2023-11-01T12:38:10-05:00 2022-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2022-01-01 943015356 United Com-Serve UNIT 9164060000 726 Fourth Street Marysville CA 95901 Heidar Thordarson Treasurer 9164060000 2023-10-25 1 Heidar Thordarson 999009999 1 Tracy S Paglia P00366884 2099556100 2023-10-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Chris Champlin 726 Fourth Street Marysville CA 95901 29734224 0 X www.adventisthealth.org/rideout/ X 1985 CA Living God's love by inspiring health, wholeness, and hope. 4 2 249 0 0 0 0 0 26573203 25488765 2592970 4244949 0 510 29166173 29734224 0 0 0 0 13397408 14604504 0 0 0 15306225 15840143 28703633 30444647 462540 -710423 82150171 76593893 24446796 25142255 57703375 51451638 Living God's love by inspiring health, wholeness, and hope. 0 0 19927450 0 20645900 The Fountains is a skilled nursing facility and serves as a continuing care provider for patients requiring rehabilitation services subsequent to acute care hospital stay and as a long-term care provider. 2706197 0 2803764 The Courtyard is a 54-bed assisted living community for seniors who require assistance to maintain their highest level of independence. 1968143 0 2039101 The Gardens is a 36-bed assisted living community providing Alzheimer's and dementia residents with a safe and nurturing home environment with personal attention from professional caregivers. 24601790 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 249 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Wing Bill Dir/Chair thru 01/22 0.00 50.00 X X 0 2511347 56319 Heinrich Kerry Dir/Chair/CEO as of 01/22 0.00 50.00 X X 0 2131443 75065 Hofheins Todd Dir/Vice Chair/COO as of 01/22 0.00 50.00 X X 0 1971652 72279 Innocent Larry Director 0.00 4.00 X 0 26478 0 Reiner Richard Director 0.00 4.00 X 0 26478 0 Beaman John CFO/Asst Secretary as of 01/22 0.00 50.00 X 0 1361096 58476 Jobe Meredith Secretary 0.00 50.00 X 0 930036 39184 Champlin Christopher President 9.00 41.00 X 0 753943 53690 Thordarson Heidar Treasurer as of 06/22 9.00 41.00 X 0 561895 23851 Gonzalez Eduardo Treasurer thru 06/22 9.00 41.00 X 0 440206 46492 Jahn Andrew Care Division President thru 02/22 0.00 50.00 X 0 1409539 74100 Nahapetian Arby - Care Division Medical Officer thru 02/22 0.00 50.00 X 0 1334111 68537 Stevens Eric - Care Division Operations Executive thru 02/22 0.00 50.00 X 0 1315314 62845 Spenst Brett - Care Division Finance Officer thru 02/22 0.00 50.00 X 0 1322824 36101 Heard Alexander Medical Officer as of 04/22 2.00 48.00 X 0 701197 49343 Spencer Lindsey Operations Executive as of 06/22 2.00 48.00 X 0 634975 74050 Gordon Cyndy Patient Care Executive 0.00 40.00 X 0 484258 39695 Chibaya Daniel Operations Manager thru 06/22 0.00 40.00 X 0 374114 53020 Oliver Robin - Business Development Executive as of 05/22 2.00 48.00 X 0 207048 48629 Sheikh Azad Medical Officer thru 04/22 0.00 40.00 X 0 157165 44820 Pannu Devinder Director, Nursing Svcs 40.00 0.00 X 210225 0 72334 Pickard Carol Director, Assisted Living 40.00 0.00 X 225276 0 12124 Kaur Paramjit RN 40.00 0.00 X 201966 0 15528 Gill Narjeet RN 40.00 0.00 X 159717 0 55702 Bottger Ofelia RN 40.00 0.00 X 169920 0 29500 Reiner Scott - Former Dir/Vice Chair thru 12/21 0.00 50.00 X 0 1222073 36652 Byrnes John - Former Medical Officer, NCR thru 02/20 0.00 50.00 X 0 841204 65864 Eller Jeff Former President, NCR 0.00 9.00 X 0 352684 52686 Lonto Robert Former Reg HP Dir, NCR thru 02/20 0.00 50.00 X 0 270421 82148 Arrowsmith Monica - Business Development Leader thru 12/20 0.00 40.00 X 0 312204 31856 967104 21653705 1430890 18 1 1 1 Sodexo Inc and Affiliates PO Box 360170 Pittsburgh PA 152516170 Nutritional services 1649682 Intergro Rehab Services Inc PO Box 69268 Baltimore MD 212649268 Therapy services 1396343 Interim HealthCare Staffing PO Box 492557 Redding CA 960492557 Medical services 390069 CEP America California 2100 Powell Street Suite 400 Emeryville CA 94608 Medical services 168000 4 Patient service revenue 623000 25260639 25260639 Dietary service revenue 621400 8814 8814 219312 219312 25488765 4244949 4244949 510 0 510 510 510 29734224 25488765 0 4245459 X 10797293 9304282 1493011 414223 380577 33646 2601585 2394908 206677 791403 688396 103007 2900576 2900576 5767736 5543904 223832 198978 131481 67497 779729 62406 717323 1039592 1039367 225 4619 2071 2548 1890 250 1640 659240 659240 1030655 1028100 2555 268720 268720 Patient care supplies 2033796 1996841 36955 Leased equipment expens 41936 26448 15488 1112676 1074799 37877 30444647 24601790 5842857 0 66811201 61762663 2984202 3227604 48323 21728 124916 128204 34179565 23237800 11974949 10941765 206580 511929 82150171 76593893 1835341 2336002 7941 2290 22603514 22803963 24446796 25142255 X 57703375 51451638 57703375 51451638 82150171 76593893 -710423 -5541314 0 X 0 1 X 1 1 1 X X 1 Rideout Memorial Hospital 941387866 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1111122 1111122 29911841 20229066 9682775 1432465 1432465 0 1724137 1576269 147868 10941765 Payables to related organizations 22473855 Other liabilities 264115 Payables to third-party payors 65993 22803963 X Part X, Line 2: The principal operations of the System is exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2022 and 2021, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2019 in major tax jurisdictions. 1 1 0 0 0 0 0 0 0 Wing Bill Dir/Chair thru 01/22 0 263334 0 662638 0 1585375 0 12220 0 44099 0 2567666 0 0 Heinrich Kerry Dir/Chair/CEO as of 01/22 0 1817710 0 76 0 313657 0 12220 0 62845 0 2206508 0 0 Hofheins Todd Dir/Vice Chair/COO as of 01/22 0 1358421 0 376216 0 237015 0 12220 0 60059 0 2043931 0 0 Jahn Andrew Care Division President thru 02/22 0 1047840 0 349414 0 12285 0 12220 0 61880 0 1483639 0 0 Beaman John CFO/Asst Secretary as of 01/22 0 1047636 0 298600 0 14860 0 12220 0 46256 0 1419572 0 0 Nahapetian Arby - Care Division Medical Officer thru 02/22 0 927049 0 234212 0 172850 0 12220 0 56317 0 1402648 0 0 Stevens Eric - Care Division Operations Executive thru 02/22 0 896507 0 250602 0 168205 0 12220 0 50625 0 1378159 0 0 Spenst Brett - Care Division Finance Officer thru 02/22 0 817612 0 416845 0 88367 0 12220 0 23881 0 1358925 0 0 Reiner Scott - Former Dir/Vice Chair thru 12/21 0 348458 0 870709 0 2906 0 12220 0 24432 0 1258725 0 0 Jobe Meredith Secretary 0 639741 0 154687 0 135608 0 12220 0 26964 0 969220 0 0 Byrnes John - Former Medical Officer, NCR thru 02/20 0 154814 0 187322 0 499068 0 12220 0 53644 0 907068 0 0 Champlin Christopher President 0 567067 0 100076 0 86800 0 12220 0 41470 0 807633 0 0 Heard Alexander Medical Officer as of 04/22 0 455182 0 102263 0 143752 0 12220 0 37123 0 750540 0 0 Spencer Lindsey Operations Executive as of 06/22 0 382833 0 93331 0 158811 0 12220 0 61830 0 709025 0 0 Thordarson Heidar Treasurer as of 06/22 0 336809 0 69116 0 155970 0 12220 0 11631 0 585746 0 0 Gordon Cyndy Patient Care Executive 0 360774 0 69544 0 53940 0 12220 0 27475 0 523953 0 0 Gonzalez Eduardo Treasurer thru 06/22 0 187406 0 66841 0 185959 0 12220 0 34272 0 486698 0 0 Chibaya Daniel Operations Manager thru 06/22 0 105015 0 85412 0 183687 0 11223 0 41797 0 427134 0 0 Eller Jeff Former President, NCR 0 0 0 177886 0 174798 0 5337 0 47349 0 405370 0 0 Lonto Robert Former Reg HP Dir, NCR thru 02/20 0 175680 0 73176 0 21565 0 8113 0 74035 0 352569 0 0 Arrowsmith Monica - Business Development Leader thru 12/20 0 218607 0 56312 0 37285 0 9366 0 22490 0 344060 0 0 Pannu Devinder Director, Nursing Svcs 187393 0 20396 0 2436 0 6307 0 66027 0 282559 0 0 0 Oliver Robin - Business Development Executive as of 05/22 0 179311 0 71 0 27666 0 6211 0 42418 0 255677 0 0 Pickard Carol Director, Assisted Living 205590 0 14202 0 5484 0 6758 0 5366 0 237400 0 0 0 Kaur Paramjit RN 201891 0 75 0 0 0 6059 0 9469 0 217494 0 0 0 Gill Narjeet RN 159567 0 150 0 0 0 4791 0 50911 0 215419 0 0 0 Sheikh Azad Medical Officer thru 04/22 0 0 0 76074 0 81091 0 4715 0 40105 0 201985 0 0 Bottger Ofelia RN 169846 0 74 0 0 0 5098 0 24402 0 199420 0 0 0 Part I, Line 3 The filing organization did not compensate its top management official, any officers or key employees during the tax year. Compensation was determined and paid by a related organization using one or more methods reported in Line 3. Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health System/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Byrnes, John - severance payment - $465,750 Chibaya, Daniel - severance payment - $170,239 Gonzalez, Eduardo - severance payment - $162,089 Sheikh, Azad - severance payment - $80,524 Wing, Bill - severance payment - $1,584,880 Select executives agreed to participate in CAP-EX in place of a traditional insurance SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life participants are John Beaman, Jeff Eller, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Scott Reiner, Brett Spenst, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an of their corporate provided benefits. The balance is set aside for forfeiture and is at risk to the creditors of Adventist Health. Payouts substantial risks of forfeiture have lapsed. The plan was frozen for new amount equivalent to 41 percent of their base compensation, less the value nonvested deferred compensation that is subject to substantial risk of occur according to the participants' payment elections after all non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2022 Part II: Eller, Jeff, Former President, NCR was paid through an unrelated organization, Jeffrey D. Eller dba Mountaingate Coaching that was reported on Form 1099 and included in Schedule J, Part II. Form 990, Part VI, Section A, line 6 The sole member of the Organization is Rideout Memorial Hospital, a California nonprofit public benefit corporation. Form 990, Part VI, Section A, line 7a Each individual who is a director of the board of Stone Point Health shall automatically be a director of United Com-Serve, and shall serve as a director of United Com-Serve until such time as that person is no longer a director of Stone Point Health. Form 990, Part VI, Section A, line 7b The sole corporate member, Rideout Memorial Hospital, must approve all changes to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11b This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the Corporate Finance Officer and Market Financial Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, corporate officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the market president immediately. The System General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders and the board. In addition, the Organization's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The System General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System General Counsel retains the COIs for all individuals. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents, conflict of interest policy, or financial statements available to the public. Form 990, Part VII, Section A: Board compensation is for Adventist Health System/West Board of Directors only - not the Organization's Board of Directors. Form 990, Part IX, line 11g Other purchased services: Program service expenses 3,217,366. Management and general expenses 49,045. Fundraising expenses 0. Total expenses 3,266,411. Physician fees: Program service expenses 386,590. Management and general expenses 0. Fundraising expenses 0. Total expenses 386,590. Purchased medical services: Program service expenses 111,974. Management and general expenses 1,462. Fundraising expenses 0. Total expenses 113,436. Repairs and maintenance: Program service expenses 28,788. Management and general expenses 14,562. Fundraising expenses 0. Total expenses 43,350. Consulting fees: Program service expenses 58,018. Management and general expenses 35,006. Fundraising expenses 0. Total expenses 93,024. Contract labor: Program service expenses 449,582. Management and general expenses 0. Fundraising expenses 0. Total expenses 449,582. Other medical professional fees: Program service expenses 1,291,586. Management and general expenses 123,757. Fundraising expenses 0. Total expenses 1,415,343. Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 845174585 Hospital CA 501(c)(3) Line 3 Stone Point Health 0 Adventist Health Physicians Network 1 Adventist Health Way Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Adventist Health SystemWest 1 Adventist Health Way Roseville CA 95661 953484589 Integrated health system CA 501(c)(3) Line 10 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital 1 Adventist Health Way Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Paradise Valley Hospital 1 Adventist Health Way Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Rideout Memorial Hospital 726 Fourth Street Marysville CA 95901 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 0 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital & Health Care Services 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Stone Point Health 1 Adventist Health Way Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Walla Walla General Hospital 1 Adventist Health Way Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 0 Western Health Resources 1 Adventist Health Way Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 0 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 FRD Management Company LLC PO Box 2128 Marysville CA 95901 943335136 Operation of cancer center CA N/A 0 0 Blue Legacy Ventures LLC 1010 NE 2nd Avenue Miami FL 33132 871254649 Real property rental FL N/A 0 0 Blue Zones LLC 200 Southdale Center Edina MN 55435 271603327 Education MN N/A 0 0 PAR LLC dba CherryWood Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 931262371 Senior housing OR N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Senior housing OR N/A 0 0 PVHR2 LLC dba Parkview Memory Care at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Senior housing OR N/A 0 0 WWGHR LLC dba Wheatland Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Senior housing OR N/A 0 0 Fremont-Rideout Management Services Organization Inc 726 Fourth Street Marysville CA 95901 271350379 DME Sales CA N/A C 0 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center 1 Adventist Health Way Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 200 Southdale Center Edina MN 55435 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1