4A (Expenses $ 148469026 including grants of $ 5311220) (Revenue $ 725567902)
SEE SCHEDULE O

4B (Expenses $ 445714849 including grants of $ 0) (Revenue $ 314210684)
SEE SCHEDULE O

PART V, SECTION B, LINE 5:
FACILITY REPORTING GROUP AVALLEY CHILDREN'S 2019 CHNA WAS BASED ON A JOINT NEEDS ASSESSMENT FOR FRESNO, KINGS, MADERA AND TULARE COUNTIES, AND THEN SEPARATE NEEDS ASSESSMENTS FOR KERN, MERCED AND STANISLAUS COUNTIES. VALLEY CHILDREN'S PARTNERED WITH 15 HOSPITALS TO CONDUCT AN ASSESSMENT OF HEALTH NEEDS FOR BOTH CHILDREN AND ADULTS. THE CHNA WAS FACILITATED BY THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA'S COMMUNITY BENEFITS WORKGROUP, AND INCLUDED A THOROUGH REVIEW OF SECONDARY DATA AS WELL AS SIGNIFICANT COMMUNITY ENGAGEMENT THROUGH SURVEYS, FOCUS GROUPS AND KEY STAKEHOLDER INTERVIEWS. TO ASSESS THE NEEDS OF CHILDREN IN KERN, MERCED, AND STANISLAUS COUNTIES, VALLEY CHILDREN'S CONSULTED SECONDARY DATA SOURCES AND WORKED WITH COMMUNITY PARTNERS TO CONVENE ONE-ON-ONE INTERVIEWS AND FOCUS GROUPS WITH ORGANIZATIONS REPRESENTING LOW INCOME, UNDERSERVED COMMUNITIES. THE FRESNO, KINGS, MADERA, AND TULARE COUNTIES CHNA WAS FACILITATED BY THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA'S COMMUNITY BENEFITS WORKGROUP. THE WORKGROUP COLLABORATED WITH HC2 STRATEGIES, INC. TO CONDUCT KEY INFORMANT INTERVIEWS, FOCUS GROUPS, AND ESTABLISH PRIORITY HEALTH NEEDS FOR THE 2019-2021 COMMUNITY HEALTH NEEDS CYCLE. ADDITIONALLY, THE COMMITTEE WORKED WITH WILDFIRE GRAPHICS & ANALYTICS, LLC TO GATHER HEALTH INDICATOR DATA, ANALYZE QUANTITATIVE AND QUALITATIVE DATA, AND PACKAGE THE FINAL REPORT. AD LUCEM CONSULTING ESTABLISHED THE METHODOLOGY FOR RANKING HEALTH NEED DATA FROM KEY INFORMANT AND FOCUS GROUP INTERVIEWS. AD LUCEM ALSO PROVIDED THE OVERALL RANKINGS FOR THE FOUR-COUNTY REGION. BIEL CONSULTING, INC. CONDUCTED THE CHNA IN KERN COUNTY. BIEL CONSULTING, INC. HAS EXTENSIVE EXPERIENCE CONDUCTING HOSPITAL HEALTH ASSESSMENTS AND WORKING WITH HOSPITALS ON DEVELOPING, IMPLEMENTING, AND EVALUATING COMMUNITY BENEFIT PROGRAMS. DR. MELISSA BIEL CONDUCTED THE KERN COUNTY CHNA.THE MERCED COUNTY CHNA WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). PRC IS A NATIONALLY RECOGNIZED HEALTHCARE CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING CHNAS IN HUNDREDS OF COMMUNITIES ACROSS THE UNITED STATES SINCE 1994. THE STANISLAUS COUNTY MAPP EFFORT COLLABORATED WITH COMMUNITY HEALTH INSIGHTS (CHI). CHI CONDUCTED THE FOCUS GROUPS AND KEY INFORMANT INTERVIEWS. THE CHNA PROCESS INCLUDED COLLECTION AND ANALYSIS OF UP-TO-DATE DATA FOR VALLEY CHILDREN'S SERVICE AREA FROM A NUMBER OF SECONDARY SOURCES. IN ADDITION, PRIMARY DATA WERE COLLECTED DIRECTLY FROM STAKEHOLDERS IN THE COMMUNITY. A VARIETY OF PRIMARY DATA COLLECTION METHODS WERE USED TO OBTAIN COMMUNITY INPUT INCLUDING, FOCUS GROUPS, INTERVIEWS AND SURVEYS. THE COLLECTED DATA WERE USED TO IDENTIFY SIGNIFICANT COMMUNITY NEEDS. FRESNO, KINGS, MADERA, AND TULARE COUNTIESSOURCES OF DATA FOR THIS ASSESSMENT INCLUDED BOTH PRIMARY AND SECONDARY DATA. SECONDARY DATA SOURCES INCLUDED PUBLICLY REPORTED STATE AND NATIONALLY-RECOGNIZED DATA SOURCES SUCH AS COMMUNITY COMMONS, CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, AND COUNTY HEALTH RANKINGS & ROADMAPS. PRIMARY DATA WERE COLLECTED THROUGH 48 KEY INFORMANT INTERVIEWS, 24 FOCUS GROUPS THAT REACHED 284 PERSONS, AND AN ONLINE SURVEY THAT REACHED 1,178 PERSONS. KEY INFORMANTS AND FOCUS GROUPS WERE PURPOSEFULLY CHOSEN TO REPRESENT MEDICALLY UNDER-SERVED, LOW-INCOME OR MINORITY POPULATIONS IN OUR COMMUNITY. THE ONLINE SURVEY WAS DISTRIBUTED TO PARTNER ORGANIZATIONS THAT WERE NOT REPRESENTED BY KEY INFORMANTS AND ADVERTISED TO THE GENERAL PUBLIC VIA A PUBLIC SERVICE ANNOUNCEMENT HOSTED ON UNIVISION'S ARRIBA VALLE CENTRAL SHOW.KERN COUNTY SECONDARY DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT A COMMUNITY PROFILE, SOCIAL DETERMINANTS OF HEALTH, HEALTH CARE ACCESS, BIRTH INDICATORS, LEADING CAUSES OF DEATH, ACUTE AND CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND MISUSE, AND PREVENTIVE PRACTICES. WHEN AVAILABLE, DATA SETS ARE PRESENTED IN THE CONTEXT OF KERN COUNTY AND CALIFORNIA TO HELP FRAME THE SCOPE OF AN ISSUE, AS IT RELATES TO THE BROADER COMMUNITY. SOURCES OF DATA INCLUDE: THE U.S. CENSUS AMERICAN COMMUNITY SURVEY, CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, CALIFORNIA HEALTH INTERVIEW SURVEY, KERN COUNTY PUBLIC HEALTH DEPARTMENT, HEALTHY KERN COUNTY, COUNTY HEALTH RANKINGS, CALIFORNIA DEPARTMENT OF EDUCATION, CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT AND CALIFORNIA DEPARTMENT OF JUSTICE, AMONG OTHERS. INFORMATION WAS ALSO OBTAINED THROUGH COMMUNITY SURVEYS AND INTERVIEWS WITH INDIVIDUALS WHO ARE LEADERS AND/OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY. INTERVIEWS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE COMMUNITY SERVED BY THE HOSPITAL. FORTY-ONE (41) INTERVIEWS WERE COMPLETED FROM OCTOBER 2018 THROUGH MARCH 2019. THE KERN COUNTY COMMUNITY BENEFIT COLLABORATIVE REPRESENTATIVES DEVELOPED A PLAN FOR DISTRIBUTION OF A SURVEY TO ENGAGE COMMUNITY RESIDENTS. THE SURVEY WAS AVAILABLE IN AN ELECTRONIC FORMAT THROUGH A SURVEY MONKEY LINK, AND IN A PAPER COPY FORMAT. THE ELECTRONIC AND PAPER SURVEYS WERE AVAILABLE IN ENGLISH AND SPANISH. THE SURVEYS WERE AVAILABLE FROM NOVEMBER 2018 TO JANUARY 2019 AND DURING THIS TIME, 1,114 USABLE SURVEYS WERE COLLECTED.MERCED COUNTY THIS ASSESSMENT INCORPORATED DATA FROM QUANTITATIVE AND QUALITATIVE SOURCES. QUANTITATIVE DATA INPUT INCLUDED PRIMARY RESEARCH FROM THE PRC COMMUNITY HEALTH SURVEY AND SECONDARY RESEARCH. THESE QUANTITATIVE COMPONENTS ALLOWED FOR TRENDING AND COMPARISON TO BENCHMARK DATA AT THE STATE AND NATIONAL LEVELS. QUALITATIVE DATA INPUT INCLUDED PRIMARY RESEARCH GATHERED THROUGH AN ONLINE KEY INFORMANT SURVEY. THE SURVEY INSTRUMENT USED FOR THIS STUDY WAS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), AS WELL AS OTHER PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES.FOR THE PRC COMMUNITY HEALTH SURVEY, A TELEPHONE INTERVIEW METHODOLOGY ONE THAT INCORPORATES BOTH LANDLINE AND CELL PHONE INTERVIEWS WAS EMPLOYED. THE SAMPLE DESIGN USED FOR THIS EFFORT CONSISTED OF A RANDOM SAMPLE OF 300 INDIVIDUALS, AGE 18 AND OLDER, IN MERCED COUNTY. ONCE THE INTERVIEWS WERE COMPLETED, THESE WERE WEIGHTED IN PROPORTION TO THE ACTUAL POPULATION DISTRIBUTION SO AS TO APPROPRIATELY REPRESENT MERCED COUNTY AS A WHOLE. AN ONLINE KEY INFORMANT SURVEY WAS ALSO COMPLETED. A LIST OF RECOMMENDED PARTICIPANTS WAS PROVIDED BY THE HOSPITAL PARTNERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS OF THE COMMUNITY OVERALL. KEY INFORMANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE. IN ALL, 49 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY.STANISLAUS COUNTY QUANTITATIVE DATA COLLECTION FOR THE CHNA WAS CONDUCTED USING SECONDARY SOURCES. IN ORDER TO IDENTIFY INDICATORS TO BE INCLUDED IN THE ANALYSIS, A LIST OF POTENTIAL INDICATORS WAS COMPILED FROM THE 2013 STANISLAUS COUNTY COMMUNITY HEALTH ASSESSMENT, HEALTHY PEOPLE 2020, LET'S GET HEALTHY CALIFORNIA, THE STANISLAUS COUNTY ADMINISTRATIVE OFFICE, COUNTY HEALTH RANKINGS, KAISER PERMANENTE'S MODESTO MEDICAL CENTER'S CHNA, SUTTER HEALTH MODESTO'S CHNA, STANISLAUS COUNTY'S FOCUS ON PREVENTION AND THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS' (NACCHO) RECOMMENDED AND EXTENDED INDICATOR AND TOPIC LISTS. THOSE INDICATORS WERE GROUPED INTO THE NACCHO RECOMMENDED CATEGORIES AND THEMATIC SUBCATEGORIES. QUALITATIVE DATA WERE GATHERED FROM PRIMARY SOURCES. NINE FOCUS GROUPS WERE CONDUCTED FROM JANUARY TO FEBRUARY,2019 IN STANISLAUS COUNTY. ELEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED FROM DECEMBER 2018 TO FEBRUARY 2019. FOCUS GROUP AND KEY INFORMANT RESPONSES TO QUESTIONS ABOUT KEY HEALTH NEEDS WERE MATCHED TO THE COMMUNITY HEALTH ASSESSMENT TOPIC CATEGORIES AND SUBCATEGORIES. THE IDENTIFICATION OF SIGNIFICANT COMMUNITY NEEDS BEGAN WITH A REVIEW OF THE DATA THAT DESCRIBED THE HOSPITAL SERVICE AREA. HEALTH NEEDS THAT DID NOT MEET STATE OR NATIONAL BENCHMARKS WERE IDENTIFIED. THE PRIMARY DATA COLLECTION PROCESS THEN OBTAINED COMMUNITY INPUT TO SUPPORT THE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS TO ADDRESS NEEDS, AND DISCOVER GAPS IN RESOURCES. COMMUNITY INPUT WAS USED TO PRIORITIZE THESE NEEDS.

PART V, SECTION B, LINE 5 (CONTINUED):
THE 2019 CHNA REPORT PROCESS IDENTIFIED THE FOLLOWING 13 HEALTH NEEDS IN FRESNO, KINGS, MADERA AND TULARE COUNTIES. - ACCESS TO CARE - ASTHMA - CANCER - CLIMATE AND HEALTH - CARDIOVASCULAR DISEASE - ECONOMIC SECURITY - HIV/AIDS/STIS - MATERNAL AND INFANT HEALTH - MENTAL HEALTH - OBESITY/HEAL/DIABETES - ORAL HEALTH - SUBSTANCE USE/TOBACCO USE - VIOLENCE AND INJURY PREVENTION COMMUNITY MEDICAL CENTERS, SAINT AGNES MEDICAL CENTER, AND VALLEY CHILDREN'S HOSPITAL, INVITED LEADERS REPRESENTING COUNTY PUBLIC HEALTH AND COMMUNITY-BASED ORGANIZATIONS FROM FRESNO, KINGS, MADERA AND TULARE COUNTIES TO PARTICIPATE IN A HEALTH NEEDS RANKING PROCESS. PUBLIC HEALTH AND COMMUNITY LEADERS WERE TASKED WITH RANKING THE NEEDS THAT WERE MOST PRESSING IN THEIR RESPECTIVE COUNTIES, BASED ON HEALTH ISSUES PREVIOUSLY IDENTIFIED IN THE 2019 PRIMARY DATA COLLECTION PHASE. PARTICIPANTS IN THE COLLABORATIVE HEALTH RANKING SESSION WERE TASKED WITH RANKING THE IDENTIFIED HEALTH NEEDS BASED ON THE FOLLOWING CRITERIA: - SEVERITY, MAGNITUDE, URGENCY - FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS - POTENTIAL IMPACT ON GREATEST NUMBER OF PEOPLE - POTENTIAL HEALTH NEED SCORE (BASED ON COMMUNITY STAKEHOLDER AND RESIDENT FEEDBACK) - OUTCOMES ARE MEASURABLE AND ACHIEVABLE IN A 3-YEAR SPAN - EXISTING RESOURCES/PROGRAMS KERN COUNTY SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED FROM SECONDARY DATA USING THE SIZE OF THE PROBLEM (RELATIVE PORTION OF POPULATION AFFLICTED BY THE PROBLEM) AND THE SERIOUSNESS OF THE PROBLEM (IMPACT AT INDIVIDUAL, FAMILY, AND COMMUNITY LEVELS). TO DETERMINE SIZE OR SERIOUSNESS OF THE PROBLEM, THE HEALTH NEED INDICATORS THAT WERE IDENTIFIED IN THE SECONDARY DATA WERE MEASURED AGAINST BENCHMARK DATA; SPECIFICALLY, COUNTY RATES, STATE RATES AND/OR HEALTHY PEOPLE 2020 OBJECTIVES. INDICATORS RELATED TO THE HEALTH NEEDS THAT PERFORMED POORLY AGAINST ONE OR MORE OF THESE BENCHMARKS MET THIS CRITERION TO BE CONSIDERED A HEALTH NEED. THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE DETERMINED: - ACCESS TO HEALTH CARE - ALZHEIMER'S DISEASE - BIRTH INDICATORS - CHRONIC DISEASES (ASTHMA, CANCER, DIABETES, HEART DISEASE, KIDNEY DISEASE, LIVER DISEASE, LUNG DISEASE, STROKE, VALLEY FEVER) - DENTAL CARE/ORAL HEALTH - ECONOMIC INSECURITY - ENVIRONMENTAL POLLUTION - FOOD INSECURITY - HOUSING AND HOMELESSNESS - MENTAL HEALTH - OVERWEIGHT AND OBESITY - PREVENTIVE PRACTICES - SEXUALLY TRANSMITTED INFECTIONS - SUBSTANCE USE AND MISUSE - UNINTENTIONAL INJURIES - VIOLENCE AND INJURY THE LIST OF SIGNIFICANT HEALTH NEEDS INFORMED PRIMARY DATA COLLECTION. THE PRIMARY DATA COLLECTION PROCESS WAS DESIGNED TO VALIDATE SECONDARY DATA FINDINGS, IDENTIFY ADDITIONAL COMMUNITY ISSUES, SOLICIT INFORMATION ON DISPARITIES AMONG SUBPOPULATIONS, ASCERTAIN COMMUNITY ASSETS TO ADDRESS NEEDS, AND DISCOVER GAPS IN RESOURCES. COMMUNITY STAKEHOLDER INTERVIEWS WERE USED TO GATHER INPUT AND PRIORITIZE THE SIGNIFICANT HEALTH NEEDS. THE FOLLOWING CRITERIA WERE USED TO PRIORITIZE THE HEALTH NEEDS: - THE PERCEIVED SEVERITY OF A HEALTH ISSUE OR HEALTH FACTOR AS IT AFFECTS THE HEALTH AND LIVES OF THOSE IN THE COMMUNITY; - THE LEVEL OF IMPORTANCE THE HOSPITAL SHOULD PLACE ON ADDRESSING THE ISSUE. THE STAKEHOLDERS WERE ALSO ASKED TO RANK ORDER (POSSIBLE SCORE OF 4) THE HEALTH NEEDS ACCORDING TO HIGHEST LEVEL OF IMPORTANCE IN THE COMMUNITY. THE TOTAL SCORE FOR EACH SIGNIFICANT HEALTH NEED WAS DIVIDED BY THE TOTAL NUMBER OF RESPONSES FOR WHICH DATA WERE PROVIDED, RESULTING IN AN OVERALL AVERAGE FOR EACH HEALTH NEED. MERCED COUNTY SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WERE IDENTIFIED FROM THE INFORMATION GATHERED THROUGH THE CHNA AND THE GUIDELINES SET FORTH IN HEALTHY PEOPLE 2020 (WWW.HEALTHYPEOPLE.GOV). SIGNIFICANT HEALTH NEEDS WERE DETERMINED AFTER CONSIDERATION OF VARIOUS CRITERIA, INCLUDING: STANDING IN COMPARISON WITH BENCHMARK DATA (PARTICULARLY NATIONAL DATA); IDENTIFIED TRENDS; THE PREPONDERANCE OF SIGNIFICANT FINDINGS WITHIN TOPIC AREAS; THE MAGNITUDE OF THE ISSUE IN TERMS OF THE NUMBER OF PERSONS AFFECTED; AND THE POTENTIAL HEALTH IMPACT OF A GIVEN ISSUE. THESE NEEDS ALSO TAKE INTO ACCOUNT THOSE ISSUES OF GREATEST CONCERN TO THE COMMUNITY STAKEHOLDERS (KEY INFORMANTS) GIVING INPUT TO THIS PROCESS. FOLLOWING IS THE LIST OF SIGNIFICANT HEALTH NEEDS IDENTIFIED IN MERCED COUNTY. - ACCESS TO HEALTH CARE - CANCER - DEMENTIA, INCLUDING ALZHEIMER'S DISEASE - DIABETES - HEART DISEASE AND STROKE - INFANT HEALTH AND FAMILY PLANNING - INJURY AND VIOLENCE - KIDNEY DISEASE - MENTAL HEALTH - NUTRITION, PHYSICAL ACTIVITY AND WEIGHT - POTENTIALLY DISABLING CONDITIONS - RESPIRATORY DISEASES - SUBSTANCE USE - TOBACCO USE STANISLAUS COUNTY AFTER GATHERING QUANTITATIVE AND QUALITATIVE DATA, TOPIC CATEGORIES AND SUBCATEGORIES WERE CONSIDERED AS KEY HEALTH NEEDS IF THEY MET THE FOLLOWING CRITERIA: - INDICATORS REVIEWED IN SECONDARY DATA DEMONSTRATED THAT THE COUNTY ESTIMATE WAS POORER BY MORE THAN ONE PERCENTAGE POINT WHEN COMPARED TO THE BENCHMARK ESTIMATE (IN MOST CASES, CALIFORNIA STATE AVERAGE). - THE HEALTH ISSUE WAS IDENTIFIED AS A KEY THEME IN AT LEAST THREE INTERVIEWS. - THE HEALTH ISSUE WAS IDENTIFIED AS A KEY THEME IN AT LEAST THREE FOCUS GROUPS. THIS METHOD REVEALED THE FOLLOWING KEY HEALTH NEEDS: - ACCESS TO CARE - ASTHMA/AIR QUALITY - CHRONIC DISEASE - COMMUNICABLE DISEASE - ECONOMIC INSECURITY - EDUCATION - HOUSING AND HOMELESSNESS - MENTAL HEALTH - SAFETY - SUBSTANCE USE - TRANSPORTATION ON MAY 30, 2019, COMMUNITY MEMBERS AND STAKEHOLDERS WERE CONVENED FOR A COMMUNITY CONVERSATION TO PRIORITIZE THESE HEALTH NEEDS. DURING THE COMMUNITY CONVERSATION BREAKOUT GROUPS, PARTICIPANTS DISCUSSED ISSUES AND CONCERNS THAT IMPACTED THE HEALTH OF STANISLAUS COUNTY. THEY WERE ALSO ASKED TO IDENTIFY COMMUNITY ASSETS AND RESOURCES.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: VALLEY CHILDREN'S HOSPITAL, - FACILITY 2: VALLEY CHILDREN'S HOME CARE

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
- ADVENTIST HEALTH HANFORD, REEDLEY, SELMA, TULARE, BAKERSFIELD AND TEHACHAPI VALLEY- CLOVIS COMMUNITY MEDICAL CENTER - COALINGA REGIONAL MEDICAL CENTER (CLOSED) - COMMUNITY REGIONAL MEDICAL CENTER (INCLUDES COMMUNITY BEHAVIORAL HEALTH CENTER) - DELANO REGIONAL MEDICAL CENTER (KERN COUNTY)- DIGNITY HEALTH (KERN COUNTY)- KAISER PERMANENTE, FRESNO SERVICE AREA, KERN COUNTY - KAWEAH DELTA HEALTH CARE DISTRICT - KERN MEDICAL- MADERA COMMUNITY HOSPITAL - MERCY MEDICAL MERCED- MEMORIAL HOSPITAL LOS BANOS- SAN JOAQUIN VALLEY REHABILITATION HOSPITAL - SIERRA VIEW MEDICAL CENTER - SAINT AGNES MEDICAL CENTER - VALLEY CHILDREN'S HOSPITAL

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
- HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA- COMMUNITY COMMONS- CALIFORNIA DEPARTMENT OF PUBLIC HEALTH- COUNTY HEALTH RANKINGS & ROADMAPS- KERN COUNTY COMMUNITY BENEFIT COLLABORATIVE- STANISLAUS COUNTY HEALTH SERVICES AGENCY PUBLIC HEALTH DEPARTMENT

PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE:
HTTPS://WWW.VALLEYCHILDRENS.ORG/GUILDS-CENTER-FOR-COMMUNITY-HEALTH/COMMUNITY-BENEFIT

PART V, SECTION B, LINE 11
"ACCESS TO CARE ENROLLMENT IN HEALTH INSURANCE VALLEY CHILDREN'S PROVIDED ENROLLMENT ASSISTANCE TO UNINSURED AND UNDER-INSURED PATIENTS WHO QUALIFIED FOR MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES PROGRAM OR VALLEY CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. ONCE ELIGIBILITY WAS DETERMINED, VALLEY CHILDREN'S STAFF ASSISTED FAMILIES WITH COMPLETING NECESSARY APPLICATIONS AND SUBMITTING THEM TO THE APPROPRIATE AGENCIES. CLINICAL PARTNERSHIPS VALLEY CHILDREN'S CLINICAL PARTNERSHIP PROGRAM BRINGS TOGETHER INSTITUTIONS FOCUSED ON ENHANCING NEONATAL AND PEDIATRIC CARE, REGARDLESS OF WHETHER THE ILL OR INJURED CHILD BECOMES A VALLEY CHILDREN'S PATIENT. THIS EFFORT HELPS PREVENT CHILDREN FROM BEING TRANSFERRED OR REFERRED UNNECESSARILY TO VALLEY CHILDREN'S AND HELPS IDENTIFY WHEN A CHILD NEEDS ADVANCED PEDIATRIC CARE. THE GOALS OF THE CLINICAL PARTNERSHIP PROGRAM INCLUDE PROVIDING: ENHANCED, COORDINATED CARE, MORE CARE DELIVERED CLOSER TO HOME, AND IMPROVED QUALITY AND CONFIDENCE IN PROVIDING PEDIATRIC CARE. IN 2017, VALLEY CHILDREN'S SUPPORTED 10 CLINICAL PARTNERSHIPS. IN 2018, VALLEY CHILDREN'S SUPPORTED 13 INPATIENT CLINICAL PARTNERS AND TWO OUTPATIENT CLINICAL PARTNERS. MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN VALLEY CHILDREN'S RECOGNIZES THE CRITICAL ROLE THAT COMMUNITY-BASED PROVIDERS AND ORGANIZATIONS PLAY IN MEETING THE NEEDS OF MEDICALLY COMPLEX CHILDREN AND IS COMMITTED TO MAKING SURE THEY HAVE THE CLINICAL SKILLS TO TAKE CARE OF THIS PATIENT POPULATION. VALLEY CHILDREN'S PROVIDED SIGNIFICANT OUTREACH AND EDUCATION FOR COMMUNITY-BASED ORGANIZATIONS AND PROVIDERS TO MAKE SURE THEY HAVE THE CLINICAL EXPERTISE NEEDED TO CARE FOR MEDICALLY COMPLEX CHILDREN, INCLUDING CHILDREN WITH TRACHEOSTOMIES AND VENTILATORS. TRANSPORTATION GIVEN THE CENTRAL VALLEY'S LARGELY RURAL LANDSCAPE AND HIGH CONCENTRATION OF POVERTY, TRANSPORTATION HAS LONG BEEN A CHALLENGE FOR MANY FAMILIES. VALLEY CHILDREN'S CONTINUED TO WORK WITH THE COMMUNITY TO IMPROVE PUBLIC TRANSPORTATION AND INCREASE ACCESS TO CARE BY PROVIDING GAS CARDS, TAXI VOUCHERS, AMTRAK TICKETS AND BUS TOKENS. VALLEY CHILDREN'S ALSO SUBSIDIZED BUS AND OTHER PUBLIC TRANSIT SERVICES FROM THE CITY OF FRESNO AND KINGS COUNTY. CHRONIC DISEASE PREVENTION HEALTH CARE LITERACY VALLEY CHILDREN'S PROVIDED ACCESS TO ONLINE EDUCATIONAL INFORMATION VIA THE HEALTH ENCYCLOPEDIA LINK ON ITS WEBSITE. THE HEALTH ENCYCLOPEDIA CONTAINS THOUSANDS OF PAGES OF INFORMATION ON PEDIATRIC DISEASES, CONDITIONS AND TREATMENTS, AS WELL AS SECTIONS ON HOW TO KEEP KIDS HEALTHY. THE ENCYCLOPEDIA IS AVAILABLE IN ENGLISH AND SPANISH. COMMUNITIES FOR HEALTHY KIDS THE COMMUNITIES FOR HEALTHY KIDS INITIATIVE IS A MULTI-SECTOR PARTNERSHIP BETWEEN HEALTH CARE PROVIDERS, HEALTH PLANS, SCHOOLS, COMMUNITY-BASED ORGANIZATIONS, PUBLIC HEALTH DEPARTMENTS AND THE AGRICULTURE INDUSTRY TO INCREASE ACCESS TO AND CONSUMPTION OF HEALTHY FOODS AND BEVERAGES AND TO INCREASE OPPORTUNITIES FOR AND PARTICIPATION IN PHYSICAL ACTIVITY. THE PURPOSE OF THIS EFFORT IS TO ALIGN AND SUPPORT EXISTING PARTNERSHIPS ACROSS FRESNO, MADERA AND KINGS COUNTIES IN AN EFFORT TO REDUCE CHILDHOOD OBESITY IN THE CENTRAL VALLEY THROUGH EDUCATION, ADVOCACY AND THE COORDINATED IMPLEMENTATION OF IDENTIFIED STRATEGIES. FURTHERMORE, VALLEY CHILDREN'S HAS IDENTIFIED FOOD INSECURITY AS A CRITICAL SOCIAL DETERMINANT OF HEALTH THAT IMPACTS THE HEALTH AND WELLBEING OF OUR PATIENTS AND FAMILIES. CHILDREN WHO ARE FOOD INSECURE LACK ACCESS TO AFFORDABLE AND HEALTHY FOODS, WHICH LEADS TO ADVERSE HEALTH OUTCOMES, INCLUDING INCREASED OBESITY RATES. TO SUPPORT THIS EFFORT, VALLEY CHILDREN'S LAUNCHED A PILOT PROJECT AT ONE OF ITS COMMUNITY-BASED PRIMARY CARE PEDIATRIC PRACTICES. PROVIDERS AT THE PRACTICE SCREEN THEIR PATIENTS FOR FOOD INSECURITY. IF ASSESSED TO BE ""AT-RISK,"" PATIENTS ARE CONNECTED TO NUTRITION PROGRAMS AND EMERGENCY FOOD RESOURCES. ADDITIONAL SUPPORT INCLUDED THE FOLLOWING ACTIVITIES: - VALLEY CHILDREN'S CONVENED A CONTINUING MEDICAL EDUCATION EVENT ON CHILDHOOD OBESITY PREVENTION FOR COMMUNITY PROVIDERS IN FRESNO, MADERA, MERCED, KINGS AND TULARE COUNTIES TO RAISE AWARENESS ABOUT WAYS TO ADDRESS CHILDHOOD OBESITY WITHIN THE CLINICAL SETTING. - VALLEY CHILDREN'S SERVED ON THE STEERING COMMITTEE FOR THE FRESNO COUNTY HEALTH IMPROVEMENT PARTNERSHIP, CO-CHAIRED THE FRESNO COUNTY DIABETES COLLABORATIVE AND PARTICIPATED IN THE LIVE WELL MADERA COUNTY DIABETES AND OBESITY WORKGROUP, THE KINGS COUNTY DIABESITY COALITION AND THE TULARE COUNTY DIABETES AND OBESITY WORKGROUP. INFANT HEALTH VALLEY CHILDREN'S PARTICIPATED IN INITIATIVES THAT SUPPORTED THE HEALTHY DEVELOPMENT OF CHILDREN, DURING PREGNANCY AND INTO THE FIRST 3-5 YEARS OF LIFE. EXAMPLES INCLUDED THE FOLLOWING: - FRESNO COUNTY PRE-TERM BIRTH INITIATIVE FRESNO COUNTY HAS ONE OF CALIFORNIA'S HIGHEST RATES OF PREMATURE BIRTH WITH 1 OUT OF EVERY 9 BABIES BORN TOO EARLY. PREMATURE BIRTH CAN CAUSE SERIOUS PHYSICAL AND MENTAL DISABILITIES, OR EVEN DEATH, BEFORE THE BABY'S FIRST BIRTHDAY. OVER A 10-YEAR PERIOD, THE FRESNO COUNTY PRE-TERM BIRTH INITIATIVE HAS WORKED TO IMPROVE THE HEALTH OF FRESNO MOTHERS AND REDUCE THE RATE OF PREMATURE BABIES. USING AN APPROACH CALLED COLLECTIVE IMPACT, PARTNERS ACROSS MANY SECTORS HAVE COME TOGETHER TO CREATE CHANGE IN FRESNO COUNTY. VALLEY CHILDREN'S HAS BEEN AN ACTIVE PARTICIPANT IN THIS INITIATIVE, WITH VALLEY CHILDREN'S SENIOR VICE PRESIDENT FOR COMMUNITY ENGAGEMENT AND POPULATION WELLNESS SERVING AS CHAIR OF THE INITIATIVE'S STEERING COMMITTEE. - CRADLE TO CAREER FRESNO AND STANISLAUS COUNTIES HAVE BEGUN FORMAL CRADLE TO CAREER INITIATIVES FOR THE PURPOSE OF CONVENING PUBLIC AND PRIVATE SECTOR STAKEHOLDERS TO WORK TOGETHER TO IMPROVE OUTCOMES FOR CHILDREN IN THEIR COMMUNITIES, FROM PRE-CONCEPTION TO COLLEGE AND/OR VOCATIONAL TRAINING. VALLEY CHILDREN'S PARTICIPATES IN BOTH INITIATIVES AND HAS BEEN A STRONG VOICE FOR THE INCLUSION OF OUTCOMES AND INDICATORS FOCUSED ON CHILD HEALTH AND WELLNESS. - HELP ME GROW FRESNO COUNTY HELP ME GROW IS A COORDINATED SYSTEM OF EARLY IDENTIFICATION AND REFERRAL FOR CHILDREN, AGES 0-5, WHO ARE AT RISK FOR DEVELOPMENTAL DELAYS. IN FY2018, VALLEY CHILDREN'S SUPPORTED THE IMPLEMENTATION OF HELP ME GROW IN ITS PEDIATRIC PRIMARY CARE PRACTICES IN FRESNO COUNTY BY PROMOTING THE USE OF A SPECIFIC DEVELOPMENTAL ASSESSMENT AND SCREENING TOOL THAT IS PART OF THE HELP ME GROW MODEL. - MARCH OF DIMES VALLEY CHILDREN'S PARTNERED WITH THE MARCH OF DIMES TO ADVOCATE FOR POLICIES AT THE STATE AND FEDERAL LEVEL THAT PROMOTE HEALTHY PREGNANCIES AND HEALTHY BABIES. ADDITIONALLY, VALLEY CHILDREN'S DIRECTOR OF COMMUNITY AND GOVERNMENT RELATIONS CHAIRED THE MARCH OF DIMES OF CALIFORNIA'S ADVOCACY AND GOVERNMENT AFFAIRS COMMITTEE IN FY2017 AND FY2018. MENTAL HEALTH ISSUES AND CHALLENGES ASSOCIATED WITH CHILD AND ADOLESCENT MENTAL HEALTH CONTINUED TO BE A MAJOR CONCERN. TO HELP IDENTIFY POTENTIAL REGIONAL SOLUTIONS, VALLEY CHILDREN'S SUPPORTED OR PARTICIPATED IN A NUMBER OF ACTIVITIES. VALLEY CHILDREN'S STAFF PROVIDED TEEN SUICIDE PREVENTION EDUCATION TO STUDENTS AND STAFF AT AREA HIGH SCHOOLS. IN FEBRUARY 2017, VALLEY CHILDREN'S HOSTED A SEMINAR TITLED ""A DISCUSSION ON TEEN DEPRESSION AND SUICIDE PREVENTION"" THAT DREW OVER 200 ATTENDEES FROM ACROSS THE CENTRAL VALLEY. VALLEY CHILDREN'S STAFF EITHER LED OR PARTICIPATED IN A NUMBER OF COMMUNITY-BASED COLLABORATIVES FOCUSED ON PREVENTING CHILD MENTAL ILLNESS AND/OR EARLY IDENTIFICATION AND TREATMENT OF CHILD MENTAL ILLNESS. VALLEY CHILDREN'S STAFF CHAIRED COMMUNITY CONVERSATIONS, A 50-MEMBER COLLABORATIVE ADDRESSING ISSUES OF MENTAL HEALTH, HOMELESSNESS AND THE IMPACT ON FAMILIES. A NUMBER OF VALLEY CHILDREN'S STAFF ALSO SERVED AS MEMBERS OF THE FRESNO SUICIDE PREVENTION COLLABORATIVE AND MADERA COUNTY SUICIDE EDUCATION AND AWARENESS COLLABORATIVE. VIOLENCE AND INJURY PREVENTION UNINTENTIONAL INJURY IS THE LEADING CAUSE OF DEATH FOR CHILDREN IN THE U.S. AS A LEADER IN PROVIDING SPECIALIZED PEDIATRIC HEALTHCARE, VALLEY CHILDREN'S RECOGNIZES THE IMPORTANCE OF INJURY PREVENTION AND WORKS COLLABORATIVELY WITH COMMUNITY AGENCIES TO PREVENT THOSE TRAGEDIES. EACH YEAR, VALLEY CHILDREN'S INJURY PREVENTION PROGRAM PROVIDES INJURY PREVENTION EDUCATION AND OUTREACH TO CHILDREN AND FAMILIES THROUGH A VARIETY OF FORUMS THROUGHOUT CENTRAL CALIFORNIA. THE PROGRAM IS DESIGNED TO HELP KEEP OUR KIDS SAFE."

PART V, SECTION B, LINE 11 (CONTINUED)
CHILD ABUSE PREVENTION THE GUILDS OF VALLEY CHILDREN'S HOSPITAL CHILD ABUSE PREVENTION AND TREATMENT CENTER'S MISSION IS TO PROVIDE COMPREHENSIVE SERVICES TO CHILDREN, DEPENDENT ADULTS AND THEIR FAMILIES THROUGH A MULTIDISCIPLINARY, CHILD-FRIENDLY PROGRAM, AND TO MEET THE PHYSICAL AND EMOTIONAL NEEDS OF VICTIMS OF CHILD ABUSE. THE CENTER'S VISION IS TO BE THE PREMIER PROVIDER IN CENTRAL CALIFORNIA FOR DIAGNOSTIC PHYSICAL ABUSE ASSESSMENTS, FOSTER CARE MEDICAL CLEARANCE EXAMINATIONS AND PEDIATRIC SEXUAL ASSAULT EVALUATIONS, INCLUDING CHILDREN WHO HAVE BEEN VICTIMS OF COMMERCIAL SEXUAL EXPLOITATION. ADDITIONALLY, THE CENTER'S PROVIDERS, KNOWN AS THE CHILD ADVOCACY TEAM, REGULARLY TESTIFY IN BOTH DEPENDENCY AND CRIMINAL COURTS THROUGHOUT THE VALLEY. THE CENTER IS RECOGNIZED IN CENTRAL CALIFORNIA AND AROUND THE STATE AS A LEADER IN ADVOCACY, INJURY PREVENTION, CLINICAL RESEARCH AND ACADEMIC TRAINING. THE CENTER INCLUDES THE CHILD ADVOCACY CLINIC, WHICH OPERATES FIVE DAYS A WEEK AND SEES APPROXIMATELY 1,000 CHILDREN EACH YEAR. CENTER PROVIDERS ALSO ARE AVAILABLE SEVEN DAYS A WEEK, 24 HOURS A DAY FOR EMERGENCY COVERAGE. THE CENTER INCLUDES AN INPATIENT COMPONENT THAT EVALUATES ABOUT 100 CHILDREN YEARLY IN THE PEDIATRIC EMERGENCY DEPARTMENT, ACUTE-CARE FLOORS AND PEDIATRIC INTENSIVE CARE UNIT. THESE CHILDREN ARE EVALUATED FOR SUSPECTED PHYSICAL ABUSE, SEXUAL ABUSE AND NEGLECT. THE STAFF INCLUDES CHILD ABUSE PEDIATRICIANS, NURSE PRACTITIONERS SPECIALIZED IN CHILD MALTREATMENT, FORENSIC NURSES, SOCIAL WORKERS, FORENSIC INTERVIEWERS, A CENTER COORDINATOR, A LICENSED MENTAL HEALTH PROVIDER AND SUPPORT STAFF. IN ADDITION TO THE CLINICAL SERVICES OFFERED BY THE CENTER, A MULTI-DISCIPLINARY INTERVIEWING CENTER IS ALSO AVAILABLE FOR VICTIMS OR WITNESSES OF CRIMES. FORENSIC INTERVIEWING SERVICES ARE REQUESTED BY LAW ENFORCEMENT AND/OR CPS. THE PURPOSE OF THE FORENSIC INTERVIEWING PROGRAM COMPONENT IS TO REDUCE THE NUMBER OF INTERVIEWS AND DECREASE THE NUMBER OF INDIVIDUALS WHO WILL TALK TO THE VICTIM. THE CENTER STRIVES TO PROVIDE A WELCOMING, CHILD-FRIENDLY ENVIRONMENT WHERE CHILDREN/DEPENDENT ADULTS CAN FEEL SAFE AND BE INTERVIEWED BY A TRAINED PROFESSIONAL. THERE IS ONGOING COLLABORATION WITH EXTERNAL COMMUNITY PARTNERS AND OTHER HOSPITAL SERVICES INCLUDING SUBSPECIALTY CLINICS, PATIENT AND FAMILY SERVICES, INTERPRETER SERVICES, RADIOLOGY, DIAGNOSTIC CLINICAL LABORATORIES, CHILD LIFE SERVICES AND PASTORAL CARE. THE CENTER WORKS CLOSELY WITH LAW ENFORCEMENT, CPS AND DISTRICT ATTORNEYS' OFFICES IN THEIR INVESTIGATIVE EFFORTS OF CHILD MALTREATMENT. COLLABORATIVE EFFORTS INCLUDE CASE CONSULTATION AND MONTHLY SUSPECT CHILD ABUSE AND NEGLECT (SCAN) MEETINGS FACILITATED BY OUR CHILD ADVOCACY CLINIC IN AN EFFORT TO TRACK, MONITOR AND ADVOCATE FOR THE HEALTH AND SAFETY OF AT-RISK CHILDREN THROUGHOUT THE VALLEY. FOR PREVENTION EDUCATION, THE CENTER COLLABORATES WITH INTERNAL AND EXTERNAL PARTNERS TO PROVIDE EDUCATION TO PARENTS, CAREGIVERS, HEALTHCARE PERSONNEL, TEACHERS AND MANDATED REPORTERS OF SUSPECTED CHILD MALTREATMENT. THESE PARTNERS INCLUDE VALLEY CHILDREN'S TRAUMA DEPARTMENT'S INJURY PREVENTION TEAM, SAFE KIDS, CHILD ABUSE PREVENTION COUNCILS OF CALIFORNIA, COMPREHENSIVE YOUTH SERVICES, CPS, EXCEPTIONAL PARENTS UNLIMITED, SEXUAL ASSAULT RESPONSE TEAMS (SART) AND COUNTY PUBLIC HEALTH DEPARTMENTS. POISON CONTROL THE CENTRAL CALIFORNIA POISON CONTROL CENTER IS LOCATED ON THE VALLEY CHILDREN'S CAMPUS AND RECEIVED A DONATION OF OFFICE SPACE FROM VALLEY CHILDREN'S. THE CENTER ANSWERS CALLS FROM THROUGHOUT THE REGION AND PROVIDES EXPERT ADVICE AND INFORMATION REGARDING EXPOSURE TO POTENTIALLY HARMFUL SUBSTANCES. THE PHONES ARE STAFFED 24 HOURS A DAY, 7 DAYS A WEEK. IN ADDITION TO PROVIDING EMERGENCY TELEPHONE ADVICE REGARDING POISON EXPOSURES, THE POISON CONTROL CENTER OPERATES SEVERAL PROGRAMS CRITICAL TO A CULTURALLY DIVERSE, AGRICULTURALLY BASED COMMUNITY LIKE THE CENTRAL VALLEY. THE CENTER HAS BEEN EXPRESSLY RESPONSIVE TO THE GROWING AND LARGELY UNDERSERVED LATINO POPULATION BY DEVELOPING SPECIALIZED TEACHING TOOLS AND PROGRAM INTERVENTIONS IN SPANISH, AND PROVIDING CUSTOMIZED TRAININGS FOR COMMUNITY HEALTH WORKERS IN SPANISH. ALSO, THE CENTER CONTRACTS WITH THE STATE DEPARTMENT OF PESTICIDE REGULATION (DPR) TO ASSIST PHYSICIANS IN COMPLYING WITH MANDATORY REPORTING REQUIREMENTS FOR PESTICIDE EXPOSURES. THE POISON CONTROL CENTER ALSO PROVIDES CASE DATA AND INFORMATION ON THE HEALTH ISSUES RELATED TO PESTICIDE EXPOSURE IN CALIFORNIA.NEEDS NOT ADDRESSEDTAKING INTO CONSIDERATION BOTH VALLEY CHILDREN'S EXISTING RESOURCES AND AS WELL AS COMMUNITY RESOURCES, VALLEY CHILDREN'S WILL NOT DIRECTLY ADDRESS THE REMAINING HEALTH NEEDS IDENTIFIED IN THE CHNA INCLUDING: ORAL HEALTH, SUBSTANCE USE, CLIMATE AND HEALTH/ENVIRONMENTAL POLLUTION, HOUSING AND HOMELESSNESS, EDUCATION, ECONOMIC SECURITY, SEXUALLY TRANSMITTED INFECTIONS, ALZHEIMER'S DISEASE, AND COMMUNICABLE DISEASES. KNOWING THAT THERE ARE NOT SUFFICIENT RESOURCES TO ADDRESS ALL THE COMMUNITY HEALTH NEEDS, VALLEY CHILDREN'S CHOSE TO CONCENTRATE ON THOSE HEALTH NEEDS THAT CAN MOST EFFECTIVELY BE ADDRESSED GIVEN THE ORGANIZATION'S AREAS OF FOCUS AND EXPERTISE. THIS IMPLEMENTATION STRATEGY REPORT IS NOT EXHAUSTIVE OF EVERYTHING VALLEY CHILDREN'S DOES TO ENHANCE THE HEALTH OF ITS COMMUNITY. VALLEY CHILDREN'S WILL CONTINUE TO LOOK FOR OPPORTUNITIES TO ADDRESS COMMUNITY NEEDS WHERE IT CAN APPROPRIATELY CONTRIBUTE TO ADDRESSING THOSE NEEDS.

PART V, SECTION B, LINE 13H:
FACILITY REPORTING GROUP - A200% OR LESS FEDERAL POVERTY GUIDELINES (FPG) - FULL CHARITABLE DISCOUNT $0 CHARGES.201%-350% FPG - LOW INCOME DISCOUNT NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.350% - HIGH MEDICAL COST DISCOUNT, INCOME FOR THE LAST 12 MONTHS DOES NOT EXCEED 350% OF FPG AND THEY HAVE NOT RECEIVED A DISCOUNTED RATE FROM THE HOSPITAL AS A RESULT OF THEIR THIRD-PARTY INSURANCE COVERAGE AND THEIR ANNUAL OUT-OF-POCKET MEDICAL EXPENSES. FOR THE PRIOR 12 MONTHS EXCEED 10% OF THEIR FAMILY'S ANNUAL INCOME. NO MORE THAN APPLICABLE MEDI CAL RATES IN EFFECT AT DATE OF SERVICE. WHERE MEDI CAL RATES CANNOT BE DETERMINED 75% DISCOUNT FROM CHARGES.PROMPT PAY DISCOUNT: VALLEY CHILDREN'S WILL EXTEND A 45% PROMPT PAY DISCOUNT TO THOSE SELF-PAY PATIENTS WHO WISH TO PAY THEIR ENTIRE OUTSTANDING BALANCE IMMEDIATELY. INSURED PATIENTS WITH NON-COVERED SERVICES WHICH ARE DEEMED MEDICALLY NECESSARY AND WISH TO PAY THEIR OUTSTANDING BALANCE IMMEDIATELY WILL BE ELIGIBLE FOR A 45% DISCOUNT UPON REQUEST.

PART V, LINE 16A, FAP WEBSITE:
HTTPS://WWW.VALLEYCHILDRENS.ORG/PATIENTS-AND-FAMILIES/RECORDS-BILLING/FINANCIAL-AID

PART V, LINE 16B, FAP APPLICATION WEBSITE:
HTTPS://WWW.VALLEYCHILDRENS.ORG/PATIENTS-AND-FAMILIES/RECORDS-BILLING/FINANCIAL-AID

PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
HTTPS://WWW.VALLEYCHILDRENS.ORG/PATIENTS-AND-FAMILIES/RECORDS-BILLING/FINANCIAL-AID

PART V, LINE 16J, FAP OTHER INFORMATION:
ADDITIONALLY THE POLICY IS SENT BY US POSTAL SERVICE TO COMMUNITY AGENCIES TO BE DISTRIBUTED.VALLEY CHILDREN'S MAINTAINS A LIST OF PROVIDERS IN A DOCUMENT SEPARATE FROM THE FINANCIAL ASSISTANCE POLICY. MEMBERS OF THE PUBLIC MAY READILY OBTAIN A COPY FREE OF CHARGE, BOTH ONLINE AND ON PAPER, AS REQUIRED BY IRS NOTICE 2015-46. THE LINK TO THE WEBSITE IS:HTTPS://WWW.VALLEYCHILDRENS.ORG/FIND-A-DOCTOR/FIND-A-DOCTOR

PART I, LINE 7:
CHARITY CARE AT COST WAS CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE DECISION SUPPORT SYSTEM WAS USED TO CALCULATE COST-TO-CHARGE FOR DETERMINING UNREIMBURSED MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THIS DECISION SUPPORT SYSTEM ADDRESSES ALL PATIENT SEGMENTS (I.E INPATIENT, OUTPATIENT, ETC.).

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 10,952,809.

PART III, LINE 4:
FOOTNOTE DESCRIBING BAD DEBT EXPENSE: SEE PAGE 12, NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS.COSTING METHODOLOGY:ALLOWANCE FOR DOUBTFUL ACCOUNTS ARE ESTIMATED BASED ON HISTORICAL WRITE-OFF PERCENTAGES AND REVIEW OF LARGE BALANCE SELF-PAY ACCOUNTS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBT IF SUBSEQUENTLY COLLECTED. THE COST OF BAD DEBT WRITE-OFFS WERE CALCULATED BY APPLYING THE OVERALL COST TO CHARGE RATIO OF THE ORGANIZATION TO THE CHARGES WRITTEN OFF.

PART III, LINE 8:
MEDICARE ALLOWABLE COST IS CALCULATED USING THE FILED 2022 MEDICARE COST REPORT. MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMPONENT OF COMMUNITY BENEFIT BECAUSE REIMBURSEMENT IS NOT NEGOTIABLE AND DOES NOT COVER THE COST TO PROVIDE SERVICES. ADDITIONALLY, THE MAJORITY OF THE HOSPITAL'S MEDICARE PATIENTS WOULD BE COVERED BY MEDI CAL IF THEY DID NOT FALL UNDER THE MEDICARE COVERAGE OPTION.

PART III, LINE 9B:
COLLECTION ATTEMPTS ARE DISCONTINUED ONCE CHARGES ARE DETERMINED TO BE ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE; INSURANCE COLLECTION ATTEMPTS CONTINUE AS APPROPRIATE.

PART VI, LINE 2:
COMMUNITY HEALTH NEEDS ASSESSMENT: VALLEY CHILDREN'S HOSPITAL'S COMMUNITY BENEFITS PROGRAM IS BASED ON A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). CONSISTENT WITH STATE AND FEDERAL LAW, VALLEY CHILDREN'S HOSPITAL COMPLETES A FORMAL CHNA AT LEAST ONCE EVERY THREE YEARS. VALLEY CHILDREN'S HOSPITAL'S 2022 COMMUNITY BENEFITS PROGRAM IS BUILT UPON THE OUTCOMES OF A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT THAT INCLUDED THE FOLLOWING ACTIVITIES:VALLEY CHILDREN'S 2019 CHNA WAS BASED ON A JOINT NEEDS ASSESSMENT FOR FRESNO, KINGS, MADERA AND TULARE COUNTIES. VALLEY CHILDREN'S PARTNERED WITH 15 HOSPITALS TO CONDUCT AN ASSESSMENT OF HEALTH NEEDS FOR BOTH CHILDREN AND ADULTS. THE CHNA WAS COORDINATED BY THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA, AND INCLUDED A THOROUGH REVIEW OF SECONDARY DATA AS WELL AS SIGNIFICANT COMMUNITY ENGAGEMENT THROUGH SURVEYS, FOCUS GROUPS AND KEY STAKEHOLDER INTERVIEWS. ADDITIONALLY, VALLEY CHILDREN'S STAFF ENGAGED REGULARLY WITH A HOST OF COMMUNITY-BASED ORGANIZATIONS AND INITIATIVES THAT KEPT US CLOSE TO THE ISSUES IMPACTING THE HEALTH AND WELLBEING OF CHILDREN IN THE REGION.

PART VI, LINE 3:
ENROLLMENT IN HEALTH INSURANCEVALLEY CHILDREN'S IDENTIFIED AND PROVIDED ENROLLMENT ASSISTANCE TO UNINSURED AND UNDER-INSURED PATIENTS WHO QUALIFIED FOR MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES PROGRAM OR VALLEY CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. ONCE ELIGIBILITY WAS DETERMINED, VALLEY CHILDREN'S STAFF ASSISTED THE FAMILIES WITH COMPLETING NECESSARY APPLICATIONS AND SUBMITTING THEM TO THE APPROPRIATE AGENCIES.

PART VI, LINE 4:
COMMUNITY INFORMATION: AS THE ONLY PEDIATRIC NETWORK OF ITS KIND IN ALL OF CENTRAL CALIFORNIA, VALLEY CHILDREN'S SERVICE AREA EXTENDS FROM SAN JOAQUIN COUNTY IN THE NORTH TO KERN COUNTY IN THE SOUTH, AND SERVES MUCH OF THE CENTRAL COAST AND EASTERN SIERRA AS WELL. VALLEY CHILDREN'S SERVICE AREA IS FOCUSED ON THOSE SEVEN COUNTIES THAT COLLECTIVELY ACCOUNT FOR MORE THAN 90% OF VALLEY CHILLDREN'S INPATIENT AND OUTPATIENT VOLUME. THOSE COUNTIES ARE FRESNO, KERN, KINGS, MADERA, MERCED, STANISLAUS AND TULARE. ACCORDING TO WWW.KIDSDATA.ORG, MORE THAN 1/4 OF CHILDREN LIVING IN THESE SEVEN COUNTIES LIVE IN POVERTY, 3/4 ARE AN ETHNICITY OTHER THAN CAUCASIAN AND CLOSE TO 1/5 LIVE IN FAMILIES WHERE ENGLISH IS NOT THE PRIMARY LANGUAGE SPOKEN AT HOME. IN 2022, VALLEY CHILDREN'S HOSPITAL HAD 10,496 INPATIENT ADMISSIONS, 86,895 EMERGENCY DEPARTMENT VISITS AND 279,027 HOSPITAL-BASED OUTPATIENT SPECIALTY CARE CENTER, REGIONAL SPECIALTY CARE CENTER, AND PRIMARY CARE CENTER VISITS. MEDI-CAL BENEFITS COVERED 73.8% OF THE HOSPITAL'S TOTAL INPATIENT AND OUTPATIENT VISITS AT VALLEY CHILDREN'S HOSPITAL IN 2022.

PART VI, LINE 5:
PROMOTION OF COMMUNITY HEALTHACCESS TO PRIMARY AND PREVENTIVE CARE FOR AT-RISK CHILDRENPEDIATRIC PHYSICIAN RESIDENTS PARTICIPATING IN VALLEY CHILDREN'S PEDIATRIC RESIDENCY PROGRAM PROVIDED PRIMARY AND PREVENTIVE HEALTHCARE SERVICES TO AT-RISK CHILDREN IN FRESNO COUNTY AS A PART OF THE FRESNO COUNTY SUPERINTENDENT OF SCHOOLS' (FCSOS) MOBILE HEALTH UNIT (MHU). DESIGNED TO HELP ENSURE THAT CHILDREN ARE HEALTHY AND ABLE TO LEARN, THE MHU VISITED 38 DIFFERENT SCHOOLS IN 2022 INCLUDING MANY LOCATED IN RURAL AND LOW-INCOME COMMUNITIES, AND AS PART OF THESE VISITS, 1,001 CHILDHOOD VACCINATIONS WERE ADMINISTERED AND 315 SPORTS PHYSICALS WERE PERFORMED.ADAPTIVE SPORTS PROGRAMVALLEY CHILDREN'S ADAPTIVE SPORTS PROGRAM PROVIDED FREE RECREATIONAL AND ATHLETIC EXPERIENCES FOR CHILDREN, ADOLESCENTS AND YOUNG ADULTS WITH DISABILITIES, REGARDLESS OF WHETHER THEY HAVE BEEN OR ARE CURRENTLY PATIENTS AT VALLEY CHILDREN'S. THE PROGRAM, THE ONLY ONE OF ITS KIND IN CENTRAL CALIFORNIA, IS DESIGNED FOR INDIVIDUALS WITH PHYSICAL IMPAIRMENTS AND CONDITIONS RANGING FROM CEREBRAL PALSY, SPINAL CORD INJURIES AND AMPUTATIONS. DISABLED YOUTH, UP TO AGE 21, WERE ESPECIALLY ENCOURAGED TO ATTEND. IN 2022, APPROXIMATELY 120 CHILDREN PARTICIPATED IN A VARIETY OF ACTIVITIES INCLUDING CANOEING, KAYAKING AND ROCK CLIMBING.FOOD FOR FAMILIES VALLEY CHILDREN'S DIETARY TEAM PROVIDED MEAL COUPONS TO BREASTFEEDING MOMS WHOSE INFANTS WERE AT VALLEY CHILDREN'S. ADDITIONALLY, THROUGH A PROGRAM CALLED MEALS FROM THE HEART, WHICH IS SPONSORED BY RONALD MCDONALD CHARITIES OF CENTRAL CALIFORNIA, VALLEY CHILDREN'S SOCIAL WORK TEAM PROVIDED PATIENTS' FAMILIES WITH MEAL COUPONS WHEN THEY ARRIVED AND WERE NOT PREPARED FOR A LONG STAY AT THE HOSPITAL. THE SOCIAL WORK TEAM ALSO WORKED CLOSELY WITH THE CALIFORNIA CHILDREN'S SERVICES PROGRAM TO PROVIDE FOOD FOR ELIGIBLE FAMILIES. FOOD SECURITY - CENTRAL CALIFORNIA FOOD BANK PARTNERSHIPIN MARCH 2022, VALLEY CHILDREN'S ENTERED INTO A THREE-YEAR PARTNERSHIP WITH THE CENTRAL CALIFORNIA FOOD BANK TO SUPPORT ACCESS TO HEALTHY AND NUTRITIOUS FOOD FOR CHILDREN AND FAMILIES ACROSS OUR SERVICE AREA. THROUGH THE PARTNERSHIP, VALLEY CHILDREN'S HAS COMMITTED FUNDING OVER THREE YEARS THAT SUPPORTS THE FOLLOWING INTERVENTIONS: A) FOOD DISTRIBUTIONS TO UP TO 70 FAMILIES WITH CHILDREN BEING SERVED BY VALLEY CHILDREN'S HOME CARE. QUALIFYING FAMILIES RECEIVE ONE FOOD BOX PER MONTH: B) FOOD DISTRIBUTIONS TO UP TO 100 FAMILIES EACH YEAR THROUGH A FOOD PANTRY AT WEST FRESNO ELEMENTARY SCHOOL: AND C) SUPPORT FOR THE FIRST FRUITS MARKET AT CITY CENTER IN FRESNO THAT WILL BE AVAILABLE TO LOW-INCOME FAMILIES WITH CHILDREN TO ACCESS NUTRITIOUS FOOD, FREE OF CHARGE, IN A SETTING MUCH LIKE ANY NEIGHBORHOOD GROCERY STORY.HELP ME GROWHELP ME GROW IS A SYSTEM USED THROUGHOUT THE UNITED STATES TO HELP CHILDREN REACH THEIR OPTIMAL DEVELOPMENT BY KINDERGARTEN. HELP ME GROW PROGRAMS INCLUDE A CENTRALIZED INTAKE AND REFERRAL PROCESS, COMMUNITY OUTREACH TO PROMOTE EARLY INTERVENTION SYSTEMS, TARGETED OUTREACH TO CHILD CARE AND CHILD HEALTH PROVIDERS, AND THE COLLECTION AND ANALYSIS OF DATA TO IMPROVE THE SYSTEM.IN 2022, VALLEY CHILDREN'S AND ITS PRIMARY CARE PRACTICES IN KERN COUNTY AND SEPARATELY IN MERCED COUNTY PARTNERED WITH STAKEHOLDERS IN BOTH COUNTIES TO IMPLEMENT HELP ME GROW PROGRAMS. VALLEY CHILDREN'S HAS BEEN AN ACTIVE PARTICIPANT IN FRESNO COUNTY'S HELP ME GROW PROGRAM FOR A NUMBER OF YEARS. ALSO IN 2022, VALLEY CHILDREN'S CONVENED STAKEHOLDERS FROM ACROSS ITS SERVICE AREA TO EXPLORE OPPORTUNITIES TO COLLABORATE REGIONALLY ON SOME OF THE HELP ME GROW PROCESSES. SCHOOLS FOR HEALTHY THRIVING STUDENTSIN JANUARY 2022, VALLEY CHILDREN'S GUILDS CENTER FOR COMMUNITY HEALTH, IN PARTNERSHIP WITH THE CENTER FOR WELLNESS AND NUTRITION, LAUNCHED SCHOOLS FOR HEALTHY THRIVING STUDENTS PHASE 2. THIS IS A TWO-YEAR INITIATIVE THAT AIMS TO ENGAGE SUPERINTENDENTS, BOARD MEMBERS AND WELLNESS CHAMPIONS FROM SCHOOL DISTRICTS IN FRESNO COUNTY AND MADERA COUNTY TO PROVIDE THEM WITH THE KNOWLEDGE, SKILLS, TECHNICAL ASSISTANCE AND RESOURCES NEEDED TO EFFECTIVELY DEVELOP AND IMPLEMENT LOCAL SCHOOL WELLNESS POLICIES. THE U.S. DEPARTMENT OF AGRICULTURE REQUIRES THAT SCHOOL DISTRICTS PARTICIPATING IN THE NATIONAL SCHOOL LUNCH PROGRAM AND/OR SCHOOL BREAKFAST PROGRAM DEVELOP A WELLNESS POLICY.SCHOOLS FOR HEALTHY THRIVING STUDENTS FOCUSES EFFORTS ON THE CENTERS FOR DISEASE AND CONTROL AND PREVENTION'S WHOLE SCHOOL, WHOLE COMMUNITY, WHOLE CHILD FRAMEWORK (WSCC). THE WSCC MODEL IS STUDENT-CENTERED AND EMPHASIZES THE ROLE OF THE COMMUNITY IN SUPPORTING THE SCHOOL, THE CONNECTIONS BETWEEN HEALTH AND ACADEMIC ACHIEVEMENT AND THE IMPORTANCE OF EVIDENCE-BASED SCHOOL POLICIES AND PRACTICES.A TOTAL OF 17 SCHOOL DISTRICTS FROM FRESNO COUNTY AND MADERA COUNTY ARE PARTICIPATING IN THIS INITIATIVE, WHICH IS JOINTLY FUNDED BY VALLEY CHILDREN'S AND NO KID HUNGRY. SPECIFIC GOALS OF THE INITIATIVE ARE TO: A) INCREASE KNOWLEDGE OF THE WHOLE SCHOOL, WHOLE COMMUNITY, WHOLE CHILD FRAMEWORK; B) INCREASE THE NUMBER OF SCHOOL DISTRICTS ADOPTING LOCAL SCHOOL WELLNESS POLICIES THAT INCORPORATE EVIDENCE-BASED PRACTICES; AND C) INSTITUTE A REGULAR, ONGOING PROCESS BY WHICH THE PARTICIPATING DISTRICTS MONITOR THEIR PERFORMANCE, SHARE PRACTICES AND DEVELOP ACCOUNTABILITY FOR COMPREHENSIVE AND ONGOING IMPLEMENTATION OF THEIR WELLNESS POLICIES.VALLEY CHILDREN'S, ALONG WITH MADERA UNIFIED SCHOOL DISTRICT (ONE OF THE DISTRICTS PARTICIPATING IN THIS INITIATIVE), AND THE CENTER FOR WELLNESS AND NUTRITION, WERE INVITED TO PRESENT THEIR FINDINGS AT THE ACTION FOR HEALTHY KIDS NATIONAL CONFERENCE IN CHICAGO. THE INVITATION TO PRESENT AT THE CONFERENCE SPEAKS TO THE IMPORTANCE OF THIS WORK AND THE POSITIVE CONTRIBUTIONS WE ARE HAVING ON CHILD HEALTH AND WELLNESS.MENTAL HEALTHMENTAL HEALTH IS ONE OF THE MOST PRESSING NEEDS FACING CHILDREN IN CALIFORNIA. CHILDREN LIVING IN VALLEY CHILDREN'S SERVICE AREA ARE PARTICULARLY UNDERSERVED DUE TO THE GEOGRAPHY, PROVIDER SHORTAGES AND LIMITED COMMUNITY-BASED SERVICES. IN 2022 VALLEY CHILDREN'S DEMONSTRATED ITS COMMITMENT TO MEETING THE MENTAL HEALTH NEEDS OF CHILDREN IN A NUMBER OF WAYS, INCLUDING THOSE LISTED BELOW AND IN PART V, SECTION B, LINE 11.ADVERSE CHILDHOOD EXPERIENCES (ACES) PROJECTIN SEPTEMBER 2022, VALLEY CHILDREN'S OLIVEWOOD PEDIATRICS IN MERCED WAS THE RECIPIENT OF AN ACES AWARE PRACTICE PATHFINDER GRANT, WHICH WILL CONTINUE THROUGH NOVEMBER 2023. THE GOALS OF THE GRANT ARE THREEFOLD: 1) STRENGTHEN PARTNERSHIPS AMONG HEALTHCARE PROVIDERS, COMMUNITY-BASED ORGANIZATIONS, AND MEDI-CAL MANAGED CARE PLANS TO SCREEN AND RESPOND TO ACES; 2) DEVELOP NEW, EVIDENCE-BASED SERVICES TO PREVENT AND TREAT TOXIC STRESS PHYSIOLOGY AND ACE-ASSOCIATED HEALTH CONDITIONS; AND 3) BUILD A SUSTAINABLE WORKFORCE THAT SUPPORTS SCREENING AND PREVENTION OF ACES.ADDITIONALLY, VALLEY CHILDREN'S IMPLEMENTED UNIVERSAL ACES SCREENINGS IN ALL OF ITS PRIMARY CARE PRACTICES IN SUMMER 2022.BEHAVIORAL HEALTH SCHOOL LIAISONTHROUGH FUNDING FROM THE FRESNO COUNTY SUPERINTENDENT OF SCHOOLS, VALLEY CHILDREN'S HIRED AN ON-SITE BEHAVIORAL HEALTH SCHOOL LIAISON. THE LIAISON COLLABORATED WITH AREA SCHOOL DISTRICTS TO ENSURE THAT CHILDREN PRESENTING TO OUR EMERGENCY DEPARTMENT AND INPATIENT UNITS WITH MENTAL HEALTH NEEDS RECEIVE APPROPRIATE RESOURCES AND SUPPORT WHEN THEY RETURN TO SCHOOL. THIS IS A VOLUNTARY PROGRAM AND VALLEY CHILDREN'S IS WORKING TO ENHANCE COMMUNICATION AND USE OF RESOURCES FOR CHILDREN SEEN AT VALLEY CHILDREN'S AND THEIR RE-ENTRY TO SCHOOL.ADDITIONALLY, VALLEY CHILDREN'S CONTINUED TO SUPPORT 360ME, AN INITIATIVE THAT IS DESIGNED TO PROVIDE FAMILIES, SCHOOLS, AND COMMUNITIES WITH TOOLS AND RESOURCES TO MAKE SURE WE ARE DOING ALL THAT WE CAN TO SAFEGUARD BOTH OUR CHILDREN'S PHYSICAL HEALTH AND THEIR MENTAL HEALTH. 360ME INTENTIONALLY HELPS STAKEHOLDERS RECOGNIZE AND UNDERSTAND THE MANY CONNECTIONS BETWEEN MENTAL AND PHYSICAL WELLNESS AND TO REDUCE THE STIGMA SOCIETY INCORRECTLY ASSOCIATES WITH MENTAL HEALTH. UNIVERSAL SCREENINGIN JANUARY 2022, VALLEY CHILDREN'S INITIATED UNIVERSAL SCREENING FOR SUICIDE RISK FOR EVERY CHILD, AGES 12 AND OLDER, WHO WAS SEEN IN OUR EMERGENCY DEPARTMENT, DAY SURGERY OR ADMITTED TO AN INPATIENT UNIT. ANY CHILD WHO WAS DETERMINED TO BE AT MODERATE OR HIGH FOR RISK FOR SUICIDE RECEIVED AN IN-DEPTH ASSESSMENT BY A VALLEY CHILDREN'S SOCIAL WORKER THAT INCLUDED EITHER THE CREATION OF A SAFETY PLAN FOR HOME OR TRANSFER TO AN ACUTE PSYCHIATRIC FACILITY FOR HIGHER LEVEL OF CARE.(PART VI, LINE 5 CONTINUED BELOW)

PART VI, LINE 6:
N/A

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

PART VI, LINE 5 (CONTINUED):
REGIONAL CAPACITYIN SEPTEMBER 2019, VALLEY CHILDREN'S ANNOUNCED A PARTNERSHIP WITH UNIVERSAL HEALTH SERVICES (UHS), ONE OF THE NATION'S LARGEST AND MOST RESPECTED PROVIDERS OF BEHAVIORAL HEALTH SERVICES. UNDER THE PARTNERSHIP, UHS WILL CONSTRUCT, OWN AND OPERATE AN 81,600-SQUARE-FOOT, 128-BED BEHAVIORAL HEALTH HOSPITAL FOR CHILDREN AND ADULTS IMMEDIATELY ADJACENT TO THE VALLEY CHILDREN'S HOSPITAL CAMPUS IN MADERA. THE FACILITY WILL INCLUDE A 24-BED INPATIENT UNIT FOR CHILDREN AND ADOLESCENTS, AGES 5-17, REPRESENTING A 49% INCREASE IN AVAILABLE BEDS FOR KIDS FROM KERN TO SAN JOAQUIN COUNTIES. THE HOSPITAL IS EXPECTED TO OPEN BY FALL 2023.VALLEY CHILDREN'S RESPONSE TO COVID-19SINCE THE START OF COVID-19, VALLEY CHILDREN'S HAS RECOGNIZED THAT IT HAS A CRITICAL ROLE TO PLAY NOT ONLY IN MEETING THE HEALTH NEEDS OF ITS PATIENTS AND ITS WORKFORCE, BUT ALSO IN HELPING THE BROADER COMMUNITY MEET THE CHALLENGES CREATED BY THE PANDEMIC. WHILE THE NEED WAS NOT AS GREAT IN 2022 DUE TO THE DECLINE IN THE NUMBER OF COVID-19 CASES, VALLEY CHILDREN'S PROVIDED THE FOLLOWING SUPPORT IN 2022:- COVID-19 TEST SAMPLE PROCESSING: VALLEY CHILDREN'S PROCESSED MORE THAN 5,000 COVID-19 TESTING SAMPLES FOR FIVE DIFFERENT COMMUNITY-BASED PROVIDERS AND ORGANIZATIONS THAT LACKED ADEQUATE LABORATORY CAPACITY OF THEIR OWN.- VALLEY CHILDREN'S PROVIDED CRITICAL FINANCIAL SUPPORT FOR THOSE ORGANIZATIONS WORKING HARD TO ADDRESS A VARIETY OF NEEDS AND CHALLENGES THAT CHILDREN AND FAMILIES WERE FACING DUE TO THE PANDEMIC, INCLUDING INADEQUATE ACCESS TO HEALTHY FOODS AND AN INCREASE IN CHILD TRAUMA.THE MISSION OF VALLEY CHILDREN'S HOSPITAL IS TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO CHILDREN REGARDLESS OF THEIR ABILITY TO PAY AND TO CONTINUOUSLY IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN. THE HOSPITAL OPERATES AN OPEN MEDICAL STAFF AND IS AN INDEPENDENT NON PROFIT ORGANIZATION GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES WHICH IS THEREFORE ACCOUNTABLE TO OUR COMMUNITY AND ONLY OUR COMMUNITY.