SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
MARIN GENERAL HOSPITAL
 
Employer identification number

94-2823538
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    1,240,681 0 1,240,681 0.310 %
b Medicaid (from Worksheet 3, column a) . . . . .     55,975,499 34,686,416 21,289,083 5.300 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     17,560   17,560 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     57,233,740 34,686,416 22,547,324 5.610 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     202,927 2,480 200,447 0.050 %
f Health professions education (from Worksheet 5) . . .     646,209   646,209 0.160 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     18,153,683   18,153,683 4.520 %
j Total. Other Benefits . .     19,002,819 2,480 19,000,339 4.730 %
k Total. Add lines 7d and 7j .     76,236,559 34,688,896 41,547,663 10.340 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     16,000   16,000 0 %
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy     5,000   5,000 0 %
8 Workforce development            
9 Other            
10 Total     21,000   21,000 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
6,694,368
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
93,600,494
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
167,884,402
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-74,283,908
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 MARIN GENERAL HOSPITAL
250 BON AIR ROAD
GREENBRAE,CA94904
WWW.MARINGENERAL.ORG
110000361
X X         X   ACUTE PSYCHIATRIC HOSPITAL  
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MARIN GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 16
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.MARINGENERAL.ORG/ABOUT-US/COMMUNITY-BENEFIT
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MARIN GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14   No
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTPS://WWW.MARINGENERAL.ORG/PATIENTS-VISITORS/BILLING-INSURANCE
b
HTTPS://WWW.MARINGENERAL.ORG/PATIENTS-VISITORS/BILLING-INSURANCE
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
MARIN GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MARIN GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
MARIN GENERAL HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS PROVIDED BY A BROAD RANGE OF COMMUNITY MEMBERS AND LEADERS THROUGH KEY INFORMANT INTERVIEWS AND FOCUS GROUPS.INDIVIDUALS IDENTIFIED BY THE MARIN COUNTY CHNA COLLABORATIVE AS HAVING VALUABLE KNOWLEDGE, INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE INTERVIEWED. INTERVIEWEES INCLUDED REPRESENTATIVES FROM THE LOCAL PUBLIC HEALTH DEPARTMENT AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. OTHER INDIVIDUALS FROM VARIOUS SECTORS WITH EXPERTISE OF LOCAL HEALTH NEEDS WERE ALSO CONSULTED. A TOTAL OF 20 KEY INFORMANT INTERVIEWS WERE CONDUCTED DURING THE NEEDS ASSESSMENT PROCESS IN SEPTEMBER/OCTOBER 2015 WITH LEADERS/REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: APPLE FAMILY WORKS, CANAL ALLIANCE, COASTAL ALLIANCE, EXTRAFOOD.ORG, HOMEWARD BOUND, HUCKLEBERRY YOUTH PROGRAM, KAISER PERMANENTE MEDICAL CENTER, MARIN CENTER FOR INDEPENDENT LIVING, MARIN COMMUNITY CLINICS, MARIN COUNTY BOARD OF SUPERVISORS, MARIN COUNTY HEALTH & HUMAN SERVVICES, MARIN COUNTY OFFICE OF EDUCATION, MARIN GENERAL HOSPITAL, NOVATO COMMUNITY HOSPITAL, ROTACARE CLINIC OF SAN RAFAEL, WHISTLESTOP, MARIN YMCA, MARIN CITY COMMUNITY SERVICES DISTRICT, THE SAN RAFAEL POLICE DEPARTMENT, AND THE NOVATO UNIFIED SCHOOL DISTRICT.ADDITIONALLY, EIGHT FOCUS GROUPS WERE CONDUCTED THROUGHOUT MARIN COUNTY DURING OCTOBER 2015. THESE GROUPS WERE INTENTIONALLY SAMPLED TO REACH SPECIFIC SUBPOPULATIONS OF THE COUNTY THAT WERE IDENTIFIED AS HIGH-RISK POPULATIONS BY THE MARIN COUNTY CHNA COLLABORATIVE. THESE SUBPOPULATIONS INCLUDED YOUTH, ADULTS IN RECOVERY FROM SUBSTANCE ABUSE, INDIVIDUALS EXPERIENCING HOMELESSNESS, AND RESIDENTS IN MARIN CITY, NOVATO, SAN GERONIMO, THE CANAL DISTRICT, AND WEST MARIN. FOCUS GROUPS WERE MONOLINGUAL, CONDUCTED IN EITHER ENGLISH OR SPANISH.
MARIN GENERAL HOSPITAL PART V, SECTION B, LINE 6A: MARIN GENERAL HOSPITAL CONDUCTED ITS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN CONJUNCTION WITH HEALTHY MARIN PARTNERSHIP, WHICH INCLUDES ALL ACUTE-CARE HOSPITALS IN MARIN COUNTY: MARIN GENERAL HOSPITAL, KAISER PERMANENTE-SAN RAFAEL, AND NOVATO COMMUNITY HOSPITAL.
MARIN GENERAL HOSPITAL PART V, SECTION B, LINE 6B: THE ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES WHO ARE MEMBERS OF HEALTHY MARIN PARTNERSHP WITH WHICH MARIN GENERAL HOSPITAL CONDUCTED ITS 2016 CHNA INCLUDE: MARIN COUNTY HEALTH & HUMAN SERVICES, MARIN COMMUNITY FOUNDATION, MARIN COUNTY OFFICE OF EDUCATION, AND REPRESENTATIVES OF THE BUSINESS COMMUNITY.
MARIN GENERAL HOSPITAL PART V, SECTION B, LINE 11: MARIN GENERAL HOSPITAL'S COMMUNITY BENEFIT ADVISORY COMMITTEE, WHICH INCLUDES COMMUNITY REPRESENTATIVES, APPLIED A CRITERIA-BASED DECISION MAKING PROCESS TO EXAMINE THE HEALTH NEEDS IDENTIFIED THROUGH THE CHNA PROCESS, TO SELECT THE COMMUNITY HEALTH NEEDS IT WILL ADDRESS, AND TO DEVELOP AN IMPLEMENTATION STRATEGY PLAN TO ADDRESS THE SELECTED HEALTH NEEDS. THESE STRATEGIES BUILD ON MARIN GENERAL HOSPITAL'S ASSETS AND RESOURCES.IN ORDER TO SELECT THE HOSPITAL PRIORITIES, THE COMMUNITY BENEFIT ADVISORY COMMITTEE REVIEWED THE CHNA DATA AND COMMUNITY-IDENTIFIED PRIORITIES, UPDATED ITS PRIORITIZATION CRITERIA FROM PREVIOUS CHNA PERIODS, AND REVIEWED THE AVAILABLE COMMUNITY RESOURCES FOR THE COMMUNITY-IDENTIFIED PRIORITIES. THE COMMUNITY BENEFIT ADVISORY COMMITTEE USED A NUMERICAL RANKING PROCESS TO IDENTIFY THE COMMUNITY NEEDS WHERE MARIN GENERAL HOSPITAL COULD BUILD ON ITS PAST COMMUNITY BENEFIT WORK AND OTHER COMMUNITY RESOURCES TO ADDRESS THE COMMUNITY PRIORITIES. THE CRITERIA USED TO RANK THE COMMUNITY PRIORITIES INCLUDE: SEVERITY; DISPARITIES; PREVENTION; LEVERAGE; AND MGH ASSETS. SPECIFIC STRATEGIES TO ADDRESS THE PRIORITIZED COMMUNITY HEALTH NEEDS WERE IDENTIFIED BY REVIEWING THE IMPACT OF PAST GRANTS OR PROGRAMS IN THE PRIORITY AREAS, EVIDENCE-BASED STRATEGIES, AND AVAILABLE MARIN GENERAL HOSPITAL AND COMMUNITY RESOURCES.MARIN GENERAL SELECTED ACCESS TO HEALTH CARE AS ITS SELECTED HEALTH PRIORITY. ACCESS TO HEALTH CARE IS A HEALTH NEED BECAUSE THE ABILITY TO UTILIZE AND PAY FOR COMPREHENSIVE, AFFORDABLE, QUALITY PHYSICAL, MENTAL AND ORAL HEALTH CARE IS ESSENTIAL TO MAXIMIZE THE PREVENTION, EARLY INTERVENTION, AND TREATMENT OF HEALTH CONDITIONS SUCH AS OBESITY, CANCER, HEART DISEASE, ASTHMA, ORAL HEALTH, MENTAL HEALTH, SUBSTANCE ABUSE, AND DIABETES. IN ORDER TO INCREASE THE NUMBER OF INDIVIDUALS WHO HAVE ACCESS TO AND RECEIVE APPROPRIATE HEALTH CARE SERVICES IN MARIN COUNTY, MARIN GENERAL HOSPITAL HAS OUTLINED THE FOLLOWING STRATEGIES: (I) PARTICIPATE IN GOVERNMENT-SPONSORED PROGRAMS FOR LOW-INCOME INDIVIDUALS, I.E., MEDI-CAL MANAGED CARE AND MEDI-CAL FEE-FOR-SERVICE; (II) PROVIDE CHARITY CARE FOR QUALIFYING INDIVIDUALS; (III) GRANT MAKING TO SUPPORT FEDERALLY QUALIFIED HEALTH CENTERS OR FREE CLINICS (E.G. MARIN COMMUNITY CLINIC AND ROTACARE FREE CLINIC) TO STRENGTHEN COORDINATED CARE FOR VULNERABLE, AT-RISK, LOW-INCOME, OR UNINSURED INDIVIDUALS; AND (IV) GRANT MAKING OR LEVERAGING INTERNAL RESOURCES TO SUPPORT COMMUNITY-BASED SERVICES THAT INCREASE ACCESS TO CULTURALLY COMPETENT HEALTH CARE, CASE MANAGEMENT, ADVOCACY, EDUCATION AND/OR SCREENING AND EARLY INTERVENTION FOR VULNERABLE, AT-RISK, LOW-INCOME, OR UNINSURED INDIVIDUALS. PLANS TO MONITOR THE MARIN GENERAL HOSPITAL STRATEGIES WILL INCLUDE THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES, SUCH AS THE NUMBER OF DOLLARS SPENT, NUMBER OF PEOPLE REACHED/SERVED, AND NUMBER OF GRANTS MADE.MARIN GENERAL HOSPITAL DOES NOT INTEND TO SPECIFICALLY ADDRESS THE FOLLOWING HEALTH NEEDS IDENTIFIED IN THE CHNA, FOR THE FOLLOWING REASONS:OBESITY AND DIABETES WILL NOT BE ADDRESSED DUE TO RESOURCE CONSTRAINTS. MARIN GENERAL HOSPITAL DOES ADDRESS THIS NEED INDIRECTLY THROUGH PARTICIPATION IN THE HEALTHY MARIN PARTNERSHIP COLLABORATIVE, HOWEVER. ALSO, OTHER HOSPITAL SYSTEMS WITH CONSIDERABLE EXPERTISE ARE FOCUSING ON OBESITY PREVENTION.ECONOMIC AND HOUSING INSECURITY AND EDUCATION WILL NOT BE ADDRESSED DUE TO RESOURCE CONSTRAINTS AND ITS LIMITED ABILITY TO HAVE A MEANINGFUL IMPACT ON EMPLOYMENT, INCOME, OR EDUCATION ACHIEVEMENT. ADDITIONALLY, MARIN GENERAL HOSPITAL ALREADY ACKNOWLEDGES THE IMPACT OF SOCIOECONOMIC STATUS ON AN INDIVIDUAL'S HEALTH STATUS BY FOCUSING ITS COMMUNITY BENEFIT CONTRIBUTIONS ON ACCESS TO CARE FOR VULNERABLE, AT-RISK, OR LOW-INCOME INDIVIDUALS.MENTAL HEALTH WILL NOT BE DIRECTLY ADDRESSED DUE TO RESOURCE CONSTRAINTS. HOWEVER, THE HEALTH NEED IS BEING PARTLY ADDRESSED VIA ITS CONTRIBUTION TO THE ACCESS TO CARE HEALTH NEED AND ITS PRIORITY TO INCREASE CARE TO THOSE IN NEED OF MENTAL HEALTH SERVICES.SUBSTANCE ABUSE WILL NOT BE ADDRESSED DUE TO RESOURCE CONSTRAINTS AND MARIN GENERAL HOSPITAL'S LIMITED ABILITY TO MAKE A MEANINGFUL IMPACT.ORAL HEALTH WILL NOT BE ADDRESSED DUE TO RESOURCE CONSTRAINTS; HOWEVER, THROUGH ITS GRANTS PROGRAM, MARIN GENERAL HOSPITAL SUPPORTS ACCESS TO FEDERALLY QUALIFIED HEALTH CENTERS, WHICH PROVIDES DENTAL SERVICES.VIOLENCE AND UNINTENTIONAL INJURY WILL NOT BE ADDRESSED DUE TO RESOURCE CONSTRAINTS AND MARIN GENERAL HOSPITAL'S LIMITED ABILITY TO MAKE A MEANINGFUL IMPACT.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
Page 9
Schedule H (Form 990) 2017
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address Type of Facility (describe)
1 1 - MARIN MAGNETIC RESONANCE IMAGING
1260 SOUTH ELISEO DRIVE SUITE 101
GREENBRAE,CA94904
IMAGING CENTER
2 2 - MARIN SPECIALTY SURGERY CENTER
505 SIR FRANCIS DRAKE BLVD
GREENBRAE,CA94904
SPECIALTY SURGERY CENTER
3 3 - BRADEN DIABETES CENTER
1100 SOUTH ELISEO DRIVE SUITE 2
GREENBRAE,CA94904
DIABETES HEALTH CLINIC
4 4 - BREAST HEALTH CENTER
100A DRAKES LANDING ROAD SUITE 140
GREENBRAE,CA94904
BREAST HEALTH CLINIC
5 5 - CANCER INSTITUTE
1350 S ELISEO DRIVE
GREENBRAE,CA94904
CANCER HEALTH CLINIC
6 6 - CENTER FOR INTEGRATIVE HEALTH & WELLNESS
1350 S ELISEO DRIVE SUITE 140
GREENBRAE,CA94904
HOLISTIC HEALTH CLINIC
7 7 - MARIN OUTPATIENT IMAGING CENTER
1240 S ELISEO DRIVE SUITE 103
GREENBRAE,CA94904
OUTPATIENT IMAGING
8 8 - OUTPATIENT LABORATORY
100A DRAKES LANDING SUITE 225
GREENBRAE,CA94904
OUTPATIENT LABORATORY
9 9 - OUTPATIENT LABORATORY
5 BON AIR ROAD SUITE 119
LARKSPUR,CA94939
OUTPATIENT LABORATORY
10 10 - OUTPATIENT LABORATORY
23 REED BOULEVARD SUITE 110
MILL VALLEY,CA94941
OUTPATIENT LABORATORY
11 11 - OUTPATIENT LABORATORY
75 ROWLAND WAY SUITE 101
NOVATO,CA94945
OUTPATIENT LABORATORY
12 12 - OUTPATIENT PHYSICAL THERAPY
1350 S ELISEO DRIVE SUITE 250
GREENBRAE,CA94904
OUTPATIENT PHYSICAL THERAPY
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINE (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: 1) SPECIAL CIRCUMSTANCES CHARITY CARE: A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, INELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING MGH'S CHARITY CARE ELIGIBILITY CRITERIA. 2) CATASTROPHIC CHARITY CARE: FULL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 10% OF PATIENT'S FAMILY INCOME.3) UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. 4) PROMPT PAYMENT DISCOUNT: ADDITIONAL DISCOUNT FOR PATIENTS RECEIVING THE UNINSURED DISCOUNT OF AT LEAST 10% WHO PAYS ESTIMATED BILL PRIOR TO DISCHARGE.
PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS ON LINES 7A, 7B, AND 7C. COST ACCOUNTING WAS USED TO DETERMINE THE AMOUNTS ON LINES 7E, 7F, AND 7I.
PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT: MGH IS A MEMBER OF THE SAN RAFAEL CHAMBER OF COMMERCE. THE SAN RAFAEL CHAMBER OF COMMERCE IS ONE OF MARIN COUNTY'S LEADING BUSINESS ADVOCATES. THEY ARE STRONG CHAMPIONS FOR LOCAL BUSINESS INTERESTS AND WORK VIGOROUSLY TO MAINTAIN A HEALTHY ECONOMY. ADDITIONALLY, DURING 2017, MGH CONTRIBUTED $10,000 TO THE MARIN ECONOMIC FORUM, A 501(C)(3) ORGANIZATION WHO STRIVES TO PROVIDE INFORMATION AND OPPORTUNITIES FOR IMPROVING MARIN COUNTY'S ECONOMIC VITALITY, WHILE SEEKING TO INCREASE SOCIAL EQUITY AND ENVIRONMENTAL PROTECTION.COALITION BUILDING: MGH WORKS WITH THE AGRICULTURAL INSTITUTE OF MARIN AND HEALTH COUNCIL OF MARIN TO PROMOTE HEALTHY INITIATIVES IN THE COMMUNITY. EXPENSES COULD NOT BE QUANTIFIED.COMMUNITY HEALTH IMPROVEMENT ADVOCACY: MGH PARTICIPATES ON A COMMUNITY COMMITTEE THROUGH THE MARIN MOBILITY CONSORTIUM FOUNDATION THAT IS WORKING TO DEVELOP A PROGRAM TO COORDINATE RIDES FOR SENIORS, DISABLED, AND PARATRANSIT PERSONS. ADDITIONALLY, MGH PROVIDED A $5,000 GRANT TO THE SAN FRANCISCO BAY AREA CHAPTED OF THE SUSAN G. KOMEN FOUNDATION.
PART III, LINE 2: THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.
PART III, LINE 4: MGH'S AUDITED FINANCIAL STATEMENTS DOES NOT HAVE A SEPARATE BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE FOOTNOTE WHICH ADDRESSES "NET PATIENT ACCOUNTS RECEIVABLE AND "ALLOWANCE FOR DOUBTFUL ACCOUNTS" CAN BE FOUND ON PAGES 9 AND 10 OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8: THE ORGANIZATION DID NOT COUNT THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. ALL MEDICARE REVENUE AND COST WAS INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT. MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.
PART III, LINE 9B: COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PRE-ADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS ARE GIVEN AN APPLICATION WHICH DOCUMENTS THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 30 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE AND HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
PART VI, LINE 2: IN ADDITION TO THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT, HEALTH NEEDS ARE MONITORED AS FOLLOWS: (I) MARIN HEALTHCARE DISTRICT BOARD MEETINGS, WHICH INCLUDE PUBLIC COMMENTS AND WHICH THE MGH CEO ATTENDS AND SHARES COMMUNITY INPUT WITH HOSPITAL STAFF AS APPROPRIATE; (II) MGH BOARD MEMBERS ARE ALL COMMUNITY RESIDENTS AND SHARE COMMUNITY HEALTH CONCERNS WHEN APPROPRIATE; (III) COMMUNITY COMMENTS ON THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE COLLECTED ON THE MGH WEBSITE AND ARE MONITORED BY THE COMMUNITY RELATIONS DEPARTMENT.
PART VI, LINE 3: COMMUNICATION OF FINANCIAL ASSISTANCE AVAILABILITY A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL SHALL PROVIDE: (I) ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS). (II) PATIENTS WHO THE HOSPITAL IDENTIFY MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE MARIN GENERAL HOSPITAL STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, "STATEMENT OF FINANCIAL CONDITION". 2. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITAL SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, MGH FINANCIAL ASSISTANCE APPLICATION FORM, "STATEMENT OF FINANCIAL CONDITION". B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS: 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE MGH WEBSITE. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE COLLECTION PRACTICES, HOSPITAL THIRD-PARTY LIENS, AND DISPUTE INITIATION POLICY. C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGES OF MGH'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATION TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL REPRESENT THE AMOUNT THE HOSPITAL WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS.
PART VI, LINE 4: COMMUNITY INFORMATION: MARIN GENERAL HOSPITAL DEFINES THE COMMUNITY SERVED BY THE HOSPITAL AS THOSE INDIVIDUALS RESIDING WITHIN ITS HOSPITAL SERVICE AREA. A HOSPITAL SERVICE AREA INCLUDES ALL RESIDENTS IN A DEFINED GEOGRAPHIC AREA SURROUNDING THE HOSPITAL AND DOES NOT EXCLUDE LOW-INCOME OR UNDERSERVED POPULATIONS. THE MARIN GENERAL HOSPITAL SERVICE AREA INCLUDES ALL OF MARIN COUNTY. THE CITIES INCLUDED ARE: BELVEDERE, CORTE MADERA, FAIRFAX, LARKSPUR, MILL VALLEY, NOVATO, ROSS, SAN ANSELMO, SAN RAFAEL, SAUSALITO, TIBURON, AND THE COASTAL TOWNS OF STINSON BEACH, BOLINAS, POINT REYES, INVERNESS, MARSHALL, AND TOMALES. CERTAIN SPECIALTY PROGRAMS, INCLUDING ITS TRAUMA SERVICE, SERVE A BROADER POPULATION, INCLUDING PATIENTS FROM SONOMA COUNTY, THE BROADER SAN FRANCISCO BAY AREA AND BEYOND.THE KEY DRIVERS OF HEALTH STATUS ARE INCOME, EDUCATION AND HEALTH INSURANCE. WHILE MARIN COUNTY COMPARES WELL WITH THE STATE, THERE ARE CLEAR VULNERABLE POPULATIONS WHOSE HEALTH STATUS IS MOST AT RISK: 19.4% OF RESIDENTS ARE LIVING BELOW 200% FEDERAL POVERTY LEVEL (FPL); 17.8% OF CHILDREN ARE LIVING BELOW 200% FPL; 8.9% OF RESIDENTS ARE UNINSURED; 7.6% OF RESIDENTS ARE WITHOUT A HIGH SCHOOL DIPLOMA; 15.5% OF RESIDENTS ARE HISPANIC/LATINO; 2.9% OF RESIDENTS ARE BLACK AND 5.6% OF RESIDENTS ARE ASIAN.MARIN COUNTY IS A HEALTHY AND AFFLUENT COUNTY, ESPECIALLY WHEN COMPARED TO CALIFORNIA AS A WHOLE. HOWEVER, MARIN IS ALSO AN AGING COUNTY WITH SUBSTANTIAL DISPARITIES IN SOCIOECONOMIC STATUS. THESE ISSUES PRESENT CHALLENGES FOR THE HEALTH OF MARIN COUNTY RESIDENTS.
PART VI, LINE 5: MARIN GENERAL HOSPITAL IS THE ONLY FULL SERVICE ACUTE CARE HOSPITAL IN THE COUNTY AND THE ONLY HOSPITAL WITH AN OBSTETRICAL SERVICE OR IN PATIENT BEHAVIORAL HEALTH SERVICE. IT SERVES AS THE TRAUMA CENTER FOR MARIN COUNTY AND SURROUNDING AREAS. THE BOARD OF DIRECTORS IS COMPOSED OF UNCOMPENSATED COMMUNITY RESIDENTS. ALL FUNDS ARE USED TO IMPROVE HEALTH CARE SERVICES, MAINTAIN UP-TO-DATE FACILITIES, AND SUPPORT TRAINING PROGRAMS FOR HEALTH PROFESSIONALS IN AREAS SUCH AS NURSING, PHARMACY, RADIOLOGY, RESPIRATORY THERAPY, REHABILITATION SERVICES AND BEHAVIORAL HEALTH. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS.
PART VI, LINE 7, REPORTS FILED WITH STATES CA
Schedule H (Form 990) 2017
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