2022-11-11T09:40:35-06:00 2021-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2021-01-01 953484589 Adventist Health SystemWest ADVE 9164060000 1 Adventist Health Way Roseville CA 95661 John Beaman Chief Financial Officer 9164060000 2022-11-07 1 John Beaman 999009999 Tracy S Paglia P00366884 2099556100 2022-11-07 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Adventist Health Kerry Heinrich 1 Adventist Health Way Roseville CA 95661 789421387 0 1071 X www.adventisthealth.org/ X 1980 CA Living God's love by inspiring health, wholeness and hope. 14 11 4980 0 -263334 1538110 656685 5429366 594258703 727224459 5929276 26246985 57591236 30520577 658435900 789421387 3181946 3335425 0 0 389662256 396550549 0 0 2784570 347228956 508629879 740073158 908515853 -81637258 -119094466 3118796040 3327906475 3317448358 3061460820 -198652318 266445655 X Living God's love by inspiring health, wholeness and hope. 0 0 364688763 3335425 727224459 See Schedule O 364688763 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 2675 0 1 4980 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 14 11 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Reiner Scott Chair/CEO thru 12/21 50.00 0.00 X X 2940088 0 62418 Wing Bill Dir/Asst Secr/Vice Chair 50.00 0.00 X X 2459079 0 76222 Jahn Andrew Care Division President 50.00 0.00 X 1848683 0 72937 Beaman John Chief Business Officer 50.00 0.00 X 1366110 0 78586 Hofheins Todd CFO 50.00 0.00 X 1319147 0 59910 Newmyer Joyce Chief Culture Officer 50.00 0.00 X 1305176 0 68696 El-Asmar Hoda - Former Chief Clinical Officer thru 10/20 0.00 0.00 X 1264697 0 23191 Ashlock Mark - Former Amb/Post-Acute President thru 06/20 0.00 0.00 X 1180696 0 32717 Jacobson Carlton Treasurer/Asst Secr AHCL 50.00 0.00 X 1138512 0 60316 Nahapetian Arby Care Division Chief Medical Officer 50.00 0.00 X 1058113 0 78302 Eller Jeff President, NCR 0.00 50.00 X 1100138 0 22996 Kofl Andrea President, AHHF 50.00 0.00 X 1033401 0 56796 Wells Jason - Chief Strategy Consumer & Innovation Officer 50.00 0.00 X 981858 0 72937 Raffoul John President, AHWM 50.00 0.00 X 986729 0 56796 Issai Alice President, AHGL 50.00 0.00 X 973479 0 56796 Wolcott Daniel President, AHLM 50.00 0.00 X 932279 0 72937 Jobe Meredith Secretary 50.00 0.00 X 932705 0 59761 Byrnes John - Health Division Chief Medical Officer 50.00 0.00 X 906436 0 56796 Larsen David Senior Finance Officer 50.00 0.00 X 876757 0 67250 Zazone Dana - Health Informatics Officer thru 08/21 50.00 0.00 X 915848 0 25812 Stevens Eric Care Division Operations Executive 50.00 0.00 X 884611 0 49992 Itani Mohamad VP Ambulatory Services thru 04/21 50.00 0.00 X 918086 0 15547 Long Collier - Business Development Executive thru 08/21 50.00 0.00 X 853660 0 18660 Beehler Robert Mkt Dev, M&A Exec thru 12/21 50.00 0.00 X 792803 0 56796 Takahashi Patrick Medical Officer, AHWM 50.00 0.00 X 785190 0 48929 Rawson Richard President, AHRO thru 10/21 50.00 0.00 X 790001 0 41954 Spenst Brett Care Division Finance Officer 50.00 0.00 X 786101 0 45300 Liebowitz Jacalyn System Chief Nursing Officer 50.00 0.00 X 750899 0 67250 Cowan Joshua Vice President, Strategy & Comm thru 02/21 50.00 0.00 X 795652 0 16711 Ferch Wayne Former President, CCR thru 02/20 0.00 0.00 X 586112 0 18351 Raethel Kathryn President, AHCS thru 08/21 50.00 0.00 X 572765 0 31053 Bancarz Gloria - System Chief Quality Officer thru 06/21 50.00 0.00 X 579986 0 16221 Olson Joaline - Former Chief Human Performance Officer, AHRS thru 0.00 0.00 X 560119 0 22512 Briggs Sharlet Former President, AHBD thru 08/20 0.00 0.00 X 548135 0 32738 Heinrich Kerry Dir/CEO Elect as of 11/21 50.00 0.00 X 282697 0 2627 Reppert Joseph Former CFO/Asst Secr thru 08/19 0.00 0.00 X 179119 0 11442 Conklin Jeffrey - Former Payer Strategy Exec thru 07/19 0.00 0.00 X 166324 0 16799 Freedman John Dir/Vice Chair/Chair as of 08/21 4.00 0.00 X X 26435 0 0 Banks David Director 4.00 0.00 X 26159 0 0 Cherry Robert Director 4.00 0.00 X 26159 0 0 Davis Andrew Director 4.00 0.00 X 26159 0 0 Innocent Larry Director 4.00 0.00 X 26159 0 0 Reiner Richard Director 4.00 0.00 X 26159 0 0 Graham Ricardo Dir/Chair thru 08/21 4.00 0.00 X X 19545 0 0 Woodson Marc Director 4.00 0.00 X 15909 0 0 Salazar Velino Director 4.00 0.00 X 6058 0 0 Ocampo Lucy Director 4.00 0.00 X 159 0 0 Fehr Joy Director 4.00 0.00 X 114 0 0 Newton Bradford Dir/Vice Chair as of 08/21 4.00 0.00 X X 0 0 0 36551206 0 1675054 895 1 1 0 Cerner Corporation 2800 Rockcreek Pkwy Kansas City MO 64117 IT solutions management 6216763 Trizetto Provider Solutions LLC 28125 Network Pl Chicago IL 60673 Software solutions 2893291 Deloitte and Touche LLP PO Box 844708 Dallas TX 75284 Consulting services 2722433 Cope Healthcare Consulting Inc 1150 S Olive St Ste 1200 Los Angeles CA 90015 Consulting services 2317395 Latham and Watkins LLP PO Box 894256 Los Angeles CA 90189 Legal services 1985782 88 4900564 528802 4900564 5429366 Management fees 541610 706746506 702972674 3773832 Other program service rev 621990 20477953 20477953 727224459 6697052 6697052 19548933 1000 0 0 19548933 1000 19549933 19549933 Health plan liability adj 561000 26351268 26351268 Vendor rebates 621990 11717659 4608240 7109419 Other revenue 900099 1376000 1376000 -8924350 -8645406 -278944 30520577 789421387 723450627 -263334 60804728 X 3319850 3319850 15575 15575 28862704 28862704 6216954 1574002 4642952 275663627 79037492 196008740 617395 17532092 2421750 15090260 20082 48946139 11905213 36972776 68150 19329033 5131609 14153231 44193 2524074 2524074 8659440 8659440 8174345 8174345 984049 984049 232213271 67268354 163421981 1522936 24371258 24371258 8657988 882413 7773093 2482 167435767 154756270 12175004 504493 6541169 5318258 1222911 2419984 427309 1988878 3797 75803 2537 72224 1042 18514594 18514594 14905721 6633383 8272338 428126 404173 23953 Income taxes 2054137 1603826 450311 Patient care supplies 1183789 1183789 Rental/lease costs equi 194889 74180 120709 9291475 3230137 6061338 908515853 364688763 541042520 2784570 109284618 135374941 97245 89184 726 9297 54208997 55371889 5870461 14305802 47575339 63431497 556949962 260747697 308997175 296202265 2019971606 1786832863 179586727 424442133 143935557 159048311 249267589 392798293 3118796040 3327906475 261367830 318646602 0 2936887 2043611693 2026833028 59997108 29999750 952471727 683044553 3317448358 3061460820 X -199886561 265165453 1234243 1280202 -198652318 266445655 3118796040 3327906475 X -119094466 69962054 509121661 5108724 X 0 1 X 1 1 1 X 96561 7311552 795492 656685 5429366 14289656 336953180 336205379 499824640 691252418 723450627 2587686244 337049741 343516931 500620132 691909103 728879993 2601975900 310029 7240793 9928758 14696260 16936877 49112717 0 310029 7240793 9928758 14696260 16936877 49112717 2552863183 8329768 2629457 5992756 4347721 6697052 27996754 8329768 2629457 5992756 4347721 6697052 27996754 517858 573287 1091145 660599 15292368 61655228 34557743 112165938 345897367 347380274 521905256 757912052 770134788 2743229737 0.93060 0.89490 0.01020 0.04140 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous revenue RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 984049 984049 0 Part II-B, Line 1: Adventist Health engages lobbyists and belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. 2383951 528802 482842 2429911 3418916 656685 1691650 2383951 3006309 795400 3399636 3782429 3418916 1146338 7277972 -3327136 2090865 3006309 1131235 96561 18082 94541 4999 1146338 0.47000 0.00000 0.53000 0 0 43409816 43409816 133709230 20013213 113696017 12828554 2577882 10250672 367002362 238156602 128845760 296202265 Partnership interests 100120152 F Hedge funds 324321981 F 424442133 Receivables from related organizations 371729758 Other receivables 15532605 Other assets 5535930 392798293 Payables to related organizations 514539265 Malpractice liability 90561289 Workers' compensation liability 66505236 Payables to third-party payors 8085193 Other liabilities 3353570 683044553 X Part V, Line 4: A $1M board-designated fund was established to honor a former AH president. The earnings are used to provide funding for paying college student interns and graduate student residents as they participate in tracks such as accounting/finance, human resources, communications and management with the goal of introducing the participants to career options in the integrated health care field. Individuals who participate in the program frequently become employed within the AH system upon completion of their academic studies. Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 50l(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, 2021 and 2020, 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 2018 in major tax jurisdictions. Central America and the Caribbean 0 0 Program services Administration, legal and accounting fees 61750 Central America and the Caribbean 0 0 Program services Reinsurance fees 1803000 Central America and the Caribbean 0 0 Investments in region N/A 292242665 Europe 0 0 Investments in region N/A 37130599 0 0 0 0 0 0 331238014 0 331238014 1 0 1 1 1 0 Part I, line 3: Accrual method Part III Accounting Method: 1 Adventist Development & Relief Agency 12501 Old Columbia Pike Silver Springs MD 20904 521314847 501(c)(3) 742600 0 COVID-19 Response $25,000 / Mission to Africa $717,600 Andrews University 4145 East Campus Circle Drive Berrien Springs MI 491041502 381627600 501(c)(3) 6250 0 Urban Mission and Ministry Congress Sponsorship Baldridge Foundation 1717 Pennsylvania Avenue NW Suite 1025 Washington DC 20006 592891462 501(c)(3) 100000 0 Founding Membership Feather River Health Foundation 1 Adventist Health Way Roseville CA 95661 680002188 501(c)(3) 420000 0 Forklift purchase and general support General Conference of Seventh Day Adventist 12501 Old Columbia Pike Silver Springs MD 20904 520643036 501(c)(3) 15000 0 Donation to Sanatorio Adventist/Clinica Belgrano Gleanings for the Hungry 43029 Rd 104 Dinuba CA 93618 770170546 501(c)(3) 8000 0 Donation for Columbia Shipments Inter-American Division Inc PO Box 830518 Miami FL 33283 11500 0 Donation to Dental Clinic/Mexico Northwest Medical Foundation Tillamook 1000 Third Street Tillamook OR 97141 930622075 501(c)(3) 6000 0 NAAHHR Sponsorship SonBridge Community Center 1200 SE 12th St Suite 1 College Place WA 99324 202958334 501(c)(3) 150000 0 Donation to run dental clinic Walla Walla University 204 S College Ave College Place WA 99324 910617727 501(c)(3) 1855000 0 Community Wellbeing Implementation $1,850,000 / Donald Blake Center - Equity Conference $5,000 9 1 Caring Connection 12 15575 Part I, Line 2: Funding provided to other organizations is provided to recipients with the understanding that the funds are being used only for the designated purposes. No monitoring is conducted by AH. X X 1 1 X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Chair/CEO thru 12/21 1801000 0 1112062 0 27026 0 11644 0 50774 0 3002506 0 0 0 Wing Bill Dir/Asst Secr/Vice Chair 1440800 0 991833 0 26446 0 11644 0 64578 0 2535301 0 0 0 Jahn Andrew Care Division President 1044420 0 600285 0 203978 0 11644 0 61293 0 1921620 0 0 0 Beaman John Chief Business Officer 892500 0 455303 0 18307 0 11644 0 66942 0 1444696 0 0 0 Hofheins Todd CFO 999600 0 116549 0 202998 0 11644 0 48266 0 1379057 0 0 0 Newmyer Joyce Chief Culture Officer 728980 0 447399 0 128797 0 11644 0 57052 0 1373872 0 107631 0 El-Asmar Hoda - Former Chief Clinical Officer thru 10/20 0 0 407203 0 857494 0 0 0 23191 0 1287888 0 0 0 Ashlock Mark - Former Amb/Post-Acute President thru 06/20 0 0 426536 0 754160 0 0 0 32717 0 1213413 0 0 0 Jacobson Carlton Treasurer/Asst Secr AHCL 267194 0 62829 0 808489 0 12672 0 47644 0 1198828 0 0 0 Nahapetian Arby Care Division Chief Medical Officer 700000 0 222478 0 135635 0 11644 0 66658 0 1136415 0 0 0 Eller Jeff President, NCR 531828 0 547897 0 20413 0 0 0 22996 0 1123134 0 0 0 Kofl Andrea President, AHHF 624000 0 263477 0 145924 0 11644 0 45152 0 1090197 0 0 0 Wells Jason - Chief Strategy Consumer & Innovation Officer 654569 0 228465 0 98824 0 11644 0 61293 0 1054795 0 0 0 Raffoul John President, AHWM 598791 0 254842 0 133096 0 11644 0 45152 0 1043525 0 0 0 Issai Alice President, AHGL 606722 0 251048 0 115709 0 11644 0 45152 0 1030275 0 0 0 Wolcott Daniel President, AHLM 601280 0 226669 0 104330 0 11644 0 61293 0 1005216 0 0 0 Jobe Meredith Secretary 616324 0 169142 0 147239 0 14609 0 45152 0 992466 0 0 0 Byrnes John - Health Division Chief Medical Officer 622962 0 172647 0 110827 0 11644 0 45152 0 963232 0 0 0 Larsen David Senior Finance Officer 567118 0 201820 0 107819 0 11644 0 55606 0 944007 0 0 0 Zazone Dana - Health Informatics Officer thru 08/21 263400 0 170916 0 481532 0 0 0 25812 0 941660 0 0 0 Stevens Eric Care Division Operations Executive 749000 0 76 0 135535 0 16336 0 33656 0 934603 0 0 0 Itani Mohamad VP Ambulatory Services thru 04/21 110757 0 102064 0 705265 0 14 0 15533 0 933633 0 0 0 Long Collier - Business Development Executive thru 08/21 388924 0 201516 0 263220 0 1156 0 17504 0 872320 0 0 0 Beehler Robert Mkt Dev, M&A Exec thru 12/21 510962 0 150206 0 131635 0 11644 0 45152 0 849599 0 0 0 Takahashi Patrick Medical Officer, AHWM 495519 0 177452 0 112219 0 11644 0 37285 0 834119 0 0 0 Rawson Richard President, AHRO thru 10/21 507813 0 190684 0 91504 0 0 0 41954 0 831955 0 0 0 Spenst Brett Care Division Finance Officer 734400 0 38124 0 13577 0 11644 0 33656 0 831401 0 0 0 Liebowitz Jacalyn System Chief Nursing Officer 507000 0 165422 0 78477 0 11644 0 55606 0 818149 0 0 0 Cowan Joshua Vice President, Strategy & Comm thru 54806 0 108880 0 631966 0 14 0 16697 0 812363 0 0 0 Ferch Wayne Former President, CCR thru 02/20 0 0 585289 0 823 0 0 0 18351 0 604463 0 0 0 Raethel Kathryn President, AHCS thru 08/21 281445 0 198882 0 92438 0 11644 0 19409 0 603818 0 0 0 Bancarz Gloria - System Chief Quality Officer thru 06/21 269028 0 0 0 310958 0 0 0 16221 0 596207 0 0 0 Olson Joaline - Former Chief Human Performance Officer, AHR 0 0 92800 0 467319 0 0 0 22512 0 582631 0 0 0 Briggs Sharlet Former President, AHBD thru 08/20 0 0 0 0 548135 0 0 0 32738 0 580873 0 0 0 Heinrich Kerry Dir/CEO Elect as of 11/21 138538 0 123000 0 21159 0 0 0 2627 0 285324 0 0 0 Reppert Joseph Former CFO/Asst Secr thru 08/19 0 0 0 0 179119 0 0 0 11442 0 190561 0 0 0 Conklin Jeffrey - Former Payer Strategy Exec thru 07/19 0 0 0 0 166324 0 0 0 16799 0 183123 0 8402 0 Part I, Line 1a First-class or charter travel - board directors are reimbursed for travel in business class for flight segments of three hours or more. If business class is unavailable, first class is reimbursed. This policy was adopted to aid in the attendee being able to work during the flight(s). Key employees occasionally utilize charter travel when alternative transportation methods cannot accommodate schedules. This is not reported as taxable income. Tax indemnification and gross-up payments - received by 10 directors; reported as taxable income. 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. Ashlock, Mark - severance payment - $749,559 Bancarz, Gloria - severance payment - $249,922 Briggs, Sharlet - severance payment - $546,914 Conklin, Jeffrey - severance payment - $167,580 Cowan, Joshua - severance payment - $623,422 El-Asmar, Hoda - severance payment - $857,260 Itani, Mohamad - severance payment - $687,764 Long, Collier - severance payment - $188,906 Olson, Joaline - severance payment - $468,375 Reppert, Joseph - severance payment - $179,957 Zazone, Dana - severance payment - $440,689 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Jacobson, Carlton - contributed and distributed - $772,048 Larsen, David - contributed and distributed - $2,496 Raffoul, John - participant, no activity in 2021 Select executives agreed to participate in CAP-EX in place of a traditional SERP. See Schedule L, Part V, for a broader description. Split-Dollar life insurance participants are Mark Ashlock, John Beaman, Jeff Eller, Wayne Ferch, Todd Hofheins, Andrew Jahn, Joyce Newmyer, JoAline Olson, 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 amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Conklin, Jeffrey - $8,402 Jahn, Andrew - participant, no activity in 2021 Newmyer, Joyce - $107,631 A CSCDA Series A 2007 680164610 1307957C5 2007-05-08 57500000 See Part VI 0 0 0 B CHFFA Series B 2009 521643828 13033LBC0 2009-05-20 30000000 See Part VI 0 0 0 C CHFFA Series C 2011 521643828 000000000 2011-06-09 130000000 See Part VI 0 0 0 D CHFFA Series A 2013 521643828 13033LS65 2013-02-14 208420907 See Part VI 0 0 0 A 21440000 57500000 643910 1409177 4480297 50966616 2010 0 0 1 1 B 30000000 216916 29783084 2009 0 0 1 1 C 49490000 130000000 478200 129521800 2015 0 0 1 1 D 44180000 208420907 979977 207440930 2016 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: CHFFA Series B 2009 Date the Rebate Computation was Performed: 06/17/2019 Issuer Name: CHFFA Series C 2011 Date the Rebate Computation was Performed: 07/14/2021 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Issuer Name: CHFFA Series A 2016 Date the Rebate Computation was Performed: 10/19/2021 Part I, Columns (A-D) Issuer's Name: CSCDA - California Statewide Communities Development Authority CHFFA - California Health Facilities Financing Authority HFA - The Hospital Facilities Authority of Multnomah County, Oregon Part I, Entity 1, Column (f), Line A: Construct, equip and remodel the following health care facilities: Feather River Hospital, Paradise, CA Hanford Community Hospital, Hanford, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Part I, Entity 1, Column (f), Line B: Acquire, construct and equip the following health care facilities: Adventist Health Clearlake Hospital Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Part I, Entity 1, Column (f), Line C: Refinance a bank loan used to construct, equip the following health care facilities: Adventist Health Clearlake Hospital, Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA Part I, Entity 1, Column (f), Line D: Refund outstanding balance of the following bond issues: 2002 California Health Facilities Financing Authority (AHS/West Series A) bonds issued March 20, 2002 2002 California Health Facilities Financing Authority (AHS/West Series B) bonds issued March 2002 2003 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 1, 2003 Part I, Entity 2, Column (f), Line A: Acquire, construct, and equip the following health care facilities: Central Valley General Hospital, Hanford, CA Feather River Hospital Paradise, CA Willits Hospital, Inc, Willits, CA Hanford Community Hospital, Hanford, CA San Joaquin Community Hospital, Bakersfield, CA Ukiah Valley Hospital, Ukiah, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA Part I, Entity 2, Column (f), Line B: Refund outstanding balance of the following bond issue: 2005 California Statewide Communities Development Authority (AHS/West Series A) bonds issued on October 18, 2005 Part I, Entity 2, Column (f), Line C: Acquire, construct, and equip the following health care facilities: Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Part I, Entity 2, Column (f), Line D: Advance refund outstanding balance of the following bond issues: 1998 California Health Facilities Financing Authority (AHS/West Series A) issued February 18, 1998 2007 California Statewide Communities Development Authority (AHS/West Series B) bonds issued May 8, 2007 2007 California Statewide Communities Development Authority (Lodi) bonds issued December 13, 2007 2009 California Health Facilities Financing Authority (AHS/West Series A) bonds issued May 20, 2009 Part I, Entity 3, Column (f), Line A: Finance the new headquarters facility for the Corporation located in Roseville, CA and refinance the following bond issues: City of Marysville, CA Rideout Series 2011 Bonds acquired in the affiliation with The Fremont-Rideout Health Group and Rideout Memorial Hospital effective April 1, 2018 Part I, Entity 3, Column (f), Line B: Refund the outstanding balance of the following bond issue: 2009 HFA - The Hospital Facilities Authority of Multnomah County, Oregon (AHS/West Series A) issued September 30, 2009 Part II, Entity 1, Line 11, Column D: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow. Part II, Entity 2, Line 11, Columns B & D: The other spent proceeds are the refunding proceeds no longer in escrow. Part II, Entity 3, Line 11, Column A: The other spent proceeds are the proceeds used to pay off the taxable line of credit which was used to finance initial costs of the project. Part II, Entity 3, Line 11, Column B: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow. A CHFFA Series A 2013 521643828 13033LS57 2013-02-14 100741934 See Part VI 0 0 0 B CSCDA Series A 2015 680164610 13080SJL9 2015-06-30 157990834 See Part VI 0 0 0 C CSCDA Series A 2015 680164610 13080SJM7 2015-06-30 42422999 See Part VI 0 0 0 D CHFFA Series A 2016 521643828 13032UGL6 2016-09-08 309720490 See Part VI 0 0 0 A 5935000 100741934 741934 100000000 2016 0 0 1 1 B 14118000 157990834 1493445 9150 156488239 2015 1 0 1 1 C 3982000 42422999 420423 2576 42000000 2019 0 0 1 1 D 54650000 309720490 2280369 307440121 2016 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 0 0 0.00000 0.00020 0.00020 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 A CSCDA Series A 2018 680164610 13080SWK6 2018-09-27 272074615 See Part VI 0 0 0 B HFA Multnomah 2019 931266280 62551PCX3 2019-11-13 60886489 See Part VI 0 0 0 A 950000 272074615 2098459 242976156 27000000 2019 0 1 1 1 B 60886489 493229 60393260 2019 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 Ashlock M Former Key employee Supplemental retirement CASD X 3724014 3780692 0 1 1 Beaman J Key employee Relocation X 125000 292150 0 1 1 Beaman J Key employee Supplemental retirement CASD X 3133349 3176405 0 1 1 Beehler R Key employee Relocation X 100000 72600 0 1 1 Byrnes J Key employee Relocation X 200000 193600 0 1 1 Eller J Key employee Supplemental retirement CASD X 7956827 8077927 0 1 1 Ferch W Former Key employee Supplemental retirement CASD X 6584597 6684812 0 1 1 Hofheins T Officer Supplemental retirement CASD X 1200000 1211081 0 1 1 Jahn A Key employee Relocation X 400000 392850 0 1 1 Jahn A Key employee Supplemental retirement CASD X 963176 971696 0 1 1 Jobe M Officer Relocation X 100000 76900 0 1 1 Larsen D Key employee Relocation X 150000 146000 0 1 1 Liebowitz J Key employee Relocation X 150000 147300 0 1 1 Newmyer J Key employee Supplemental retirement CASD X 4475347 4543460 0 1 1 Olson J Former Key employee Supplemental retirement CASD X 1862254 1890597 0 1 1 Rawson R Key employee Relocation X 100000 93600 0 1 1 Reiner S Officer Supplemental retirement CASD X 12103504 12269403 0 1 1 Spenst B Key employee Supplemental retirement CASD X 990000 998757 0 1 1 Stevens E Key employee Relocation X 200000 198800 0 1 1 Wing B Officer Relocation X 200000 185200 0 1 1 Wing B Officer Supplemental retirement CASD X 9637107 9769159 0 1 1 Wolcott D Key employee Relocation X 200000 198900 0 1 1 55371889 Beehler Matthew Family member of Key EE, B. Beehler 474800 Employment 0 Bancarz Michelle Family member of Key EE, G. Bancarz 181669 Employment 0 Bancarz Theodore Family member of Key EE, G. Bancarz 150618 Employment 0 Eller Eric Family member of Key EE, J. Eller 109296 Employment 0 Ferch Josiah Family member of Former Key EE, W. Ferch 121378 Employment 0 PVHR LLC Greater than 35% owned by former Director, M. Gabriel and family members Interest 0 Ashlock Ryan Family member of Former Key EE, M. Ashlock 536242 Employment 0 Part II, Supplemental Retirement Benefits: The organization provides supplemental retirement benefits through an alternative funding arrangement the IRS calls "collateral assignment split dollar" (CASD). Although the IRS requires reporting in the loan section of Schedule L, CASD is not an actual loan - no funds are transferred to the executive. Rather, the "loan" treatment applies because after the executive has received retirement benefits, the organization recovers all outlays plus interest.The recovery right is a key advantage of CASD for the organization. Rather than paying retirement benefits to the executive that would never be recovered, under CASD the organization recovers not only its outlays, but also consideration for the time value of money.CASD works as follows. The organization deposits funds into a cash value life insurance policy on the executive's life. During life, to the extent the executive fulfills service and vesting requirements, the executive can borrow against values in the policy to supplement retirement income. Policy performance is closely monitored. If policy performance lags, the executive's borrowing rights are reduced to protect the organization's recovery rights.At the executive's death, the policy death proceeds are first used to repay the organization its deposits plus compounded interest (at the IRS long-term applicable federal rate). The executive's beneficiary then receives any projected retirement borrowing the executive did not access during life. Any remaining death proceeds were available to be paid to the executive's beneficiary. However, the executives made a gift of the excess proceeds, estimated to total $118 million, to the organization to provide additional funding for the organization's charitable activities.Gift of excess proceeds (estimated):Mark Ashlock $6,524,818; John Beaman $8,065,764; Jeff Eller $14,691,335; Alan Ferch $10,168,008; Todd Hofheins $6,001,825; Andrew Jahn $9,547,699; Joyce Newmyer $5,794,901; JoAline Olson $1,753,593; Brian Reiner $19,715,436; Brett Spenst $2,526,693; Jack Wagner $13,041,026; Bill Wing $17,275,773; Beth Zachary $2,739,445. Part IV, Page 1, Line 1: Melody Gabriel, a former AH director, and her husband are owners and officers of businesses that engage in joint ventures with AH and member hospitals. Other family members with ownership and officer positions in these businesses include her parents, her brother and his wife, and trusts established on behalf of her children. The ventures are organized as LLCs. At the end of 2021, PVHR, LLC had an outstanding balance of $1,215,042 secured and unsecured market rate interest bearing loans. This LLC is 50% controlled by another LLC of which Ms. Gabriel and her family have a controlling interest. Interest is accrued on these loans, principal and interest at the end of 2021 was $307,026. Principal and interest payments are being made monthly. Total interest paid during 2021 was $21,722. X Fixed assets 1 4900564 Net book value 0 0 0 0 Part I, Column (b): The number of contributors is reported in column (b). Form 990, Part III, Line 4a: Adventist Health is a faith-based, nonprofit integrated health system serving more than 80 communities on the West Coast and Hawaii. Founded on Seventh-day Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care agencies, hospice agencies and joint-venture retirement centers in both rural and urban communities. Our compassionate and talented team of 34,000 includes associates, medical staff physicians, allied health professionals and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope. Together, we are transforming the American healthcare experience with an innovative, yet timeless, whole person focus on physical, mental, spiritual and social healing. Mission-driven The healthcare industry continues to experience significant changes. From high and rising costs to regulatory initiatives, these issues are causing hospitals and health systems to re-think who they are and how they want to deliver care. At Adventist Health, we are thriving and growing in the face of this transition by building on our legacy and re-establishing ourselves as the leader in physical, mental, spiritual and social health. We remain committed to "living God's love by inspiring health, wholeness and hope." Our mission represents the heart of our people. It expresses that we know the love of God and consistently reflect that love in our actions, relationships and work. Mission is the reason our organization exists. Community Health Development Adventist Health's commitment to improve well-being not only grew out of our mission to live God's love, but also from the needs we see in communities across our system of 23 hospitals. While diseases of despair continue to escalate along with healthcare costs, we are presented with the opportunity to bring whole person care, philanthropy, public heath, human services, government, community members, and business owners together to change the well-being of people, places, and equity. A key step toward well-being transformation is the integration of well-being into our strategy, providing a foundation for impacting measurable and sustainable well-being improvement for individuals, organizations and communities. This strategy was further strengthened in 2020 after the Adventist Health acquisition of Blue Zones, a pioneer in taking a systemic and environmental approach to improving the health of entire cities and communities. Moving toward our vision to see a time when well-being is accessible to everyone, the Well-Being team works with Blue Zones to design, leverage and demonstrate evidence-informed solutions that measurably and sustainably improve well-being. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint and as we enter 2022 these projects are currently active, with many community members actively taking the pledge to live longer healthier lives. Complementing the broad population-wide impact of Blue Zones specific initiatives, the Well-Being team leads strategies for community health well-being improvement and clinical integration initiatives across the Adventist Health footprint (ex: ACEs, mobile health, transportation, recuperative care, etc.) across our markets that, like Blue Zones Projects, align and respond to overlapping needs identified in each hospital Community Health Needs Assessment (CHNA). The well-being strategies are broken down into three tiers; Tier One: Access to Care, Financial Stability, and Mental Health; Tier Two: Health Risk Behaviors and Health Conditions; Tier Three: Food Security, Housing and Homelessness. Behind the scenes work includes the production of performance management dashboards to achieve functionality and communicate impact, and the development of program-specific logic models. An example of a market meeting all Tier One strategies has been at Adventist Health Rideout, along with Yuba and Sutter Counties. Together, they developed a multi-sector care management program that transforms the care and outcomes of community members with a primary behavioral health diagnosis. This program alone has led to a 16% decline in inpatient visits, 36% drop in overall volume of Emergency Department (ED) visits, and a significant 97% decline in ED utilization. These intentionally targeted and strategically aligned initiatives not only alleviate a significant equity gap in our communities but have also proven to produce lasting, transformative change. Adventist Health has developed a substantiated capacity for vulnerable population community well-being solutions designed for replication-further establishing our commitment to ensuring an equity lens through access to well-being for all. Additionally, our Roseville team supports the research, assessment, data collection and reporting process for the following systemwide community benefit work streams: Community Health Needs Assessment (CHNA), Community Health Implementation Strategy (CHIS) and annual community benefit expense reporting. In 2021, our community benefit team insourced 16 CHNA reports, creating a more collaborative, engaging and equitable CHNA process that prioritized input from minority and underserved populations in our communities. Additionally, operational tasks such as Community Benefit Inventory for Social Accountability (CBISA) entries and editing of 22 community health plan update reports were also insourced, to make our local hospital teams available to drive impactful programs. These activities help ensure that we continue to drive community health improvement and foster collaboration to build stronger communities in which we serve. Together, these system-led support efforts facilitated the following impacts across our system in 2021: A total of $48.2 million was spent on free and discounted care, $206.9 million on public programs such as Medicare, $307.1 million aid to the elderly, $78.4 million in subsidized community healthcare, $26.3 million in community health improvement, and $24.9 million on education and research. These efforts totaled close to $754.9 million in community benefit expenses. Population Health Population health is a whole-person, outcomes-based approach that works to improve the health of entire communities. It requires collaboration among researchers, providers, public health entities, and policymakers. Population health aligns with Adventist Health's philosophy of care and provides unprecedented opportunities as overall health declines in North America. Adventist Health believes that employers have a significant opportunity and responsibility to support overall well-being and influence health status indicators of entire populations by providing access to resources and tools in the workplace, reducing gaps in care, and addressing determinants of health in the surrounding community. In 2021, Adventist Health offered one plan. The health plan worked alongside the associate well-being team to deliver wellness-focused programs for chronic conditions, mental health, physical activity, nutrition, offer a digital wellness platform, and more. Whole-person health involves mind, body, and spirit. The health plan empowers associates, their families, and, by extension, the larger community to take an active role in managing their health so they may live vibrant and productive lives. Care Transformation Care Transformation in Adventist Health reflects our promise to deliver top decile safety and quality performance and top quartile in clinical operations. The transformation focuses on initiatives such as Clinical Leadership Development, High Reliability Organization, Patient Experience, Care Redesign, Population Health and Clinical Workforce. All these efforts focus on effectively blending people, processes and technology, and include consistent design, delivery and evaluation of care performance. Our caregivers are working hard every day to achieve the clinical goals and continue to spread our mission. Patient Safety & Quality Adventist Health focuses not only on patient safety and quality patient care, but also provides a quality work environment for its associates. Maintaining a culture of teamwork and safety among clinicians and staff is foundational to Care Transformation. For the past nine years, Adventist Health has participated in the Culture of Safety survey, which provides insight into focused areas where actions can be taken to improve the safety and teamwork climate in clinical departments. Adventist Health hospitals received quality and safety awards from The Joint Commission, The LeapFrog Group, Healthgrades, CMS and Malcolm Baldrige. Form 990, Part III, Line 4a (continued): Physician Alignment Adventist Health operates 379 medical offices across the West Coast and Hawaii. These ambulatory care centers include Rural Health Clinics (RHC), hospital-based outpatient clinics (HBOC), employed physician models in Oregon and Hawaii, medical foundations in California, and community health clinics. These medical offices offer primary care and more than 50 different specialties in medical offices large and small. We have more than 500 primary care providers and about 700 specialists providing services ranging from Addiction Medicine to Wound Care; Audiology to Vascular Surgery. Adventist Health also provides much-needed dental care in 10 of our rural communities. The providers in these medical offices are committed to providing best practice, quality-driven care with excellent health outcomes and exceptional patient experience. We provide more than two million patient visits annually. In the initial months of the pandemic, we pivoted to offering virtual visits and continue to provide those to our most vulnerable populations and those patients who have found it to be a more convenient way to receive care. We have also launched online scheduling for all of our primary care providers to increase access to care for our communities. As an organization, we have had to prioritize continued pay for our providers and employees to minimize the loss of clinicians during the extended public health emergency. Throughout these challenges, our physicians and Advanced Practice Providers have continued to provide excellent patient satisfaction resulting in an overall Adventist Health clinic star rating of 4.7 out of 5 stars. Rural Health Clinics (RHC) As an extension of our mission, high-quality services are provided to rural communities where access to care is often significantly more challenging than in urban areas. We have 69 rural health clinics (RHCs) providing healthcare to underserved populations throughout Northern and Central California, Hawaii, and Oregon. Our system of rural health continues to be the largest network of clinics in the state of California (about 12% of the RHCs in the state are part of Adventist Health). Our RHC network also is one of the largest in the country, representing almost one percent of the nation's RHCs. Adventist Health provides oversight services for all our RHCs to include financial monitoring, program audits, operational support, professional development, advocacy, and education regarding new regulations. Thanks to the RHCs, many of these rural communities' most disenfranchised have access to primary care, dentistry, women's and children's services, and health education. Specialty care services are also available at many RHC locations, including 24 behavioral health programs. Home Care Services Adventist Health Home Care offers advanced, high quality health care in an at-home setting by operating 14 home health agencies and seven hospices. In 2021, care, compassion and high-quality services were provided with 210,225 home health visits and 74,069 hospice days. Many of the agencies provide specialized programs and treatment plans, such as, wound care, CHF and diabetes management. Our home health mission is to help patient's recover, regain independence and become as self-sufficient as possible in the comfort of their home. Our hospice mission is to provide whole-person care that envelopes the body, comforts the mind and nurtures the spirit. We are most proud of the following accomplishments in 2021: 1. Implemented telehealth/remote patient monitoring for CHF patients 2. Bakersfield Hospice cared for their first patient, earned their Medicare certification and CHAP accreditation 3. Mendocino Coast Home Health joined the AH family and became integrated into our EMR, operational processes and platforms 4. New devices were rolled out to all AH associates 5. Enhanced hospice ePrescribe platform was implemented to meet patient, MD and regulatory needs 6. Re-launched and expanded ExactCare pharmacy services to assist patients with medication management 7. Implemented a readmission task force to reduce hospital readmissions and improve hospital partnerships 8. Glendale Home Health and Hospice were accredited by CHAP 9. Received regulatory change of ownership approval for Rideout Home Health Developing a Virtual Care Network The Adventist Health Virtual Care Network allows healthcare professionals to evaluate, diagnose, and treat patients using video conferencing software technology. Virtual Care is the umbrella term for the group of services and functions that include telemedicine, telepharmacy, teleICU, telestroke, teledentistry, teleradiology, and telepathology, but which also includes and can support regional health information sharing, patient education and provider networking. Virtual Care provides patients with access to high-quality, affordable specialty care when and where they need it, aiding in rapid diagnosis, treatment, and improved patient outcomes. This collaboration supports Adventist Health's mission of bringing high-quality health and healing to the communities it serves, and is consistent with the organization's focus on innovation, strategic growth, and population health. Virtual Care services took a huge leap with the onset of the COVID-19 pandemic, and we continue to monitor virtual visit volumes and the Public Health Emergency regulations related to virtual care. We now have an integrated platform that enables providers to see patients in their own home more seamlessly through our patient portal and a direct text-to-video option. Our clinics have recently upgraded their telehealth equipment to provide specialty outpatient care in our rural communities in California and Oregon sites, including a small number of non-Adventist Health sites. We continue to offer store and forward services for dermatology and diabetic retinopathy screenings, as well as peer-to-peer e-consults, as well as a direct-to-consumer service, Adventist Health OnDemand, for consumers. Adventist Health is also a preferred provider for Virtual Care with the California Department of Corrections and Rehabilitation, serving multiple prison locations through the Virtual Care Coordination Center. In 2021, we piloted a virtual behavioral health counseling service to clinic patients in some of our rural communities and we continue to look at how we can duplicate the program across the rest of the communities we serve. Our Hawaii and our Mendocino Coast markets now have sites that have video conferencing software with state-of-the-art virtual stethoscope technology to ensure patients can be seen close to where they live. Inpatient virtual care continues to serve hundreds of patients. Thirteen hospitals use telehealth stroke services, seven hospitals use pediatric services, five sites use infectious disease services with ten sites using emergency psychiatry assessment services. We are looking forward to having a systemwide offering in the next few years in the areas of stroke, general neurology, and psych for all of our ICUs and ERs. Strategic Planning Adventist Health's mission of living God's love, inspiring health, wholeness and hope is our greatest calling as an organization. Our strategic planning builds on a vision to provide exceptional care at every stage of life, inspiring community transformation through health and well-being for all. To support this vision, we have shifted our structure to strategic networks of care, bringing local and system leadership closer together to organize our work around our patients, communities and key opportunities to serve all through a deeply integrated and collaborative network of care. We are engaging our strong, innovative teams to shape a thriving culture. We are expanding our networks creating community relevance and well-being. We are empowering exceptional teams to deliver unparalleled care. We are embedding disciplined stewardship to drive operational excellence. Form 990, Part VI, Section A, line 4 During the year, the corporation's Bylaws were amended as follows: -Article 2, Members - updated that the CEO and three representatives of the corporation will be members. -Article 3, Board of Directors - updated the language to address who should be a board member when the corporation does not have a president. -Article 8, Legal Instruments, Section 1, Subsection (a) - updated the language to authorize CEO, president, treasurer, secretary or other person or officers to execute all legal instruments and not only real estate transactions. -Article 8, Legal Instrument, Section 1, Subsection (b) and (c) - these subsections were removed and consolidated in 8.1 for the execution of legal documents by the CEO, president, treasurer, or secretary, as authorized by the board. -Article 9, General Provision - Updated to include section 4, Emergency Power. This subsection lists out actions that board members can take during emergency events or circumstances. Form 990, Part VI, Section A, line 6 Individuals who represent the Seventh-day Adventist Church and lay people who are in good standing with the Seventh-day Adventist Church serve as members of Adventist Health System/West (the Organization") including the following: (a) the president, treasurer, and one other representative from both the Pacific Union Conference and the North Pacific Union Conference; (b) one representative from each of the local conferences of the Church in which affiliated health care facilities are located; (c) two representatives selected from among the colleges and universities affiliated with the Church and located in the Pacific Union Conference or North Pacific Union Conference; (d) the CEO of the Organization, plus three additional representatives of the management of the Organization; (e) three representatives selected from the presidents of the hospitals affiliated with the Organization; (f) three healthcare leaders; (g) up to 16 lay representatives who do not belong to any of the other categories set forth but who otherwise meet the qualifications for membership. Annually, the members meet for the purpose of conducting the business of the membership. Actions are taken as required to enable Adventist Health System/West to continue operating in concert with its Articles and Bylaws. Form 990, Part VI, Section A, line 7a The Organization's Board of Directors consists of the following ex-officio members: (a) The president of the Pacific Union and North Pacific Union of the Seventh-day Adventist Church; (b) two presidents selected from among the local conferences of the Church in which are located affiliated health care institutions; (c) The CEO of the Organization; (d) the president of the Organization, if there is no president, such other person as the membership shall appoint; (e) two professional health care providers who are practicing or serving in healthcare leadership; and (f) seven lay representatives as elected by the membership. Ex-officio members are appointed to their positions pursuant to the governing instruments of those organizations. Form 990, Part VI, Section A, line 7b Amendments to the Organization's Bylaws require approval by the membership. 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 System Senior Finance Officer and System Chief 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 remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The statements for the AHSW Board of Directors are reviewed by the EY auditors as part of the annual financial statement audit. All conflicts are reviewed by the System General Counsel. For potential conflicts, the System General Counsel will determine and present all relevant facts to the governing body for decision. After addressing any questions asked by the governing body, the person with a declared conflict must leave the meeting during the discussion of the matter that involves a conflict and during any vote on the matter. Form 990, Part VI, Section B, line 15 The Organization's Board of Directors has established a Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital presidents and finance officers that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital president has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital (iIncentive potential is industry norm). Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents publicly available beyond required filings of Articles of Incorporation with the Secretary of State. The Organization does not make its Conflict of Interest Policy available to the public. Form 990, Part VII: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported. Form 990, Part IX, line 11g Other purchased services: Program service expenses 12,797,911. Management and general expenses 110,152,099. Fundraising expenses 89,788. Total expenses 123,039,798. Repairs & maintenance: Program service expenses 46,384,846. Management and general expenses 205,939. Fundraising expenses 0. Total expenses 46,590,785. Consulting and other management fees: Program service expenses 1,760,758. Management and general expenses 37,693,818. Fundraising expenses 1,433,148. Total expenses 40,887,724. Contract labor: Program service expenses 6,132,933. Management and general expenses 4,872,297. Fundraising expenses 0. Total expenses 11,005,230. Other professional fees non-medical: Program service expenses 13,559. Management and general expenses 8,606,508. Fundraising expenses 0. Total expenses 8,620,067. Purchased medical services: Program service expenses 106,102. Management and general expenses 1,682,138. Fundraising expenses 0. Total expenses 1,788,240. Physician professional fees: Program service expenses 72,245. Management and general expenses 209,182. Fundraising expenses 0. Total expenses 281,427. Form 990, Part XI, line 9: Capital contribution to BlueLegacy 3,000,000. Change in net assets of BlueZones -1,669,560. Change in value of CAP-EX -4,867,122. Partnership loss reported on Sch K-1 8,645,406. Form 990, Part XI, Line 8: Prior period adjustments were a result of cash balance correction and clean up books due to prior period activities including debt service, capital expenditures, and other items for $509,121,661. Adventist Health Outpatient Pharmacy Services LLC 1 Adventist Health Way Roseville CA 95661 Inactive CA 0 0 Adventist Health SystemWest Dwellcare LLC 1 Adventist Health Way Roseville CA 95661 Inactive CA 0 0 Adventist Health SystemWest Incentive Acute Care Network LLC 1 Adventist Health Way Roseville CA 95661 Acute care network CA 0 0 Adventist Health SystemWest Incentive Health LLC 1 Adventist Health Way Roseville CA 95661 MSO CA 1337608 5857533 Adventist Health SystemWest Paradise Skyway LLC 1 Adventist Health Way Roseville CA 95661 Inactive CA 0 0 Adventist Health SystemWest Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health 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0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 Feather River Hospital C 4900564 Net book value Adventist Health Clearlake Hospital Inc L 22109724 FMV Adventist Health Delano L 13605218 FMV Adventist Health Medical Center Tehachapi L 6660761 FMV Adventist Health Mendocino Coast L 1980735 FMV Adventist Health Physicians Network L 17475979 FMV Adventist Health Tulare L 10360091 FMV Castle Medical Center L 26526108 FMV Glendale Adventist Medical Center L 75198683 FMV Hanford Community Hospital L 51789543 FMV Lodi Memorial Hospital Association Inc L 36812610 FMV Northwest Medical Foundation of Tillamook L 12953126 FMV Portland Adventist Medical Center L 41134241 FMV Reedley Community Hospital L 27631643 FMV Rideout Memorial Hospital L 69034358 FMV San Joaquin Community Hospital L 66368948 FMV Simi Valley Hospital and Health Care Services L 28908427 FMV Sonora Community Hospital L 40075108 FMV St Helena Hospital L 35257813 FMV Ukiah Adventist Hospital L 30028005 FMV Western Health Resources L 3430725 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