Community Benefit Insight - Tax-exempt hospital

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Gardens Regional Hospital & Medical Center Inc

Tri-City Regional Medical Center

21530 S Pioneer Blvd
Hawaiian Gardens, CA 90716

Bed count	150	Medicare provider number	050575	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 330738307

Display data for year:

Community Benefit Spending- 2013
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

3.93%

Spending by Community Benefit Category- 2013
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2013

Additional data

Community Benefit Expenditures: 2013

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 2,176,931 0.89 %
Medicaid as % of operating expenses	$ 4,181,239 1.72 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 308,095 0.13 %
Subsidized health services as % of operating expenses	$ 2,430,219 1.00 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 477,654 0.20 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 1,081 0.00 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2013

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 424,428 0.17 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 95,012 22.39 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:

Reported to credit agency	YES
Filed lawsuit	Not available
Placed liens on residence	Not available
Issue body attachments? (an order by the court commanding a sheriff or other official to physically bring before the court a person who is guilty of contempt of court)	Not available

Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2013

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	Not available
Did the tax-exempt hospital execute the implementation strategy?	Not available
Did the tax-exempt hospital participate in the development of a community-wide plan?	YES

Supplemental Information: 2013

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 233484407 including grants of $ 0) (Revenue $ 239222338)
TRI-CITY PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN A LICENSED 107-BED ACUTE CARE HOSPITAL. AS PART OF TRI-CITY'S COMMITMENT TO AFFORDABLE HEALTH CARE AND SOCIAL SERVICES, TRI-CITY PROVIDES A SIGNIFICANT AMOUNT OF CHARITY CARE, INCLUDING DISCOUNT PAYMENT PROGRAMS AND FREE HEALTH CARE TO THOSE PATIENTS WITH DEMONSTRATED FINANCIAL NEED. IN 2013, THERE WERE 3,145 INPATIENT ADMISSIONS; 14,602 OUTPATIENT VISITS; AND 9,493 EMERGENCY ROOM VISITS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

TRI CITY REGIONAL MEDICAL CENTER
"PART V, SECTION B, LINE 3: DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY, AND STATE SOURCES TO PRESENT THE HOSPITAL SERVICE AREA DEMOGRAPHICS, SOCIAL AND ECONOMIC FACTORS, HEALTH ACCESS, BIRTH CHARACTERISTICS, LEADING CAUSES OF DEATH, CHRONIC DISEASE, AND HEALTH BEHAVIORS. ANALYSES WERE CONDUCTED AT THE MOST LOCAL LEVEL POSSIBLE FOR THE HOSPITAL SERVICE AREA, GIVEN THE AVAILABILITY OF THE DATA. FOR EXAMPLE, DEMOGRAPHIC DATA, BIRTH AND DEATH DATA ARE BASED ON ZIP CODES. ECONOMIC INDICATORS ARE AVAILABLE BY CITY. OTHER DATA ARE ONLY AVAILABLE AT THE COUNTY LEVEL. SOURCES OF DATA INCLUDE THE U.S. CENSUS 2010 DECENNIAL CENSUS AND AMERICAN COMMUNITY SURVEY, CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, CALIFORNIA EMPLOYMENT DEVELOPMENT DEPARTMENT, CALIFORNIA DEPARTMENT OF EDUCATION, CALIFORNIA DEPARTMENT OF JUSTICE, CALIFORNIA HEALTH INTERVIEW SURVEY, COUNTY HEALTH RANKINGS, LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH, UNIFORM DATA SET, AND OTHERS. WHEN PERTINENT, THESE DATA SETS ARE PRESENTED IN THE CONTEXT OF LOS ANGELES COUNTY AND CALIFORNIA STATE. THE REPORT INCLUDES BENCHMARK COMPARISON DATA THAT MEASURES TRI-CITY REGIONAL MEDICAL CENTER'S COMMUNITY DATA FINDINGS WITH HEALTHY PEOPLE 2020 OBJECTIVES. HEALTHY PEOPLE 2020 OBJECTIVES ARE A NATIONAL INITIATIVE TO IMPROVE THE PUBLIC'S HEALTH BY PROVIDING MEASURABLE OBJECTIVES AND GOALS THAT ARE APPLICABLE AT NATIONAL, STATE, AND LOCAL LEVELS. TARGETED INTERVIEWS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. FIFTEEN INTERVIEWS WERE COMPLETED DURING JUNE AND JULY 2013. FOR THE INTERVIEWS, COMMUNITY STAKEHOLDERS IDENTIFIED BY TRI-CITY WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. INTERVIEWEES INCLUDED INDIVIDUALS WHO ARE LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATIONS, OR REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE ""CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY.""INTERVIEW PARTICIPANTS WERE ASKED TO SHARE THEIR PERSPECTIVES ON A NUMBER OF TOPICS, INCLUDING: - BIGGEST ISSUES OR CONCERNS FACING THE COMMUNITY - EXISTING AND NEEDED ACTIONS/ACTIVITIES TO ADDRESS COMMUNITY ISSUES - HEALTH PROBLEMS IMPACTING PEOPLE IN THE COMMUNITY - CHALLENGES FACED IN OBTAINING PRIMARY CARE, SPECIALTY CARE, MENTAL/BEHAVIORAL HEALTH SERVICES AND SOCIAL SERVICES, AND SUGGESTED STRATEGIES TO FACILITATE ACCESS - VIOLENCE PREVENTION AND SAFETY FOR YOUTH: ISSUES, CURRENT EFFORTS AND NEEDED STRATEGIES - OVERWEIGHT AND OBESITY: CONTRIBUTING FACTORS, EXISTING PROGRAMS AND WHAT ELSE IS NEEDED - FOOD INSECURITY/HUNGER - RECOMMENDED ROLES FOR HOSPITALS AND HEALTH CARE PROVIDERS IN ADDRESSING COMMUNITY HEALTH NEEDS"

TRI CITY REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 12I: CO-PAYS AND DEDUCTIBLES

TRI CITY REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 22: THE HOSPITAL ONLY CHARGES GROSS CHARGES FOR SERVICES PROVIDED WHEN THERE IS NO INSURANCE PAYMENT. OTHERWISE, THE PATIENT IS ONLY CHARGED THE CO-PAY AND/OR DEDUCTIBLE.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 7:
IN ORDER TO DETERMINE THE AMOUNTS REPORTED, THE HOSPITAL USED THE GROSS PATIENT CHARGES FROM PROGRAMS AND MULTIPLIED THESE AMOUNTS BY THE RATIO OF PATIENT COSTS TO PATIENT CHARGES. THE MANNER IN WHICH THE HOSPITAL DETERMINED ITS COST-TO-CHARGE RATIO WAS BY UTILIZING THE NUMBERS REPORTED IN THEIR AUDITED FINANCIAL STATEMENTS TO ANALYZE THE RATIO OF TOTAL EXPENSES EXCLUDING IPA PAID CLAIM EXPENSES, BAD DEBTS, AND MEDI-CAL HOSPITAL FEE PROGRAM EXPENSES TO TOTAL GROSS PATIENT REVENUES REPORTED IN THE FINANCIAL STATEMENTS.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES IS NET LOSS FROM THE EMERGENCY ROOM

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $424,428.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY PARTNERSHIPS ARE DESIGNED TO INTEGRATE HOSPITAL SERVICES WITHIN THE COMMUNITY AND INCLUDE THOSE PROGRAMS THAT PROMOTE COMMUNITY HEALTH AND WELLNESS. THE PRIMARY COMMUNITY PARTNERSHIP IS THROUGH THE SOUTHEAST COLLABORATIVE WHICH IS COMPRISED OF COMMUNITY AND HOSPITAL LEADERS FROM THE PRIMARY AND SECONDARY SERVICE AREAS.THE COLLABORATIVE IS USED FOR: - EVALUATING ATTITUDES AND PERCEPTIONS OF THE NEEDS OF THE COMMUNITY. - EVALUATING CURRENT ROLES AND EFFORTS THAT RELATE TO ONGOING HEALTH ASSESSMENT. - MAINTAINING A MECHANISM FOR VISUALIZING THE ORGANIZATION'S CURRENT RELATIONSHIPS IN THE COMMUNITY - DEFINING AND MAXIMIZING EFFORTS BY COMMUNITY STAKEHOLDERS - PROMOTING AND SUPPORTING PROGRAMS THAT DEVELOP CHARACTER, CITIZENSHIP, AND RESPONSIBILITY FOR THE YOUTH AND FAMILIES OF THE COMMUNITY - WORKING WITH CITY REPRESENTATIVES AND OTHER LOCAL, STATE, AND FEDERAL LEADERS TO IDENTIFY AND ADDRESS POLICIES THAT CAN IMPACT THE SOCIAL,ECONOMIC, EMPLOYMENT, AND HEALTH CARE NEEDS OF THE COMMUNITY.

PART III, LINE 2:
BAD DEBTS REPORTED IN ACCORDANCE WITH HEALTHCARE MANAGEMENT ASSOCIATION STATEMENT 15 ARE PROVIDED FOR USING THE RESERVE METHOD AND ARE CALCULATED BASED ON HISTORICAL TRENDS, BUSINESS AND ECONOMIC CONDITIONS, AND SPECIFIC ACCOUNT INFORMATION. ACCOUNTS ARE WRITTEN OFF TO THE BAD DEBT ALLOWANCE FROM RECEIVABLES WHEN CONFIRMATION IS RECEIVED THAT AN ACCOUNT HAS BEEN DETERMINED TO BE UNCOLLECTABLE.

PART III, LINE 3:
TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY, THE HOSPITAL REVIEWED A LIST OF PENDING CHARITY CARE APPLICATIONS AS OF 12/31/13. AFTER THOSE AMOUNTS WERE DETERMINED, THE TOTAL WAS MULTIPLIED BY THE COST-TO-CHARGE RATIO TO DETERMINE THE REPORTED COST.

PART III, LINE 4:
THERE IS NO AUDITED FINANCIAL STATEMENT FOOTNOTE RELATED TO BAD DEBT EXPENSE IN 2013.TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY, THE HOSPITAL REVIEWED A LIST OF PENDING CHARITY CARE APPLICATIONS AS OF 12/31/13. AFTER THOSE AMOUNTS WERE DETERMINED, THE TOTAL WAS MULTIPLIED BY THE COST-TO-CHARGE RATIO TO DETERMINE THE REPORTED COST.

PART III, LINE 8:
THE ENTITY IS REPORTING A SHORTFALL IN THE AMOUNT OF $3,036,960. ALL OF THESE AMOUNTS ARE REPORTED ON COMMUNITY BENEFIT.MEDICARE ALLOWABLE COST OF CARE RELATING TO PAYMENTS OF MEDICARE ARE CALCULATED ON THE ACCRUAL BASIS. THE HOSPITAL ADDS THE TOTAL MEDICARE INPATIENT REVENUE TOGETHER WITH THE TOTAL MEDICARE OUTPATIENT REVENUE FOR TOTAL MEDICARE PATIENT REVENUE. THESE TOTALS ARE THEN MULTIPLIED BY THE COST TO CHARGE RATIO THAT IS CALCULATED IN THE FINANCIAL STATEMENTS FOR THE YEAR ENDING DECEMBER 31, 2013.

PART III, LINE 9B:
AS NOTED IN THE CHARITY CARE POLICY, THE REQUEST FOR CHARITY CARE AND DETERMINATION SHOULD OCCUR PRIOR TO THE RENDERING OF SERVICES. HOWEVER, THE DETERMINATION MAY BE DONE AT ANY POINT IN THE COLLECTION CYCLE.THE HOSPITAL'S POLICY CONCERNING COLLECTIONS INCLUDES ALL COMMUNICATIONS WITH A PATIENT AFTER THE INITIAL BILL IS SENT. ONCE IT HAS BEEN ESTABLISHED THAT A PATIENT MAY QUALIFY FOR CHARITY CARE, THEN THE HOSPITAL (OR THE VENDOR WHO HAS THE ACCOUNT) WILL SEND OUT A CHARITY APPLICATION TO THE PATIENT. THE HOSPITAL WILL REQUEST THAT ALL SUPPORTING DOCUMENTATION BE ATTACHED TO THE APPLICATION SO THAT WE CAN VERIFY WHETHER THE PATIENT MEETS THE CRITERIA FOR CHARITY OR A DISCOUNT BASED ON THE FEDERAL POVERTY GUIDELINES.THE HOSPITAL HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH A PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM THE HOSPITAL, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS TO THE HOSPITAL. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS, THE HOSPITAL MAY OFFER AN EXTENDED PAYMENT PLAN TO ELIGIBLE PATIENTS, WILL NOT IMPOSE WAGE GARNISHES OR LIENS ON PRIMARY RESIDENCES, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTIONS EFFORTS.

PART VI, LINE 2:
TRI-CITY REGIONAL MEDICAL CENTER COMPLETES A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS AS REQUIRED BY CALIFORNIA LAW (SB 697). THE MOST RECENT NEEDS ASSESSMENT WAS CONDUCTED IN 2010. THE NEEDS ASSESSMENT IS MADE WIDELY AVAILABLE TO THE PUBLIC THROUGH POSTING ON THE HOSPITAL WEBSITE.TRI-CITY REGIONAL MEDICAL CENTER IS LOCATED IN HAWAIIAN GARDENS, CA. THE SERVICE AREA ENCOMPASSES SEVEN ZIP CODES REPRESENTING FIVE CITIES.ARTESIA 90701CERRITOS 90703HAWAIIAN GARDENS 90716LAKEWOOD 90712LAKEWOOD 90713LAKEWOOD 90715NORWALK 90650THE COMMUNITY HEALTH NEEDS ASSESSMENT ASSESSES THE COMMUNITIES WE SERVE THROUGH THE COLLECTION AND ANALYSES OF PRIMARY AND SECONDARY DATA. SERVICE AREA DESCRIPTION:THE NEEDS ASSESSMENT EXAMINED UP TO DATE DATA SOURCES FOR THE SERVICE AREA TO PRESENT A COMMUNITY PROFILE, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACCESS TO HEALTH CARE, CHRONIC DISEASE, COMMUNICABLE DISEASE, HEALTH BEHAVIORS, SOCIAL ISSUES, AND SCHOOL AND STUDENT CHARACTERISTICS. WHEN APPLICABLE, THESE DATA SETS WERE PRESENTED IN THE CONTEXT OF LOS ANGELES COUNTY AND/OR THE STATE. STAKEHOLDER INTERVIEWS:PRIMARY DATA WERE COLLECTED DIRECTLY FROM PEOPLE IN THE COMMUNITY. FIFTEEN PEOPLE REPRESENTING PUBLIC HEALTH AND COMMUNITY ORGANIZATIONS AND AGENCIES THAT SERVE LOW-INCOME UNDERSERVED POPULATIONS WERE INTERVIEWED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT.

PART VI, LINE 3:
THE HOSPITAL MAINTAINS A PAYMENT ASSISTANCE PROGRAM DESIGNED TO REFER INPATIENTS TO AGENCIES AND RESOURCES THAT HELP DETERMINE ELIGIBILITY FOR GOVERNMENT SPONSORED HEALTH INSURANCE PROGRAMS. RESOURCE STAFF PROVIDE ASSISTANCE WITH THE APPLICATION PROCESS AND IN IDENTIFYING WHETHER ELIGIBILITY REQUIREMENTS ARE MET. IF THE PATIENT IS UNINSURED OR DOES NOT QUALIFY FOR A GOVERNMENT SPONSORED INSURANCE PROGRAM, THE PATIENT MAY BE ELIGIBLE FOR FREE OR DISCOUNTED SERVICES, DEPENDING ON INCOME LEVEL OR SPECIFIC CIRCUMSTANCES.NOTIFICATION ABOUT CHARITY CARE IS AVAILABLE FROM THE HOSPITAL, WHICH INCLUDES A CONTACT NUMBER, IS DISSEMINATED BY VARIOUS MEANS, INCLUDING WHEN POSSIBLE IN THE PATIENT'S LANGUAGE. PUBLICATION OF NOTICES ON FINANCIAL ASSISTANCE IS PROVIDED IN THE PATIENT BILLS AND POSTED IN THE EMERGENCY ROOM, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICE, AND PATIENT FINANCIAL SERVICES OFFICE. INFORMATION IS INCLUDED ON THE HOSPITAL'S WEBSITE AND IN THE CONDITION OF ADMISSION FORM. INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY THE HOSPITAL, INCLUDING ENGLISH AND SPANISH. REFERRALS OF PATIENTS FOR CHARITY CARE ARE MADE BY MEMBERS OF THE STAFF OR MEDICAL STAFF. A REQUEST FOR CHARITY MAY BE MADE BY THE PATIENT, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO THE PRIVACY LAWS.

PART VI, LINE 4:
COMMUNITY PROFILE: - THE POPULATION IN THE TRI-CITY SERVICE AREA IS 277,993. - CHILDREN AND YOUTH, AGES 0-19, MAKE UP 29.4% OF THE POPULATION; 11.1% OF THE POPULATION ARE SENIORS, 65 YEARS OF AGE AND OLDER. - AMONG THE SERVICE AREA POPULATION, 43% ARE HISPANIC OR LATINO, 24.7% OF THE POPULATION IS ASIAN/PACIFIC ISLANDER AND 23.7% ARE WHITE. AFRICAN AMERICANS, AMERICAN INDIAN AND OTHER RACES TOTAL 8.6% OF THE POPULATION. - WITHIN THE SERVICE AREA, UNEMPLOYMENT WAS 10.2% IN 2010. AREAS WITH THE HIGHEST UNEMPLOYMENT ARE: HAWAIIAN GARDENS (14.2%) AND NORWALK (13.3%). - HAWAIIAN GARDENS HAS THE LARGEST PERCENTAGE OF FAMILIES LIVING IN POVERTY (14.5%). - HAWAIIAN GARDENS AND NORWALK HAVE HIGH PERCENTAGES OF SPANISH SPEAKERS, AND CERRITOS HAS A LARGE PERCENTAGE OF THE POPULATION THAT SPEAKS AN ASIAN LANGUAGE IN THE HOME. BIRTH CHARACTERISTICS: - IN 2009, THERE WERE 3,441 BIRTHS IN THE AREA. THE MAJORITY OF BIRTHS (61.8%) WERE TO MOTHERS WHO ARE HISPANIC OR LATINO; 17.6% OF BIRTHS WERE TO ASIANS/PACIFIC ISLANDERS; AND 13.5% OF BIRTHS WERE TO WHITES/CAUCASIANS. - TEEN BIRTH RATES OCCURRED AT A THREE-YEAR AVERAGE RATE OF 93.0 PER 1,000 BIRTHS (OR 9.3% OF TOTAL BIRTHS). HAWAIIAN GARDENS (15.8%) AND NORWALK (11.4%) HAVE HIGH RATES OF TEEN BIRTHS. - AMONG PREGNANT WOMEN, 86.6% OBTAIN PRENATAL CARE AS RECOMMENDED IN THE FIRST TRIMESTER. - LOW BIRTH WEIGHT BABIES (LESS THAN 2500 G) ARE 6.7% OF LIVE BIRTHS. - THE INFANT DEATH RATE IS 4.6 PER 1,000 LIVE BIRTHS. LEADING CAUSES OF DEATH: - THE THREE LEADING CAUSES OF DEATH ARE HEART DISEASE, CANCER AND LUNG DISEASE. - THE HEART DISEASE AND STROKE DEATH RATES IN THE TRI-CITY SERVICE AREA EXCEED THE HEALTHY PEOPLE 2020 OBJECTIVE.ACCESS TO HEALTH CARE: - AMONG THE ADULT POPULATION IN BELLFLOWER HEALTH DISTRICT, AGES 18-64, 82.8% HAVE HEALTH INSURANCE AND 92.5% OF CHILDREN, AGES 0-17, ARE INSURED. - AMONG THE AREA RESIDENTS, 83% INDICATE THEY HAVE A USUAL SOURCE OF CARE. - ADULTS EXPERIENCE A NUMBER OF BARRIERS TO ACCESSING CARE, INCLUDING: COST OF CARE, LACK OF A MEDICAL HOME, AND LANGUAGE BARRIERS. CHRONIC DISEASE: - AREA RESIDENTS HAVE HIGHER RATES OF DIABETES, HEART DISEASE, HIGH CHOLESTEROL AND HYPERTENSION THAN FOUND IN SPA7 AND THE COUNTY. - AMONG CHILDREN, AGES 0-17, 8.8% HAVE BEEN DIAGNOSED WITH ASTHMA.COMMUNICABLE DISEASE: - IN 2010, 29 CASES OF HIV/AIDS WERE DIAGNOSED IN THE BELLFLOWER HEALTH DISTRICT FOR A RATE OF 8 PER 100,000 PERSONS. - THE BELLFLOWER HEALTH DISTRICT HAS HIGHER RATES OF GONORRHEA AND SYPHILIS COMPARED TO SPA 7. FEMALES HAVE THE HIGHEST RATES OF CHLAMYDIA. YOUNG ADULTS, AGES 20-24, AND BLACKS/AFRICAN AMERICANS HAVE THE HIGHEST RATES OF SEXUALLY TRANSMITTED INFECTIONS.HEALTH BEHAVIORS: - 78% OF SENIORS RECEIVED A FLU SHOT AND 60.9% OF SENIORS RECEIVED A PNEUMONIA VACCINE. - PAP SMEARS SCREEN FOR CERVICAL CANCER. AMONG ADULT WOMEN, 83.7% RECEIVED A PAP SMEAR IN THE LAST THREE YEARS. - MAMMOGRAMS ARE USED FOR DETECTION OF BREAST CANCER AND 81.7% OF WOMEN, 40 YEARS AND OVER, RECEIVED A MAMMOGRAM IN THE LAST TWO YEARS. PREVENTIVE PRACTICES: - IN THE AREA, 35.6% OF ADULTS ARE OVERWEIGHT AND 24% ARE OBESE. THESE PERCENTAGES EQUATE TO 59.6% OF THE ADULT POPULATION BEING OVERWEIGHT OR OBESE. - HAWAIIAN GARDENS, NORWALK AND ARTESIA RANK VERY HIGH FOR CHILDHOOD OBESITY PREVALENCE. IN THESE COMMUNITIES OVER ONE-FOURTH OF THE KIDS ARE OBESE. - IN SPA 7, OVER HALF OF CHILDREN (53.7%) OF CHILDREN CONSUMED FAST FOOD TWICE OR MORE IN A WEEK; 46.4% OF ADULTS CONSUMED FAST FOOD TWO OR MORE TIMES A WEEK. - 49.8% OF CHILDREN AND 54% OF ADULTS CONSUME TWO OR MORE SODAS OR SWEETENED DRINKS A DAY. - 13.8% OF ADULTS CONSUME FIVE OR MORE FRUITS AND VEGETABLES A DAY. - OVER HALF OF ADULTS (51.9%) AND 44.2% OF YOUTH ARE PHYSICALLY ACTIVE. - NORWALK HAS THE HIGHEST PERCENT OF SMOKERS (14.5%), AND CERRITOS HAS THE SMALLEST PERCENT OF SMOKERS (9.8%) IN THE SERVICE AREA. SOCIAL ISSUES: - AMONG ADULTS, 5.5% EXPERIENCED SOME TYPE OF PSYCHOLOGICAL DISTRESS IN THE PAST YEAR; 11.9% NEEDED HELP FOR A MENTAL HEALTH PROBLEM; 8.6% OF ADULTS SAW A HEALTH CARE PROVIDER FOR MENTAL HEALTH OR DRUG/ALCOHOL RELATED ISSUES, 7.8% HAVE TAKEN MEDICINE FOR MORE THAN TWO WEEKS FOR MENTAL HEALTH ISSUES. - AMONG ADULTS WHO NEEDED HELP FOR AN EMOTIONAL OR MENTAL HEALTH PROBLEM 45.7% DID NOT RECEIVE TREATMENT. - IN THE BELLFLOWER HEALTH DISTRICT, 45.3% OF ADULTS CONSUMED ALCOHOL AND 15.5% ENGAGED IN BINGE DRINKING. - CRIME STATISTICS INDICATE THAT CRIMES OF THEFT ARE AMONG THE HIGHEST IN THE TRI-CITY SERVICE AREA. AMONG AREA COMMUNITIES, HAWAIIAN GARDENS HAS THE HIGHEST RATE OF VIOLENT CRIME (512.2 PER 100,000). CERRITOS HAS THE HIGHEST RATE OF PROPERTY CRIME (1889.8 PER 100,000) AND THEFT (2427.6 PER 100,000). NORWALK HAS THE HIGHEST RATE OF ARSON (20.8 PER 100,000 PERSONS).STUDENT AND SCHOOL CHARACTERISTICS: - THE NUMBER OF STUDENTS ELIGIBLE FOR THE FREE AND REDUCED PRICE MEAL PROGRAM IS ONE INDICATOR OF THE SOCIOECONOMIC STATUS OF A SCHOOL DISTRICT'S STUDENT POPULATION. IN THE ABC UNIFIED SCHOOL DISTRICT, 45.6% OF STUDENTS ARE ELIGIBLE FOR THE FREE OR REDUCED PRICE LUNCH PROGRAM. - 21.6% OF STUDENTS ARE ENGLISH LEARNERS. - OVER HALF OF STUDENTS IN ALL GRADES ARE PROFICIENT IN LANGUAGE ARTS (62%) AND MATHEMATICS (58%). - THE HIGH SCHOOL GRADUATION RATE IS 89.3% AND 36.5% OF GRADUATES ARE UC/CSU READY.COMMUNITY STAKEHOLDER INTERVIEW FINDINGSBIGGEST ISSUES OR CONCERNS: - THE CURRENT ECONOMIC CRISIS - UNEMPLOYMENT - POVERTY IN THE COMMUNITY - LACK OF INSURANCE / UNDERINSURANCE - PERSONAL SAFETY - INCLUDING GANG ACTIVITY AND ISSUES AROUND NARCOTICS - MEDICAL ILLITERACY/LACK OF HEALTH EDUCATIONPROBLEMS IN OBTAINING CARE: - TRANSPORTATION IS A BARRIER TO OBTAINING CARE. TO COMBAT THE ISSUE, SOME GROUPS OFFER BUS TOKENS OR TAXI VOUCHERS, AND THE HOSPITAL HAS A VAN DURING THE WEEK AND OFFERS TAXI SERVICE ON THE WEEKEND - ACCESS TO MENTAL HEALTH CARE IS LACKING IN THE COMMUNITY. ONCE PATIENTS REALIZE THEY NEED HELP AND GET PAST THE SOCIAL STIGMA, THE NUMBER OF PROVIDERS AVAILABLE IS INSUFFICIENT, AND EVEN HMO-APPROVED DOCTORS AREN'T SURE WHERE TO SEND PATIENTS. PATIENTS OFTEN CAN'T GET IN TO BE SEEN, EVEN IF THE REFERRAL HAS BEEN MARKED AS CRITICAL - BEHAVIORAL HEALTH AND DRUG-AND-ALCOHOL TREATMENT WERE ALSO SAID TO BE DIFFICULT TO ACCESS, WITH FUNDING HAVING BEEN 'SLASHED' - NOT KNOWING WHAT HELP IS AVAILABLE. THIS MAY BE PARTICULARLY PRONOUNCED AMONG THE RECENTLY-UNEMPLOYED/UNINSURED. SOME ORGANIZATIONS HAVE A SOCIAL-WORKER OR SIMILAR POSITION WHO ARE KEPT 'VERY BUSY' GIVING REFERRALS FOR MEDICAL, MENTAL AND 'BASIC' ASSISTANCE, SUCH AS FOOD AND SHELTER - PEOPLE DON'T HAVE INSURANCE, CAN'T AFFORD THEIR MEDICATIONS, AND WILL DELAY SEEKING TREATMENT UNTIL THE SITUATION BECOMES AN EMERGENCY. EVEN LOW FEES OF $10 OR $20 CAN PUT TREATMENT FOR CHRONIC ILLNESS OR IMMUNIZATIONS OUT OF SOME PATIENTS' REACH - LONG WAITS TO GET AN APPOINTMENT WITH A PHYSICIAN, TO BE SEEN IN THE ER, TO GET HMO APPROVAL FOR A REFERRAL OR TO GET IN TO SEE A SPECIALIST, PARTICULARLY FOR VISION AND PODIATRY. WITH NEED OUTSTRIPPING THE RESOURCES, WAITING TIMES ARE ON THE RISE ALL OVER - LANGUAGE BARRIERS - THE UNDOCUMENTED HAVE HUGE NEEDS FOR HEALTH ACCESS - DPSS CASE-WORKERS ARE OVERWHELMED

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TRI-CITY REGIONAL MEDICAL CENTER ENGAGES IN A NUMBER OF EFFORTS THAT FURTHER ITS EXEMPT PURPOSE AND PROMOTE THE HEALTH OF THE COMMUNITY. THE HOSPITAL EMERGENCY ROOM SERVES ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. WE PARTICIPATE IN GOVERNMENT-SPONSORED HEALTH PROGRAMS, INCLUDING MEDICARE AND MEDICAID. WE HAVE AVAILABLE FINANCIAL ASSISTANCE AND PROVIDE CLIENTS WITH ASSISTANCE TO ENROLL IN LOW-COST OR FREE INSURANCE PROGRAMS. THIS PAST YEAR, TRI-CITY REGIONAL MEDICAL CENTER INCREASED THE NUMBER OF COMMUNITY ACTIVITIES WITHIN ITS SERVICE AREA TO SERVE A PRIMARILY LOW-INCOME, ETHNICALLY DIVERSE POPULATION. A SUMMARY OF THESE ACTIVITIES FOLLOWS:COMMUNITY HEALTH IMPROVEMENT SERVICES: - HEALTH SCREENINGS - OVER 1,200 PERSONS SERVED (SERVICES INCLUDED BODY FAT AND BMI ANALYSIS, TESTING FOR CHOLESTEROL, BLOOD GLUCOSE AND BLOOD PRESSURE, DIABETES AND NUTRITION PRESENTATION WITH HOSPITAL DIETITIAN - PROGRAMS TO REDUCE SPORTS INJURIES AMONG YOUTHS - COMMUNITY FLU VACCINES - 256 PERSONS SERVED (PNEUMONIA AND FLU VACCINES) - HEALTH EDUCATION SESSIONS ON A VARIETY OF TOPICS, INCLUDING: NUTRITION, STRESS RELIEF, SUGAR AND THE BODY, AND FLU PREVENTION - 11 SESSIONS, 353 PERSONS SERVED - COMMUNITY FITNESS - TRI-CITY HOSTED A ZUMBA FITNESS EXERCISE CLASS AT THE FEDDE COMMUNITY RESOURCE CENTER FOR COMMUNITY RESIDENTS - 6 SESSIONS, 156 PERSONS SERVED - ASSISTANCE TO ENROLL LOW-INCOME PATIENTS IN PUBLIC PROGRAMS FOR LOW-COST OR NO-COST INSURANCE - TRANSPORTATION SUPPORT TO ENHANCE LOW-INCOME PATIENT ACCESS TO CARE - HOSPITAL VAN TRANSPORTS PATIENTS WHO LACK TRANSPORTATION TO HEALTH CARE APPOINTMENTS, AND TAXI VOUCHERS WERE DISTRIBUTEDTHE HOSPITAL OFFERS PROFESSIONAL EDUCATION OPPORTUNITIES THAT ARE OPEN TO ALL MEDICAL PROFESSIONALS IN THE COMMUNITY. WE WORK WITH A NUMBER OF NURSING SCHOOLS AND ALLIED HEALTH PROFESSIONS PROGRAMS TO PROVIDE PRECEPTED TRAINING AND CLINICAL ROTATIONS. TRI-CITY REGIONAL MEDICAL CENTER IS PROUD TO WORK WITH DEDICATED COMMUNITY PARTNERS TO IDENTIFY AND ADDRESS THE NEEDS OF OUR SERVICE AREA. THESE PARTNERS INCLUDE: - ARTESIA HIGH SCHOOL, LAKEWOOD - CITY OF HAWAIIAN GARDENS - DOWNEY ADULT SCHOOL - EL CAMINO COLLEGE COMPTON CENTER - FEDDE MIDDLE SCHOOL, HAWAIIAN GARDENS - FERGUSON ELEMENTARY SCHOOL, HAWAIIAN GARDENS - HAWAIIAN GARDENS SENIOR CENTER

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THE ORGANIZATION WAS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

Operating expenses	$ 243,783,989
Total amount spent on community benefits as % of operating expenses	$ 9,575,219 3.93 %