4A (Expenses $ 1033735414 including grants of $ 71723) (Revenue $ 1159053705)
SEE SCHEDULE OEach organization included in this group return operates as part of the nonprofit integrated healthcare delivery system known as MemorialCare Health System (MemorialCare). The largest program services of the three organizations are inpatient and outpatient hospital services, and the largest program services of the fourth organization are outpatient services; all as described in the response for Lines 4a through 4d, respectively.Long Beach Memorial Medical Center (LBMMC) is a nonprofit corporation which provides inpatient and outpatient hospital care to improve the health of the communities it serves at three licensed hospital facilities: MemorialCare Long Beach Medical Center (LBM), Miller Children's and Women's Hospital Long Beach (Miller), and Community Hospital Long Beach (CHLB). All of LBMMC's hospitals are committed to meeting the health care needs of patients who may be uninsured or underinsured, and providing medically necessary services, without cost or at a reduced cost, to patients who qualify under the applicable financial assistance policy in compliance with Internal Revenue Code section 501(r). In the year ending June 30, 2018, LBMMC recorded 195,318 patient days, discharged 41,093 patients, provided 19,003 surgical procedures, delivered 5,621 babies, and had 131,554 emergency department visits.LBM is a 453-bed adult community hospital that is home to specialized services including the Todd Cancer Institute, the MemorialCare Heart & Vascular Institute, rehabilitation & physical therapy and a 24-hour emergency/trauma center. LBM has been a teaching hospital for more than 50 years, and trains residents and fellows in graduate medical education through affiliations with California medical schools and academic medical centers. In the year ending June 30, 2018, LBM recorded 103,456 patient days, discharged 20,818 patients, provided 18,095 surgical procedures, and had 106,826 emergency department visits. Medicare eligible acute care patients accounted for 15% of discharges and Medi-Cal eligible acute care patients accounted for 15% of acute care discharges. Miller is a 357-bed pediatric teaching hospital which features eight centers of excellence, including seven major inpatient care centers within the hospital and comprehensive outpatient specialty centers that feature more than 30 sub-specialties. Miller offers 18 California Children's Services approved special care centers which provide specialized care for children with conditions such as pulmonary, gastroenterology, orthopedics, cardiology, rehabilitation, diabetes, asthma, autism, and cancer. In the year ending June 30, 2018, Miller provided inpatient care to more than 19,921 children, delivered more than 5,621 babies and cared for more than 1,127 of them in its neonatal intensive care unit (NICU). Medi-Cal eligible acute care patients accounted for 26% of acute care discharges. Miller is one of 22 hospitals in California to feature a regional Level III NICU and is the largest Level III NICU in Los Angeles, Orange and San Diego Counties treating more than 1,000 critically ill and premature babies each year. Miller is a California Children's Services (CCS) approved provider.CHLB is a 158-bed acute-care hospital that offers intensive care, state-of-the-art imaging, a comprehensive cancer care center, cardiovascular diagnostics, behavioral health, heart screenings, occupational medicine, wellness and diabetes services, and a 24-hour emergency department. In the year ending June 30, 2018, CHLB recorded 21,897 patient days, discharged 5,272 patients, provided 908 surgical procedures, and had 24,728 emergency department visits. Medicare eligible acute care patients accounted for 40% of discharges and Medi-Cal eligible acute care patients accounted for 37% of acute care discharges.Effective July 3, 2018, MemorialCare closed CHLB. CHLB is located on an active geologic fault zone. MemorialCare discussed and determined that after much diligence, including consulting with seismic experts, structural engineers, and architects that the seismic remediation necessary to achieve SB1953 compliance (California's seismic safety building standards for hospitals) for CHLB as it currently exists is not feasible.

4B (Expenses $ 306775996 including grants of $ 152155) (Revenue $ 346588615)
See Schedule OSaddleback Memorial Medical Center (SMMC) is a nonprofit corporation which provides inpatient and outpatient hospital services to the community through its 252-bed acute care hospital in Laguna Hills and several outpatient locations in Orange County, California. Through centers of excellence in cancer, heart disease, stroke, pulmonary disease, orthopedics and disabilities, and its highly-regarded women's services, SMMC cares for a wide range of community health needs in Orange County, serves patients who may be uninsured or underinsured, and provides medically necessary services, without cost or at a reduced cost, to patients who qualify under the financial assistance policy in compliance with Internal Revenue Code section 501(r). In the year ending June 30, 2018, SMMC recorded 43,363 patient days, discharged 12,648 patients, provided 4,469 surgical procedures, delivered 2,385 babies, and had 38,738 emergency department visits. Medicare eligible acute care patients accounted for 47% of discharges and Medi-Cal eligible acute care patients accounted for 5% of acute care discharges.

4C (Expenses $ 268652324 including grants of $ 161033) (Revenue $ 294852525)
See Schedule OOrange Coast Memorial Medical Center (OCMMC) is a nonprofit corporation which provides inpatient and outpatient hospital services to the community through its 218-bed acute care hospital in Fountain Valley and several outpatient locations in Orange County, California. OCMMC offers a 24- hour emergency service, a Digestive Disease Center, a Childbirth Center, a Cancer Institute, a Heart and Vascular Center, a Joint Replacement Center, a Spine Health Center, and a Surgical Weight Loss Center, and offers programs and resources to serve its culturally and ethnically diverse community (such as interpreter services in languages such as Spanish, Khmer, Vietnamese, Korean, Arabic, Chinese, Farsi, and Japanese). OCMMC serves patients who may be uninsured or underinsured, and provides medically necessary services, without cost or at a reduced cost, to patients who qualify under its financial assistance policy, which complies with Internal Revenue Code section 501(r). In the year ending June 30, 2018, OCMMC recorded 40,546 patient days, discharged 11,297 patients, provided 6,837 surgical procedures, delivered 1,345 babies, and had 34,499 emergency department visits. Medicare eligible acute care patients accounted for 38% of discharges and Medi-Cal eligible acute care patients accounted for 13% of acute care discharges.

4D (Expenses $ 470815988 including grants of $ 59722) (Revenue $ 495917977)
MemorialCare Medical Foundation (MCMF) is a nonprofit medical practice foundation described in Section 1206(l) of the California Health & Safety Code which provides comprehensive outpatient clinical services at approximately 30 sites throughout Orange and Los Angeles counties in the areas of internal medicine, family medicine, and multiple other specialties. Also, MCMF provides administration, management and contracting services for exclusive primary care providers and a specialty network of affiliated individual and physician groups. MCMF also operates several ambulatory surgery centers and imaging centers throughout Orange and Los Angeles counties. Additionally, MCMF is part of several joint venture partnerships for dialysis clinics throughout Orange and Los Angeles counties. For the year ending June 30, 2018, MCMF provided 569,826 clinic visits and performed 41,107 ambulatory surgeries.

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: Long Beach Memorial Medical Center, - Facility 2: Miller Children's and Women's Hospital Long Be, - Facility 6: Community Hospital of Long Beach

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 5:
The following description applies to all facilities included in Facility Reporting Group A (Long Beach Medical Center, Miller Children's and Women's Hospital Long Beach, and Community Hospital Long Beach):Community input was provided through key informant interviews and focus groups. Key informants included public health experts, representatives from governmental public health agencies, and representatives of medically underserved, low-income and minority populations. Interviews with 34 key informants were conducted during October and November, 2015 for the most recent community health needs assessment. The organizations that provided input through key informant interviews included: the American Cancer Association, Khmer Girls in Action, California State University, Long Beach, YMCA Greater Long Beach, VA Hospital, The California Endowment, Mental Health America, The Children's Clinic, Long Beach Human Trafficking Task Force, Heart of IDA, The LGBTQ Center Long Beach, AIDS Project Los Angeles, The David Geffen Center, Molina Healthcare of California, Long Beach Department of Health and Human Services, ALSAA/CAARE/Healthy Homes Programs, Legal Aid Foundation of Los Angeles, Pacific Asian Counseling Services, Latinos in Action, Second Samoan Congregational Church, Greater Long Beach Interfaith Community Organization, LA County Department of Public Health, Port of Long Beach, Long Beach City Councilmember, Century Villages of Cabrillo, LA County Supervisor, Long Beach Alliance for Children with Asthma, Long Beach Unified School District, and Violence Prevention City of Long Beach. Eight focus groups consisting of community members were assembled, using a number of outreach strategies (e.g., flyers printed in three languages, postings with and notices to community groups, neighborhood organizations, public health agencies and coalitions convened by them, and nonprofit health and welfare organizations). A total of 52 community members participated in the focus groups held in October 2015, including persons who by representation or personal experience had knowledge, information, or expertise relevant to the health needs of medically underserved, low-income and minority populations. Focus groups participants included persons who self-identified as (1) white, Hispanic, black, Cambodian, Vietnamese, Filipino, Chinese, Japanese, Thai and Sri Lankan; (2) members or representatives of a medically underserved, low income or minority population (39%), public health experts (29%), or representatives of governmental or other agency with current information or expertise regarding community health needs (37%).

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 6a:
The following description applies to all facilities included in Facility Reporting Group A:Long Beach Medical Center, Miller Children's and Women's Hospital Long Beach, Community Hospital Long Beach, St. Mary Medical Center Long Beach, and Kaiser Foundation Hospital South Bay.

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 6b:
The following description applies to all facilities included in Facility Reporting Group:The Children's Clinic and the Long Beach Department of Health and Human Services.

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 11:
"Long Beach Memorial: To address the significant health needs identified in its most recent CHNA, Long Beach Memorial (LBM) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, LBM is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; providing transportation to health care services; providing community based clinical services to increase availability of care to underserved populations; and providing sports physicals at no cost to student athletes at area schools.(2) addressing chronic disease by: providing diabetes education to the community at no charge; offering free disease support groups for specific chronic conditions; making oncology life coaches and help lines available to the community; providing chronic disease education, screening and treatment; and providing public health education thought the media and community awareness events regarding healthy behaviors and chronic diseases.(3) addressing mental and behavioral health by: providing education and support groups to offer information, resources and assistance on mental health issues; partnering with the Long Beach Police Department's Homeless Assistance Project to connect homeless persons to services and resources; partnering with community organizations to provide outreach and education through physician led workshops; offering smoking cessation resources; and conducting the ""Tar Wars"" tobacco education program to 5th graders in the Long Beach Unified School District. (4) addressing overweight and obesity by: offering community education on healthy eating and exercise; offering free body mass index screenings; providing nutritional counseling; offering yoga and walking programs; partnering with the City of Long Beach to promote the Healthy Active Long Beach Initiative. (5) addressing preventive care by: providing community health education, presentations, and workshops related to disease prevention and health improvement; providing free health screenings and flu shots; offering senior exercise and fall prevention programs; and offering public health education through media and community events. Needs identified in the most recent CHNA that are not being addressed are access to housing, crime and violence, economic security, education, environment and climate, oral health, and pregnancy and birth outcomes. There are other organizations and agencies that are addressing (and are better qualified to address) these needs."

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 13h:
The following description applies to all facilities included in Facility Reporting Group A:Patients who are homeless, have recently been declared bankrupt, or qualify for a government-sponsored low-income assistance program, are presumptively eligible for assistance under the Financial Assistance Policy.

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 15e:
The following description applies to all facilities included in Facility Reporting Group A:Patients are encouraged to submit their completed application with required documents via United States Mail.

Group A-Facility 1 -- Memorialcare Long Beach Medical Center Part V, Section B, line 16j:
The following description applies to all facilities included in Facility Reporting Group A:A plain language summary of the FAP was translated in to the following languages: English, Spanish, Vietnamese, Farsi, Tagalog, Chinese, Korean and Khmer.

Group A-Facility 6 -- COMMUNITY HOSPITAL OF LONG BEACH Part V, Section B, line 11:
Community Hospital Long Beach: To address the significant health needs identified in its most recent CHNA, Community Hospital Long Beach (CHLB) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, CHLB is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; and providing transportation to health care services.(2) addressing chronic disease by: offering disease support groups; providing chronic disease education, screening and treatment; and providing public health education though the media and community awareness events regarding healthy behaviors and chronic diseases.(3) addressing mental and behavioral health by: providing education and support groups to offer information, resources and assistance on mental health issues; providing services to address chemical dependency; expanding opportunities to address chemical dependency and behavioral/mental health issues in the community through collaboration with other organizations; providing precepted clinical rotation opportunities for registered nursing students to learn about mental health nursing care; and partnering with community organizations to provide outreach and education though physician-led workshops and presentations. (4) addressing overweight and obesity by: offering community education on healthy eating and exercise; offering free body mass index screenings; providing nutritional counseling; and partnering with the City of Long Beach to promote the Healthy Active Long Beach Initiative (5) addressing preventive care by: increasing availability and access to preventive care services; and offering public health education through media and community events.Needs identified in the most recent CHNA that are not being addressed are access to housing, crime and violence, economic security, education, environment and climate, oral health, and pregnancy and birth outcomes. Resources for pregnancy and birth outcomes are available from other organizations, including Miller's Childrens and Women's Hospital of Long Beach. CHLB does not have the expertise or resources to address the other needs. There are other organizations and agencies that are addressing (and are better qualified to address) these other issues.

Group A-Facility 2 -- Miller Children's and Women's Hospital L Part V, Section B, line 11:
"Miller Children's and Women's Hospital Long Beachl: To address the significant health needs identified in its most recent CHNA, Miller Children's & Women's Hospital Long Beach (Miller) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, Miller is:(1) addressing access to care by: promoting the medical home model to improve access to care for children and adolescents in the community; partnering with The Children's Clinic to increase access to care; providing free and discounted care in accordance with its Financial Assistance Policy; providing transportation to medical services; and providing community based clinical services to increase availability of care to underserved populations.(2) addressing chronic disease by: continuing to work with the Long Beach Alliance for Children with Asthma to provide education and advocacy for children with asthma, their families, clinicians and community health workers; providing chronic disease education, screening and treatment; providing public health education through the media and community awareness events regarding healthy behaviors and chronic diseases in children; and developing easy to understand health education information for children and their families.(3) addressing mental and behavioral health by: promoting and participating in school reintegration programs for children with long term mental illness; providing support groups for parents and children; and providing education to providers performing school mental health screenings. (4) addressing overweight and obesity by: offering community education on healthy eating and exercise; offering free body mass index screenings; providing nutritional counseling; and partnering with the City of Long Beach to promote the Healthy Active Long Beach Initiative.. (5) addressing pregnancy and birth outcomes by: offering post-partum support groups for new mothers; tracking birth outcomes in partnership with the Black Infant Health Program; offering education and services through the ""Welcome Baby"" program to new mothers; and supporting breast feeding initiatives and lactation support. (6) addressing preventive care by: providing community health improvement and prevention services; providing community education, bicycle helmets and car seats though a pediatric safety program; and providing free health screenings and flu shots. Needs identified in the most recent CHNA that are not being addressed are access to housing, crime and violence, economic security, education, environment and climate, and oral health. There are other organizations and agencies that are addressing (and better qualified to address) these needs. In addition, Miller does not have the expertise or resources to address these needs."

Part V, Section B
Facility Reporting Group B

Facility Reporting Group B consists of:
- Facility 3: Orange Coast Memorial Medical Center, - Facility 4: Saddleback Memorial Medical Center, - Facility 5: Saddleback Memorial Medical Center - San Cleme

Group B-Facility 5 -- Saddleback Memorial Medical Center - San Part V, Section B, line 11:
Saddleback Memorial Medical Center: To address the significant health needs identified in its most recent CHNA, Saddleback Memorial Medical Center (SMMC) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, SMMC is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; and providing transportation to health care services.(2) addressing chronic disease by: offering community health education, community lectures, presentations and workshops; hosting health and wellness fairs for seniors, including screenings; offering flu shot clinics; providing support groups to assist persons with chronic diseases and their families; providing public education though media and community events to encourage healthy behaviors and prevent chronic diseases; and providing funding and in-kind support to community organizations to support chronic disease prevention and treatment. (3) addressing mental and behavioral health (including substance abuse) by: offering community health education through lectures, presentations and workshops; participating in health and wellness fairs that provide screenings for anxiety and depression; supporting multi-sector collaborative efforts to improve access to mental and behavioral health services; increasing community awareness of available resources; and providing funding and in-kind support to community organizations for mental and behavioral health awareness and access to care. Needs identified in the most recent CHNA that are not being addressed are dental health and overweight/obesity. SMMC does not have the expertise or resources to address these needs. There are other organizations and agencies that are addressing (and are better qualified to address) these issues.

Group B-Facility 3 -- ORANGE COAST MEMORIAL MEDICAL CENTER Part V, Section B, line 5:
Targeted interviews and focus groups were used to gather information and opinions from persons who represent the community served by the facility. The following organizations provided input: Orange County Healthcare Agency, the City of Fountain Valley, the City of Huntington Beach, the Huntington Beach Council on Aging, the Boys & Girls Club of Huntington Valley, the Fountain Valley School District, the Vietnamese American Cancer Foundation, the Alzheimer's Family Services Center, MemorialCare Medical Group, and Orange Coast Memorial Medical Center. Thirteen interviews were conducted with representatives of these organizations during February and March, 2016. The organizations and their representatives were selected based on their leadership or representation of medically underserved, low-income, and minority populations, or because they have current data or other information relevant to the health needs of the community served by the facility. Three focus groups were conducted in April 2016 that engaged 29 persons who were identified based on their representation of medically underserved, low-income, and minority populations in the community or their having information relevant to the health needs of the community served by the facility. The focus group participants were seniors and volunteers at the Fountain Valley Senior Center; seniors and disabled community members at the Huntington Beach Seniors' Outreach Center; and parents and staff at the Boys & Girls Club of Huntington Valley. The focus group participants were asked to share their perspectives on a wide range of issues relating to health and wellness of the community, including barriers and challenges and vulnerable populations.

Group B-Facility 3 -- ORANGE COAST MEMORIAL MEDICAL CENTER Part V, Section B, line 11:
Orange Coast Memorial Medical Center: To address the significant health needs identified in its most recent CHNA, Orange Coast Memorial Medical Center (OCMMC) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, OCMMC is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; providing transportation to health care services; and providing a senior advocate to work with local organizations to assist older adults in securing needed services and coordinating the free senior medical transportation program.(2) addressing chronic disease by: offering community health education, community lectures, presentations and workshops; hosting health and wellness fairs targeting the Vietnamese community, including screenings; offering flu shot clinics; providing support groups to assist persons with chronic diseases and their families; providing public education though media and community events to encourage healthy behaviors and prevent chronic diseases; and providing funding to community organizations to support chronic disease prevention and treatment. (3) addressing overweight and obesity by: offering community health education through lectures, presentations and workshops; hosting health and wellness fairs that include screenings for body mass index, blood pressure and blood glucose; providing support for educational outreach to children and their families on nutrition, healthy food choices, and physical activity; providing funding to support community organizations that encourage and educate regarding healthy eating and physical activity; and supporting services to improve senior nutrition. (4) addressing preventive practices by: providing free health screenings; providing education and resources focused on healthy living and disease prevention; reducing injuries and falls among seniors through balance improvement and fall prevention classes; offering flu shot clinics; providing public health education through media and community events to encourage healthy behaviors and promote preventive care; and providing funding to community organizations to support preventive health services. Needs identified in the most recent CHNA that are not being addressed are dental health, mental health, and substance abuse. Resources for mental health are available from other organizations, including Community Hospital Long Beach. OCMMC does not have the expertise or resources to address these needs.

Group B-Facility 3 -- ORANGE COAST MEMORIAL MEDICAL CENTER Part V, Section B, line 13h:
Patients who are homeless, have recently been declared bankrupt, or qualify for a government-sponsored low-income assistance program are presumptively eligible for assistance under the Financial Assistance Policy.

Group B-Facility 3 -- ORANGE COAST MEMORIAL MEDICAL CENTER Part V, Section B, line 15e:
Patients are encouraged to submit their completed application with required documents via United States Mail.

Group B-Facility 3 -- ORANGE COAST MEMORIAL MEDICAL CENTER Part V, Section B, line 16j:
A plain language summary of the FAP was translated in to the following languages: English, Spanish, Vietnamese, Farsi, Tagalog, Chinese, Korean and Khmer.

Group B-Facility 4 -- SADDLEBACK MEMORIAL MEDICAL CENTER Part V, Section B, line 5:
Targeted interviews and focus groups were used to gather information and opinions from persons who represent the community served by the facility. The following organizations provided input: Orange County Healthcare Agency, the City of Laguna Hills, Laguna Woods Village, Mission Hospital, Age Well Senior Services, Orange County Office on Aging, Illumination Foundation, Las Palmas Elementary School, Family Assistance Ministries, Capistrano Unified School District, Camino Health Clinic, Saddleback Valley Unified School District, Families Forward, and Saddleback Church PEACE Clinic.Sixteen interviews were conducted with representatives of these organizations during February and March, 2016. The organizations and their representatives were selected based on their leadership or representation of medically underserved, low-income, and minority populations, or because they have current data or other information relevant to the health needs of the community served by the facility.Two focus groups were conducted in March 2016 that engaged 20 persons who represented medically underserved, low-income, and minority populations in the community or had material information relevant to the health needs of the community served by the facility. The focus group participants were parents, community members, nonprofit organization employees and city employees of the San Clemente Collaborative; and case managers from Age Well Senior Services. The focus group participants were asked to share their perspectives on a wide range of issues relating to health and wellness of the community, including barriers and challenges and vulnerable populations.

Group B-Facility 4 -- SADDLEBACK MEMORIAL MEDICAL CENTER Part V, Section B, line 11:
Saddleback Memorial Medical Center: To address the significant health needs identified in its most recent CHNA, Saddleback Memorial Medical Center (SMMC) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, SMMC is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; and providing transportation to health care services.(2) addressing chronic disease by: offering community health education, community lectures, presentations and workshops; hosting health and wellness fairs for seniors, including screenings; offering flu shot clinics; providing support groups to assist persons with chronic diseases and their families; providing public education though media and community events to encourage healthy behaviors and prevent chronic diseases; and providing funding and in-kind support to community organizations to support chronic disease prevention and treatment. (3) addressing mental and behavioral health (including substance abuse) by: offering community health education through lectures, presentations and workshops; participating in health and wellness fairs that provide screenings for anxiety and depression; supporting multi-sector collaborative efforts to improve access to mental and behavioral health services; increasing community awareness of available resources; and providing funding and in-kind support to community organizations for mental and behavioral health awareness and access to care. Needs identified in the most recent CHNA that are not being addressed are dental health and overweight/obesity. SMMC does not have the expertise or resources to address these needs.

Group B-Facility 4 -- SADDLEBACK MEMORIAL MEDICAL CENTER Part V, Section B, line 13h:
Patients who are homeless, have recently been declared bankrupt, or qualify for a government-sponsored low-income assistance program are presumptively eligible for assistance under the Financial Assistance Policy.

Group B-Facility 4 -- SADDLEBACK MEMORIAL MEDICAL CENTER Part V, Section B, line 15e:
Patients are encouraged to submit their completed application with required documents via United States Mail.

Group B-Facility 4 -- SADDLEBACK MEMORIAL MEDICAL CENTER Part V, Section B, line 16j:
A plain language summary of the FAP was translated in to the following languages: English, Spanish, Vietnamese, Farsi, Tagalog, Chinese, Korean and Khmer.

Facility Reporting Group A, Line 11
"Long Beach Memorial: To address the significant health needs identified in its most recent CHNA, Long Beach Memorial (LBM) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, LBM is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; providing transportation to health care services; providing community based clinical services to increase availability of care to underserved populations; and providing sports physicals at no cost to student athletes at area schools.(2) addressing chronic disease by: providing diabetes education to the community at no charge; offering free disease support groups for specific chronic conditions; making oncology life coaches and help lines available to the community; providing chronic disease education, screening and treatment; and providing public health education thought the media and community awareness events regarding healthy behaviors and chronic diseases.(3) addressing mental and behavioral health by: providing education and support groups to offer information, resources and assistance on mental health issues; partnering with the Long Beach Police Department's Homeless Assistance Project to connect homeless persons to services and resources; partnering with community organizations to provide outreach and education through physician led workshops; offering smoking cessation resources; and conducting the ""Tar Wars"" tobacco education program to 5th graders in the Long Beach Unified School District.(4) addressing overweight and obesity by: offering community education on healthy eating and exercise; offering free body mass index screenings; providing nutritional counseling; offering yoga and walking programs; partnering with the City of Long Beach to promote the Healthy Active Long Beach Initiative.(5) addressing preventive care by: providing community health education, presentations, and workshops related to disease prevention and health improvement; providing free health screenings and flu shots; offering senior exercise and fall prevention programs; and offering public health education through media and community events. Needs identified in the most recent CHNA that are not being addressed are access to housing, crime and violence, economic security, education, environment and climate, oral health, and pregnancy and birth outcomes. There are other organizations and agencies that are addressing (and are better qualified to address) these needs."

Facility Reporting Group A, Line 11 cont.
"Miller Children's and Women's Hospital Long Beach: To address the significant health needs identified in its most recent CHNA, Miller Children's & Women's Hospital Long Beach (Miller) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, Miller is:(1) addressing access to care by: promoting the medical home model to improve access to care for children and adolescents in the community; partnering with The Children's Clinic to increase access to care; providing free and discounted care in accordance with its Financial Assistance Policy; providing transportation to medical services; and providing community based clinical services to increase availability of care to underserved populations.(2) addressing chronic disease by: continuing to work with the Long Beach Alliance for Children with Asthma to provide education and advocacy for children with asthma, their families, clinicians and community health workers; providing chronic disease education, screening and treatment; providing public health education through the media and community awareness events regarding healthy behaviors and chronic diseases in children; and developing easy to understand health education information for children and their families.(3) addressing mental and behavioral health by: promoting and participating in school reintegration programs for children with long term mental illness; providing support groups for parents and children; and providing education to providers performing school mental health screenings.(4) addressing overweight and obesity by: offering community education on healthy eating and exercise; offering free body mass index screenings; providing nutritional counseling; and partnering with the City of Long Beach to promote the Healthy Active Long Beach Initiative.(5) addressing pregnancy and birth outcomes by: offering post-partum support groups for new mothers; tracking birth outcomes in partnership with the Black Infant Health Program; offering education and services through the ""Welcome Baby"" program to new mothers; and supporting breast feeding initiatives and lactation support. (6) addressing preventive care by: providing community health improvement and prevention services; providing community education, bicycle helmets and car seats though a pediatric safety program; and providing free health screenings and flu shots.Needs identified in the most recent CHNA that are not being addressed are access to housing, crime and violence, economic security, education, environment and climate, and oral health. There are other organizations and agencies that are addressing (and better qualified to address) these needs. In addition, Miller does not have the expertise or resources to address these needs."

Facility Reporting Group A, Line 11 cont.
Community Hospital Long Beach: To address the significant health needs identified in its most recent CHNA, Community Hospital Long Beach (CHLB) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, CHLB is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; and providing transportation to health care services.(2) addressing chronic disease by: offering disease support groups; providing chronic disease education, screening and treatment; and providing public health education though the media and community awareness events regarding healthy behaviors and chronic diseases.(3) addressing mental and behavioral health by: providing education and support groups to offer information, resources and assistance on mental health issues; providing services to address chemical dependency; expanding opportunities to address chemical dependency and behavioral/mental health issues in the community through collaboration with other organizations; providing precepted clinical rotation opportunities for registered nursing students to learn about mental health nursing care; and partnering with community organizations to provide outreach and education though physician-led workshops and presentations.(4) addressing overweight and obesity by: offering community education on healthy eating and exercise; offering free body mass index screenings; providing nutritional counseling; and partnering with the City of Long Beach to promote the Healthy Active Long Beach Initiative.(5) addressing preventive care by: increasing availability and access to preventive care services; and offering public health education through media and community events.Needs identified in the most recent CHNA that are not being addressed are access to housing, crime and violence, economic security, education, environment and climate, oral health, and pregnancy and birth outcomes. There are other organizations and agencies that are addressing (and are better qualified to address) these issues. In addition, CHLB does not have the expertise or resources to address these needs.

Facility Reporting Group B, Line 11
Orange Coast Memorial Medical Center: To address the significant health needs identified in its most recent CHNA, Orange Coast Memorial Medical Center (OCMMC) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, OCMMC is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; providing transportation to health care services; and providing a senior advocate to work with local organizations to assist older adults in securing needed services and coordinating the free senior medical transportation program.(2) addressing chronic disease by: offering community health education, community lectures, presentations and workshops; hosting health and wellness fairs targeting the Vietnamese community, including screenings; offering flu shot clinics; providing support groups to assist persons with chronic diseases and their families; providing public education though media and community events to encourage healthy behaviors and prevent chronic diseases; and providing funding to community organizations to support chronic disease prevention and treatment. (3) addressing overweight and obesity by: offering community health education through lectures, presentations and workshops; hosting health and wellness fairs that include screenings for body mass index, blood pressure and blood glucose; providing support for educational outreach to children and their families on nutrition, healthy food choices, and physical activity; providing funding to support community organizations that encourage and educate regarding healthy eating and physical activity; and supporting services to improve senior nutrition. (4) addressing preventive practices by: providing free health screenings; providing education and resources focused on healthy living and disease prevention; reducing injuries and falls among seniors through balance improvement and fall prevention classes; offering flu shot clinics; providing public health education through media and community events to encourage healthy behaviors and promote preventive care; and providing funding to community organizations to support preventive health services. Needs identified in the most recent CHNA that are not being addressed are dental health, mental health, and substance abuse. Resources for mental health are available from other organizations, including Community Hospital Long Beach. OCMMC does not have the expertise or resources to address these needs.

Facility Reporting Group B, Line 11 cont.
Saddleback Memorial Medical Center: To address the significant health needs identified in its most recent CHNA, Saddleback Memorial Medical Center (SMMC) has adopted an Implementation Strategy. Pursuant to the Implementation Strategy, SMMC is:(1) addressing access to care by: providing free and discounted care pursuant to its Financial Assistance Policy; and providing transportation to health care services.(2) addressing chronic disease by: offering community health education, community lectures, presentations and workshops; hosting health and wellness fairs for seniors, including screenings; offering flu shot clinics; providing support groups to assist persons with chronic diseases and their families; providing public education though media and community events to encourage healthy behaviors and prevent chronic diseases; and providing funding and in-kind support to community organizations to support chronic disease prevention and treatment. (3) addressing mental and behavioral health (including substance abuse) by: offering community health education through lectures, presentations and workshops; participating in health and wellness fairs that provide screenings for anxiety and depression; supporting multi-sector collaborative efforts to improve access to mental and behavioral health services; increasing community awareness of available resources; and providing funding and in-kind support to community organizations for mental and behavioral health awareness and access to care. Needs identified in the most recent CHNA that are not being addressed are dental health and overweight/obesity. SMMC does not have the expertise or resources to address these needs.

Part I, Line 6a:
Each facility prepares a separate community benefit report for the California Office of Statewide Health Planning and Development filing purposes. A consolidating schedule for the dollar amounts of charity & community benefit provided to the communities is prepared by the corporate office for the audited financial statements and the annual report.

Part I, Line 7:
The amounts reported on Lines 7a, 7b, and 7c were calculated using a cost-to-charge ratio derived from Worksheet 2. The amounts reported on Line 7g were calculated using a cost accounting system that addresses all expenses from the consolidated income statement of each facility, and all patient care areas are included in the indirect allocation (inpatient, hospital billed outpatient and emergency room and external billed outpatient), with no exception by payer. Additionally, a cost allocation method based on reasonable allocation factors including: square footage, funding source, employee wages, and fair rental value, was used to include estimated expense for Lines 7f, 7h, and 7i. The amounts reported on Line 7e are direct costs from the general ledger.

Part I, Line 7g:
"All expenses reported on Line 7g are subsidized health services provided at the outpatient specialty centers (clinics) of the Miller Children's and Women's Hospital Long Beach. These specialty centers offer more than 30 pediatric sub-specialty services. Children are seen for acute, chronic or surgical conditions. These outpatient centers serve as the patient's ""medical home"" for the many that will need ongoing follow-up care and support on a regular basis. These much needed pediatric services are subsidized in order to provide services regardless of ability to pay."

Part I, Ln 7 Col(f):
Provision for doubtful accounts is recorded based on historical experience and collection trends for major payer types. These are amounts for which the patient or a guarantor is responsible and no other third party liability exists. A minimum of two statements will be sent to the patient or guarantor notifying them that the balance is due. After reasonable and customary collection efforts have been made and the liability remains outstanding for more than 120 days from the mailing date of the first bill, the account will be referred to an outside collection agency. At that time the account is written off to provision for doubtful accounts. The unpaid patient portion of Medicare accounts will not be deemed uncollectible and sent to a collection agency until a minimum of 120 days have passed from the date of the first bill mailed to the beneficiary. The patient portion of a Medicare account will then be sent to a collection agency but will not be written off to provision for doubtful accounts until it is returned from the collection agency after a determination that there is no likelihood of recovery. Unresolved accounts are returned to the facility by the collection agencies after they have performed all reasonable and customary collections efforts and determined that there is no likelihood of recovery.Payments are received for services under the Medicare and Medi-Cal programs and private managed care programs based on contract terms, and from other payers. Receivables from non-government payers are subject to differing economic conditions. Reserves associated with receivables are continually monitored and adjusted. Estimates of the provision for doubtful accounts and the allowance for uncollectible accounts are based on historical collection experience.

Part II, Community Building Activities:
The organizations included in this group return engaged in community building activities in the following categories during the year:Community Support - Staff from each facility identified in Part V of Schedule H participated in coalitions, on committees and on advisory and governing boards of community groups and public health agencies to address health and wellness issues. Staff members also engage in community health planning activities, educational presentations, and consortia, summits, and meetings with community groups.Leadership Development - The 13th Annual Health Care Forum for Business Leaders, the President's Partnership was a conference hosted by MemorialCare President, Dr. Arbuckle. The conference, The Puzzling Economics of Healthcare 2018, engaged employers in the region to better understand health care reform, create a healthier workforce, and advocate for better care in the communities they serve.Coalition Building - Facility staff hold member, advisory committee, and governing body positions in local, regional, state and national health and welfare coalitions.Community Health Improvement Advocacy - Facility staff is involved in advocacy activities for improved health and wellness. Staff engages in local, state and national advocacy efforts that support access to health care.Workforce Development - The facilities staff participated in community programs that encourage careers in nursing and other health professions and promote diversity in health care careers. Staff members visited local schools to discuss careers in health care and shared their expertise as mentors to high school students.

Part III, Line 2:
Bad debt is determined based on patient liability, irrespective of any previous payments or discounts on the account. For accounts with insurance coverage, once the insurance has paid, a statement is sent to the patient for their portion (deductible, co-pay, non-covered charges). For self-pay accounts, several options for discounts are available. After a set period of time, if payments are not made, the patient portion is written off as bad debt.

Part III, Line 8:
The entire Medicare shortfall should be treated as a community benefit because the amount reflects the value of patient care services subsidized by the organizations. The organizations cannot collect the shortfall in reimbursement from the patient therefore, are providing a benefit to the community by offering services to Medicare beneficiaries at financial loss. This loss prevents the organizations from investing in other community benefit activities.

Part VI, Line 7, Reports Filed With States
CA

Part III, Line 4:
Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Corporation analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Corporation analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with self-pay patients, which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, a significant provision for bad debts is recorded in the period of service on the basis of its past experience. The difference between the standard rates, or the discounted rates if negotiated, and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.

Part III, Line 9b:
Once an account balance has been determined to be solely a patient responsibility, a minimum of two statements are sent to the patient or any identified guarantor notifying them of the amount due. If the patient liability remains unpaid despite reasonable and customary collection efforts, the account may be referred to an outside collection agency, and the collection agency will pursue reasonable and customary collection efforts. If at any time during this process the patient indicates financial hardship, the patient will be informed of the organization's Financial Assistance Policy. If all or part of a balance qualifies for charity care under the Financial Assistance Policy, that amount will be treated as charity care. The remainder, if any, remains classified as bad debt. When the collection agency determines there is no likelihood of recovery, the agency ceases all collection efforts, and notifies the organization. Collection procedures are applied consistently for all patients, regardless of insurance status. For those patients indicating financial hardship, the organization's Financial Assistance Policy will be followed to determine the extent to which charity care, low income financial assistance or extended payment plans may be available. Patients are informed of the Financial Assistance Policy and payment options by the patient statements provided at 30 day intervals up to 120 days from the first statement, and advised to contact the organization's Patient Financial Services department for more information about payment options or financial assistance that may be available. If a patient is not eligible for a government assistance program and the patient indicates a need for financial assistance or an extended payment plan, an application is promptly provided to the patient. No organization included in this group return or its agent or assignee (including a collection agency) will report adverse information to a consumer credit reporting agency or commence civil action against a patient for nonpayment at any time prior to 150 days after initial billing.

Part VI, Line 2:
In addition to performing the community health needs assessment (CHNA), each facility identified in Part V of Schedule H engages a Community Benefit Oversight Committee, which is led by community members and supported by facility staff. This Committee meets regularly to identify and discuss community health needs and possible resources to meet those needs. Each facility has made its CHNA available on its public website, and has asked for public comments to solicit additional information and input on community health needs. Facility staff actively participate in local collaborative groups that convene to identify and address community health and welfare needs. Members of facility staff serve on a number of community organization governing boards and advisory bodies to public health agencies, and information obtained from this active community involvement factors into identification of community health needs.

Part VI, Line 3:
Each facility identified in Part V of Schedule H posts notices informing the public of its financial assistance program in the emergency service area and other high volume inpatient and outpatient areas. In addition, notices are posted in patient financial services and collection departments, and on the facility's website. These notices are posted in English and Spanish and any other languages that are representative of 5% or more of the patients in the facility's service area.Each facility offers brochure about the program, which expressly states that facility staff will help patients identify all of their options and assist patients in applying for assistance, and provides contact information for the facility's program and governmental programs. The brochures are posted in English and Spanish and any other languages that represent 5% or more of the patients in the facility's service area.

Part VI, Line 4:
Community Hospital Long Beach serves the communities of Bellflower, Long Beach and Signal Hill, with a population of over 500,000. The largest ethnic group is Hispanic/Latino, (approximately 40%), followed by White, Blacks/African American, Asians, Native Americas and Pacific Islanders. English is spoken in over half the homes and Spanish is spoken in about one-third of the homes. Children (age 0-18) account for approximately 28% of the population, and seniors (age 65 and older) are about 10% of the population. Of the service area population age 25 and over, 20.7% do not have a high school diploma. Over 20% of the population lives at or below the federal poverty level and over 40% are considered low income. Miller Children's and Women's Hospital Long Beach, serves the communities of Bell, Bellflower, Compton, Lakewood, Long Beach, Lynwood, Norwalk, Paramount, San Pedro, South Gate, and Wilmington, with a population of over 1,200,000. The largest ethnic group is Hispanic/Latino (approximately 60%), followed by White, Black/African American, Asian, and Native American or Pacific Islander. English is spoken in over 40% of the homes, and Spanish is spoken almost half the homes. Children (age 0-18) account for approximately 31% of the population, and seniors (age 65 and older) are about 8% of the population. Of the population age 25 and over, more than 30% do not have a high school diploma. Approximately 20% of the population lives at or below the federal poverty level and over 40% are considered low income. Long Beach Memorial serves the communities of Bellflower, Compton, Lakewood, Long Beach, Seal Beach and Signal Hill, with a population of over 740,000. The largest ethnic group is Hispanic/Latino (over 40%), followed by White, Black/African American, Asians, Native Americans and Pacific Islanders. English is spoken in over half the homes and Spanish is spoken in approximately 35% of homes. Children (age 0-18) account for approximately 28% of the population, and seniors (age 65 and older) are about 10% of the population. Of the service area population age 25 and over, 21.7% do not have a high school diploma. Approximately 23% of the population lives at or below the federal poverty level and over 40% are considered low income. Orange Coast Memorial Medical Center serves the communities of Anaheim, Buena Park, Costa Mesa, Cypress, Fountain Valley, Garden Grove, Huntington Beach, Midway City, Santa Ana, Seal Beach, Stanton, Tustin and Westminster, a population of over 1,200,000. The largest ethnic group is Hispanic/Latino (approximately 40%), followed by White (approximately 30%) and Asian (over 20%). Spanish is spoken in approximately one-third of the homes, and an Asian or a Pacific Islander language is spoken in approximately 18% of the homes. Children (age 0-17) account for approximately 23% of the population, and seniors (age 65 and older) are about 12% of the population. Approximately 22% of adults have not graduated high school. Approximately 15% are at or below the federal poverty level, and over 35% are considered low-income. Saddleback Memorial Medical Center serves the communities of Aliso Viejo, Capistrano Beach, Dana Point, Foothill Ranch, Irvine, Ladera Ranch, Laguna Beach, Laguna Hills, Laguna Niguel, Laguna Woods, Lake Forest, Mission Viejo, Newport Beach, Rancho Santa Margarita, San Clemente, San Juan Capistrano and Trabuco Hills, a population over 840,000. More than half of the population (approximately 68%) is White, and Asians are the second largest ethnic group in the service area (approximately 17%). Hispanics/Latinos account for about 15% of the population. An Asian or Pacific Islander language is spoken in approximately 11% of homes and Spanish is spoken in approximately 10% of homes. Children (age 0-17) account for approximately 22% of the population, and seniors (age 65 and older) are about 14% of the population. Over 5% of adults have not graduated from high school. Less than 8% are at or below the federal poverty level and over 17% are considered low income.

Part VI, Line 5:
"The governing board of each organization included in this group return, and the governing board of the sole member of each organization, is comprised of members of the communities served, and none of the governing body members are compensated for their board service (other than the Memorial Health Services Chief Executive Officer, who is compensated as the Chief Executive Officer by Memorial Health Services, and part of his duties include service on the board of each organization). Each facility identified on Part V of Schedule H has a Community Benefit Oversight Committee, which is led by volunteer community members and supported by facility employees. These Committees have oversight of each community health needs assessment and the development of implementation strategies to address identified community health needs. Each facility identified in Part V of Schedule H maintains an open medical staff except in rare instances when a clinical department is ""closed"" in accordance with California law for hospital-based services.As a nonprofit organization, any surplus of funds is invested back into providing health care services and resources to the community, including but not limited new patient care locations and equipment, expanded programs and services, and the training of physicians, nurses and other professionals including pharmacists and speech, occupational, physical and respiratory therapists. One of the facilities partners with the University of California, Irvine to train medical residents in various specialties, maintains a pharmacy residency program, and partners with California State University Long Beach to provide clinical training to nursing students. A coordinated research administration function oversees scientific and clinical research at the organizations. Through the MemorialCare Physician Society, independently practicing physicians are supported in their efforts to promote and share best practices in evidence-based medicine."

Part VI, Line 6:
Each organization included in this group return is part of the MemorialCare Health System (MemorialCare), the parent of which is Memorial Health Services. Three of the organizations included in this group return operated one or more hospitals: Long Beach Memorial Medical Center, Orange Coast Memorial Medical Center, and Saddleback Memorial Medical Center. MemorialCare Medical Foundation is a nonprofit medical practice foundation described in Section 1206(l) of the California Health & Safety Code and provides primary care and specialty physician services to the community at over 30 sites across south Los Angeles County and Orange County. The mission of each of these organizations is to improve the health and well-being of individuals, families and our communities, and each organization has a role in promoting the health of the communities served, including providing education to members of the community about health and wellness, and conducting research. In addition, MemorialCare founded and supports the MemorialCare Physician Society, an unincorporated association of more than 1,700 independently practicing doctors who are committed to improving clinical outcomes and patient safety through the use and sharing of best practices in evidence based medicine. MemorialCare also includes philanthropic foundations, which have strong community ties and raise money to fund patient care programs, needed facilities and equipment, medical education, community education and outreach, and research.