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/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
SEVENTH-DAY ADVENTISTS LOMA LINDA
UNIVERSITY MEDICAL CENTER
Employer identification number

95-3522679
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
 
No
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
 
 
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) . . . 		    10,248,165   10,248,165 0.750 %
b Medicaid (from Worksheet 3, column a) . . . . .     429,218,449 345,358,432 83,860,017 6.130 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     439,466,614 345,358,432 94,108,182 6.880 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 71 20,468 986,339   986,339 0.070 %
f Health professions education (from Worksheet 5) . . .     117,964,534 49,439,694 68,524,840 5.010 %
g Subsidized health services (from Worksheet 6) . . . .     7,176,579 7,290,025 0 0 %
h Research (from Worksheet 7) .     1,945,476   1,945,476 0.140 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     24,125   24,125 0 %
j Total. Other Benefits . . 71 20,468 128,097,053 56,729,719 71,480,780 5.220 %
k Total. Add lines 7d and 7j . 71 20,468 567,563,667 402,088,151 165,588,962 12.100 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
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            
3 Community support 19 5,606 883,637   883,637 0.060 %
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total 19 5,606 883,637   883,637 0.060 %
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 Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
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
37,703,194
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
6,839,359
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
190,246,524
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
340,728,633
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-150,482,109
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) 2019
Schedule H (Form 990) 2019
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 LOMA LINDA UNIVERSITY MEDICAL CENTER
11234 ANDERSON ST
LOMA LINDA,CA92354 		X X X X   X X X    
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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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)
LOMA LINDA UNIVERSITY MEDICAL CENTER
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): 		 
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 19
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   No
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 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): REFER TO SUPPLEMENTAL SECTION OF SCHEDULE H
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) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
LOMA LINDA UNIVERSITY MEDICAL CENTER
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 Yes  
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
LLUH.ORG/PATIENTS-VISITORS/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE
b
LLUH.ORG/PATIENTS-VISITORS/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Billing and Collections
LOMA LINDA UNIVERSITY MEDICAL CENTER
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) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
LOMA LINDA UNIVERSITY MEDICAL CENTER
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) 2019
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Schedule H (Form 990) 2019
Page 8
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, 20a, 20b, 20c, 20d, 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
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 3J: LLUH CONDUCTS A COMPREHENSIVE CHNA THAT INCLUDES PATIENT DEMOGRAPHIC AND CHRONIC DISEASE TRENDS AND ASSESSES COMMUNITY NEEDS BASED SURVEYS AND FOCUS GROUPS TO DETERMINE PRIORITIES FOR THE SOCIAL DETERMINANT OF HEALTH.
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 5: THE 2019 CHNA SUPPORTING THE FY 20, 21 & 22 IMPLEMENTATION YEARS WAS DESIGNED TO BE A STATISTICALLY VALID SAMPLING OF BOTH THE PATIENT POPULATION AND THE GENERAL PUBLIC QUALITATIVE COMMUNITY SURVEYS AND QUANTITATIVE FOCUS GROUPS WITH EMPHASIS ON PEOPLE REPRESENTING HOUSEHOLDS OF $50,000 OR LESS TO ACHIEVE A MORE ACCURATE UNDERSTANDING OF COMMUNITY MEMBER SOCIAL DETERMINANT OF HEALTH NEEDS FOR VULNERABLE POPULATIONS. PUBLIC HEALTH EXPERTS WERE PART OF THE CHNA DESIGN AND OUTCOMES ANALYSIS FROM THE LLUH HEALTH SYSTEM INCLUDING LLU SCHOOL OF PUBLIC HEALTH FACULTY, AND THE CHNA WAS REVIEWED BY THE SAN BERNARDINO COUNTY DEPARTMENT OF PUBLIC HEALTH, WHICH PROVIDED A LETTER OF SUPPORT IN THE CHNA DOCUMENT. TO VIEW THE COUNTY DEPARTMENT PUBLIC HEALTH ENDORSEMENT OF THE CHNA FINDINGS AND SEE THE COMPLETE REPORT: PLEASE VISIT THE PUBLICLY AVAILABLE ON THE LLUH CHNA & CHIS AND THE ANNUAL COMMUNITY BENEFIT REPORTS FOR THE LLUH HOSPITALS, PLEASE VISIT: HTTPS://LLUH.ORG/ABOUT-US/COMMUNITY-BENEFIT/REPORTS-AND-RESOURCES.
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 6A: THE LOMA LINDA UNIVERSITY HEALTH SYSTEM IS COMPRISED OF FOUR LICENSED HOSPITALS THAT CONDUCT ONE SYSTEM COMMUNITY HEALTH NEEDS ASSESSMENT AND PROGRAMMATICALLY REPORT THEIR COMMUNITY BENEFIT IMPLEMENTATION AND OUTCOMES TOGETHER FOR COLLECTIVE IMPACT IN OUR REGION WHILE THE FINANCIALS AND INVESTMENTS ARE REPORTED PER LICENSED HOSPITAL IN KEEPING WITH FEDERAL AND CALIFORNIA STATE REGULATIONS. THE FOUR LICENSED HOSPITALS REPRESENTED BY THE FOLLOWING COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE: LOMA LINDA UNIVERSITY MEDICAL CENTER (EIN: 95-3522679);LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL (EIN: 46-3214504);LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER (EIN: 33-0245579); LOMA LINDA UNIVERSITY MEDICAL CENTER MURRIETA (EIN: 37-1705906).LLUH DID NOT CONDUCT THE 2019 ASSESSMENT WITH OTHER NON-AFFILIATED HOSPITALS THIS CYCLE BUT IS WORKING WITH OTHER HOSPITAL SYSTEMS TO IMPLEMENT INTERVENTIONS IN A COLLABORATIVE, COLLECTIVE IMPACT MODEL. THE COMMUNITY BENEFIT REPORT IS COMPLIANT WITH STATE AND FEDERAL REGULATIONS INCLUDING CALIFORNIA'S OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) FOR THE FILING OF THE ANNUAL COMMUNITY BENEFIT REPORT BOTH WITH THE STATE AND ON THE PUBLIC WEBSITE, PER THE DEADLINE OR EXTENSION GRANTED EACH YEAR.
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 6B: THREE ORGANIZATIONS WERE PARTNERED WITH LLUH ON THE 2019 CHNA: -EL SOL NEIGHBORHOOD EDUCATION CENTER (SAN BERNARDINO COUNTY)-COPE: CONGREGATIONS FOR PROPHETIC ENGAGEMENT (SAN BERNARDINO COUNTY)- FIND FOOD BANK (COACHELLA VALLEY, RIVERSIDE COUNTY)
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 7D: THE CHNA IS AVAILABLE ON OUR WEBSITE, IS DISTRIBUTED ELECTRONICALLY TO OVER 100 COMMUNITY-PARTNERS ORGANIZATIONS, IS PRINTED AND PRINTABLE FOR WHEN REQUESTED BY COMMUNITY MEMBERS, AND THE FULL DATA SET OF FINDINGS IS IN THE APPENDIX OF THE REPORT SO ANY COMMUNITY AGENCY CAN USE THE ASSESSMENT DATA. FACILITY WEBSITE: HTTPS://LLUH.ORG/LOCATIONS/LOMA-LINDA-UNIVERSITY-MEDICAL-CENTERCHNA WEBSITE: HTTPS://LLUH.ORG/ABOUT-US/COMMUNITY-BENEFIT/REPORTS-AND-RESOURCES
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 11: REFER TO SUPPLEMENTAL SECTION OF SCHEDULE H
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 13H: NUMBER OF FAMILY MEMBERS.
LOMA LINDA UNIVERSITY MEDICAL CENTER PART V, SECTION B, LINE 16J: THE POLICY IS POSTED ON THE STATE OF CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE.
SCHEDULE H, PART V, SECTION B, LINE 11 POPULATIONS SERVED THROUGH 2020-2022 IMPLEMENTATION CYCLE: WORKFORCE DEVELOPMENT (YOUTH/ADULTS FROM SAN BERNARDINO & RIVERSIDE COUNTIES; HOUSEHOLDS AT 350% BELOW FEDERAL POVERTY LINE; 1ST GENERATION COLLEGE STUDENTS; INTERNSHIP AND WORKFORCE DEVELOPMENT PROGRAMS TO EXTEND ACCESS TO JOB EXPERIENCE FOR UNDERREPRESENTED GROUPS, COMMUNITIES, AND PEOPLE OF COLOR). EDUCATION (STUDENTS FROM UNDERREPRESENTED GROUPS, COMMUNITIES, OR PEOPLE OF COLOR; SCHOOL-AGE YOUTH EXPERIENCING CHRONIC ABSENTEEISM FROM SCHOOL; PIPELINE PROGRAMS TO LINK MIDDLE AND HIGH SCHOOL YOUTH TO WORKFORCE OPPORTUNITIES IN MULTIPLE SECTORS, ESPECIALLY HEALTH CARE; BRIDGE SCHOLARSHIPS FOR YOUTH TO INCREASE ACCESS TO HIGHER EDUCATION). GREEN SPACES (SAN BERNARDINO RESIDENTS LIVING IN FOOD DESERTS AND THOSE WHO LACK ACCESS TO AFFORDABLE PRODUCE; FAMILIES WITHIN A 5-MILE RADIUS OF THE SAC NORTON 3RD STREET CLINIC IN NEED OF SAFE GREEN SPACES FOR RECREATION). BEHAVIORAL HEALTH: (OUTREACH TO MIDDLE AND HIGH SCHOOL YOUTH EXPERIENCING BEHAVIORAL HEALTH CONCERNS, ACCESS TO BEHAVIORAL HEALTH RESOURCES FOR ADOLESCENTS AND TEENS). FOOD SECURITY (ACCESS TO HEALTHY, ORGANIC FOOD FOR PEOPLE LIVING IN FOOD DESERTS; COMMUNITY ENGAGEMENT THROUGH GARDENING IN OUTDOOR COMMUNITY CENTERS AND LOCALLY GROWN FOOD AND SAFE GREEN SPACES; EMERGENCY ACCESS TO PRODUCE AND RELIEF FOOD PANTRY DISTRIBUTION (COVID- 19). SOCIAL ISOLATION (ISOLATED SENIORS EXPERIENCING FINANCIAL INSECURITY). ACCESS TO HEALTHCARE FOR UNDER-REPRESENTED POPULATIONS (FQHC POPULATIONS; RURAL COMMUNITIES & AGRICULTURAL WORKERS; COMMUNITY INJURY PREVENTION; MOTHERS & MEDICALLY FRAGILE INFANTS; LIFESTYLE (METABOLIC SYNDROME; PEOPLE EXPERIENCING: HOMELESSNESS; DISABILITY, CANCER, PRE-DIABETES AND DIABETES). COMMUNITY HEALTH IMPLEMENTATION STRATEGY FY 20-FY 22: THE THREE-YEAR PLAN FOR THE FY 20- FY 22 FISCAL YEARS CENTERS ON LLUH'S ATTEMPT TO ADDRESS THE ROOT CAUSE OF POVERTY IN OUR REGION THROUGH WORKFORCE DEVELOPMENT AND EDUCATION AND TO INCREASE ACCESS TO CARE FOR VULNERABLE POPULATIONS WHO LIVE WITH UN-MET HEALTH NEEDS THAT CLUSTER INTO "LIFESTYLE DISEASES." THE TWO ARE INEXTRICABLY LINKED AS POVERTY DECREASES HEALTH STATUS IS A WELL-DOCUMENTED CONTRIBUTOR TO CHRONIC STRESS AND HIGHER RATES OF HYPERTENSION, DIABETES, DECREASED CARDIAC HEALTH, AND EVEN ENVIRONMENTALLY TRIGGERED CONDITIONS LIKE ASTHMA. POPULATIONS LIVING AT THE LOWER LEVELS OF INCOME, OR HAVING A LOW SOCIOECONOMIC STATUS, IS ALSO A WELL-DOCUMENTED CORRELATION TO A DECREASE IN MENTAL AND BEHAVIORAL HEALTH AND HIGHER PREVALENCE RATES OF SUBSTANCE USE. WHEN POVERTY IS PERVASIVE, THOSE LIVING IN POVERTY CANNOT MAXIMIZE THEIR HEALTH STATUS AS SURVIVAL CONCERNS DECREASE OVERALL HEALTH AND WELLNESS. TO MAXIMIZE OUR WORK AND INVESTMENTS IN COMMUNITIES OF HIGHEST NEED, LLUH IS BUILDING ON OUR STRENGTHS AS AN ECONOMIC ANCHOR IN OUR REGION IN ORDER TO STRATEGICALLY RESPOND TO THE NEEDS EXPRESSED BY OUR COMMUNITY. LLUH EMPLOYS OVER 16,000 PEOPLE BETWEEN OUR UNIVERSITY AND HEALTHCARE SYSTEM AND WE ARE A JOB ENGINE FOR PEOPLE IN OUR COMMUNITY AND PROVIDE ACCESS TO HIGHER, LIVABLE WAGES THROUGH OUR HEALTH SYSTEM. AS LLUH IS ALSO A GRADUATE INSTITUTION FOR HEALTH EDUCATION, WE CAN INCREASE LOCAL RESIDENT'S ACCESS TO EDUCATION THROUGH OUR EXPERTISE IN THIS INDUSTRY. THE MISSION OF LLUH IS TO CONTINUE BOTH THE TEACHING AND HEALING MINISTRY OF JESUS CHRIST TO MAKE MAN WHOLE WITH EQUAL EMPHASIS AS ON BOTH ASPECTS OF THE MISSION, INCLUDING HOW THIS MISSION INFORMS OUR RESPONSIVENESS TO THE COMMUNITIES WE SERVE. FOR THE FY 20 FY 22 THREE YEAR CYCLE, LLUH IS COMMITTED TO ADDRESSING UN-MET HEALTH NEEDS THAT ARE EXACERBATED BY POVERTY THROUGH A FOCUS OF COMMUNITY BENEFIT INVESTMENT IN WORKFORCE DEVELOPMENT & EDUCATION AND HEALTH AND WELLNESS ISSUES WHERE LLUH CAN MAKE TARGETED INVESTMENTS IN INTERVENTIONS IN OUR WORK WITH NON-PROFIT PARTNERS AND COMMUNITY MEMBERS. RESOURCES ALLOCATED TO THE NEEDS: THE FOLLOWING IMPLEMENTATION STRATEGY OUTLINES THE ACTIVITIES AND INVESTMENTS MADE BY THE FOUR LICENSED HOSPITALS AS EXECUTED THROUGH THE INSTITUTE FOR COMMUNITY PARTNERSHIPS. MAJOR INITIATIVES ARE COVERED IN THE FOLLOWING IMPLEMENTATION STRATEGY, ROUTINE SYSTEM ACTIVITIES RELATED TO HEALTH ACCESS OR OUTREACH ARE REPORTED ANNUALLY ONLY AS THEY FIT AND ADDRESS THE NEEDS IDENTIFIED FOR FOCUS BY THE FY 20 FY 22 CHIS. THROUGH ICP, THE HOSPITALS ARE INVESTING IN THE DEVELOPMENT OF THE COMMUNITY HEALTH WORKER WORKFORCE IN OUR REGION IN SCHOOL DISTRICTS, WITH NON-PROFIT PARTNERS, AND IN HEALTH SYSTEMS. THE IMPLEMENTATION PLAN FOR THIS EFFORT INCLUDES THE FOLLOWING MAJOR INITIATIVES: 1) ICP CONTRACTS AND PROVIDES TECHNICAL ASSISTANCE TO SCHOOL DISTRICTS TO CREATE CHEW JOBS: LLUH THROUGH ICP IS BUILDING COMMUNITY HEALTH EDUCATION WORKER TEAMS (CHEWS) IN LOCAL SCHOOL DISTRICTS IN ORDER TO EXTEND OUTREACH TO AT-RISK POPULATIONS OF STUDENTS, OR YOUTH WHO ARE AT-PROMISE, BASED ON WHAT DISTRICTS MOST NEED ADDRESSED. THE CHEWS ARE TRAINED TO WORK IN THE EDUCATION SYSTEM AND THROUGH RELATIONSHIP BUILDING AND HOME VISITS, EXTEND OUTREACH, SOCIAL SUPPORTS, LINKAGES AND ACCOMPANIMENTS TO FAMILIES, RESOURCE SUPPORT, AND INFORMAL PEER COUNSELING TO HELP STUDENTS WHO ARE CHRONICALLY ABSENT, FACE UNDUE HEALTH CHALLENGES, OR ARE EXPERIENCING MENTAL OR BEHAVIORAL HEALTH CRISIS HAVE ADDITIONAL, INTENSIVE SUPPORTIVE RESOURCES. ICP CURRENTLY CONTRACTS WITH 2 SCHOOL DISTRICTS AND EMPLOYS 6-8 CHEWS WORKING IN THE COMMUNITY, A MANAGER OF INTEGRATION TO OVERSEE THE PROJECT, AND IS CONDUCTING INTERVENTIONS WITH FAMILIES WHO HAVE CHILDREN WHO ARE CHRONICALLY ABSENT (ONE DISTRICT) AND THE OTHER DISTRICT IS A FOCUSED INTERVENTION TO PREVENT AGAINST SUICIDAL IDEATION OR ACTION (BEHAVIORAL HEALTH PREVENTION). RESOURCES ALLOCATED: ALL FOUR LICENSED HOSPITALS INVEST IN ICP OPERATIONS IN ORDER TO CARRY OUT THIS LEVEL OF PARTNERSHIP, RESPONSIVENESS, AND INTERVENTION IN OUR COMMUNITIES. ONLY EXPENSES ABOVE AND BEYOND CONTRACTUAL REVENUE ARE REPORTED AS COMMUNITY BENEFIT. ICP IS INVESTING IN NON-PROFIT, COMMUNITY-BASED ORGANIZATIONAL PARTNERS WHO WANT TO EXPAND OUTREACH TO THEIR POPULATIONS THROUGH THE ADDITION OF COMMUNITY HEALTH WORKERS THROUGH EITHER SEED FUNDING FOR COMMUNITY HEALTH WORKER POSITIONS OR, THROUGH TECHNICAL ASSISTANCE WITH GRANT ACTIVITIES TO HELP INCREASE PARTNER POTENTIAL TO ACQUIRE DOLLARS TO HIRE COMMUNITY HEALTH WORKERS. ICP INVESTED IN A COMMUNITY HEALTH WORKER INTEGRATION PROGRAM WITH A NON-PROFIT PARTNER IN THE COACHELLA VALLEY WHERE FIND FOOD BANK ADDED A CHW TO THEIR OUTREACH TEAM. THE POSITION WILL BE SUSTAINED BY CAL FRESH ENROLLMENT DOLLARS AS A SUSTAINABILITY PLAN WHILE THE CHW WORKING THERE IS FOCUSED ON INTENSIVE OUTREACH VISITS TO AT-RISK FAMILIES. RESOURCES ALLOCATED: ALL FOUR LICENSED HOSPITALS INVEST IN ICP OPERATIONS IN ORDER TO CARRY OUT THIS LEVEL OF PARTNERSHIP, RESPONSIVENESS, AND INTERVENTION IN OUR COMMUNITIES. LLUMC AND LLUCH DOLLARS ARE CURRENTLY INVESTED IN THE NON-PROFIT PARTNER CHW POSITION. CREATION AND INTEGRATION OF THE CHW WORKFORCE IN THE LLUH SYSTEM. IN FY 2019 LLUH CONDUCTED A PILOT WITH 2 CHWS WHO INTEGRATED INTO HIGH-RISK AREAS WHERE VULNERABLE POPULATIONS ACCESS OUR HEALTH SYSTEM BUT FACE UNDUE HEALTH BURDENS IN TRYING TO ADDRESS THEIR HEALTH AND WELLNESS POST-ENCOUNTER IN EITHER INPATIENT OUR OUTPATIENT SETTINGS. THIS INCLUDES LINKAGES TO LLUH'S PRIORITY ON DISEASE RELATED TO POVERTY THROUGH A FOCUS ON AT-RISK INFANTS AND MOTHERS IN THE NICU AND AT-RISK ADULTS WITH DIABETES IN THE OUTPATIENT DIABETES TREATMENT CENTER. DUE TO THE INITIAL SUCCESS OF THE PILOT PROGRAM IN 2019, LLUH IS FORMALLY CREATING A CHW INTEGRATION AND INTERVENTION PROGRAM THROUGH THE INSTITUTE FOR COMMUNITY PARTNERSHIPS BASED ON THE FOLLOWING PARAMETERS: LLUH HOSPITALS WILL INVEST IN HIRING 6 CHW POSITIONS AND TWO OPERATIONS POSITIONS (MANAGER & COORDINATOR/SUPERVISOR) TO RUN THE PROGRAM. THE ICP MANAGEMENT/OPERATIONS POSITIONS OVERSEE THE CHEW CONTRACTS IN SCHOOL DISTRICTS IN ADDITION TO THE ESTABLISHMENT OF THE CHW PROGRAM AT LLUH. THE LLUH CHWS WILL BE ENTIRELY FOCUSED ON THE TARGET POPULATION, THOSE FROM UNDERSERVED COMMUNITIES WHO LACK ACCESS TO SERVICES AND FACE POVERTY, BASED ON THE COMMUNITY BENEFIT INVESTMENT IN THIS COMMUNITY INTERVENTION. IT IS THE GOAL OF THIS PROGRAM TO USE THE HOSPITAL'S INVESTMENT TO INTERVENE AND LIGHTEN THE BURDEN OF THE SOCIAL DETERMINANTS OF HEALTH THROUGH COMMUNITY PEERS WHO ARE EXPERTLY TRAINED IN RECOGNIZING AND NAVIGATING THE SOCIAL DETERMINANTS OF HEALTH. WHILE THE CHWS ARE EMPLOYED BY LLUH AND MEET PEOPLE WHO REPRESENT VULNERABLE POPULATIONS IN OUR REGION, THEY ARE ASSIGNED TO WORK IN THE COMMUNITY WITH PATIENTS AND THEIR FAMILIES WHO REPRESENT THE TARGET POPULATION, AS DEFINED BY COMMUNITY BENEFIT PARAMETERS. TO ENSURE THIS IS UPHELD, CHWS WORKING WITHIN THE LLUH PROGRAM WILL ABIDE BY THE FOLLOWING METRICS: A 51% MINIMUM OF TIME IN THE COMMUNITY WITH A STRETCH GOAL OF 60% TIME SPENT IN THE COMMUNITY WILL SERVE AS THE MACRO INDICATOR FOR THE PROGRAM.
SCHEDULE H, PART V, SECTION B, LINE 11 CONTINUED SECONDARY OUTCOMES RELATED TO SPECIAL POPULATIONS, AS WELL AS DEMOGRAPHIC INFORMATION, WILL BE CAPTURED TO STUDY THE IMPACT OF CHWS WORKING WITH UNDERSERVED OR MARGINALIZED POPULATIONS. OUTCOMES WILL BE PRESENTED IN COMMUNITY BENEFIT REPORTING AND IN RESEARCH PUBLISHED AND PRESENTED ON IN PROFESSIONAL CIRCLES BY ICP TO HELP INCREASE THE ACCESS AND TECHNICAL ASSISTANCE AVAILABLE TO HEALTH SYSTEMS ON HOW TO INTEGRATE AND CREATE THIS RESOURCE IN OTHER HEALTH SYSTEMS. LLUH CHWS WILL FOCUS ON HOME VISITS AND COMMUNITY OUTREACH CLASSES/PEER SUPPORT GROUPS FOR VULNERABLE POPULATIONS WITH THE FOLLOWING PROGRAMMATIC GOALS: TIME IS THE MEDICINE UNLIKE MANY OF THE HEALTH CARE PROVIDERS AND WORKFORCE, CHWS ARE ABLE TO DO TIME-INTENSIVE INTERVENTIONS. THIS IS ACCOMPLISHED THROUGH A TRUSTED RELATIONSHIP AS CHWS ARE ABLE TO QUICKLY ESTABLISH AS COMMUNITY PEERS AND ENGAGE WITH COMMUNITY MEMBERS ONCE THEY ARE HOME. CHWS WORK WITH COMMUNITY MEMBERS AND THEIR FAMILY MEMBERS TO NAVIGATE COMPLEX SOCIAL AND HEALTH SYSTEMS TO ADDRESS, MANAGE, AND MAINTAIN THEIR HELP ONCE THESE COMMUNITY MEMBERS ARE NO LONGER "PATIENTS" IN OUR FACILITY, BUT INTEGRATING BACK TO THE HOME TO GET THE CARE THEY NEED. INTERVENTIONS WITHOUT BORDERS CHWS ARE ABLE TO PROVIDE SUPPORTIVE COACHING AND MENTORING TO HELP THOSE THEY WORK NAVIGATE COMPLEX SOCIAL SERVICES AND BENEFITS LIKE (DMV, SOCIAL SECURITY, VETERANS AFFAIRS, ETC.). CHWS ARE ALSO ABLE TO PROVIDE ACCOMPANIMENT BY MEETING WITH COMMUNITY MEMBERS AT APPOINTMENTS AND IN OUTPATIENT AND INPATIENT SYSTEMS OF CARE (BOTH LLUH AND NON-LLUH), AND CHWS ARE ABLE TO SUPPORT INDIVIDUALS IN ACCESSING RESOURCES FOR SURVIVAL NEEDS LIKE FOOD BANKS, HOUSING AND RENTAL ASSISTANCE, AND OTHER SUPPORTIVE SOURCES IN THE COMMUNITY OFFERED BY NON-PROFITS AND COMMUNITY ORGANIZATIONS. SPECIAL POPULATIONS FOCUS THE LLUH CHWS WILL BE STATIONED IN CRITICAL ACCESS AREAS OF THE HEALTH SYSTEM IN ORDER TO BECOME CONNECTED TO COMMUNITY MEMBERS WHO ARE EXPERIENCING THE HIGHEST LEVELS OF NEED. THE FOLLOWING ARE SPECIAL POPULATIONS THE CHW PROGRAM WILL ADDRESS: AT-RISK INFANTS AND MOTHERS; ADULTS WITH DIABETES; CHILDREN AND YOUTH WITH DIABETES; HOMELESS INDIVIDUALS IN OUR EMERGENCY DEPARTMENT; INDIVIDUALS EXPERIENCING ESCALATION OF SYMPTOMS RELATED TO SICKLE CELL DISEASES; INDIVIDUALS EXPERIENCE A LACK OF ACCESS TO MENTAL HEALTH OR BEHAVIORAL HEALTH SERVICES AND RESOURCES; HIGH UTILIZERS OF THE LLUH SYSTEM WHO EXPERIENCE UNDUE SOCIAL DETERMINANT BURDEN AND REQUIRE EXTENSIVE, SUPPORTIVE ACCOMPANIMENT AND LINKAGE TO HEALTH AND SOCIAL SERVICES UPON DISCHARGE FROM THE LLUH INPATIENT SYSTEM. DUE TO COVID-19: COMMUNITY MEMBERS WHO NEED ACCESS TO THE VACCINE TO DECREASE THE BARRIERS AND ADJUST FOR EQUITY IN OUR COMMUNITY FOR MEMBERS OF AFRICAN AMERICAN AND HISPANIC/LATINO COMMUNITIES. FINALLY, SPECIAL TO THIS PROGRAM IS THE TWO-FOR-ONE INVESTMENT THAT CREATING THE CHW WORKFORCE DOES TO CREATE JOBS AND DEVELOP THE WORKFORCE. TO GIVE CHWS JOBS IS AN ACT OF ECONOMIC DEVELOPMENT AS PEOPLE DOING THE WORK OF A CHW OFTEN NEED THE SAME ACCESS TO EMPLOYMENT AS THOSE THEY ARE TIRELESSLY SERVING. CHWS ARE TRADITIONALLY, NOT PART OF THE SYSTEMS THEY SUPPORT, NOR DO THEY HAVE ACCESS TO THE WORKPLACE BENEFITS. EMPLOYMENT REDUCES THE RELIANCE ON GRANT-BASED OR PROJECTBASED EMPLOYMENT FOR CHWS, A SOURCE OF INCOME INSECURITY. IN ADDITION TO THE PROGRAMMATIC OUTREACH AND INTERVENTION PROVIDED BY THE CHWS, THE CREATION OF THE JOBS FOR COMMUNITY MEMBERS WHO ARE TRAINED IN THIS WORK IS ALSO A FULFILLMENT OF THE COMMUNITY BENEFIT WORKFORCE DEVELOPMENT STRATEGY AS PRIORITY HIRING IS RESERVED FOR PEOPLE WITH LIVED EXPERIENCE IN NAVIGATING THE SOCIAL DETERMINANTS OF HEALTH, HAVING LIVED EXPERIENCE WITH POVERTY, AND THOSE WHO HAVE RECEIVED TRAINING TO BECOME COMMUNITY HEALTH WORKERS IN THE COMMUNITIES FROM WHICH THEY ARE FROM OR WITH SPECIAL POPULATIONS OF WHICH THEY HAVE SPECIAL KNOWLEDGE OR LIVED EXPERIENCE. RESOURCES ALLOCATED: ALL FOUR LICENSED HOSPITALS INVEST IN ICP OPERATIONS IN ORDER TO CARRY OUT THIS LEVEL OF PARTNERSHIP, RESPONSIVENESS, AND INTERVENTION IN OUR COMMUNITIES. ALL FOUR LICENSED HOSPITALS ARE INVESTING DOLLARS IN WORKFORCE DEVELOPMENT AND JOB CREATION FOR THE COMMUNITY HEALTH WORKER WORKFORCE PROGRAM AT LLUH. HOW THE NEEDS ARE DIRECTLY OR INDIRECTLY ADDRESSED: DUE TO THE REALITY THAT MORE NEEDS ARE OFTEN IDENTIFIED IN COMMUNITY HEALTH ASSESSMENTS THAN WHAT CAN BE ACTED UPON IN ORDER TO SHOW AN IMPACT, LLUH PRIORITIZED THE NEEDS AND IMPLEMENTATION STRATEGY ACCORDING TO THE HIGHEST PRIORITY NEEDS, REFLECTED IN THIS IMPLEMENTATION STRATEGY: A) DIRECTLY ADDRESSED BY THE CHIS AND THE ANNUAL SYSTEM ACTIVITIES THAT ARE IN ALIGNMENT WITH COMMUNITY BENEFIT PRINCIPLES AND CONNECTED TO THE 2019 CHNA NEEDS IDENTIFIED; B) INDIRECTLY ADDRESSED BY LLUH'S PARTNERSHIPS WITH OTHER ORGANIZATIONS ALREADY WORKING IN THESE AREAS IN THE COMMUNITY; C) NOT ADDRESSED DUE TO IT NOT BEING AN AREA OF EITHER DIRECT INVESTMENT OR INDIRECT WORK WITH PARTNER ORGANIZATIONS. THE LISTS OF THESE NEEDS ARE AVAILABLE IN OUR PUBLIC REPORTS. TO LEARN ABOUT HOW ALL NEEDS IDENTIFIED BY LLUH WERE EITHER ADDRESSED DIRECTLY, INDIRECTLY, OR NOT ADDRESSED, PLEASE SEE THE CHIS DOCUMENT PUBLICLY POSTED ON THE LLUH REPORTS WEBSITE FOR AN INVENTORY. FOR COMPLETE INFORMATION ON LLUH CHNA & CHIS AND THE ANNUAL COMMUNITY BENEFIT REPORTS FOR THE LLUH HOSPITALS, PLEASE VISIT: HTTPS://LLUH.ORG/ABOUT-US/COMMUNITY-BENEFIT/REPORTS-AND-RESOURCES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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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?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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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: LLUMC USES FPG TO DETERMINE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE TO LOW INCOME INDIVIDUALS.
PART I, LINE 6A: LLUH, ON BEHALF OF LLUMC, SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO OSHPD.
PART I, LINE 7: WE USED THE WORKSHEETS AVAILABLE IN THE INSTRUCTION SECTION OF SCHEDULE H TO DERIVE THE AMOUNTS REPORTED IN THIS SECTION.PART I, LINE 7G: HOME CARE -$113,446 & UNREIMBURSED ORGAN COSTS PART I, LINE 7 COLUMN E: HEALTH PROFESSIONALS EDUCATION & RESEARCH -$70,470,317PART I, LINE 7: MEDICAL CARE SERVICES - $94,108,182, COMMUNITY HEALTHIMPROVEMENT - $1,894,101 PART III, LINE 3: BAD DEBT - $6,839,359 PART III, LINE 8: N/A
PART I, LINE 7G: WE DID NOT INCLUDE ANY COST ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES.
PART II, COMMUNITY BUILDING ACTIVITIES: REFER TO 990, PART III, LN 4A & SCHEDULE O FOR MORE INFORMATION LOMA LINDA UNIVERSITY MEDICAL CENTER - COMMUNITY HEALTH BENEFIT SELECTED PROGRAM HIGHLIGHTS
PART III, LINE 2: IN FY19, LLUMC ADOPTED THE NEW REVENUE STANDARD USING THE MODIFIED RETROSPECTIVE METHOD. PATIENT SERVICE REVENUES ARE PRESENTED NET OF ESTIMATED IMPLICIT PRICE CONCESSION REVENUE DEDUCTIONS. THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED AND EXPECTED COLLECTIONS BASED ON HISTORICAL COLLECTIONS. SEE FOOTNOTE TO FY2020 LLUMC'S COMBINED FINANCIAL STATEMENTS, PAGE 14-16, NOTES TOCOMBINED FINANCIAL STATEMENTS
PART III, LINE 3: ESTIMATED AMOUNT OF BAD DEBT EXPENSE REPORTED FOR PATIENTS ELIGIBLE UNDER LLUMC'S FINANCIAL ASSISTANCE POLICY IS DERIVED BY DEVELOPING A COST-TO-CHARGE RATIO OF 18.14% (ADJUSTED PATIENT CARE COSTS/GROSS PATIENT CHARGES) AND MULTIPLYING AGAINST BAD DEBT EXPENSE. LLUMC'S ESTIMATED COSTS OF CARE FOR ELIGIBLE PATIENTS REPRESENT THE AMOUNT OF BAD DEBT EXPENSE RELATED TO COMMUNITY BENEFIT. THE RATIONALE FOR THIS METHODOLOGY IS THAT ELIGIBLE PATIENTS WILL QUALIFY FOR DEEPLY DISCOUNTED OR FULLY DISCOUNTED PAYMENT FINANCIAL ASSISTANCE THAT WOULD RESULT IN ADJUSTED CHARGES THAT ARE COMPARABLE WITH ACTUAL COST.
PART III, LINE 4: THE FOOTNOTE TO FY2020 LLUMC'S COMBINED FINANCIAL STATEMENTS THATDESCRIBES BAD DEBT EXPENSE IS FOUND ON PAGES 14-16, NOTES TO COMBINED FINANCIAL STATEMENTS.
PART III, LINE 9B: AS A FAITH BASED ORGANIZATION, LLUMC STRIVES TO MEET THE HEALTH CARE NEEDS OF PATIENTS IN ITS GEOGRAPHIC SERVICE AREA. THE FIRST AND FOREMOST RESPONSIBILITY OF LLUMC IS TO SEE THAT ITS PATIENTS RECEIVE COMPASSIONATE, TIMELY, AND APPROPRIATE MEDICAL CARE WITH CONSIDERATION FOR PATIENT PRIVACY, DIGNITY, AND INFORMED CONSENT.ELIGIBILITY UNDER THE LLUMC FINANCIAL ASSISTANCE POLICY IS PROVIDED FOR ANY PATIENT WHOSE FAMILY INCOME IS LESS THAN 350% OF THE CURRENT FEDERAL POVERTY LEVEL, IF NOT COVERED BY THIRD PARTY INSURANCE OR, IF COVERED BY THIRD PARTY INSURANCE WHICH DOES NOT RESULT IN FULL PAYMENT OF THE ACCOUNT.FOR FURTHER INFORMATION, PLEASE REFER TO OUR CHARITY CARE AND FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 2: THE COMMUNITY HEALTH NEEDS ASSESSMENT 2019 AS THE BASELINE FOR 2020-2022 IMPLEMENTATION STRATEGY: IN 2019, LOMA LINDA UNIVERSITY HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN PARTNERSHIP WITH NON-PROFIT, COMMUNITY-BASED PARTNERS AND THEIR COMMUNITY HEALTH WORKERS IN ORDER TO IMPLEMENT A SOCIAL DETERMINANTS OF HEALTH SURVEY WITH 1060 COMMUNITY MEMBERS AND DATA FROM THE LLUH PATIENT POPULATION; TO CONDUCT COMMUNITY CONVERSATIONS IN BOTH ENGLISH AND SPANISH (FOCUS GROUPS) WITH OVER 200 COMMUNITY MEMBERS; AND TO SURVEY 74 FAMILIES ON CHILDREN'S HEALTH. SEVENTY-NINE PERCENT OF THE PEOPLE WHO PARTICIPATED IN THE EXTENSIVE SURVEY EFFORT WERE FROM HOUSEHOLDS LIVING ON $50,000 A YEAR OR LESS, WITH 44% OF PARTICIPANTS LIVING ON $25,000 OR LESS. THE CHNA ACHIEVED A STATISTICALLY SIGNIFICANT SAMPLING OF COMMUNITY MEMBERS LIVING ON LOWER INCOMES AND ACHIEVED REPRESENTATION FOR THE 4.85 MILLION PEOPLE IN OUR REGION, IN KEEPING WITH COMMUNITY BENEFIT GUIDELINES FOR IDENTIFYING THE UN-MET HEALTH NEEDS OF THE MOST VULNERABLE MEMBERS OF THE COMMUNITY. MOST IMPORTANTLY, THE NEEDS IDENTIFIED THROUGH THE METHODOLOGY OF THIS STUDY WERE THOSE THE COMMUNITY MEMBERS IDENTIFIED AS THE MOST PRESSING NEEDS IN THEIR COMMUNITIES. OVER AND OVER AGAIN, THE DIFFICULTIES PEOPLE FACE DAY-TO-DAY IN AFFORDING THE ESSENTIALS AND BY THE EXPERIENCE OF POVERTY WERE ECHOED AS PEOPLE SHARED THE CHALLENGES WITH COST OF LIVING IN OUR REGION. THE TRIPLE IMPACT OF THE NEED FOR JOBS, AFFORDABILITY OF HOUSING, AND THE ABILITY TO AFFORD HEALTHY FOODS EXPERIENCED BY COMMUNITY MEMBERS MOVED POVERTY AND ACCESS TO ESSENTIALS TO THE TOP OF THE AREAS OF GREATEST NEED REPRESENTING A CLUSTER OF THE FOLLOWING: INCOME INSECURITY (OR THE NEED FOR JOBS), FOOD INSECURITY, AND AFFORDABLE HOUSING OR HOUSING INSECURITY. THE POPULATION DATA FROM LLUH & SAC HEALTH SYSTEM, AN FQHC PARTNER IN LLUH'S COMMUNITY HEALTH INVESTMENT STRATEGY, PROVIDED SUMMARY DATA ON THE TOP HEALTH NEEDS OF SOME OF THE MOST VULNERABLE POPULATIONS IN OUR REGION. FROM THE TWO SYSTEMS DATA, THE TRENDS INDICATE THAT THE CHRONIC DISEASE BURDEN IN LOWER INCOME POPULATIONS IN OUR COMMUNITY FORM A SET OF HEALTH CONDITIONS COLLECTIVELY REFERRED TO AS "LIFESTYLE DISEASE." GIVEN THE CORRELATION BETWEEN POVERTY, ACCESS TO CARE, AND THE PREVALENCE OF REDUCED OR POOR HEALTH DUE TO CHRONIC STRESS AT THE LOWER END OF THE SOCIOECONOMIC SPECTRUM, THE TOP HEALTH CONDITIONS PEOPLE ARE STRUGGLING IN OUR REGION ARE COLLECTIVELY REFERRED TO LIFESTYLE DISEASES WHERE THE SOCIAL DETERMINANTS OF HEALTH CONTRIBUTE TO HIGHER PREVALENCE RATES: ASTHMA, BEHAVIORAL HEALTH, CARDIOVASCULAR DISEASE, HYPERTENSION, AND OBESITY. IN ADDITION TO ACCESS TO CARE, A CORE FOCUS AREA OF COMMUNITY BENEFIT INVESTMENT STRATEGIES ON BEHALF OF THE MOST VULNERABLE, CONCERNS IN THE COMMUNITY OVER BEHAVIORAL HEALTH (INCLUDING SUBSTANCE USE) WAS BY FAR THE TOP RATED HEALTH CONCERNS OF THE COMMUNITY ACROSS ALL AGE GROUPS. ADDITIONALLY, THE PREVALENCE OF ISOLATION EXPERIENCED BY COMMUNITY MEMBERS WAS AN UNEXPECTED NEED IDENTIFIED: 1 IN 3 ADULTS WHO PARTICIPATED IN SURVEYS REPORTED FEELING ISOLATED. FINALLY, THE REMAINING AREA OF GREATEST NEED IDENTIFIED DUE TO THE AGGREGATION OF THE FINDINGS WAS THE NEED FOR SAFE PLACES TO PLAY FOR CHILDREN IN GREEN SPACES. OVER AND OVER AGAIN, COMMUNITY MEMBERS SHARED A LACK OF ACCESS TO SAFE GREEN SPACES WHERE FAMILIES AND ESPECIALLY CHILDREN COULD EXERCISE AND BE IN COMMUNITY WITH ONE ANOTHER. CRIME, LACK OF INFRASTRUCTURE, AND/OR LACK OF ACCESS DUE TO GEOGRAPHY WERE THE TOP REASONS WHY MANY COMMUNITIES LACK BASIC ACCESS TO SAFE GREEN SPACES WHERE FAMILIES AND ESPECIALLY CHILDREN COULD EXERCISE AND BE IN COMMUNITY WITH ONE ANOTHER. CRIME, LACK OF INFRASTRUCTURE, AND/OR LACK OF ACCESS DUE TO GEOGRAPHY WERE THE TOP REASONS WHY MANY COMMUNITIES LACK BASIC ACCESS.
PART VI, LINE 3: LLUMC POST NOTICES INFORMING THE PUBLIC OF THE CHARITY CARE/DISCOUNT PAYMENT POLICY. SUCH NOTICES SHALL BE POSTED IN HIGH VOLUME INPATIENT, AND OUTPATIENT SERVICE AREAS OF LLUMC, INCLUDING BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, INPATIENT ADMISSION AND OUTPATIENT REGISTRATION AREAS OR OTHER COMMON PATIENT WAITING AREAS OF LLUMC. NOTICES ARE ALSO POSTED AT ANY LOCATION WHERE A PATIENT MAY PAY THEIR BILL. NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE.1) THES NOTICES ARE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT ARE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN LLUMC'S SERVICE AREA.2) A COPY OF THIS CHARITY CARE/DISCOUNT PAYMENT POLICY IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. LLUMC WILL RESPOND TO SUCH REQUESTS IN A TIMELY MANNER.
PART VI, LINE 4: LOMA LINDA UNIVERSITY HEALTH'S PRIMARY SERVICE AREA CAN BE DEFINED, BROADLY, AS CALIFORNIA'S SAN BERNARDINO, RIVERSIDE, AND ONTARIO METROPOLITAN AREAS. SAN BERNARDINO AND RIVERSIDE COUNTIES MAKE UP THE GEOGRAPHIC AREA HISTORICALLY NAMED "THE INLAND EMPIRE" DUE TO THE REGION'S RICH DIVERSITY OF NATIVE PEOPLES AND AGRICULTURAL HISTORY. THE REGION TOTALS 27,000 SQUARE MILES AND IS SITUATED APPROXIMATELY 60 MILES EAST FROM THE LOS ANGELES METROPOLITAN AREA AND THE PACIFIC OCEAN, THE INLAND EMPIRE IS HOME TO A QUICKLY GROWING POPULATION OVER 4.6 MILLION PEOPLE AND IS THE 3RD MOST POPULOUS METROPOLITAN AREA IN THE STATE OF CALIFORNIA AND THE 13TH MOST POPULOUS METROPOLITAN AREA IN THE UNITED STATES. THE TWO COUNTIES ARE HOME TO SOME OF THE MOST DIVERSE PEOPLE IN CALIFORNIA, WITH HISPANIC POPULATIONS NOW REPRESENTING THE MAJORITY OF THE POPULATION. SAN BERNARDINO AND RIVERSIDE COUNTY HEALTH RANKINGS PUBLISHED ONLINE AT COUNTYHEALTHRANKINGS.ORG, THE RANKINGS HELP COUNTIES UNDERSTAND WHAT INFLUENCES THE HEALTH OF RESIDENTS AND AVERAGE LIFESPANS BY GEOGRAPHIC REGION. THE RANKINGS ARE UNIQUE IN THEIR ABILITY TO MEASURE THE CURRENT OVERALL HEALTH OF NEARLY EVERY COUNTY IN ALL 50 STATES. THEY ALSO LOOK AT A VARIETY OF MEASURES THAT AFFECT THE FUTURE HEALTH OF COMMUNITIES, SUCH AS HIGH SCHOOL GRADUATION RATES, ACCESS TO HEALTHY FOODS, RATES OF SMOKING, OBESITY AND TEEN BIRTHS. LLUH'S GOAL IS TO BRING PEOPLE TOGETHER TO LOOK AT THE MANY FACTORS THAT INFLUENCE HEALTH AND OPPORTUNITIES TO REDUCE HEALTH GAPS. FOR PROGRAMS AND INTERVENTIONS TO HAVE A LASTING IMPACT, THEY MUST FOCUS ON STRATEGIES THAT IMPROVE HEALTH FROM A POPULATION STANDPOINT. FOR LLUH, WE ARE STRATEGICALLY POSITIONED IN TWO COUNTIES THAT TOGETHER, FACE SIGNIFICANT ECONOMIC CHALLENGES. SAN BERNARDINO RANKS 41ST OUT OF 58 COUNTIES IN CALIFORNIA IN TERMS OF HEALTH FACTORS WHILE RIVERSIDE RANKS 35TH. DESPITE THE CHALLENGE, LLUH BELIEVES THAT OUR COMMUNITY IS RESILIENT AND WITH OUR COMMUNITY PARTNERS, WE ARE ADDRESSING POVERTY THROUGH WORKFORCE DEVELOPMENT AND HEALTH & WELLNESS. WITH A TOTAL OF 249,000 CONFIRMED CASES AS OF THE TIME OF THIS REPORT, AND OVER 2,800 DEATHS DUE TO COVID-19 ACROSS SAN BERNARDINO AND RIVERSIDE COUNTIES, THE PANDEMIC HAS A GREATLY IMPACTED THOSE LIVING IN THE REGION, WITH SOME OF THE BIGGEST CHALLENGES BEING FOOD INSECURITY, UNEMPLOYMENT, HOUSING BURDEN, AND SOCIAL ISOLATION. AS A RESULT OF THE PANDEMIC, THE NUMBER OF FOOD INSECURE HOUSEHOLDS HAS RISEN CONSIDERABLY, WITH LOCAL FOOD BANKS MORE THAN DOUBLING THE AMOUNT OF THEIR FOOD DISTRIBUTIONS. THE MOST GREATLY IMPACTED BY THE LACK OF ACCESS TO FOOD HAS BEEN MINORITY POPULATIONS AND FAMILIES WITH CHILDREN. UNEMPLOYMENT IN SAN BERNARDINO AND RIVERSIDE COUNTIES REACHED A PEAK OF 15% LEAVING 300,000 PEOPLE WITHOUT WORK, A SIGNIFICANT INCREASE FROM THE PREVIOUS, PRE-PANDEMIC RATE OF 4%. HOWEVER, UNEMPLOYMENT RATES IN THE REGION HAVE SINCE BEEN RECOVERING SLOWLY BUT STEADILY (AS OF OCTOBER 2020, THE UNEMPLOYMENT RATE IS AT 9%). LESS INCOME, COMBINED WITH AN ALREADY EXPENSIVE HOUSING MARKET THAT HAS RENT PRICES RISING AT A FASTER RATE THAN OTHER SOUTHERN CALIFORNIA COUNTIES, HAS INCREASED THE HOUSING BURDEN ON MANY HOUSEHOLDS IN THE REGION. ADDITIONALLY, ISOLATION, WHICH HAD ALREADY BEEN IDENTIFIED AS A GREAT NEED OF OUR COMMUNITY BEFORE THE SPREAD OF COVID-19, HAS BECOME EVEN MORE OF A CHALLENGE DUE TO PHYSICAL DISTANCING MEASURES AND A LACK OF ACCESS TO TECHNOLOGY. AS THE REGIONAL ACADEMIC, QUATERNARY, AND SPECIALTY CARE PROVIDER, LLUH SERVICE REGION COVERS ALMOST ONE QUARTER OF THE GEOGRAPHIC LANDMASS OF THE STATE OF CALIFORNIA, ESPECIALLY WHEN ACCOUNTING FOR THE SERVICE REGION OF CHILDREN'S HOSPITAL INTO INYO AND MONO COUNTIES. IN ADDITION TO THE 4.6 MILLION RESIDENTS OF THESE TWO COUNTIES, IT IS ESTIMATED DUE TO SEASONAL AGRICULTURAL WORK THAT THERE ARE ESTIMATED TO BE 296,000 IMMIGRANTS WHO ARE UNDOCUMENTED IN OUR TWO COUNTIES, WITH LLUH AS THE REGIONAL SAFETY-NET PROVIDER FOR ALL PEOPLE. IN 2019, LLUH HOSPITALS TREATED 53,455 PEOPLE IN OUR HOSPITALS, WITH 1.8 MILLION PEOPLE IN THE OUTPATIENT SYSTEM WITH 135,603 OF THOSE OUTPATIENT VISITS TO OUR EMERGENCY DEPARTMENTS AS A LEVEL-1 TRAUMA CENTER.
PART VI, LINE 5: LLUH HAS A CENTRALIZED COMMUNITY BENEFIT MODEL MANAGED BY AN INSTITUTE DEVOTED TO PROMOTING COMMUNITY HEALTH WITH PUBLIC HEALTH EXPERTISE: LLUH HAS A UNIQUE, BEST-PRACTICE MODEL IN THE IMPLEMENTATION OF COMMUNITY BENEFIT IN ORDER TO ACHIEVE COLLECTIVE IMPACT WITH THEIR INVESTMENT AND PROGRAM STRATEGY: SINCE 2006, ALL LICENSED HOSPITALS WITHIN THE LLUH SYSTEM HAVE CENTRALIZED THEIR COMMUNITY BENEFIT INVESTMENTS THROUGH THE INSTITUTE FOR COMMUNITY PARTNERSHIPS TO MORE STRATEGICALLY ALIGN AND IMPLEMENT COMMUNITY HEALTH INVESTMENTS AND SINCE THE BEGINNING, LLUH HAS REPORTED PROGRAMMATICALLY AT THE HEALTH SYSTEM LEVEL TO MAXIMIZE OUTCOMES. THE COMMUNITY BENEFIT NUMBERS ARE REPORTED FINANCIALLY AND INDEPENDENTLY ON EACH LICENSED HOSPITAL'S 990 SCHEDULE H BASED ON THEIR INDIVIDUAL HOSPITAL FINANCIALS WITH ATTENTIVE MANAGEMENT TO BOTH THE COLLECTIVE AND INDIVIDUAL PROGRAMS, ACTIVITIES, AND OUTCOMES REPORTED IN THE ANNUAL SYSTEM COMMUNITY BENEFIT REPORT, IN COMPLIANCE WITH THE ACA (2010) AND CALIFORNIA'S AB 204 (2019). THE CENTRALIZED MODEL ALLOWS THE HOSPITALS TO ACCOMPLISH MORE IMPACT IN THE COMMUNITY FROM THE COMMUNITY HEALTH IMPLEMENTATION STRATEGY (CHIS) AND IN MORE EFFECTIVELY WORKING WITH PARTNER ORGANIZATIONS WITH SIMILAR GOALS. THE INSTITUTE FOR COMMUNITY PARTNERSHIPS IS COMMITTED TO SUPPORTING IMPLEMENTATION OF LLUH'S HOSPITAL COMMUNITY BENEFIT INVESTMENTS AND FULFILLMENT OF THE PRIORITY FOCUS AREAS, IN CLOSE COLLABORATION WITH THE COMMUNITY, TO COMMUNITY-BASED RESEARCH, AND TO SERVICE-LEARNING AT LOMA LINDA UNIVERSITY HEALTH (LLUH). THE INSTITUTE PLAYS A CENTRALIZING, COORDINATING, AND IMPLEMENTATION FUNCTION FOR THE FOUR LICENSED HOSPITALS AT LLUH'S COMMUNITY BENEFIT INVESTMENT DOLLARS. OUR INSTITUTE IS COMMITTED TO STRATEGICALLY WORKING WITH OUR COMMUNITY PARTNERS TO BETTER UNDERSTAND AND ADDRESS THE NEEDS OF THE COMMUNITY THROUGH ACTIVITIES SUCH AS RESEARCH, TEACHING, AND SERVICE-BASED LEARNING. COMMUNITY PARTICIPATION IS AT THE CORE OF OUR EFFORTS, WITH STRUCTURED LEARNING OPPORTUNITIES FOR UNDERREPRESENTED MINORITY STUDENTS, TRAINING PROGRAMS FOR COMMUNITY HEALTH WORKERS, AND COMMUNITY RESEARCH PROJECTS. THE INSTITUTE FOR COMMUNITY PARTNERSHIPS: SEEKS TO WORK "WITH" THE COMMUNITY RATHER THAN "IN" THE COMMUNITY; STRIVES TO BETTER UNDERSTAND AND ADDRESS THE NEEDS OF THE COMMUNITY, WHILE RECOGNIZING AND CAPITALIZING ON ITS ASSETS; SEEKS TO INTEGRATE SERVICES FROM RESEARCH TO TEACHING THROUGH COMMUNITY-BASED PARTICIPATION AND SERVICE-BASED LEARNING; PROVIDES A SUPPORTING AND COORDINATING ROLE ACROSS THE VARIOUS SCHOOLS AND THE MEDICAL CENTER. OUR COMMUNITY BENEFIT OBJECTIVES INCLUDE: IMPROVING ACCESS TO HEALTH SERVICES; ENHANCING THE ROLE OF PUBLIC HEALTH IN HEALTH CARE SERVICES; SERVING THOSE WHO LIVE IN POVERTY OR OTHER VULNERABLE POPULATIONS; PROMOTING AND ENHANCING COMMUNITY BUILDING ACTIVITIES; AND COMMITTING TO COMMUNITY HEALTH IMPROVEMENT THROUGHOUT THE ORGANIZATION.
PART VI, LINE 6: EXPLANATION: AFFILIATED HEALTHCARE SYSTEMWE ARE AFFILIATED WITH LOMA LINDA UNIVERSITY HEALTH SYSTEM WHICH INCLUDES 4 HOSPITALS, A UNIVERSITY, AND A FACULTY MEDICAL GROUP; COLLECTIVELY PLAYING AN ACTIVE ROLE IN PROMOTING THE HEALTH OF THEIR COMMUNITIES. A DETAILED COMMUNITY BENEFIT REPORT OF THE HOSPITAL'S ACTIVITIES WILL BE PROVIDED UPON REQUEST.
PART VI, LINE 7, REPORTS FILED WITH STATES CA
Schedule H (Form 990) 2019
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