2026-09-14T19:10:50-05:00 2025-10-31 390859910 BAKER TILLY ADVISORY GROUP LP 2882 PROSPECT PARK DR STE 300 RANCHO CORDOVA CA 95670 990 2024-11-01 941450151 MARSHALL MEDICAL CENTER MARS 5306221441 1100 MARSHALL WAY PLACERVILLE CA 95667 MARTIN ENTWISTLE INTERIM PRESIDENT/CEO 5306221441 2026-09-11 1 1 AMY L HENDLEY P01300654 9165038100 2026-09-11 2024 MARTIN ENTWISTLE 1100 MARSHALL WAY PLACERVILLE CA 95667 368049416 0 X WWW.MARSHALLMEDICAL.ORG X 1957 CA TO IMPROVE THE HEALTH OF OUR COMMUNITY AND OFFER HEALTH SERVICES OF SUPERIOR VALUE AND QUALITY. 12 11 1753 120 0 0 1134267 5159338 339575189 357833059 1295493 2802245 1626722 1745838 343631671 367540480 12300 10090 0 0 165390358 176935875 0 0 0 174842458 195119751 340245116 372065716 3386555 -4525236 350530200 346756890 150729348 149159959 199800852 197596931 X MARSHALL MEDICAL CENTER PROUDLY SERVES THE WESTERN SLOPE OF EL DORADO COUNTY. OUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITY AND OFFER HEALTH SERVICES OF SUPERIOR VALUE AND QUALITY, CENTERED ON THE GOALS AND NEEDS OF OUR PATIENTS. WE STRIVE TO DELIVER SERVICE THAT EXCEEDS OUR PATIENTS' EXPECTATIONS. 0 0 267963986 10090 357833059 SEE SCHEDULE OIN KEEPING WITH THE COMMITMENT TO IMPROVE THE HEALTH OF OUR COMMUNITY AND OFFER HEALTH SERVICES OF SUPERIOR VALUE AND QUALITY, THE FOLLOWING WILL BE CONSIDERED WHEN INDIVIDUALS WHO NEED HEALTH CARE CANNOT PAY:- PROVIDING FREE CARE AND/OR SUBSIDIZED CARE;- PROVIDING CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND- PROVIDING HEALTH/WELLNESS ACTIVITIES AND COMMUNITY EDUCATION PROGRAMS.NOT ONLY DOES MARSHALL MEDICAL CENTER PROVIDE LOW-COST CARE TO INDIVIDUALS COVERED BY GOVERNMENT PROGRAMS AND THOSE UNABLE TO AFFORD HEALTH CARE, BUT IT ALSO HELPS PATIENTS FIND AND ACCESS PRIVATE AND GOVERNMENTAL RESOURCES FOR HEALTH CARE BENEFITS. MARSHALL MEDICAL CENTER RECOGNIZES BELOW-COST REIMBURSEMENTS AS CHARITY AND UNCOMPENSATED CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY.INPATIENT SERVICESIN TAX YEAR 2024, INPATIENT SERVICES WERE PROVIDED TO 5,067 PATIENTS. EXAMPLES OF INPATIENT SERVICES INCLUDED:- 355 BABIES DELIVERED- 11 SPECIAL PROCEDURES PERFORMED- 168 CARDIAC CATHETERIZATIONS- 134,372 LABORATORY TESTS PERFORMED- 5,671 CT SCANS- 10,468 RADIOLOGY PROCEDURES PERFORMEDOUTPATIENT SERVICESIN TAX YEAR 2024, OUTPATIENT SERVICES WERE PROVIDED TO 216,583 PATIENTS. EXAMPLES OF OUTPATIENT SERVICES INCLUDED:- 32,158 EMERGENCY ROOM VISITS- 2,117 OUTPATIENT SPECIAL PROCEDURES PERFORMED- 77,941 RADIOLOGY PROCEDURES PERFORMED- 495 CARDIAC CATHETERIZATIONS- 406,537 LABORATORY TESTS PERFORMED- 18,131 CT SCANS- 5,938 RURAL HEALTH CLINIC VISITS- 23,528 CARDIOLOGY CLINIC VISITS- 4,684 PULMONOLOGY CLINIC VISITS- 5,960 ONCOLOGY CLINIC VISITS- 6,465 OUTPATIENT INFUSION CLINIC VISITS- 2,405 RHEUMATOLOGY CLINIC VISITS- 16,801 PEDIATRIC CLINIC VISITS- 9,460 OB CLINIC VISITS- 10,671 CANCER PROGRAM CASES- 57,382 FAMILY PRACTICE CLINIC VISITS- 7,491 GASTROENTEROLOGY CLINIC VISITS- 2,129 ENT CLINIC VISITS- 3,491 HEARING CLINIC VISITS- 13,535 ORTHOPEDIC CLINIC VISITS- 6,242 SURGERY CLINIC VISITS- 6,290 UROLOGY CLINIC VISITS- 3,972 PODIATRY CLINIC VISITS- 4,187 HBO AND WOUND CARE CLINIC VISITS- 24,772 HOSPITALIST VISITS- 6,244 CARES CLINIC VISITS- 1,593 SPECIALTY SERVICES VISITSMARSHALL MEDICAL CENTER RECOGNIZES IT HAS AN OBLIGATION TO PROVIDE SERVICES ABOVE AND BEYOND ITS ROLE AS A HEALING FACILITY. THE FOLLOWING COMMUNITY BENEFITS DEMONSTRATE THE TANGIBLE WAYS IN WHICH THE ORGANIZATION IS FULFILLING ITS MISSION:COMMUNITY BENEFITS- BLOOD PRESSURE CLINICS;- FLU CLINICS;- VOLUNTEER PROGRAM;- FOR YOUR HEALTH COMMUNITY MAGAZINE;- CANCER RESOURCE CENTER;- PALLIATIVE CARE PROGRAM;- HOLIDAY FOOD DRIVE FOR VARIOUS FOOD BANKS;- SEXUAL ASSAULT RESPONSE TEAM (SART) PROGRAM;- COMMUNITY HEALTH LIBRARY;- CHILDBIRTH CLASSES;- CONGESTIVE HEART ACTIVE TELEPHONE TREATMENT PROGRAM;- SCHOLARSHIPS;- PHARMACEUTICAL TRIALS;- USE OF HOSPITAL CONFERENCE ROOMS FOR COMMUNITY-BASED ORGANIZATIONS;- SEMINARS AND SUPPORT GROUPS;- FREE TRAINING FOR PHARMACY STUDENTS, NURSING STUDENTS, LVN STUDENTS, AND OTHER HEALTH CARE PROFESSIONALS;- SMOKING CESSATION PROGRAM;- VOLUNTEER SERVICE TO COMMUNITY ORGANIZATIONS, INCLUDING CHAMBERS OF COMMERCE;- LOW-COST MAMMOGRAPHY PROGRAM;- NUMEROUS COMMUNITY HEALTH EDUCATION CLASSES;- MARSHALL MEDICAL CENTER'S CHAPLAIN PROVIDED 1,167 PATIENT VISITS, 114 PATIENT COUNSELING VISITS, AND CONDUCTED THREE MEMORIAL SERVICES;- ACCEL PROGRAM (LOCAL PROJECT COORDINATING THE SAFETY NETWORK FOR EL DORADO COUNTY);- ELECTRONIC HEALTH INFORMATION EXCHANGE;- FREE TRANSPORTATION FOR PATIENTS UNABLE TO AFFORD TRANSPORTATION;- MEETING SPACE PROVIDED AT NO CHARGE FOR NUMEROUS SUPPORT GROUPS, INCLUDING MENTAL HEALTH FIRST AID, STROKE EDUCATION AND SUPPORT, AND OTHERS;- COMMUNITY SPONSORSHIPS, INCLUDING BUT NOT LIMITED TO THE CENTER FOR VIOLENCE-FREE RELATIONSHIPS, SOROPTIMIST INTERNATIONAL, HANDS4HOPE, AND THE ROTARY CLUB OF EL DORADO HILLS; AND- ENCOURAGEMENT OF EMPLOYEE PARTICIPATION IN COMMUNITY-BUILDING ORGANIZATIONS, INCLUDING BUT NOT LIMITED TO THE EL DORADO COUNTY ECONOMIC DEVELOPMENT CORPORATION, LEADERSHIP EL DORADO, THE EL DORADO UNION HIGH SCHOOL DISTRICT CAREER EDUCATION ADVISORY COMMITTEE, AND VARIOUS HEALTH ORGANIZATION BOARDS. 267963986 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 127 0 1 1753 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X JOEL ENGELMANN 5306262606 1100 MARSHALL WAY PLACERVILLE CA 95667 SIRI NELSON PRESIDENT/CEO 39.00 1.50 X X 834563 0 19969 JON HAUGAARD CHAIR 2.00 0.00 X X 0 0 0 THOMAS CUMPSTON VICE CHAIR 2.00 2.00 X X 0 0 0 JOHN R KNIGHT SECRETARY (THRU 04/25)/TREASURER 2.00 0.00 X X 0 0 0 SYLVIA STEPHENSON SECRETARY (AS OF 04/25) 2.00 0.00 X X 0 0 0 SEAN ANDERSON MD CHIEF OF STAFF (THRU 12/24) 2.00 0.00 X 0 0 0 LEANNE CAMISA CHIEF OF STAFF (AS OF 01/25) 2.00 0.00 X 0 0 0 ANNA BLAIR RN DIRECTOR 2.00 0.00 X 0 0 0 GERARDO GALANG MD DIRECTOR 2.00 0.00 X 0 0 0 ANDREA HOWARD DIRECTOR (THRU 02/25) 2.00 0.00 X 0 0 0 ALEXIS LONG MD DIRECTOR 2.00 0.00 X 0 0 0 MIKE PERVIS DIRECTOR 2.00 0.00 X 0 0 0 KIM STOLL DIRECTOR 2.00 0.00 X 0 0 0 BRIAN VEERKAMP DIRECTOR 2.00 0.00 X 0 0 0 JOEL ENGELMANN VP OF FINANCE 39.00 1.00 X 161566 0 9100 MARTIN ENTWISTLE - ASSOCIATE CHIEF MEDICAL OFFICER/VP OF POP. 40.00 0.50 X 438707 0 22204 LAURIE ELDRIDGE CHIEF FINANCIAL OFFICER (THRU 10/24) 39.00 1.00 X 364665 0 61784 BRIAN GOLDSMITH MD CHIEF MEDICAL OFFICER 40.00 0.00 X 394000 0 13588 CYNTHIA RICE CHIEF NURSING OFFICER 40.00 0.00 X 355126 0 32538 JONATHAN RUSSELL CHIEF AMBULATORY OFFICER 40.00 0.50 X 320515 0 30249 ELLE KARIMKHANI CHIEF LEGAL OFFICER 40.00 0.00 X 274632 0 784 LISA KISSEL COMPLIANCE & PRIVACY OFFICER 40.00 0.00 X 219051 0 0 BRETT APPLEBERG - CHIEF HUMAN RESOURCES OFFICER (THRU 04/24) 40.00 0.00 X 163246 0 12637 CORINA BRONNY STAFF RN - ICU 40.00 0.00 X 357207 0 21900 CHERYL MORGAN SONOGRAPHER 3 - DIAGNOSTIC IMAGING 40.00 0.00 X 281774 0 34113 MARTIN DALY VP OF INFORMATION TECHNOLOGY 40.00 0.00 X 299508 0 15850 MINDY DANOVARO EXECUTIVE DIRECTOR OF PHILANTHROPY 39.00 1.00 X 289396 0 18253 PHILLIP LEONERIO STAFF RN 40.00 0.00 X 286374 0 7850 5040330 0 300819 416 0 1 0 EL DORADO MULTISPECIALTY MED GROUP 1095 MARSHALL WAY PLACERVILLE CA 95667 MULTISPECIALTY CARE SERVICES 28187708 MARSHALL PRIMARY CARE MED ASSOC 2882 PROSPECT PARK DR RANCHO CORDOVA CA 95670 PHYSICIAN PRIMARY CARE SERVICES 14222511 EL DORADO ANESTHESIA MED GROUP 113 MIRAMONT COURT EL DORADO HILLS CA 95670 ANESTHESIA SERVICES 5655435 OBHG CALIFORNIA PC 777 LOWNDES HILL ROAD BUILDING 1 GREENVILLE SC 29607 OB/GYN CARE SERVICES 2956140 THE REGENTS OF UC(PSA) PO BOX 741816 LOS ANGELES CA 90074 PROFESSIONAL MEDICAL SERVICES 2185077 42 493400 4045350 620588 20720 5159338 PATIENT REVENUE, NET 621110 357597235 357597235 EL DORADO SURGERY CENT 621110 235824 235824 357833059 2855975 2855975 336087 192676 143411 143411 143411 240913 294643 -53730 -53730 -53730 32346 21617 10729 10729 CAFETERIA REVENUE 900099 857780 857780 MISCELLANEOUS REVENUE 900099 357153 357153 REBATE REVENUE 900099 208504 208504 168261 168261 1591698 367540480 357833059 0 4548083 X 10090 10090 3166367 2603249 563118 118107359 93262901 24844458 2895769 1815839 1079930 43034666 26450620 16584046 9731714 6492104 3239610 3824454 42847 3781607 528177 528177 253236 253236 43846 43846 71978030 66728251 5249779 692898 1555 691343 2071198 803578 1267620 9848025 9848025 7258627 1497679 5760948 472795 156034 316761 225036 17799 207237 2532563 2532563 14211944 14211944 2030712 489675 1541037 MEDICAL SUPPLIES 51196872 51065048 131824 BAD DEBT EXPENSE 8574476 8574476 REGISTRY 1705696 1433299 272397 SECURITY 1325702 1325702 16345464 6518942 9826522 372065716 267963986 104101730 0 22243320 12083336 15423806 12341549 83333621 85293307 959893 1168735 5830048 6464999 2789120 2767653 366545316 221797899 136683640 144747417 36466670 36153952 5503196 5391020 41296886 40344922 350530200 346756890 50524745 53180674 76158005 74040849 19524629 18379787 4521969 3558649 150729348 149159959 X 199800852 197596931 199800852 197596931 350530200 346756890 X -4525236 2554965 -233650 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2555 0 41291 0 43846 0 372043487 372087333 0 1000000 0 250000 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 60250 15967 23373 43846 143436 250000 250000 250000 250000 1000000 1500000 7789 2555 10344 X 1 0.10 0 0 0 1 0 0.00 0 7124430 7124430 184736115 98932001 85804114 30546326 23800247 6746079 135187871 99065651 36122220 8950574 8950574 144747417 PREPAID PENSION COSTS 33740801 RIGHT-OF-USE LEASE ASSET 3320183 UNAMORTIZED LOAN COSTS 2248119 THIRD PARTY COST SETTLEMENT 95308 OTHER ASSETS 940511 40344922 LEASE LIABILITY 3359841 THIRD PARTY PAYOR SETTLEMENTS 198808 3558649 X 361362666 2554965 -158303 2396662 358966004 8574476 8574476 367540480 363566587 75347 75347 363491240 8574476 8574476 372065716 PART II, LINE 9: MARSHALL MEDICAL CENTER HAS ONE CONSERVATION EASEMENT FOR THE PROTECTION OF NATURAL HABITAT, WHICH WAS OBTAINED ON APRIL 16, 2003. THE CONSERVATION EASEMENT IS INCLUDED AS PART OF LAND THAT IS INCLUDED IN PROPERTY AND EQUIPMENT ON THE BALANCE SHEET. NO REVENUE OR MATERIAL EXPENSES ARE ASSOCIATED WITH THE EASEMENT. PART X, LINE 2: THE MEDICAL CENTER IS A TAX-EXEMPT ORGANIZATION AND IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES, EXCEPT FOR UNRELATED BUSINESS INCOME, IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IN ADDITION, THE MEDICAL CENTER QUALIFIED FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. THE PROVISION FOR INCOME TAXES WAS $0 FOR THE YEARS ENDED OCTOBER 31, 2025 AND 2024. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -233,650. LOSS ON SALE OF FIXED ASSETS 53,730. COST OF GOODS SOLD 21,617. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 8,574,476. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS 53,730. COST OF GOODS SOLD 21,617. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 8,574,476. 1 1 X 1 X 149.000000000000 1 X 450.000000000000 1 1 0 1 1 10 694 1727350 3902985 0 0.00000 2 15298 17757552 73774581 0 0.00000 12 15992 19484902 77677566 0 0.00000 0 42213 3847703 152165 3695538 0.00990 0 282 3991875 0 3991875 0.01070 191562 14864 176698 0.00050 42495 8031140 167029 7864111 0.02110 12 58487 27516042 77844595 7864111 0.02110 3 218 32727 0 32727 0.00010 2 69 237750 660 237090 0.00060 5 287 270477 660 269817 0.00070 1 8574476 2580917 69791528 130595177 -60803649 X 1 1 1 EL DORADO SURGERY CENTER LLC OUTPATIENT SURGERY CENTER 0.87000 0.00000 0.13000 1 1 MARSHALL MEDICAL CENTER 1100 MARSHALL WAY PLACERVILLE CA 95667 WWW.MARSHALLMEDICAL.ORG 30000059 X X X MARSHALL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X SEE LINE 7D X X 1 24 1 SEE LINE 7D 0 1 X 149.000000000000 450.000000000000 X X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 5: EIGHTEEN (18) PHONE INTERVIEWS WERE CONDUCTED DURING MAY AND JUNE 2025. COMMUNITY STAKEHOLDERS IDENTIFIED BY THE HOSPITAL WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT INTERVIEWS. INTERVIEW PARTICIPANTS INCLUDED A BROAD RANGE OF STAKEHOLDERS CONCERNED WITH HEALTH AND WELLBEING IN EL DORADO COUNTY WHO SPOKE ABOUT ISSUES AND NEEDS IN COMMUNITIES SERVED BY THE HOSPITAL.THE IDENTIFIED STAKEHOLDERS WERE INVITED BY EMAIL TO PARTICIPATE IN THE PHONE INTERVIEW. APPOINTMENTS FOR THE INTERVIEWS WERE MADE ON DATES AND TIMES CONVENIENT TO THE STAKEHOLDERS. AT THE BEGINNING OF EACH INTERVIEW, THE PURPOSE OF THE INTERVIEW IN THE CONTEXT OF THE ASSESSMENT WAS EXPLAINED, THE STAKEHOLDERS WERE ASSURED THEIR RESPONSES WOULD REMAIN CONFIDENTIAL, AND CONSENT TO PROCEED WAS GIVEN.THE INTERVIEWS WERE STRUCTURED TO OBTAIN GREATER DEPTH AND RICHNESS OF INFORMATION ON SIGNIFICANT HEALTH NEEDS. FIRST, INTERVIEW PARTICIPANTS WERE ASKED TO DESCRIBE THE MAJOR HEALTH ISSUES IMPACTING THE COMMUNITY AS WELL AS THE SOCIAL DETERMINANTS OF HEALTH CONTRIBUTING TO POOR HEALTH. INTERVIEW PARTICIPANTS WERE ALSO ASKED TO RATE THE IMPACT AND IMPORTANCE OF EACH SIGNIFICANT HEALTH NEED ON A BRIEF SURVEY PRIOR TO PARTICIPATING IN THE TELEPHONE INTERVIEWS.DURING THE INTERVIEWS, PARTICIPANTS WERE ASKED TO SHARE THEIR PERSPECTIVES ON THE ISSUES, CHALLENGES AND BARRIERS RELATED TO THE SIGNIFICANT HEALTH NEEDS AND IDENTIFY KNOWN RESOURCES TO ADDRESS THE SIGNIFICANT HEALTH NEEDS.SECONDARY DATA WERE COLLECTED FROM A VARIETY OF LOCAL, COUNTY, AND STATE SOURCES TO PRESENT COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, ACCESS TO HEALTH CARE, BIRTH CHARACTERISTICS, LEADING CAUSES OF DEATH, ACUTE AND CHRONIC DISEASE, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND PREVENTIVE PRACTICES. WHERE AVAILABLE, THESE DATA ARE PRESENTED IN THE CONTEXT OF EL DORADO COUNTY AND CALIFORNIA.ANALYSIS OF SECONDARY DATA INCLUDES AN EXAMINATION AND REPORTING OF HEALTH DISPARITIES FOR SOME HEALTH INDICATORS. THE REPORT INCLUDES BENCHMARK COMPARISON DATA THAT MEASURE THE DATA FINDINGS AS COMPARED TO HEALTHY PEOPLE 2030 OBJECTIVES, WHERE APPROPRIATE (ATTACHMENT 1). HEALTHY PEOPLE OBJECTIVES ARE A NATIONAL INITIATIVE TO IMPROVE THE PUBLIC'S HEALTH BY PROVIDING MEASURABLE OBJECTIVES THAT ARE APPLICABLE AT NATIONAL, STATE, AND LOCAL LEVELS. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.MARSHALLMEDICAL.ORG/ABOUT-US/COMMUNITY-BENEFIT/. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 11: THE 2025 CHNA IDENTIFIED THE FOLLOWING PRIORITY HEALTH NEEDS: ACCESS TO CARE, CHRONIC DISEASES, CLIMATE HAZARDS, FOOD INSECURITY, HOUSING AND HOMELESSNESS, MENTAL HEALTH, OVERWEIGHT AND OBESITY, PREVENTIVE CARE, SUBSTANCE USE, AND UNINTENTIONAL INJURIES. THESE NEEDS WILL BE ADDRESSED BASED ON THE FY26-FY28 IMPLEMENTATION STRATEGY.IN FY25, MARSHALL ENGAGED IN ACTIVITIES AND PROGRAMS THAT ADDRESSED THE PRIORITY HEALTH NEEDS IDENTIFIED IN THE FY23-FY25 IMPLEMENTATION STRATEGY. MARSHALL COMMITTED TO COMMUNITY BENEFIT EFFORTS THAT ADDRESSED BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE), CHRONIC DISEASE PREVENTION, MANAGEMENT, AND TREATMENT, AND SUPPORT FOR THE HEALTH AND WELFARE OF THE COMMUNITY. SELECTED ACTIVITIES AND PROGRAMS THAT HIGHLIGHT THE HOSPITAL'S COMMITMENT TO THE COMMUNITY ARE DETAILED BELOW.ACCESS TO BEHAVIORAL HEALTH SERVICES (MENTAL HEALTH AND SUBSTANCE USE) RESPONSE TO NEED:1. MARSHALL CARES (CLINICALLY ASSISTED RECOVERY & EDUCATION SERVICES) - CARES TREATS OPIATE USE DISORDER AND HAS GROWN INTO A CLINIC FOCUSED ON SUPPORTIVE TREATMENT FOR PEOPLE WITH ANY SUBSTANCE DEPENDENCY, INCLUDING ALCOHOL, TOBACCO, STIMULANTS, OPIOIDS, BENZODIAZEPINES, AND OTHER SEDATIVE HYPNOTICS. CLINIC SERVICES SERVED 833 PEOPLE AND INCLUDED COMPREHENSIVE MEDICATION ASSISTED TREATMENT WITH A PHYSICIAN, COUNSELING, CASE MANAGEMENT AND BEHAVIORAL HEALTH SUPPORT SERVICES.2. MEDICATION ASSISTED TREATMENT (MAT) - SINCE DECEMBER 2016, MARSHALL HAS PARTICIPATED IN A JOINT EFFORT WITH THE EL DORADO COMMUNITY HEALTH CENTER (EDCHC) AND THE CALIFORNIA HEALTHCARE FOUNDATION TO PROVIDE MEDICATION ASSISTED TREATMENT (MAT) FOR OPIOID ADDICTION. WHEN PEOPLE COME TO MARSHALL'S EMERGENCY DEPARTMENT IN WITHDRAWAL, THEY WORK WITH A SUBSTANCE USE NAVIGATOR (SUN) AND ARE OFFERED PARTICIPATION IN THE MAT/ED BRIDGE PROGRAM, WHICH INCLUDES BUPRENORPHINE TO ALLEVIATE WITHDRAWAL SYMPTOMS. THROUGH THE EDCHC AND MARSHALL CARES, THEY ARE ALSO REFERRED TO OUTPATIENT THERAPY, WHERE THEY MEET WITH A DOCTOR WITHIN 48 HOURS. THE PROGRAM INCLUDES GROUP SESSIONS, COUNSELING, AND SOCIAL SERVICES. IN FY25, THE SUN CONSULTED WITH 833 PEOPLE. BEYOND OPIOID USE DISORDER TREATMENT, MARSHALL HAS ALSO ENGAGED TO SUPPORT TREATING ALCOHOL USE DISORDER, NICOTINE USE DISORDER, AS WELL AS METHAMPHETAMINE USE. FENTANYL-SPECIFIC USE AND OVERDOSE CONTINUES TO RISE AS SIGNIFICANT PUBLIC HEALTH IMPACT DUE TO ITS HIGHLY CONCENTRATED AND OFTEN POLLUTED NATURE, PARTICULARLY IN SEMI-RURAL WESTERN EL DORADO COUNTY.3. OVERDOSE RECOGNITION AND PREVENTION - OUTREACH TO THE COMMUNITY FOR EDUCATION ON SUBSTANCE USE TREATMENT, OVERDOSE PREVENTION AND STIGMA REDUCTION. MARSHALL REACHED 230 PEOPLE AT A FENTANYL AND OVERDOSE AWARENESS DAY. OVERDOSE EDUCATION AND PREVENTION REACHED 130 HIGH SCHOOL STUDENTS. OPIOID PREVENTION COMMUNITY EDUCATION REACHED 90 PEOPLE. OVER 700 PEOPLE WERE PROVIDED WITH NARCAN FOR USE IN THE COMMUNITY. STAFF AT MARSHALL LED THE SUBSTANCE USE DISORDER BOARD FOR INTERDISCIPLINARY REVIEW AND EDUCATION REGARDING CARE FOR CURRENT AND EMERGING SUBSTANCE USE DISORDERS AND PARTICIPATED IN THE EL DORADO COUNTY PERINATAL SUD TREATMENT COLLABORATIVE. AND OUTREACH AND RESOURCE NAVIGATION WERE PROVIDED FOR INDIVIDUALS AND THEIR FAMILIES EXPERIENCING SUBSTANCE USE DISORDERS. MARSHALL PROVIDED COLLABORATIVE COMMUNITY SUPPORT WITH ST. PATRICK'S CHURCH. THIS COLLABORATION SUPPORTED UNDERSERVED POPULATIONS AND PROVIDED ASSISTANCE WITH COMMUNITY RESOURCE NAVIGATION, INCLUDING SUBSTANCE USE DISORDER (SUD)RELATED SUPPORT AND REFERRALS FOR RESIDENTS AT MOTHER TERESA MATERNITY HOME RESIDENTIAL PROGRAM FOR PREGNANT MOTHERS.OUTREACH AND COMMUNITY INTERVENTION ACTIVITIES CONNECTED 545 COMMUNITY MEMBERS TO HEALTH, BEHAVIORAL HEALTH, AND SUBSTANCE USE DISORDERRELATED EDUCATION AND RESOURCES. OUTREACH AND ENGAGEMENT OCCURRED AT WOODRIDGE APARTMENTS, CEDAR GROVE MOBILE HOME PARK, COTTONWOOD APARTMENTS, SANTA MARIA TAQUERIA, LA PROMESA, AND EXHILARATION STATION. THESE ACTIVITIES SUPPORTED ACCESS TO CULTURALLY RESPONSIVE OUTREACH, RESOURCE NAVIGATION, AND COMMUNITY-BASED INTERVENTIONS AIMED AT IMPROVING CONNECTION TO CARE AND SUPPORT SERVICES FOR UNDERSERVED POPULATIONS.CHRONIC DISEASE PREVENTION, MANAGEMENT AND TREATMENT RESPONSE TO NEED:1. POPULATION HEALTH - THE MARSHALL POPULATION HEALTH TEAM COORDINATED THE COMMUNITY SERVICES THAT MARSHALL PROVIDED, WITH THE OBJECTIVE OF STRENGTHENING THE CONTINUUM OF CARE PROVIDED TO OUR PATIENTS AND THE COMMUNITY. DRIVEN BY PRIMARY CARE PROVIDERS, AND WITH ENGAGEMENT OF CLINIC STAFF AND SPECIALISTS, MARSHALL PLACED A PARTICULAR FOCUS ON SCREENINGS FOR BREAST CANCER, COLON CANCER AND DIABETES AND MET OR EXCEEDED ITS PERFORMANCE TARGETS IN ALL THREE AREAS. POPULATION HEALTH, IN ADDITION TO COORDINATING HEALTH PROMOTION ACTIVITIES FOR EXISTING PATIENTS, COMPLETED SEVEN OUTREACH EVENTS REACHING OVER 200 PEOPLE TO EDUCATE THE COMMUNITY REGARDING CANCER SCREENINGS AND HEALTH PROMOTION ACTIVITIES.2. FLU VACCINES - WITHIN THE VULNERABLE POPULATIONS STREET NURSING PROGRAM, MARSHALL PROVIDED 15 PEOPLE WITH FLU VACCINE CLINICS IN THE COMMUNITY IN FY25 WHILE MANY MORE VACCINES WERE PROVIDED THROUGH NORMAL COURSE OF PATIENT CARE.3. COMMUNITY CARE NETWORK (CCN) - THE CCN FOCUSES ON IMPROVING THE EFFECTIVENESS AND QUALITY OF CARE FOR HIGH-RISK PATIENTS. THROUGH THE COMMUNITY CARE NETWORK (CCN) HIGH RISK PATIENT CASE MANAGEMENT, TRANSITIONAL CASE MANAGEMENT (TCM) AND ENHANCED CARE MANAGEMENT (ECM) PROGRAMS, MARSHALL ASSISTS CHRONICALLY ILL PATIENTS WITH HEALTH CARE COORDINATION AND MANAGEMENT, IN-HOME CARE, MEDICAL SUPPLIES, AND VOLUNTEER HEALTH COACHES, AT NO COST. CCN REMOVES OBSTACLES THAT OFTEN PREVENT PEOPLE FROM RECEIVING ROUTINE AND PREVENTIVE CARE. THESE PROGRAMS REDUCE READMISSIONS AND UNNECESSARY EMERGENCY ROOM VISITS. FOR PEOPLE WITH MORE COMPLEX NEEDS, A TEAM OF SOCIAL WORKERS, LVNS, RN CASE MANAGERS, PHARMACISTS, DIABETES EDUCATORS, DIETITIANS, AND PHYSICAL THERAPISTS WORK WITH THEM IN THEIR HOMES TO NAVIGATE THEIR PATHS TO IMPROVED HEALTH AND OVERCOME COMMUNITY BARRIERS. IN FY25, 7,484 ENCOUNTERS WERE PROVIDED TO PEOPLE THROUGH THESE CCN PROGRAMS.4. CONGESTIVE HEART ACTIVE TELEPHONE TREATMENT (CHATT) - THE CHATT PROGRAM HELPED PEOPLE MANAGE CONGESTIVE HEART FAILURE. CHATT IMPROVED QUALITY OF LIFE, REDUCED CHF COMPLICATIONS AND HELPED KEEP PEOPLE WITH CHF OUT OF THE HOSPITAL. THIS SERVICE INCLUDED FREQUENT TELEPHONE CALLS FROM A REGISTERED NURSE, WHO SPECIALIZES IN CARDIOVASCULAR CARE. IN FY25, CHATT PROVIDED 7,346 ENCOUNTERS FOR CARE.5. CANCER RESOURCE CENTER - MARSHALL'S CANCER RESOURCE CENTER PROVIDED CLASSES, SUPPORT GROUPS AND SERVICES. SERVICES WERE AVAILABLE TO ANYONE IMPACTED BY CANCER IN EL DORADO COUNTY.- TRANSPORTATION IS A WELL-KNOWN BARRIER TO ACCESSING HEALTH CARE, ESPECIALLY IN RURAL AREAS. THE CANCER RESOURCE CENTER PROVIDED 132 ONE-WAY RIDES AS WELL AS PROVIDED 470 GAS CARDS.- THE WIG BANK SERVED 24 PEOPLE.- PROVIDED 49 NO-COST MAMMOGRAMS.- PROVIDED LODGING ASSISTANCE FOR TWO PEOPLE WHO COULD NOT AFFORD THE COST OF A HOTEL ROOM WHILE OBTAINING CANCER TREATMENT.- PARTICIPATED IN A COMMUNITY WIDE MAKING STRIDES AGAINST BREAST CANCER PREVENTION EVENT.- NUTRITION CONSULTATIONS AND SERVICES REACHED 229 PEOPLE.- 368 PEOPLE WITH CANCER WERE PROVIDED WITH CASE MANAGEMENT NAVIGATION SERVICES.- 260 PEOPLE RECEIVED PSYCHOSOCIAL DISTRESS SCREENING.- SOCIAL WORK CONSULTATIONS AND SERVICES ASSISTED 366 PEOPLE.6. HEALTH EDUCATION - IN FY25, MARSHALL REACHED 655 COMMUNITY MEMBERS WITH THE FOLLOWING COMMUNITY HEALTH EDUCATION SESSIONS:- CANCER EXERCISE- FALL PREVENTION- JOINT CARE- STROKE EDUCATION AND SUPPORT GROUP- WEIGHT LOSS MANAGEMENTMARSHALL PARTICIPATED IN AND/OR SPONSORED COMMUNITY EVENTS TO RAISE AWARENESS ABOUT CHRONIC DISEASE AND TO PROVIDE OUTREACH AND EDUCATION INCLUDING: THE AMERICAN HEART ASSOCIATION HEART WALK, MARSHALL GOLD COUNTRY 5K, CANCER ASSOCIATION SURVIVORS 5K, AND THE GEORGETOWN HEALTH FAIR.7. NIH STRIVE STUDY FOR CARDIAC REHABILITATION - MARSHALL CARDIAC REHAB HAS PARTNERED WITH UC DAVIS AND UCSF TO PROVIDE VIRTUAL HEALTH COACHING AND PSYCHOSOCIAL SUPPORT TO HELP MAINTAIN PHYSICAL ACTIVITY AFTER A CARDIAC EVENT. CLIENTS PERFORM BASELINE EXERCISE TESTING MEASUREMENTS AND REVIEW HABITS. CLIENTS ARE GIVEN A FIT BIT FOR EXERCISE TRACKING PURPOSES AS WELL AS VIRTUAL ACCESS TO HEALTH COACHING. IN 2025, FIVE PEOPLE PARTICIPATED IN THE PROGRAM. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 13B: A PATIENT WHOSE FAMILY INCOME DOES NOT EXCEED 450 PERCENT OF THE FEDERAL POVERTY LEVEL MAY QUALIFY FOR CHARITY CARE ON THE BASIS OF HIGH MEDICAL COSTS, WHICH IS DEFINED TO MEAN ANY OF THE FOLLOWING:1. ANNUAL OUT-OF-POCKET COSTS INCURRED BY THE PATIENT FOR SERVICES AND ITEMS RENDERED AT MARSHALL MEDICAL CENTER THAT EXCEED THE INDIVIDUAL THE LESSER OF TEN (10)% OF THE PATIENT'S CURRENT INCOME OR FAMILY INCOME IN THE PRIOR 12 MONTHS;2. ANNUAL OUT-OF-POCKET COSTS THAT EXCEED THE PATIENT'S FAMILY INCOME, IF THE PATIENT PROVIDES DOCUMENTATION OF THE PATIENT'S MEDICAL EXPENSES PAID BY THE PATIENT OR THE PATIENT'S FAMILY IN THE PRIOR 12 MONTHS; OR3. A LOWER LEVEL DETERMINED BY MARSHALL IN ACCORDANCE WITH THIS POLICY. MARSHALL MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE AVAILABLE ONLINE AT HTTPS://WWW.MARSHALLMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-INFORMATION/INSURANCE-BILLING-INFORMATION/BUSINESS-OFFICE/HELP-PAYING-YOUR-BILL/,MARSHALL MEDICAL CENTER'S HOSPITAL BILLING DEPARTMENT ALSO ATTEMPTS TO MAKE CONTACT WITH PATIENTS TO INFORM THEM THAT THEY SHOULD APPLY FOR FINANCIAL ASSISTANCE. PART V, SECTION B, LINE 11 (CONTINUED): SUPPORT FOR THE HEALTH AND WELFARE OF THE COMMUNITY RESPONSE TO NEED:1. FINANCIAL AID AND HEALTH INSURANCE ASSISTANCE - PROVIDED FINANCIAL ASSISTANCE THROUGH FREE AND DISCOUNTED CARE FOR HEALTH CARE SERVICES, CONSISTENT WITH MARSHALL MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY. OFFERED ASSISTANCE TO ENROLL IN PUBLIC HEALTH INSURANCE PROGRAMS.2. TRANSPORTATION - PROVIDED TRANSPORTATION TO 52 PEOPLE WHO COULD NOT AFFORD TRANSPORTATION TO OR FROM MEDICAL SERVICES AND APPOINTMENTS.3. COMMUNITY HEALTH LIBRARY - MARSHALL'S COMMUNITY HEALTH LIBRARY CONTAINS OVER 5,000 RESOURCES, WHICH WERE MADE AVAILABLE AT NO CHARGE FOR USE BY COMMUNITY RESIDENTS. STAFF LIBRARIANS ALSO CONDUCTED MEDICAL TOPIC SEARCHES FOR COMMUNITY MEMBERS. IN FY25, 940 COMMUNITY MEMBERS ACCESSED THESE SERVICES.4. STREET NURSING AND OUTREACH PROGRAM - THE STREET NURSING AND OUTREACH PROGRAM PROVIDED TRAUMA-INFORMED CARE DIRECTLY TO UNHOUSED AND UNSTABLY HOUSED COMMUNITY MEMBERS. THE TEAM PROVIDED DIRECT MEDICAL CARE, ADDRESSING CHRONIC DISEASES, ACUTE ILLNESS, WOUND CARE, MEDICATION ACCESS, AND HEALTH EDUCATION. MOBILE CARE WAS DELIVERED AT ENCAMPMENTS, SHELTERS, AND TRANSITIONAL HOUSING SITES, HELPING PATIENTS MANAGE HEALTH CONDITIONS OUTSIDE OF TRADITIONAL CARE SYSTEMS. THE PROGRAMS PROVIDED CARE AT LOCATIONS THROUGHOUT EL DORADO COUNTY, INCLUDING THE PLACERVILLE AND GEORGETOWN LIBRARIES, UPPER ROOM DINING HALL, GREEN VALLEY CHURCH SHOWER PROGRAM, AND THE NAVIGATION CENTER OPERATED BY VOLUNTEERS OF AMERICA.SERVICES INCLUDED MEDICAL COORDINATION, MENTAL HEALTH REFERRALS, HOUSING NAVIGATION, BENEFITS ASSISTANCE, TRANSPORTATION SUPPORT, AND RESOURCE DISTRIBUTION (E.G., HYGIENE KITS, FOOD, CLOTHING, TENTS, AND MEDICAL SUPPLIES). THE STREET OUTREACH TEAM SERVED 627 PEOPLE IN FY25. THEY PROVIDED 1,554 PHONE CONTACTS AND REFERRALS FOR 178 PEOPLE. THEY HOSTED OUTREACH EVENTS, TRAININGS, AND FLU CLINICS.5. EMERGENCY EVACUATION SHELTER CLINIC PLANNING - IN ADDITION TO THE SERVICES PROVIDED ABOVE, THE STREET NURSING AND OUTREACH PROGRAM HAS UNDERTAKEN EMERGENCY PREPAREDNESS PLANNING TO BUILD THE INFRASTRUCTURE NECESSARY TO DEPLOY AN EMERGENCY EVACUATION SHELTER MEDICAL/NURSING CLINIC. MARSHALL HAS PROVIDED THESE SERVICES IN THE PAST AND HAS ANALYZED THE COMPONENTS NECESSARY TO DEPLOY RAPIDLY AND PROVIDE SUFFICIENT CARE IN THE COMMUNITY. THE PROGRAM NOW HAS A TRAILER PREPARED WITH URGENT CARE SUPPLIES, ELECTRONIC EQUIPMENT FOR REGISTRATION AND DOCUMENTATION, VITAL SIGN EQUIPMENT, AND FIRST AID/MINOR WOUND CARE SUPPLIES. THIS ENSURES THAT OUR VULNERABLE POPULATIONS ARE ABLE TO RAPIDLY AND PROACTIVELY RECEIVE CARE WHILE DISPLACED AND THAT MARSHALL IS PREPARED TO RESPOND WITH URGENCY.6. TRAUMA SERVICES - MARSHALL PROVIDED COMMUNITY EDUCATION, OUTREACH AND RESOURCES TO REDUCE INJURIES AND ACCIDENTS. THEY REACHED OVER 1,000 PEOPLE AT THESE EVENTS: - DIVIDE WELLNESS FAIR- EVERY 15 MINUTES- FOLSOM FAMILY EXPO- WILD FIRE SAFETY DAY7. STOP THE BLEED - MARSHALL TRAINED STAFF MEMBERS AS INSTRUCTORS TO EDUCATE COMMUNITY MEMBERS TO TREAT INJURIES CAUSED BY HOME ACCIDENTS, MOTOR VEHICLE ACCIDENTS, ACTIVE SHOOTERS, BOMBINGS, AND WORK-RELATED INJURIES. IN FY25, MARSHALL STAFF INSTRUCTORS TRAINED 150 EL DORADO COUNTY RESIDENTS, WHICH INCLUDED ONLINE COURSES AND IN-PERSON TRAINING.8. FOOD DISTRIBUTION - FOOD WAS DISTRIBUTED TO 44 FAMILIES EXPERIENCING FOOD INSECURITY.9. COMMUNITY HEALTH MAGAZINE - FOR YOUR HEALTH IS MARSHALL'S QUARTERLY MAGAZINE, WHICH WAS WIDELY DISTRIBUTED THROUGHOUT EL DORADO COUNTY AND AVAILABLE IN DIGITAL FORMAT ON THE HOSPITAL'S WEBSITE. TOPICS IN FY25 INCLUDED ALZHEIMER'S DISEASE, INJURY PREVENTION, CANCER TREATMENT, HEART DISEASE AND DIABETES.SINCE MARSHALL MEDICAL CENTER CANNOT DIRECTLY ADDRESS ALL THE HEALTH NEEDS PRESENT IN THE COMMUNITY, WE WILL CONCENTRATE ON THOSE HEALTH NEEDS THAT WE CAN MOST EFFECTIVELY ADDRESS GIVEN OUR AREAS OF FOCUS AND EXPERTISE. HOWEVER, AND WITH THIS IN MIND AND TAKING EXISTING HOSPITAL AND COMMUNITY RESOURCES INTO CONSIDERATION, MARSHALL WILL ENDEAVOR TO ADDRESS ANY PREVALENT OR UNANTICIPATED ISSUES THAT SURGE TO A LEVEL THAT THREATENS THE HEALTH AND WELLBEING OF THE COMMUNITY. SUCH ISSUES MAY INCLUDE COVID-19 AND OTHER INFECTIOUS DISEASES, ENVIRONMENTAL POLLUTION, FOOD INSECURITY, OVERWEIGHT AND OBESITY, AND UNINTENTIONAL INJURIES. 1 1 - CARES 1045 MARSHALL WAY PLACERVILLE CA 95667 OTHER OUTPATIENT CLINIC - CLINICALLY ASSISTED RECOVERY AND EDUCATION SERVICE PART I, LINE 3C: MARSHALL MEDICAL CENTER IS COMMITTED TO SERVING THE MEMBERS OF OUR COMMUNITY. WE WANT TO MAKE SURE THAT YOU ARE GIVEN EVERY OPPORTUNITY TO APPLY FOR ANY FINANCIAL ASSISTANCE, INCLUDING CHARITY CARE, FOR WHICH YOU MAY BE ELIGIBLE. YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF YOU SUBMIT THE NECESSARY DOCUMENTATION AND EITHER: (1) YOUR FAMILY INCOME IS BELOW 450% OF THE CURRENT FEDERAL POVERTY GUIDELINES; OR (2) YOU INDIVIDUALLY OR YOUR FAMILY HAS HIGH MEDICAL COSTS. YOU WOULD HAVE HIGH MEDICAL COSTS IF YOUR INDIVIDUAL OR YOUR FAMILY ANNUAL OUT-OF-POCKET COSTS EXCEED 10% OF YOUR OR YOUR FAMILY GROSS INCOME AND ESSENTIAL LIVING EXPENSES IN THE PRIOR 12 MONTHS. THE SPECIFIC LEVEL OF ASSISTANCE YOU MAY BE ELIGIBLE FOR WILL DEPEND ON YOUR PARTICULAR FAMILY INCOME LEVEL. PART I, LINE 7: BEGINNING WITH TAX YEAR 2014, MARSHALL MEDICAL CENTER IMPLEMENTED A COST ACCOUNTING SYSTEM TO ESTIMATE DIRECT AND INDIRECT COSTS OF PROVIDING PATIENT CARE. THE RESULTING COST-TO-CHARGE RATIO WAS APPLIED TO GROSS REVENUES ASSOCIATED WITH FINANCIAL ASSISTANCE AND MEANS-TESTED PROGRAMS IN ORDER TO CALCULATE FINANCIAL ASSISTANCE AT COST. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $8,574,476. PART II, COMMUNITY BUILDING ACTIVITIES: WORKFORCE DEVELOPMENT - MARSHALL LEADERSHIP PARTICIPATED IN THE EL DORADO UNION HIGH SCHOOL DISTRICT CAREER TECHNICAL EDUCATION ADVISORY COMMITTEE, A GROUP OF PRIVATE ENTITIES THAT ASSIST THE HIGH SCHOOL DISTRICT PLAN AND PREPARE FOR TECHNICAL CAREERS AND EDUCATION OFFERINGS. THIRTY-THREE STUDENTS PARTICIPATED IN THE HEALTH CAREER EXPLORATION DAY.ECONOMIC DEVELOPMENT - HOSPITAL LEADERS SUPPORTED LOCAL CHAMBERS OF COMMERCE AND FOCUSED ON ISSUES RELATED TO COMMUNITY HEALTH AND SAFETY. PART III, LINE 2: MARSHALL MEDICAL CENTER MAKES A BEST EFFORT TO APPLY ALL KNOWN DISCOUNTS AND PAYMENTS POSTED TO THE PATIENT ACCOUNT PRIOR TO DETERMINATION OF BAD DEBT WRITE-OFF. NON-COMPLIANT PATIENTS MAY RESULT IN THE DELAY OF PROPERLY APPLIED DISCOUNTS.IN ACCORDANCE WITH CALIFORNIA HEALTH AND SAFETY CODE SECTIONS 127400 ET SEQ., MARSHALL MEDICAL CENTER DISCOUNTS PAYMENTS AND PROVIDES CHARITY CARE TO FINANCIALLY QUALIFIED PATIENTS. PATIENTS WHO QUALIFY FOR THESE DISCOUNTS OR CHARITY CARE UNDER OUR POLICIES INCLUDE PATIENTS WHO MEET BOTH OF THE FOLLOWING QUALIFICATIONS:1. THE PATIENT EITHER IS SELF-PAY OR HAS HIGH MEDICAL COSTS, AS DEFINED IN OUR FINANCIAL ASSISTANCE POLICY; AND2. THE PATIENT HAS A FAMILY INCOME (AS DEFINED IN THE FINANCIAL ASSISTANCE POLICY) THAT DOES NOT EXCEED 450% OF THE FEDERAL POVERTY LEVEL. PART III, LINE 3: MARSHALL MEDICAL CENTER ESTIMATES THAT APPROXIMATELY 30.1% OF ALL PATIENT ACCOUNTS ASSIGNED TO BAD DEBT MIGHT BE ATTRIBUTABLE TO PATIENTS WHO MIGHT HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. THIS REPRESENTS THE PERCENTAGE OF INDIVIDUALS THAT WERE DENIED CHARITY CARE AS A RESULT OF SUBMITTING INSUFFICIENT INFORMATION. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" SECTION IN NOTE 1, PAGE 12, IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DISCUSSION OF THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: THE SHORTFALL INCURRED ON MEDICARE PATIENTS CAN BE CONSIDERED A COMMUNITY BENEFIT BECAUSE MARSHALL MEDICAL CENTER IS THE ONLY HOSPITAL FACILITY WITHIN APPROXIMATELY 25 MILES. THEREFORE, PATIENTS WOULD HAVE TO TRAVEL OUTSIDE OF THE COMMUNITY TO OBTAIN HEALTHCARE SERVICES. THE ONLY OTHER HOSPITAL FACILITY IN EL DORADO COUNTY IS APPROXIMATELY 50 MILES FROM PLACERVILLE AND PATIENTS WOULD HAVE TO TRAVERSE A 7,000+ FOOT ELEVATION MOUNTAIN PASS TO OBTAIN HEALTHCARE SERVICES FROM THAT FACILITY. OUR PATIENT POPULATION IS HEAVILY MEDICARE-WEIGHTED AND MARSHALL PROVIDES A VAST AMOUNT OF CARE TO THIS MEDICARE POPULATION, WHICH TEND TOWARDS MORE ACUTE ILLNESSES THAT MAKE TRAVEL DIFFICULT. BECAUSE WE ARE A COMMUNITY-BASED HOSPITAL, WE HAVE TO PROVIDE A BROAD RANGE OF SERVICES TO MEET THE NEEDS OF THE COMMUNITY, WHICH IMPACTS OUR ABILITY TO SPECIALIZE IN MORE FOCUSED SERVICES.NON-NEGOTIABLE MEDICARE RATES ARE NOT ALWAYS CONSISTENT WITH ACTUAL COSTS OF TREATING MEDICARE PATIENTS. TREATING MEDICARE PATIENTS, REGARDLESS OF REIMBURSEMENT RATE, HELPS TO ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR PROVIDING HEALTHCARE SERVICES. PART III, LINE 9B: AT THE TIME OF REGISTRATION AND IN THE FIRST BILLING STATEMENT, PATIENTS ARE PRESENTED WITH ALL DISCOUNT AND PROGRAM OPTIONS AVAILABLE. BILLING STATEMENTS 2 THROUGH 5 REMIND THE PATIENT OF DISCOUNTS AVAILABLE. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED COVERAGE OR FOR MARSHALL MEDICAL CENTER'S OWN FINANCIAL ASSISTANCE PROGRAM, MARSHALL MEDICAL CENTER SHALL NOT KNOWINGLY SEND OR ASSIGN SUCH PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY PRIOR TO 180 DAYS FROM THE DATE OF MARSHALL MEDICAL CENTER'S INITIAL BILLING OF THAT ACCOUNT. PRIOR TO FILING ANY LEGAL ACTION AGAINST A PATIENT, THE DEBT COLLECTION AGENCY WILL (A) PERFORM AN ANALYSIS OF THE PATIENT'S ASSETS AND INCOME TO DETERMINE WHETHER THE PATIENT HAS ASSETS AND INCOME SUFFICIENT TO JUSTIFY FILING THE LEGAL ACTION, (B) PRESENT THE ANALYSIS TO MARSHALL MEDICAL CENTER'S DIRECTOR OF HOSPITAL PATIENT BILLING, IN SUCH FORMAT AS MARSHALL MEDICAL CENTER MAY REQUEST, AND (C) OBTAIN THE DIRECTOR'S APPROVAL FOR FILING THE LEGAL ACTION AGAINST THE PATIENT.AN ACCOUNT IS CONSIDERED BAD DEBT WHEN ALL ATTEMPTS TO CONTACT THE PATIENT VIA TELEPHONE CALLS, CONTACT LETTERS, AND MONTHLY STATEMENTS, TO ASSIST THE PATIENT/GUARANTOR IN APPLYING FOR AVAILABLE PROGRAMS, OR SETTING UP A MONTHLY PAYMENT PLAN HAVE BEEN EXHAUSTED. PART VI, LINE 2: THE COMMUNITY'S HEALTHCARE NEEDS ARE DETERMINED BASED ON MANY FACTORS INCLUDING BUT NOT LIMITED TO MARKET STUDIES, PHYSICIAN FEEDBACK BASED ON THE NEEDS OF THEIR PATIENTS, HEALTH MANPOWER STUDIES, SURVEYS, AND A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. PART VI, LINE 3: AT THE TIME OF REGISTRATION, EVERY UNINSURED PATIENT IS PRESENTED WITH A DOCUMENT THAT OUTLINES ALL THE FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS, AS WELL AS THE FINANCIAL ASSISTANCE POLICY THAT THEY MAY BE ABLE TO QUALIFY FOR. MARSHALL MEDICAL CENTER PROVIDES, AT ITS EXPENSE, PRIVATE CONSULTANTS AND COUNTY MEDI-CAL EMPLOYEES WHO WORK WITH PATIENTS DURING AND AFTER SERVICES TO ASSIST THEM IN COMPLETING THE NECESSARY FORMS, TO FILE ALL THE NECESSARY DOCUMENTS, AND TO ATTEND ANY REQUISITE APPOINTMENTS WITH PROVIDING AGENCIES. FINANCIAL COUNSELORS ARE ALSO PROVIDED TO ASSIST PATIENTS IN UNDERSTANDING ELIGIBILITY REQUIREMENTS RELATED TO QUALIFYING FOR CHARITY CARE OR DISCOUNTED CARE UNDER THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: MARSHALL MEDICAL CENTER SERVES APPROXIMATELY 162,213 RESIDENTS ON THE WESTERN SLOPE OF THE SIERRAS IN EL DORADO COUNTY. OTHER PERTINENT DEMOGRAPHICS ABOUT OUR HOSPITAL SERVICE AREA FOR TAX YEAR 2024 INCLUDE:- THE HOSPITAL SERVICE AREA POPULATION BY GENDER IS 50.2% FEMALE AND 49.8% MALE.- IN EL DORADO COUNTY, 92.3% OF THE ADULT POPULATION IDENTIFY AS STRAIGHT OR HETEROSEXUAL, AND 99.6% AS CISGENDER, OR NOT TRANSGENDER. 2.3% IDENTIFY AS GAY, LESBIAN OR HOMOSEXUAL AND 4.5% IDENTIFY AS BISEXUAL.-IN EL DORADO COUNTY, 1.8% TEENS IDENTIFY AS TRANSGENDER OR GENDER NON-CONFORMING. 12.9% OF TEENS SAID THAT OTHER PEOPLE AT SCHOOL WOULD DESCRIBE THEM AS GENDER NON-CONFORMING (MALES WHO WOULD BE DESCRIBED AS FEMININE, FEMALES WHO WOULD BE DESCRIBED AS MASCULINE, OR EITHER GENDER DESCRIBED AS EQUALLY FEMININE AND MASCULINE). FEWER TEENS IN THE COUNTY IDENTIFY AS TRANSGENDER OR HAVING A NON-CONFORMING GENDER EXPRESSION THAN DO TEENS STATEWIDE.- CHILDREN AND YOUTH, AGES 0-17, MAKE UP 20.3% OF THE POPULATION OF THE SERVICE AREA, 56.1% ARE ADULTS, AGES 18-64, AND 23.6% OF THE POPULATION ARE SENIOR ADULTS, AGES 65 AND OLDER.- WHEN THE SERVICE AREA IS EXAMINED BY ZIP CODE, RIVER PINES (45.8%) HAS THE HIGHEST PERCENTAGE OF CHILDREN AND YOUTH. SOMERSET (6.4%) AND PILOT HILL (6.6%) HAVE THE LOWEST PERCENTAGES OF CHILDREN AND YOUTH IN THE SERVICE AREA. GEORGETOWN HAS THE HIGHEST PERCENTAGE OF SENIOR ADULTS IN THE SERVICE AREA (40.2%), FOLLOWED BY SOMERSET (37.8%) AND PILOT HILL (34.7%). RIVER PINES REPORTED NO SENIOR ADULT POPULATION.- SENIOR ADULTS LIVING ALONE MAY BE ISOLATED AND LACK ADEQUATE SUPPORT SYSTEMS. AMONG THE SENIOR ADULTS IN THE SERVICE AREA, THOSE WHO LIVE ALONE RANGED FROM 10.5% OF SENIOR ADULTS IN CAMINO/APPLE HILL TO 94.5% IN LOTUS. NOTE THAT THE NUMBER OF SENIORS IN LOTUS IS COMPARATIVELY SMALL.- MORE THAN THREE-QUARTERS OF THE POPULATION IN THE SERVICE AREA IDENTIFY AS NON-HISPANIC WHITE RESIDENTS (75.9%), 12.5% OF THE POPULATION ARE HISPANIC OR LATINO RESIDENTS, 4.9% AS NON-LATINO ASIAN RESIDENTS, 4.9% ARE NON-LATINO MULTIRACIAL (TWO-OR-MORE RACES) RESIDENTS, AND 0.9% ARE NON-LATINO BLACK OR AFRICAN AMERICAN RESIDENTS. RESIDENTS WHO IDENTIFY AS A RACE AND ETHNICITY NOT LISTED REPRESENT 0.5% OF THE SERVICE AREA POPULATION, 0.4% IDENTIFY AS AMERICAN INDIAN OR ALASKAN NATIVE (AIAN), AND 0.1% IDENTIFY AS NATIVE HAWAIIAN OR PACIFIC ISLANDER (NHPI).- WHEN RACE AND ETHNICITY ARE EXAMINED BY ZIP CODE, RIVER PINES HAS THE HIGHEST PERCENTAGE OF WHITE RESIDENTS IN THE SERVICE AREA (93.9%), FOLLOWED BY GRIZZLY FLATS (88%). DIAMOND SPRINGS (23.6%) AND LOTUS (20.7%) HAVE THE HIGHEST PERCENTAGE OF HISPANIC OR LATINO RESIDENTS IN THE SERVICE AREA. LOTUS HAS THE HIGHEST PERCENTAGE OF ASIAN RESIDENTS (26.5%). PILOT HILL HAS THE HIGHEST PERCENTAGE OF BLACK OR AFRICAN AMERICAN RESIDENTS IN THE SERVICE AREA (7.8%).- IN THE SERVICE AREA, 89.8% OF THE POPULATION, 5 YEARS AND OLDER, SPEAK ONLY ENGLISH IN THE HOME. AMONG THE AREA POPULATION, 4.4% SPEAK SPANISH, 2.9% SPEAK AN ASIAN OR PACIFIC ISLANDER LANGUAGE, 2.6% SPEAK AN INDO-EUROPEAN LANGUAGE OTHER THAN SPANISH OR ENGLISH IN THE HOME, AND 0.2% SPEAK SOME OTHER LANGUAGE.- THE HIGHEST PERCENTAGE OF SPANISH SPEAKERS IN THE SERVICE AREA IS IN CAMINO/APPLE HILL (8.5%). LOTUS (18.1%) HAS THE HIGHEST PERCENTAGE OF ASIAN OR PACIFIC ISLANDER LANGUAGE SPEAKERS. GARDEN VALLEY (6.1%) HAS THE HIGHEST PERCENTAGE OF NON-SPANISH INDO-EUROPEAN LANGUAGES SPOKEN AT HOME, FOLLOWED BY EL DORADO HILLS (5.6%). ENGLISH IS SPOKEN IN THE HOME BY 100% OF THE POPULATION OF GRIZZLY FLAT AND 97.3% OF THE POPULATION OF GEORGETOWN.- IN THE SERVICE AREA, 8.6% OF THE CIVILIAN POPULATION, AGES 18 AND OLDER, ARE VETERANS.- IN THE SERVICE AREA, 7.7% OF THE POPULATION IS FOREIGN-BORN. AMONG THE FOREIGN-BORN, 39.8% ARE NOT U.S. CITIZENS. IT IS IMPORTANT TO NOTE THAT NOT BEING A U.S. CITIZEN DOES NOT INDICATE AN ILLEGAL RESIDENT STATUS WITHIN THE U.S. PART VI, LINE 5: MARSHALL MEDICAL CENTER PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A COMPREHENSIVE CONTINUUM OF HIGH-QUALITY HEALTHCARE SERVICES DESIGNED TO MEET THE EVOLVING NEEDS OF THE RESIDENTS OF EL DORADO COUNTY AND SURROUNDING COMMUNITIES. SERVICES INCLUDE A BROAD RANGE OF INPATIENT CARE, INCLUDING OBSTETRICS, SURGICAL SERVICES, RADIOLOGY, AND DIAGNOSTIC CARDIAC CATHETERIZATIONS, AS WELL AS EXTENSIVE OUTPATIENT SERVICES, INCLUDING EMERGENCY CARE, OUTPATIENT SURGERY, DIAGNOSTIC IMAGING, LABORATORY SERVICES, DIAGNOSTIC CARDIAC CATHETERIZATIONS, PRIMARY AND SPECIALTY CARE CLINICS, A RURAL HEALTH CLINIC, COMPREHENSIVE CANCER SERVICES, AND HOME HEALTH SERVICES. MARSHALL MEDICAL CENTER IS COMMITTED NOT ONLY TO PROVIDING EXCEPTIONAL CLINICAL CARE BUT ALSO TO IMPROVING THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITY THROUGH EDUCATION, PREVENTION, OUTREACH, AND ACCESS TO ESSENTIAL HEALTHCARE SERVICES.MARSHALL MEDICAL CENTER FULFILLS ITS CHARITABLE AND COMMUNITY BENEFIT MISSION THROUGH THE FOLLOWING PRACTICES:- OPEN MEDICAL STAFF: MARSHALL MEDICAL CENTER MAINTAINS AN OPEN MEDICAL STAFF, ALLOWING QUALIFIED PHYSICIANS AND OTHER CREDENTIALED HEALTHCARE PROVIDERS TO APPLY FOR CLINICAL PRIVILEGES, SUBJECT TO ESTABLISHED CREDENTIALING AND QUALITY STANDARDS. EXCLUSIVE CONTRACTUAL ARRANGEMENTS ARE UTILIZED ONLY IN LIMITED SPECIALTY AREAS WHERE NECESSARY TO ENSURE CONSISTENT, HIGH-QUALITY PATIENT CARE.- COMMUNITY GOVERNANCE: MARSHALL MEDICAL CENTER IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS COMPOSED OF UP TO 14 COMMUNITY MEMBERS WHO REPRESENT THE INTERESTS OF THE COMMUNITIES SERVED. BOARD MEMBERS CONTRIBUTE SIGNIFICANT TIME, EXPERTISE, AND OVERSIGHT TO ENSURE THE ORGANIZATION REMAINS RESPONSIVE TO LOCAL HEALTHCARE NEEDS AND FULFILLS ITS CHARITABLE MISSION.- REINVESTMENT IN THE COMMUNITY: AS A NONPROFIT HEALTHCARE ORGANIZATION, MARSHALL MEDICAL CENTER REINVESTS ANY OPERATING SURPLUS INTO PROGRAMS AND SERVICES THAT BENEFIT THE COMMUNITY. SURPLUS FUNDS ARE USED TO SUPPORT CAPITAL IMPROVEMENTS, ACQUIRE ADVANCED MEDICAL TECHNOLOGY, EXPAND CLINICAL PROGRAMS AND ACCESS TO CARE, RECRUIT HEALTHCARE PROVIDERS, IMPROVE PATIENT SAFETY AND QUALITY INITIATIVES, AND ADDRESS EMERGING HEALTHCARE NEEDS. DECISIONS REGARDING THE USE OF THESE FUNDS ARE MADE UNDER THE OVERSIGHT OF THE COMMUNITY-BASED BOARD OF DIRECTORS TO ENSURE THEY ARE ALIGNED WITH THE ORGANIZATION'S EXEMPT PURPOSE AND LONG-TERM COMMITMENT TO COMMUNITY HEALTH. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 EL DORADO COUNTY CHAMBER OF COMMERCE 542 MAIN STREET PLACERVILLE CA 95667 941328508 501(C)(6) 10090 0 GENERAL OPERATING SUPPORT 0 1 PART I, LINE 2: MARSHALL MEDICAL CENTER MONITORS THE USE OF GRANT FUNDS THROUGH ESTABLISHED GRANT MANAGEMENT POLICIES AND FINANCIAL CONTROLS. GRANT EXPENDITURES ARE REVIEWED FOR COMPLIANCE WITH APPROVED BUDGETS AND FUNDER REQUIREMENTS, MONITORED BY THE PROJECT DIRECTOR, FINANCE DEPARTMENT, AND GRANT WRITER & ADMINISTRATOR, AND SUPPORTED BY REGULAR FINANCIAL REPORTING, COMPLIANCE REVIEWS, AND RECORDKEEPING TO ENSURE ACCOUNTABILITY AND PROPER STEWARDSHIP OF GRANT FUNDS. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 SIRI NELSON PRESIDENT/CEO 642997 0 191566 0 0 0 14850 0 5119 0 854532 0 0 0 MARTIN ENTWISTLE - ASSOCIATE CHIEF MEDICAL OFFICER/VP OF POP. 372974 0 65733 0 0 0 14850 0 7354 0 460911 0 0 0 LAURIE ELDRIDGE CHIEF FINANCIAL OFFICER (THRU 10/24) 298673 0 65992 0 0 0 56100 0 5684 0 426449 0 0 0 BRIAN GOLDSMITH MD CHIEF MEDICAL OFFICER 341916 0 52084 0 0 0 12798 0 790 0 407588 0 0 0 CYNTHIA RICE CHIEF NURSING OFFICER 300252 0 54874 0 0 0 31565 0 973 0 387664 0 0 0 CORINA BRONNY STAFF RN - ICU 338767 0 18440 0 0 0 18781 0 3119 0 379107 0 0 0 JONATHAN RUSSELL CHIEF AMBULATORY OFFICER 268163 0 52352 0 0 0 22867 0 7382 0 350764 0 0 0 CHERYL MORGAN SONOGRAPHER 3 - DIAGNOSTIC IMAGING 278253 0 1958 0 1563 0 27794 0 6319 0 315887 0 0 0 MARTIN DALY VP OF INFORMATION TECHNOLOGY 261765 0 37743 0 0 0 14913 0 937 0 315358 0 0 0 MINDY DANOVARO EXECUTIVE DIRECTOR OF PHILANTHROPY 275947 0 13449 0 0 0 12149 0 6104 0 307649 0 0 0 PHILLIP LEONERIO STAFF RN 266095 0 20279 0 0 0 7577 0 273 0 294224 0 0 0 ELLE KARIMKHANI CHIEF LEGAL OFFICER 224632 0 50000 0 0 0 0 0 784 0 275416 0 0 0 LISA KISSEL COMPLIANCE & PRIVACY OFFICER 209129 0 9922 0 0 0 0 0 0 0 219051 0 0 0 BRETT APPLEBERG - CHIEF HUMAN RESOURCES OFFICER (THRU 04/24) 107082 0 56164 0 0 0 12637 0 0 0 175883 0 0 0 JOEL ENGELMANN VP OF FINANCE 160101 0 1465 0 0 0 8163 0 937 0 170666 0 0 0 PART I, LINE 1A CHERYL MORGAN RECEIVED GROSS-UP PAYMENTS OF $1,563. THIS WAS INCLUDED IN TAXABLE INCOME. ANY EMPLOYEE WHO MEETS A 20+ YEAR LONGEVITY THRESHOLD RECEIVES A BONUS OF $1,000-$3,000 THAT WAS GROSSED UP TO COVER INCOME TAXES AND PAYROLL TAXES. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13032UVPO 2020-04-27 54734815 SEE PART VI 0 0 0 B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033L6R3 2015-04-09 30423048 SEE PART VI 0 0 0 A 56167132 2911731 224642 636674 2289428 31239066 19459114 95686 2025 1 0 1 1 B 7760000 30423055 3849054 498389 791050 29133616 2015 1 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 1 1 B 1 0 0 0 0 1 A 1 B 1 COLUMN A, PART I (F): THE BONDS CURRENTLY REFUNDED THE BORROWER'S SERIES 2004B BONDS (ORIGINALLY ISSUED ON MARCH 25, 2004) AS WELL AS FOR THE FINANCING AND RENOVATIONS TO CERTAIN HEALTH FACILITIES, TO FUND A DEBT SERVICE RESERVE, TO PAY RELATED CAPITALIZED INTEREST AND TO PAY THE COST OF ISSUANCE RELATED TO THE BONDS. COLUMN A, PART II, LINE 3: THE TOTAL PROCEEDS SHOWN IN PART II, LINE 3 DIFFERS FROM THE ISSUE PRICE SHOWN IN PART I, COLUMN (E) DUE TO INTEREST EARNINGS ON INVESTED PROCEEDS. COLUMN A, PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE SECURITY OR PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY OR PAYMENT TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. COLUMN A, PART IV, LINE 2 (A): THE REBATE COMPUTATION FOR SERIES 2020 WAS PERFORMED AS OF APRIL 27, 2025 AND A YIELD REDUCTION PAYMENT WAS DUE. COLUMN B, PART I (F): THE BONDS CURRENTLY REFUNDED THE BORROWER'S SERIES 2004A BONDS (ORIGINALLY ISSUED ON MARCH 25, 2004). COLUMN B, PART II, LINE 4: THE SERIES 2015 BOND RESERVE ACCOUNT WAS FUNDED BY BOND PROCEEDS OF THE SERIES 2004A AND SERIES 2012A BONDS. COLUMN B, PART II, LINE 13: PROCEEDS OF THE BONDS WERE ISSUED FOR THE PURPOSE OF CURRENT REFUNDING; THEREFORE, THE PROJECT PERIOD IS NOT APPLICABLE FOR THIS BOND ISSUE. COLUMN B, PART III, LINE 7: AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE SECURITY OR PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY OR PAYMENT TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. COLUMN B, PART IV, LINE 2 (B): THE REBATE COMPUTATION FOR SERIES 2015 WAS PERFORMED AS OF APRIL 9, 2025 AND A YIELD REDUCTION PAYMENT WAS DUE. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD, THE PAST CHAIR, THE PRESIDENT/CEO, THE CHIEF OF THE MEDICAL STAFF, AND THE LONGEST-TENURED MEDICAL GROUP DIRECTOR. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION IT TAKES CANNOT CONFLICT WITH THE POLICIES AND PRIOR RESOLUTIONS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 SIRI NELSON, JONATHAN RUSSELL, AND MARTIN ENTWISTLE WERE BOARD MEMBERS OF EL DORADO SURGERY CENTER DURING THE FISCAL YEAR ENDED OCTOBER 31, 2025. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, MANAGEMENT (CFO AND EXECUTIVE DIRECTOR OF FINANCE) REVIEWED THE FORM 990 IN DETAIL. ANY APPROPRIATE CHANGES WERE MADE. THE FULL GOVERNING BOARD OF DIRECTORS (BOD) HAS DELEGATED THE RESPONSIBILITY OF REVIEWING THE FORM 990 PRIOR TO FILING WITH THE IRS TO THE BOD AUDIT COMMITTEE, A SUBCOMMITTEE OF THE FULL GOVERNING BOD, SO THE FORM 990 WAS THEN SUBMITTED TO THE GOVERNING BOD AUDIT COMMITTEE. THE AUDIT COMMITTEE PERFORMED A HIGH-LEVEL REVIEW OF THE FORM 990 AND REQUESTED MANAGEMENT TO MAKE ANY CHANGES THE COMMITTEE DEEMED NECESSARY. PRIOR TO FILING THE FORM 990 WITH THE IRS, THE AUDIT COMMITTEE PROVIDED A SUMMARY TO THE FULL GOVERNING BOD OF THE BOD AUDIT COMMITTEE'S REVIEW OF THE FORM 990. AT ANY TIME, BOTH BEFORE OR AFTER FILING, THE COMPLETE FORM 990 WAS AVAILABLE UPON REQUEST TO ANY MEMBER OF THE GOVERNING BOD. FORM 990, PART VI, SECTION B, LINE 12C CHIEF ADMINISTRATIVE OFFICERS, VICE PRESIDENTS, DIRECTORS, ASSISTANT DIRECTORS, PURCHASING STAFF, LEGAL STAFF, COMPLIANCE STAFF, AND MEMBERS OF THE GOVERNING BOARD ARE REQUIRED TO ANNUALLY PROVIDE A DISCLOSURE STATEMENT IDENTIFYING ANY ORGANIZATIONS IN WHICH THE INDIVIDUAL OR AN IMMEDIATE FAMILY MEMBER HAS AN INTEREST. THERE IS NO MINIMUM AMOUNT OF VALUE OF AN ITEM, SERVICE, OR ARRANGEMENT THAT WILL TRIGGER A CONFLICT OF INTEREST. DISCLOSURE STATEMENTS ARE REVIEWED BY THE CEO FOR ANY ACTUAL OR POTENTIAL CONFLICTS. THE CEO'S DISCLOSURE STATEMENT IS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEES OF THE GOVERNING BOARD. THE GOVERNING BOARD'S DISCLOSURE STATEMENTS ARE REVIEWED BY THE ADMINISTRATIVE OFFICE PERSONNEL. SHOULD ANY TRANSACTION INVOLVING POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARISE, THE CEO APPOINTS A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE ARRANGEMENT IN QUESTION, CONCLUDE THAT THE TRANSACTION IS FAIR AND REASONABLE TO THE HOSPITAL, BE APPROVED IN GOOD FAITH BY A VOTE OF THE DIRECTORS THAT DO NOT HAVE A CONFLICT, AND THAT THE HOSPITAL COULD NOT OBTAIN A MORE ADVANTAGEOUS ARRANGEMENT UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD DETERMINES THE CEO'S COMPENSATION WITH INPUT FROM THE AUDIT AND COMPLIANCE COMMITTEES, USING DATA COMPILED FROM THE CALIFORNIA HEALTHCARE ASSOCIATION'S ALLIED FOR HEALTH EXECUTIVE COMPENSATION SURVEY, WILLIS TOWERS WATSON EXECUTIVE COMPENSATION SURVEY, AND OTHER SOURCES SUCH AS AN INDEPENDENT COMPENSATION CONSULTANT, ALL IN ACCORDANCE WITH THE HOSPITAL'S EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT. THE PROCESS FOR DETERMINING THE CEO'S COMPENSATION INVOLVES THE EXECUTIVE TEAM MEETING WITH THE BOARD TO DISCUSS COMPENSATION MATTERS. KASSY PAUL, EXECUTIVE ASSISTANT TO THE BOARD, RECORDS THESE DISCUSSIONS IN THE BOARD MINUTES, WHICH ARE THEN APPROVED AT THE FOLLOWING BOARD MEETING. THE CEO'S TOTAL REWARDS PACKAGE IS REVIEWED EVERY THREE YEARS BY OUTSIDE CONSULTANTS. IN 2024, THIS REVIEW WAS CONDUCTED BY WILLIS TOWERS WATSON. ADDITIONALLY, THE CEO IS ELIGIBLE FOR THE ANNUAL INCENTIVE PROGRAM (AIP) AND MERIT INCREASES, CONSISTENT WITH OTHER ASSOCIATES. THE CEO DETERMINES COMPENSATION FOR OFFICERS AND KEY EMPLOYEES. EXECUTIVE COMPENSATION SURVEYS, AN INDEPENDENT COMPENSATION CONSULTANT, AND COMPARABILITY DATA WERE USED TO DETERMINE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES - PHYSICIANS: PROGRAM SERVICE EXPENSES 62,359,986. MANAGEMENT AND GENERAL EXPENSES 1,612,183. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,972,169. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,368,265. MANAGEMENT AND GENERAL EXPENSES 3,637,596. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,005,861. FORM 990, PART XI, LINE 9: PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -233,650. 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