH A LOCAL COMMUNITY CLINIC; THIS PRACTICE HAD ALREADY SHOWN POSITIVE RESULTS IN RESIDENTS BETTER MANAGING THEIR DIABETES. FREE SUPPORT GROUPS ARE OFFERED AT FOOTHILL EDUCATION CENTER IN GLENDORA AND EMANATE HEALTH RESOURCE CENTER IN COVINA TO HELP RESIDENTS WITH THEIR CONCERNS, ACHIEVEMENTS AND CHALLENGES IN MANAGING THEIR DIABETES. THE LATINO COMMUNITY HAS ACCESS TO SPANISH LANGUAGE GROUPS LED BY A REGISTERED NURSE AND CERTIFIED DIABETES EDUCATOR. EMANATE HEALTH'S VISION IS TO BE AN INTEGRAL PARTNER IN ELEVATING COMMUNITIES' HEALTH THROUGH PARTNERSHIPS. EMANATE HEALTH HAS FORMED A DIABETES PREVENTION AND MANAGEMENT MULTIDISCIPLINARY GROUP MADE UP OF 18 PUBLIC AND PRIVATE AGENCIES WHO JOIN MINDS TO RESPOND TO THE NEEDS OF THE DIABETIC POPULATION AND DECREASE THE DEVASTATING EFFECTS THAT COME WITH IT. EMANATE HEALTH'S BEST BABIES COLLABORATIVE PROGRAM OFFERS FREE HOME VISITATION SERVICES FOR HIGH RISK TEENS AND WOMEN IN PARTNERSHIP WITH SIX COMMUNITY PARTNERS. THIS PROGRAM IS MADE POSSIBLE THROUGH FUNDING AND PARTNERSHIP WITH FIRST 5 LA. EMANATE HEALTH HAS BEEN PROACTIVE IN OFFERING OUTREACH AND EDUCATION THROUGHOUT THE COMMUNITY IN THE AFFORDABLE CARE ACT/MEDI-CAL EXPANSION AND MARKET PLACE. SINCE CONCEPTION, EVERY CHILD'S HEALTHY OPTION (ECHO) IS A COLLABORATIVE EFFORT INVOLVING EMANATE HEALTH, COORDINATED AND LEAD BY LOCAL SCHOOL DISTRICTS. THE ECHO PROGRAM HAS IN PLACE A CADRE OF VOLUNTEER HEALTH PROVIDERS WHO OFFER FREE URGENT CARE SERVICES IN VARIOUS SPECIALTIES; IT ENSURES THAT EVERY CHILD, REGARDLESS OF INCOME LEVEL, HAVE ACCESS TO URGENT QUALITY HEALTH CARE AND PROVIDES ENROLLMENT FOR THE CHILD IN HEALTH INSURANCE. OTHER IMPORTANT PROGRAMS THAT RECEIVE SUPPORT FROM EMANATE HEALTH ARE THE SAN GABRIEL VALLEY COALITION ON HOMELESSNESS AND THE SAN GABRIEL VALLEY DISABILITIES COLLABORATIVE.AS A TEAM OF THE FOUR FINEST HEALTH CARE INSTITUTIONS IN THE REGION, OUR COLLECTIVE STRENGTHS ENABLE US TO CONTINUE THE COMMITMENT TO EXCELLENCE THE SAN GABRIEL VALLEY HAS COME TO KNOW AND TRUST.