4A (Expenses $ 496116700 including grants of $ 0) (Revenue $ 516652052)
PATIENT SERVICES TO INCLUDE 81,425 PATIENT DAYS, 158,032 OUTPATIENT VISITS, AND 340,567 VISITS TO THE CENTERS FOR FAMILY HEALTH AND MIDTOWN MEDICAL GROUP (THE HEALTHCARE SYSTEM'S OUTPATIENT CARE CLINICS). INCLUDED IN PATIENT SERVICE EXPENSE ARE THE SYSTEM'S EFFORTS TO PREVENT THE SPREAD OF COVID-19 AND TREAT COVID-19 PATIENTS. THROUGHOUT 2021, THE HEALTHCARE SYSTEM PROVIDED COVID-19 VACCINES AND BOOSTERS TO EMPLOYEES, MEDICAL STAFF, AREA PHYSICIAN OFFICES, SCHOOL DISTRICT EMPLOYEES, AND ELIGIBLE MEMBERS OF THE GENERAL PUBLIC. SEE SCHEDULE O FOR FURTHER DETAIL ON THE SYSTEM'S COVID-19 RESPONSE EFFORTS.

4B (Expenses $ 979968 including grants of $ 513643) (Revenue $ 0)
STANDARD COMMUNITY OUTREACH PROGRAMS INCLUDE: FREE BLOOD PRESSURE CHECKS; CANCER RESOURCE CENTER AND SUPPORT GROUPS; HEART-AWARE PROGRAM THAT PROVIDES FREE RISK EVALUATION, PREVENTATIVE INFORMATION AND RESOURCES. IN ADDITION TO OUR REGULAR OUTREACH PROGRAMS, THE HEALTHCARE SYSTEM PROVIDED THE COMMUNITY WITH INFORMATION ON COVID-19 TESTING, TREATMENT, SUPPORT RESOURCES AND VACCINATIONS. THE HEALTHCARE SYSTEM'S SOCIAL MEDIA PLATFORMS WERE MOBILIZED TO POSITION CMHS AS THE COMMUNITY'S TRUSTED RESOURCE FOR PUBLIC HEALTH UPDATES AND VENTURA COUNTY MANDATES. SEE SCHEDULE O.

PART V, SECTION B, LINE 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

PART V, SECTION B, LINE 5
COMMUNITY MEMORIAL HEALTH SYSTEM (CMHS) CONDUCTED ITS MOST RECENT CHNA THROUGH A COORDINATED EFFORT WITH ITS PARTNERS AT THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH, ADVENTIS HEALTH SIMI VALLEY, CAMARILLO HEALTH CARE DISTRICT, CLINICAS DEL CAMINO REAL, ST. JOHN'S REGIONAL MEDICAL CENTER, ST. JOHN'S PLEASANT VALLEY HOSPITAL, VENTURA COUNTY PUBLIC HEALTH AND THE VENTURA COUNTY HEALTH CARE AGENCY COMMUNITY HEALTH CENTER. THESE PARTNERS MAKE UP THE VENTURA COUNTY COMMUNITY NEEDS ASSESSMENT COLLABORATIVE (VCCNAC). A COMMUNITY HEALTH ASSESSMENT SURVEY (2019) WAS DESIGNED AND DISSEMINATED BY THE VENTURA COUNTY COMMUNITY NEEDS ASSESSMENT COLLABORATIVE. THE CHNA FINDINGS ARE DRAWN FROM AN ANALYSIS OF AN EXTENSIVE SET OF SECONDARY DATA (OVER 240 INDICATORS FROM NATIONAL AND STATE DATA SOURCES) AND IN-DEPTH PRIMARY DATA FROM COMMUNITY HEALTH LEADERS AND ORGANIZATIONS THAT SERVE THE COMMUNITY AT LARGE, AS WELL AS NON-HEALTH PROFESSIONALS AND COMMUNITY MEMBERS. THE MAIN SOURCE FOR THE SECONDARY DATA IS THE HEALTH MATTERS IN VENTURA COUNTY PLATFORM, A PUBLIC DATA PLATFORM MADE AVAILABLE BY VENTURA COUNTY PUBLIC HEALTH. THE PRIMARY DATA COLLECTION PROCESS INCLUDED A COMMUNITY HEALTH ASSESSMENT SURVEY. A TOTAL OF 2,722 RESPONSES WERE COLLECTED. ONE OF THE KEY OBJECTIVES OF THE ASSESSMENT WAS TO ENGAGE THE COMMUNITY, INCLUDING VULNERABLE POPULATIONS, PHYSICIANS, AND OTHER SERVICE PROVIDERS TO SHARE THEIR PERCEPTIONS ON HEALTH NEEDS FOR VENTURA COUNTY RESIDENTS. KEY INFORMATION INTERVIEWS AND FOCUS GROUP DISCUSSIONS WERE HELD TO HELP DEVELOP A DEEPER UNDERSTANDING OF THE DATA COLLECTED. ON APRIL 23, 2019, 25 STAKEHOLDERS OF THE VCCNAC CONVENED IN AN ALL-DAY EXERCISE TO REVIEW THE FINDINGS FROM THE PRIMARY DATA AND THE SECONDARY DATA COLLECTION EFFORTS TO PRIORITIZE THE SIGNIFICANT HEALTH ISSUES THAT AROSE THROUGH THIS ANALYSIS.

PART V, SECTION B, LINE 6A
CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES ADVENTIST HEALTH SIMI VALLEY ST. JOHN'S REGIONAL MEDICAL CENTER, DIGNITY HEALTH ST. JOHN'S PLEASANT VALLEY HOSPITAL, DIGNITY HEALTH

PART V, SECTION B, LINE 6B
CHNA CONDUCTED WITH OTHER ORGANIZATIONS CAMARILLO HEALTH CARE DISTRICT CLINICAS DEL CAMINO REAL, INC. VENTURA COUNTY HEALTH CARE AGENCY COMMUNITY HEALTH CENTER VENTURA COUNTY PUBLIC HEALTH

PART V, SECTION B, LINE 7
CHNA WEBSITE https://www.cmhshealth.org/about/community-health-needs-assessment/

PART V, SECTION B, LINE 10
IMPLEMENTATION STRATEGY WEBSITE https://www.cmhshealth.org/about/community-health-needs-assessment/

PART V, SECTION B, LINE 11
"THE COMMUNITY MEMORIAL HEALTH SYSTEM BOARD OF TRUSTEES ESTABLISHED A COMMUNITY BENEFIT COMMITTEE TO OVERSEE THE DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF ONGOING COMMUNITY BENEFIT ACTIVITIES AND THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE CMHS BOARD OF TRUSTEES APPROVES THE IMPLEMENTATION STRATEGY RECOMMENDED BY THE COMMITTEE. THE CHNA IDENTIFIED FIVE HEALTH PRIORITIES FOR THE COUNTY OF VENTURA: 1. IMPROVE ACCESS TO HEALTH SERVICES 2. REDUCE THE IMPACT OF BEHAVIORAL HEALTH ISSUES 3. IMPROVE HEALTH AND WELLNESS FOR OLDER ADULTS 4. REDUCE THE BURDEN OF CHRONIC DISEASE 5. ADDRESS SOCIAL NEEDS OF THE FIVE INDENTIFIED PRIORITIES, THE ORGANIZATIONS PARTICIPATING IN THE JOINT COMMUNITY HEALTH IMPLEMENTATION STRATEGY HAVE CHOSEN NOT TO ADDRESS TWO OF THE PRIORITIZED HEALTH NEEDS IDENTIFIED IN THE CHNA: 1. REDUCE THE IMPACT OF BEHAVIORAL HEALTH ISSUES 2. REDUCE THE BURDEN OF CHRONIC DISEASE THE PRIORITIZED HEALTH NEEDS WERE NOT SELECTED BECAUSE VCCNAC HAS IDENTIFIED OTHER COMMUNITY STAKEHOLDERS THAT ARE CURRENTLY LEADING INTERVENTIONS TO ADDRESS THESE HEALTH NEEDS IN THE COUNTY, INCLUDING VENTURA COUNTY BEHAVIORAL HEALTH. COMMUNITY MEMORIAL HEALTH SYSTEM HAS SEPARATELY IMPLENTED ALL FIVE PRIORITIES IDENTIFIED IN THE CHNA. COMMUNITY MEMORIAL HEALTH SYSTEM ADDRESSED THE PRIORITY AREAS BY: IMPROVE ACCESS TO HEALTH SERVICES - COLLABORATING WITH CLINICAS DEL CAMINO REAL TO ENHANCE PATIENT ACCESS TO SPECIALTY CARE. INVESTMENT IN TECHNOLOGY HAS REDUCED THE NO-SHOW RATE AND THE APPOINTMENT BACKLOG. ONGOING PARTICIPATION WITH GOLD COAST HEALTH PLAN ON INITIATIVE TO IMPROVE ""CHILDREN AND ADOLESCENTS' ACCESS TO PRIMARY CARE PRACTITIONERSINCREASE HEDIS SCORES FOR GCHP. - CONTINUED TO IMPROVE PHYSICIAN RESIDENT TRAINING AT THE CMHS GRADUATE MEDICAL EDUCATION PROGRAM THROUGH FACULTY RECRUITMENT AND LOCAL PARTNERSHIPS. - ENHANCING THE PHYSICIAN RESIDENT FREE CLINIC PROGRAM IN UNDERSERVED COMMUNITIES. - CONTINUED GROWTH OF THE MULTI-SPECIALTY CLINIC IN OJAI. THIS CLINIC WAS CLOSED IN 2020 DUE TO COVID-19 AND REOPENED IN 2021 WITH RENEWED FAMILY PRACTICE AND SPECIALTY PHYSICIANS. - PARTICIPATING IN THE UNITED WAY'S BUILDING HEALTHY SMILES CAMPAIGN TO ADDRESS THE NEED FOR ACCESS TO DENTAL CARE. - RECRUITING SPECIALTY AND FAMILY PHYSICIANS. REDUCE THE IMPACT OF BEHAVIORAL HEALTH ISSUES - LAUNCHING TELEMEDICINE FOR BEHAVIORAL HEALTH. - ENHANCING ACCESS TO BEHAVIORAL HEALTH PROVIDERS BY COLLABORATING WITH CLINICAS DEL CAMINO REAL AND WORKING WITH VISTA DEL MAR FOR DEVELOPING INTEGRATED SERVICES AT CMHS' OUTPATIENT CLINICS. IMPROVE HEALTH AND WELLNESS FOR OLDER ADULTS - PROVIDING IN-KIND SUPPORT AND STAFF ENGAGEMENT TO THE EXPLORATION AND DEVELOPMENT EFFORTS OF SENIOR INDEPENDENT LIVING SUPPORT IN THE OJAI VALLEY AND WEST VENTURA. REDUCE THE BURDEN OF CHRONIC DISEASE - CMHS AMBULATORY MEDICINE RELAUNCHED INTENSIVE CASE MANAGEMENT TO IMPROVE COORDINATION OF CARE. THE CHRONIC CARE MANAGEMENT PROGRAM HAS OVER 1,000 PATIENTS ON SERVICE. - CMHS HEALTHAWARE HAS PROMOTED CARDIAC AND VASCULAR HEATLH BY PROVIDING THOUSANDS OF COMMUNITY MEMBERS WITH ONGOING HEALTH EDUCATION, SUPPORT, FREE SCREENINGS, AND HEALTH ASSESSMENTS. - PROVIDING FREE CHRONIC DISEASE DETECTION AND SCREENING SERVICES - THE HEALTH AREA OF OBESE/OVERWEIGHT YOUTH WAS NOT ADDRESSED IN 2020. ADDRESS SOCIAL NEEDS - IMPLEMENTED ELECTRONIC PRESCRIBING AT THE OUTPATIENT HOSPITAL CLINICS FOR CONTROLLED SUBSTANCES TO SET A GENERAL STANDARD OF PRESCRIBING OPIOID PAIN MEDICATION TO REDUCE OPIOID OVERDOSE RELATED DEATHS. - THREE PHYSICIANS OBTAINED CERTIFICATION FOR PRESCRIBING SUBOXONE FOR OPIOID DEPENDENCE TREATMENT. - THE SYSTEM CONTRACTED THE SERVICES OF A PHYSICIAN THAT SPECIALIZES IN ADDICTION MEDICINE TO PROVIDE LEADERSHIP AND IMPROVE THE QUALITY OF THE SYSTEM'S ADDICTION MEDICINE PROGRAM. - CONNECTING WITH WEST VENTURA SCHOOLS TO CONTRIBUTE TO MOTIVATING STUDENTS TO GRADUATE FROM HIGH SCHOOL INCLUDING ACTIVITIES SUCH AS CAREER DAY, CPR AND FIRST AID EDUCATION, AND DISASTER PLANNING. - OFFERING EDUCATIONAL PROGRAMS. - HOSTING SUPPORT GROUPS THAT ARE WIDELY AVAILABLE TO THE PUBLIC. - PROVIDING RECUPERATIVE CARE TO THE HOMELESS WITH SHORT TERM CARE AND CASE MANAGEMENT. - A PILOT PROJECT WAS IMPLEMENTED TO REDUCE FOOD INSECURITY BY CONNECTING HIGH NEED/HIGH RISK CLIENTS TO FEDERAL/STATE/LOCAL FOOD ACCESS PROGRAMS AND FOOD RESOURCES FOR THEIR UNMET NEEDS. THE PROJECT ADMINISTERS FOOD INSECURITY SCREENING IN CLINICAL ENVIRONMENTS AND MAKE REFERRALS TO THE COUNTY FOR ENROLLMENT IN CALFRESH AND/OR WIC."

PART V, SECTION B, LINE 15E
CMHS PUBLICIZES A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ON THE FACILITY'S WEBSITE. INCLUDED ON THE BACK OF EACH BILLING STATEMENT IS A DISCLAIMER REGARDING FINANCIAL ASSISTANCE BEING AVAILABLE AND A CONTACT NUMBER TO CALL IF INTERESTED. MOREOVER, CMHS HAS SIGNAGE POSTED IN THE ADMITTING AND EMERGENCY ROOM AREAS. A WRITTEN COPY OF THIS POLICY IS AVAILABLE UPON REQUEST, AS INDICATED ON THIS SIGNAGE DISPLAYED.

PART V, SECTION B, LINE 16A
FINANCIAL ASSISTANCE POLICY WEBSITE HTTP://WWW.CMHSHEALTH.ORG/PATIENTS-AND-VISITORS/PATIENT-INFORMATION/COMMUN ITY-MEMORIAL-HOSPITAL/FINANCIAL-SERVICES/

PART V, SECTION B, LINE 16B
FINANCIAL ASSISTANCE POLICY APPLICATION WEBSITE HTTP://WWW.CMHSHEALTH.ORG/PATIENTS-AND-VISITORS/PATIENT-INFORMATION/COMMUN ITY-MEMORIAL-HOSPITAL/FINANCIAL-SERVICES/

PART V, SECTION B, LINE 16C AND 16F
PLAIN LANGUAGE SUMMARY WEBSITE HTTP://WWW.CMHSHEALTH.ORG/PATIENTS-AND-VISITORS/PATIENT-INFORMATION/COMMUN ITY-MEMORIAL-HOSPITAL/FINANCIAL-SERVICES/

PART V, SECTION B, LINE 16H
CMHS CREATED A BILINGUAL FINANCIAL ASSISTANCE FLYER THAT IS DISTRIBUTED TO THE COMMUNITY AT HEALTH FAIRS, FREE CLINICS, COMMUNITY EVENTS AND SUPPORT GROUPS. THIS FLYER PROVIDES DETAILS ON THE CMHS FINANCIAL ASSISTANCE PROGRAM AS WELL AS DIRECTION ON HOW TO SOLICIT SUPPORT WITH ENROLLMENT.

PART I, LINE 3C
IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO USED AN ALGORITHM TO DETERMINE QUALIFICATION OF CHARITY CARE FROM INFORMATION PROVIDED BY PATIENTS AT INTAKE AS WELL AS INFORMATION FROM CREDIT REPORTS.

PART I, LINE 7
COSTING METHOD USED IS COST-TO-CHARGE USING WORKSHEET 2.

PART I, LINE 7B
"UNREIMBURSED MEDICAID THE CALIFORNIA HOSPITAL FEE PROGRAM (THE PROGRAM) AND AMENDING-LEGISLATION WAS SIGNED INTO LAW BY THE GOVERNOR OF CALIFORNIA ON JANUARY 1, 2010 AND SEPTEMBER 8, 2010, RESPECTIVELY. THE PRIMARY LEGISLATION (AB 1383) AND AMENDING LEGISLATION (AB 1653) CONTAINS TWO COMPONENTS: THE QUALITY ASSURANCE FEE ACT, WHICH GOVERNS THE ""HOSPITAL FEE""QUALITY ASSURANCE FEE"" (QA FEE) PAID BY PARTICIPATING HOSPITALS, AND THE MEDI-CAL HOSPITAL PROVIDER STABILIZATION ACT, WHICH GOVERNS SUPPLEMENTAL MEDI-CAL PAYMENTS (SUPPLEMENTAL PAYMENTS) MADE TO PROVIDERS FROM THE FUND. HOSPITAL PARTICIPATION IS MANDATORY, WITH LIMITED EXCEPTIONS. IN JUNE 2012, THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) AMENDED LEGISLATION TO ALLOW FOR THE FEE-FOR-SERVICE PORTION OF THE PROGRAM TO BE ADMINISTERED SEPARATELY FROM THE MANAGED CARE COMPONENT. THE SYSTEM MADE PAYMENTS TO THE DHCS FOR THE QA FEE IN THE AMOUNT OF $18,549,262 IN 2021. THE SYSTEM MADE CALIFORNIA HEALTH FOUNDATION AND TRUST PAYMENTS IN THE AMOUNT OF $423,360 IN 2021, AND THE PLEDGE PAYMENTS WERE RECORDED WITHIN THE QA FEE IN OPERATING EXPENSES WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. THE SYSTEM RECEIVED SUPPLEMENTAL PAYMENTS OF $43,627,356 OVER THE COURSE OF THE PROGRAM IN 2021. THE SYSTEM RECORDED THE SUPPLEMENTAL PAYMENTS AS OPERATING REVENUE WITHIN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS. PART I, LINE 7E COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS COMMUNITY HEALTH IMPROVEMENT SERVICES INCLUDE: - PROJECT SAFE HARBOR, WHICH SUPPORTS VICTIMS OF DOMESTIC ABUSE - CANCER CENTER SERVICES, WHICH INCLUDE INFORMATIONAL MATERIALS, PATIENT AND FAMILY CONSULTATIVE SERVICES, AND CANCER SUPPORT GROUPS - HEALTHAWARE SERVICES, INCLUDING FREE HEALTH ASSESSMENTS, ANNUAL HEALTH SCREENINGS, AND FREE EDUCATIONAL CLASSES - TUMOR REGISTRY, WHICH IS A GROUP OF RADIOLOGISTS, MEDICAL AND RADIATION ONCOLOGISTS, SURGEONS, PATHOLOGISTS, AND OTHER PHYSICIANS, WHO'S MISSION IS TO SHARE THEIR INDIVIDUAL EXPERTISE, EXPERIENCES AND KNOWLEDGE IN AN EFFORT TO BATTLE CANCER TOGETHER - HEALTH SEMINARS AND CONFERENCES, WHICH ARE PROVIDED FREE TO THE COMMUNITY. EXPENSES INCLUDE PROGRAM MATERIALS, PRODUCTION COSTS, AND MAILERS. - NEW PARENT RESOURCE CENTER SERVICES, WHICH INCLUDE CHILDBIRTH CLASSES, BREASTFEEDING CLASSES AND CONSULTATIONS, PRENATAL YOGA, AND SUPPORT GROUPS COMMUNITY BENEFIT OPERATIONS INCLUDE: - COMMUNITY RELATIONS ADMINISTRATIVE COSTS, WHICH INCLUDES LABOR EXPENSES FOR THE SYSTEM'S HEALTH SEMINARS AND CONFERENCES (SOCIAL MEDIA POSTING, RADIO ADVERTISEMENTS, PRESS RELEASES, PRESENTATION SLIDE PREPARATION AND DISSEMINATION, EVENT RECORDING AND POSTING TO YOUTUBE, AND FOLLOW-UP CAMPAIGNS) - TRANSPORTATION EXPENSES FOR DISCHARGED PATIENTS, WHICH INCLUDES TAXI AND RIDE-SHARE COSTS - HOMELESS DISCHARGE PROGRAM, WHICH PROVIDES PHARMACEUTICALS, CLOTHING, AND TRANSPORTATION SERVICES - COMMUNITY BENEFIT REPORT PREPARATION, WHICH INCLUDES IDENTIFYING COMMUNITY BENEFIT NEEDS, COLLECTING COMMUNITY BENEFIT EXPENSES, AND PREPARING THE COMMUNTIY BENEFIT REPORT"

PART II
COMMUNITY BUILDING ACTIVITIES CMHS REGULARLY EVALUATES THE HEALTH NEEDS OF THE COMMUNITIES SURROUNDING ITS OUTPATIENT AND HOSPITAL LOCATIONS AND STRATEGICALLY RECRUITS FAMILY AND SPECIALTY PHYSICIANS TO MEET THE IDENTIFIED NEEDS. CMHS ALSO SUPPORTS ITS AFFILIATED MEDICAL GROUPS WITH PHYSICIAN RECRUITMENT WHERE A COMMUNITY NEED IS DEMONSTRATED. THE MARKET NEED IS EVALUATED BY A TARGETED STUDY OF THE NUMBER OF PHYSICIANS NEEDED PER PRACTICE AREA BASED ON POPULATION SIZE. AS A MEMBER AND ENGAGED PARTICIPANT IN THE VENTURA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT COLLABORATIVE, CMHS HAS TAKEN AN ACTIVE LEADERSHIP ROLE IN THE SHARING OF VALUABLE INFORMATION ON HEALTH IMPROVEMENT INITIATIVES AND THE PLANNING OF THE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT PROJECT IN 2019. THE 2019 JOINT CHNA WAS A SYNERGISTIC PROCESS INVOLVING ALL MEMBERS OF THE CHNA COLLABORATIVE WORKGROUP. A COORDINATED, CROSS-ORGANIZATIONAL STRATEGY WAS UTILIZED TO EVALUATE AND ADDRESS THE HEALTH NEEDS OF COMMUNITIES ACROSS VENTURA COUNTY.

PART III, LINE 8
THE ENTIRE SHORTFALL OF MEDICARE EXPENSES OVER MEDICARE REIMBURSEMENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT EXPENSE. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE COSTS ATTRIBUTABLE TO SERVICE MEDICARE PATIENTS. THE SYSTEM IS REIMBURSED FOR SERVICES PROVIDED TO PATIENTS UNDER CERTAIN PROGRAMS ADMINISTERED BY GOVERNMENTAL AGENCIES, WHICH INCLUDES THE MEDICARE PROGRAM. THE MEDICARE PROGRAM CONSISTS OF 22.8% OF THE SYSTEMS NET REVENUE FOR 2021. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FROM THE MEDICARE PROGRAM, AND THE MEDICARE PROGRAM DOES NOT COVER THE COSTS OF TREATING THE SYSTEM'S MEDICARE PATIENTS, ALTHOUGH THE QUALITY OF CARE AND ACCESS TO CARE IS THE SAME FOR ALL PATIENTS, REGARDLESS OF PAYER SOURCE. UNREIMBURSED COST UNDER THE MEDICARE PROGRAM IS A TRUE LOSS TO THE SYSTEM AND THE LOSS IS REFLECTED IN THE SYSTEM'S FINANCIAL STATEMENTS. AS SUCH, MEDICARE LOSSES SHOULD BE CONSIDERED A COMMUNITY BENEFIT PROVIDED BY THE SYSTEM.

PART VI, LINE 1
MANAGEMENT COMPANIES AND JOINT VENTURES GROSSMAN IMAGING CENTER OF CMH, LLC BUENAVISTA MEDICAL PROPERTIES, LTD VENTURA CARDIOVASCULAR CO-MANAGEMENT COMPANY, LLC

PART VI, LINE 2
IN 2019, CMHS WORKED CLOSELY WITH THE VENTURA COUNTY DEPARTMENT OF PUBLIC HEALTH, ADVENTIST HEALTH SIMI VALLEY, CAMARILLO HEALTH CARE DISTRICT, CLINICAS DEL CAMINO REAL, ST. JOHN'S REGIONAL MEDICAL CENTER, ST. JOHN'S PLEASANT VALLEY HOSPITAL, AND THE VENTURA COUNTY HEALTH CARE AGENCY COMMUNITY HEALTH CENTER TO UPDATE ITS COMMUNITY NEEDS ASSESSMENT. THE AREA-WIDE SURVEY AND STUDY CONSISTED OF AN ANALYSIS OF THE SOCIO-ECONOMIC PROFILE OF VENTURA COUNTY, A COMPREHENSIVE EXAMINATION OF THE HEALTH CARE STATUS AND NEEDS OF COMMUNITIES ACROSS VENTURA COUNTY, THE STATE OF HEALTHCARE DELIVERY AND ITS ASSOCIATED SERVICES, COMMUNITY REPORTED HEALTH NEEDS, AND COMMUNITY PRIORITIZATION AND IMPLEMENTATION STRATEGIes.

PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL ASSISTANCE PROGRAM BROCHURES EXPLAINING THE SYSTEM'S POLICY ARE POSTED AND MADE AVAILABLE TO PATIENTS AT THE TIME OF ADMITTANCE. SIGNS ALERTING PATIENTS TO THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE PROMINENTLY DISPLAYED. AN INSERT REGARDING FINANCIAL ASSISTANCE ACCOMPANIES EACH INVOICE OF HOSPITAL SERVICES SENT TO EACH PATIENT.

PART I, LINE 7G
NO AMOUNT ATTRIBUTABLE TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G. PART I, LINE 7H RESEARCH ACTIVITIES INCLUDE: - INDUSTRY SPONSORED REGISTRY FOR ATRIAL FIBRILLATION ABLATIONS - INDUSTRY SPONSORED CLINICAL EVALUATIONS OF ELECTROPHYSIOLOGY CARDIAC MAPPING SOFTWARE - INVESTIGATOR INITIATED CROSS-SECTIONAL NURSING STUDY UTILIZING SURVEY OF SUBJECTS - INVESTIGATOR INITIATED CLINICAL TRIAL OF PROCEDURAL CHANGE DURING TAVR - INVESTIGATOR INITIATED RETROSPECTIVE STUDY USING CHART REVIEW FOR DATA COLLECTION PART I, LINE 7, COLUMN F THE ORGANIZATION INCLUDED ($1,988) OF BAD DEBT EXPENSE IN PART IX. THE AMOUNT HAS BEEN SUBTRACTED FROM THE CALCULATION OF COLUMN F. COVID-19 IN MARCH 2020, THE WORLD HEALTH ORGANIZATION DECLARED THE NOVEL CORONAVIRUS DISEASE (COVID-19) A PANDEMIC. THE CENTERS FOR DISEASE CONTROL AND PREVENTION CONFIRMED ITS SPREAD TO THE UNITED STATES AND IT WAS DECLARED A NATIONAL PUBLIC HEALTH EMERGENCY. CALIFORNIA FOLLOWED BY DECLARING A STATE OF EMERGENCY ACROSS ALL COUNTIES AND HAD SOME LEVEL OF STAY-AT-HOME ORDERS THROUGHOUT 2020 TO PREVENT THE SPREAD OF COVID-19. THE NEED FOR THE SYSTEM TO RESPOND TO COVID-19 HAS BEEN AND CONTINUES TO BE A COSTLY AND DIFFICULT ENDEAVOR. BELOW DESCRIBES THE SYSTEM'S RESPONSE TO COVID-19 AND THE ACTIVITIES TAKEN TO TREAT COVID-19 PATIENTS AND PROTECT THE LIFE, HEALTH AND SAFETY OF THE COMMUNITY AND HEALTHCARE PROVIDERS. - TO PROTECT PATIENTS, EMPLOYEES AND MEMBERS OF THE COMMUNITY, CMHS MANDATED A STRICT PPE (PERSONAL PROTECTIVE EQUIPMENT) POLICY IN WHICH IT REQUIRED EVERYONE ENTERING ALL LOCATIONS (BOTH CLINICAL AND NON-CLINICAL) TO WEAR A MASK. FREE MASKS WERE AVAILABLE AT THE ENTRANCES OF ALL LOCATIONS. - EMPLOYEES IN PATIENT CARE AREAS WERE ALSO REQUIRED TO WEAR EYE PROTECTION. - SCREENING TENTS WERE SET UP AT THE ENTRANCES TO BOTH HOSPITALS AND THE URGENT CARE CLINICS TO SCREEN EMPLOYEES AND VISITORS FOR COVID-19 SYMPTOMS. - AT THE CMH FACILITY, 209 PATIENT ROOMS WERE CONVERTED TO NEGATIVE-PRESSURE ROOMS WHERE THE ORIGINAL GLASS WINDOWS WERE REMOVED AND REPLACED WITH TEMPORARY WINDOWS COVERS TO ACCOMMODATE AIR SCRUBBERS WITH HEPA FILTRATION. IN HEALTHCARE SETTINGS, NEGATIVE PRESSURE ROOMS ARE USED TO ISOLATE PATIENTS WITH AIRBORNE INFECTIONS. ROOMS ARE NEGATIVELY PRESSURIZED IN RELATION TO THE HOSPITAL CORRIDOR IN ORDER TO PREVENT INFECTIOUS PARTICLES FROM ESCAPING THE ROOM. AT THE OJAI FACILITY, 3 PATIENT ROOMS WERE CONVERTED, AND AT CENTERS FOR FAMILY HEALTH SAVIERS, SANTA PAULA AND CAMARILLO 2 EXAM ROOMS WERE CONVERTED. - NURSING UNITS IN THE DECOMMISSIONED MOUNTAIN TOWER AT THE CMH CAMPUS RECEIVED TEMPORARY LICENSING IN ORDER TO EXPAND PATIENT ROOM CAPACITY DURING SURGE CONDITIONS. THE UNITS WERE SUPPLIED WITH PATIENT CARE ITEMS SUCH AS BEDS, MEDICATION DISPENSERS, NURSING UNIT COMPUTERS, PATIENT MONITORING EQUIPMENT AND NEGATIVE PRESSURE ROOM UNITS. - INVESTMENT WAS MADE IN ULTRAVIOLET DISINFECTION ROBOTS THAT HAVE THE ABILITY TO DISINFECT AREAS THROUGHOUT THE HOSPITAL AND SPECIFICALLY IN AREAS WHERE COVID-19 PATIENTS ARE TREATED. UVC ROBOTS ARE CRITICAL FOR INFECTION CONTROL AND PROVIDES AN EXTRA LAYER OF SAFETY THAT CAN DISINFECT LARGE AREAS EFFICIENTLY AND EFFECTIVELY. - HAND SANITIZER, AND OTHER CLEANING PRODUCTS WERE PURCHASED TO SANITIZE ALL FACILITIES. - THE SYSTEM INCURRED EXTRAORDINARY COSTS FOR PPE SUCH AS MASKS, GLOVES, EYE WEAR, AND GOWNS. - DISPOSABLE OXISENSOR TRANDUCERS WERE PURCHASED TO MONITOR OXYGEN LEVELS IN PATIENTS WITH WEAK PULSES. THE SINGLE USE MONTITORS MINIMIZE POTENTIAL FOR CROSS CONTAMINATION. - THE SYSTEM PURCHASED PNEUMATIC OXYGEN UNITS FOR USE WITH COUNTY SUPPLIED VENTILATORS TO ACCESS OXYGEN SUPPLY. - THE SYSTEM CONTRACTED THE SERVICES OF AN INFECTION DISEASE PHYSICIAN TO AID IN THE DEVELOPMENT OF POLICIES AND PROTOCOLS FOR PPE USE, PATIENT TREATMENT AND ISOLATION, EXPOSURE INVESTIGATION, LAB TESTING, COVID-19 EDUCATION AND EMPLOYEE TRAVEL AND EXPOSURE GUIDELINES. - IN ACCORDANCE WITH THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, EMPLOYEES AT THE OJAI CONTINUING CARE CENTER WERE REQUIRED TO BE TESTED FOR COVID-19 WEEKLY TO PROTECT PATIENTS. - ALL EMPLOYEES WERE REQUIRED TO BE TESTED FOR COVID-19 WHEN SYMPTOMATIC, EXPOSED TO SOMEONE WITH A POSITIVE COVID-19 DIAGNOSIS, OR RETURNING FROM TRAVEL OUTSIDE OF THE STATE. - INVESTMENT WAS MADE IN LAB ANALYZER EQUIPMENT IN ORDER TO IMPROVE THE TURN AROUND TIME FOR RECEIVING COVID-19 TEST RESULTS. - CMHS HIRED ADDITIONAL PERSONNEL TO CONDUCT ENTRANCE SCREENINGS, CARE FOR THE SURGE OF COVID-19 PATIENTS, SANITIZE FACILITIES, SECURE ENTRY WAYS, STAY CURRENT ON CDC AND CDPH INFECTION DISEASE PANDEMIC GUIDANCE, AND DIRECT PATIENT FLOW. - ONCE AVAILABLE, CMHS MADE THE COVID-19 VACCINES AVAILABLE TO ALL EMPLOYEES, THEIR DEPENDENTS, AND PATIENTS. CMHS ALSO COLLABORATED WITH THE COUNTY OF VENTURA TO VACCINATE SCHOOL DISTRICT EMPLOYEES AND ELEGIBLE MEMBERS OF THE GENERAL PUBLIC AT NORDHOFF HIGH SCHOOL IN OJAI. CMHS REQUESTED $10,430,614 AND $9,493,590 IN REIMBURSEMENT FOR THE ABOVE COVID-19 RELATED EXPENSES INCURRED IN 2021 AND 2020, RESPECTIVELY, FROM THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA). CMHS RECEIVED $920,291 FROM FEMA DURING 2021.

PART III, LINE 9B
THE PATIENT'S ABILITY TO PAY IS EVALUATED UPON ADMISSION. A PATIENT FINANCIAL SERVICES STAFF ASSISTS PATIENTS WITH APPLYING FOR LOCAL, STATE AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT. IN THE EVENT THAT NO THIRD-PARTY PAYMENT SOURCE IS AVAILABLE, PATIENTS ARE PROVIDED WITH INFORMATION ON THE SYSTEM'S FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE AND CHARITY CARE IS BASED ON A SLIDING SCALE FEE SCHEDULE UTILIZING THE CURRENT UNITED STATES FEDERAL POVERTY GUIDELINES. INFORMATION FROM THE APPLICANT'S FINANCIAL APPLICATION AND SUPPORTING DOCUMENTATION IS USED TO DETERMINE THE AMOUNT OF THE QUALIFIED FINANCIAL ASSISTANCE TO BE GRANTED. THE SYSTEM HAS A WRITTEN COLLECTION POLICY TO PROVIDE FOR AN EQUITABLE PROCESS BY WHICH A PATIENT AND/OR RESPONSIBLE PARTY CAN MAKE A PAYMENT OR PAYMENT ARRANGEMENT PRIOR TO OR AT THE TIME OF SERVICE. THE SYSTEM WILL PROACTIVELY DETERMINE THE PATIENT'S ABILITY TO PAY. A DEPOSIT, BASED UPON SELF-PAY LIABILITY IS COLLECTED PRIOR TO ADMISSION OR AT THE TIME OF SERVICE. FOR PATIENTS WHO ARE UNABLE TO PAY THEIR ESTIMATED LIABILITY AT THE TIME OF SERVICE, THE SYSTEM WILL OFFER A FINANCING OPTION. PATIENTS WHO MEET CHARITY OR INDIGENT GUIDELINES WILL BE REFERRED TO A FINANCIAL ADVOCATE FOR FINANCIAL AID.

PART VI, LINE 4
"COMMUNITY INFORMATION THE HEALTH SYSTEM'S TWO HOSPITALS ARE LOCATED IN THE CITY OF VENTURA AND THE CITY OF OJAI. THE HEALTH SYSTEM PROVIDES SERVICES THROUGH ITS HOSPITALS AND CENTERS FOR FAMILY HEALTH TO ALL WESTERN VENTURA COUNTY, WHICH INCLUDES THE CITIES AND UNINCORPORATED AREAS SURROUNDING VENTURA, OJAI, SANTA PAULA, FILLMORE, OXNARD, PORT HUENEME AND CAMARILLO. THE POPULATION OF VENTURA COUNTY IS APPROXIMATELY 860,000 AND MADE UP OF 43% HISPANIC, 41% WHITE AND 16% OTHER RESIDENTS. THE POPULATION IS MADE UP OF 50.5% FEMALES AND 49.5% MALE WITH 15% OF THE POPULATION OVER THE AGE OF 65. THE POVERTY RATE FOR THE COUNTY IS 10.3% AND 9.3% OF THE POPULATION UNDER 65 YEARS IS UNINSURED. THE COUNTY OF VENTURA PROVIDES COMMUNITY DATA THROUGH ITS WEBSITE ""HEALTH MATTERS IN VCCAN BE ACCESSED AT HTTP://WWW.HEALTHMATTERSINVC.ORG/ FOR FURTHER INFORMATION. IT HAS LONG BEEN ESTABLISHED THAT THERE ARE SIGNIFICANT VARIANCES IN PHYSICAL AND BEHAVIORAL HEALTH CONCERNS BETWEEN GROUPS BASED ON ETHNICITY, INCOME AND RESIDENCE. AS A RESULT, CMHS CAREFULLY CONSIDERS MEANINGFUL DEMOGRAPHIC VARIABLES SUCH AS AGE, RACE AND ETHNICITY WHEN PLANNING FOR BOTH INPATIENT AND OUTPATIENT CARE TO ENSURE THAT THE PATIENT CARE SERVICES IT PROVIDES ARE SENSITIVE AND RELEVANT TO THE PROGRAM PLANNING NEEDS OF THE COMMUNITIES IT SERVES."

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"PROMOTION OF COMMUNITY HEALTH CMHS IS GOVERNED BY A DIVERSE BOARD OF DIRECTORS WHOSE MEMBERS ARE REPRESENTATIVE OF THE COMMUNITY, HOSPITAL AND MEDICAL STAFF LEADERSHIP. CONSISTENT WITH THE IRS ""COMMUNITY BENEFIT STANDARD"", A MAJORITY OF THE BOARD OF DIRECTORS ARE NEITHER EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS OF THE ORGANIZATION. CMHS HAS AN OPEN MEDICAL STAFF, EXTENDING STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS FOR ALL AREAS AND DEPARTMENTS OF ITS FACILITY. THE EMERGENCY DEPARTMENTS AT BOTH COMMUNITY MEMORIAL HOSPITAL AND OJAI VALLEY COMMUNITY HOSPITAL TREAT ALL PATIENTS, REGARDLESS OF THEIR SOCIO-ECONOMIC STATUS OR ABILITY TO PAY. THE HEALTH SYSTEM PROVIDES EMERGENCY SERVICES TO ALL PATIENTS, WITH OR WITHOUT INSURANCE, AND CONTRACTS WITH PHYSICIANS TO PROVIDE SPECIALTY EMERGENCY COVERAGE. THIS EMERGENCY TEAM INCLUDES BOARD-CERTIFIED EMERGENCY PHYSICIANS, PHYSICIAN ASSISTANTS; BOARD CERTIFIED NURSES, EMERGENCY MEDICAL TECHNICIANS, RESPIRATORY THERAPISTS AND OTHER HIGHLY TRAINED EMERGENCY CARE PROFESSIONALS. ALL ARE DEDICATED TO PROVIDING TECHNOLOGICALLY ADVANCED AND LIFESAVING MEDICAL SERVICES. CMHS OFFERS FREE, EDUCATIONAL SEMINARS ON A MONTHLY BASIS TO COMMUNITIES ACROSS VENTURA COUNTY. THESE EVENTS COVER A WIDE VARIETY OF HEALTH-RELATED TOPICS SUCH AS DIABETES, CANCER, HEART DISEASE AND VASCULAR HEALTH. CMHS ALSO OFFERS NUMEROUS CLASSES AND SUPPORT GROUPS THROUGH ITS CANCER RESOURCE CENTER, NEW PARENT RESOURCE CENTER, WELLNESS AND FITNESS CENTER, AND HEART AND VASCULAR HEALTH DEPARTMENT. THESE RESOURCES ARE DESIGNED TO PROVIDE A COMMUNITY OF SUPPORT TO THOSE NAVIGATING A SERIOUS ILLNESS, WORKING TO PREVENT OR ADDRESS A CHRONIC DISEASE, OR BUILDING A HEALTHY FUTURE FOR THEIR NEW FAMILY."