2022-11-11T09:44:45-06:00 2021-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2021-01-01 770258013 Adventist Health Delano ADVE 9164060000 1401 Garces Hwy Delano CA 93215 Shane Cox Treasurer 9164060000 2022-10-26 1 Shane Cox 999009999 Tracy S Paglia P00366884 2099556100 2022-10-26 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Daniel Wolcott 1401 Garces Hwy Delano CA 93215 108672886 0 X www.adventisthealth.org/delano X 1990 CA Living God's love by inspiring health, wholeness, and hope. 14 11 675 13 3017354 0 32645 45935 85393426 103990278 2913752 4636673 -941706 0 87398117 108672886 1156627 366691 0 0 40345467 36707368 0 0 609 44878213 64829565 86380307 101903624 1017810 6769262 197667914 205373442 36714633 37654641 160953281 167718801 X Living God's love by inspiring health, wholeness, and hope. 0 0 83597414 366691 103990278 See Schedule O 83597414 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 675 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X John Beaman 9164060000 1 Adventist Health Way Roseville CA 95661 X Reiner Scott Chair/CEO thru 12/21 0.00 50.00 X X 0 2940088 62418 Wing Bill Dir/Asst Secr/Vice Chair 0.00 50.00 X X 0 2459079 76222 Jahn Andrew Care Division President 2.00 48.00 X 0 1848683 72937 Hofheins Todd CFO 0.00 50.00 X 0 1319147 59910 Nahapetian Arby Care Division Chief Medical Officer 2.00 48.00 X 0 1058113 78302 Eller Jeff Vice Chair/AHDL 0.00 50.00 X 0 1100138 22996 Jobe Meredith Secretary 0.00 50.00 X 0 932705 59761 Stevens Eric Care Division Operations Executive 2.00 48.00 X 0 884611 49992 Spenst Brett Care Division Finance Officer 2.00 48.00 X 0 786101 45300 Butler David President 50.00 0.00 X 0 680823 72937 Ghaffari Bahram President thru 12/19 0.00 0.00 X 616927 0 0 Cox Shane Finance Officer as of 11/21 12.50 37.50 X 0 504779 83596 Longo James Compliance Officer/IS Director 40.00 0.00 X 0 490797 57557 Van Housen Heather Chief Nursing Officer as of 05/21 40.00 0.00 X 0 434611 68835 Cantrell Misty Chief Nursing Officer thru 05/21 40.00 0.00 X 0 401495 97156 Hutcheson Walter Treasurer/Asst Secr/Finance Officer thru 10/21 50.00 0.00 X 0 309969 88516 Monrian Terrence Pharmacy Director 40.00 0.00 X 263377 0 47451 Lee Mee Young Pharmacist 40.00 0.00 X 259489 0 40692 Heinrich Kerry Dir/CEO Elect as of 11/21 0.00 50.00 X 0 282697 2627 Meng Bryant Pharmacist 40.00 0.00 X 231542 0 37865 Khalil Samuel Pharmacist 40.00 0.00 X 210401 0 50636 Rouhotas Louie Admin Director, Operations 40.00 0.00 X 191346 0 39528 Wade Evelyn Dir/Patient Care Exec thru 04/21 40.00 0.00 X 0 186525 19851 Freedman John Dir/Vice Chair/Chair as of 08/21 0.00 4.00 X X 0 26435 0 Banks David Director 0.00 4.00 X 0 26159 0 Cherry Robert Director 0.00 4.00 X 0 26159 0 Davis Andrew Director 0.00 4.00 X 0 26159 0 Innocent Larry Director 0.00 4.00 X 0 26159 0 Reiner Richard Director 0.00 4.00 X 0 26159 0 Graham Ricardo Dir/Chair thru 08/21 0.00 4.00 X X 0 19545 0 Woodson Marc Director 0.00 4.00 X 0 15909 0 Salazar Velino Director 0.00 4.00 X 0 6058 0 Ocampo Lucy Director 0.00 4.00 X 0 159 0 Fehr Joy Director 0.00 4.00 X 0 114 0 Newton Bradford Dir/Vice Chair as of 08/21 0.00 4.00 X X 0 0 0 1773082 16819376 1235085 71 1 1 0 Westways Staffing Services Inc 500 City Parkway W Ste 130 Orange CA 92868 Contract labor 3227597 Sound Physicians Emergency Medicine of S PO Box 742936 Los Angeles CA 90074 ER physician services 2008367 Comfort Anesthesia Associates Inc 11704 Nantwick Crt Bakersfield CA 93311 Certified RN anesthetist services 1354962 Quest Imaging Medical Associates Inc PO Box 21178 Bakersfield CA 93390 Comprehensive imaging services 1158604 Fastaff LLC 5700 S Quebec Stt Ste 300 Greenwood Village CO 80111 Contract labor 996958 29 13683 32252 45935 Patient service revenue 621400 98896948 95879594 3017354 CARES Act revenue 621990 4514336 4514336 Related rental revenue 621400 291609 291609 Dietary revenue 621400 190483 190483 Incentive and quality revenue 621400 4081 4081 92821 92821 103990278 4636173 4636173 500 0 500 500 500 108672886 100972924 3017354 4636673 X 366691 366691 29604906 27276059 2328847 1599767 1459702 140065 3404577 3268547 136030 2098118 1938469 159649 11224305 11224305 148751 148751 8937 8937 8841 8841 22317466 21232661 1084805 2326 2326 478697 403142 74946 609 3885133 1485993 2399140 2162416 2162187 229 30261 12257 18004 9938 6823 3115 451899 451722 177 5151429 5102628 48801 431735 431735 Medical/non-medical sup 12448928 12403033 45895 Quality Assurance Fees 4910313 4910313 Rental/leases costs equ 381636 351554 30082 Bad debts 134416 134416 642138 325057 317081 101903624 83597414 18305601 609 112172683 119539343 0 5105 10761207 9061089 1436409 1465242 458595 401549 155711525 107538242 54675051 48173283 76845 73103 18087124 26654728 197667914 205373442 9395469 11630537 8204 203912 27310960 25820192 36714633 37654641 X 160953281 167718801 160953281 167718801 197667914 205373442 X 6769262 -3742 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8841 8841 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to NL Short Public Affairs were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 9120000 9120000 81919349 50265003 31654346 63541961 56537063 7004898 1130215 736176 394039 48173283 Receivables from third-party payors 25996833 Receivables from related organizations 529381 Other assets 128514 26654728 Payables to related organizations 19221893 Payables to third-party payors 6563894 Other liabilities 34405 25820192 X Part X, Line 2: The principal operations of the System are 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, 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 306890 306890 0.00300 306890 306890 0.00300 381597 381597 0.00370 401383 401383 0.00390 240202 240202 0.00240 53750 53750 0.00050 1076932 1076932 0.01050 1383822 1383822 0.01350 1 1249408 340144 11007593 10891307 116286 X 1 1 1 1 Adventist Health Delano 1401 Garces Hwy Delano CA 93215 https://www.adventisthealth.org/delano 120000180 X X X Adventist Health Delano 1 0 0 1 X X X X X X X X X 19 1 1 0 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 19 1 See Sch H Part VI - Needs Assesment 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Adventist Health Delano Part V, Section B, Line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data. 3. Data gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews.Community Survey: The Kern County Community Benefit Collaborative hospital representatives developed a plan for distribution of a survey to engage community residents. The survey was available in an electronic format through a Survey Monkey link, and in a paper copy format. The electronic and paper surveys were available in English and Spanish. The surveys were available from November 2018 to January 2019 and during this time, 1,114 usable surveys were collected. The hospitals distributed the surveys to their clients, in hospital waiting rooms and service sites, and through social media, including posting the survey link on hospital Facebook pages. The survey was also distributed to community partners who made them available to their clients. A written introduction to the survey questions explained the purpose of the survey and assured participants the survey was voluntary, and that they would remain anonymous. For community members who were illiterate, an agency staff member read the survey introduction and questions to the client in his/her preferred language and marked his/her responses on the survey. The survey included the following: demographics, biggest health issues in the community, greatest needs facing children and families, where residents and their families receive routine health care services, problems faced accessing health care, mental health care, dental care or supportive services, what would make it easier to obtain care, types of support or services needed in the community, and safety concerns in the community.Targeted Interviews: Interviews were used to gather information and opinions, by phone, from persons who represent the community served by the hospital. Interview participants were asked to share their perspectives on a number of topics related to the identified preliminary health needs in the community area. Given shared community areas, the Kern County Community Benefit Adventist Health Bakersfield 14 Collaborative hospitals worked together to conduct the interviews. Forty-one (41) interviews were completed from October 2018 through March 2019. Secondary data were collected from a variety of local, county and state sources to present a community profile, social determinants of health, health care access, birth indicators, leading causes of death, acute and chronic disease, health behaviors, mental health, substance use and misuse, and preventive practices. When available, data sets are presented in the context of Kern County and California to help frame the scope of an issue, as it relates to the broader community. Sources of data include: the U.S. Census American Community Survey, California Department of Public Health, California Health Interview Survey, Kern County Public Health Department, Healthy Kern County, County Health Rankings, California Department of Education, California Office of Statewide Health Planning and Development and California Department of Justice, among others. Adventist Health Delano Part V, Section B, Line 6a: The Kern County Community Benefit Collaborative convened area hospitals and included these partners:Adventist Health Bakersfield and Adventist Health Tehachapi Valley Hospitals, Delano Regional Medical Center, Dignity Health Bakersfield, Mercy and Memorial Hospitals, Kaiser Permanente Kern County, Kern Medical, and Valley Children's Healthcare. Adventist Health Delano Part V, Section B, Line 11: The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible, while ensuring the health and safety of those participating. Our 2019 CHNA identified three areas of significant need: Access to Health Care, Food Insecurity, Chronic Disease (Including Overweight and Obesity). Priority Need 1 - Access to Health Care - The goal is to increase coverage and access to health care for the medically underserved. Strategy 1 - Partner to make a collective impact on removing barriers for care, while providing accessibility and care coordination for our vulnerable populations. Activity 1.1 - Provide financial assistance through free and discounted care for health care services, consistent with the hospital's financial assistance policy - Adventist Health Delano actively participated in several key community collaboratives to promote wellness and promote coverage with access to health care services for medically underserved within the Delano community. Additionally, Adventist Health Delano also successfully brought awareness of the financial assistance policy. Activity 1.2 - Bring Adventist Health clinicians and services to community events - Adventist Health Delano accepted invitations and actively participated in several events providing awareness and health education regarding COVID-19, as well as health and safety measures the community should take. In partnership with Kern County Public Health, California Farmworkers Foundation, City of Delano, and other community-based organizations, we facilitated over ten community COVID-19 safety programs for the community at large. Activity 1.3 - Vaccinations Clinics - Number of persons served with free Flu vaccine: 750. Priority Need 2 - Chronic Disease (Including Overweight and Obesity) - The goal is to reduce the impact of chronic disease on health and increase the focus on prevention and treatment education. Strategy 1 - Partner to make a collective impact on removing barriers for care, while providing education and resources to manage chronic disease. Activity 1.1 - Diabetes Workshops focused on prevention and disease self-management, health lifestyles, nutrition, and physical activity - Diabetes education workshops and seminars were facilitated through the local Senior Center. Education content included how to live a healthy lifestyle. In 2021, a total of eight monthly seminars were facilitated and approximately 20 individuals per session were impacted. Activity 1.2 - Population Health Outreach Events and Education - In 2021, Adventist Health Delano worked to reduce the impact of chronic disease and focus on increasing prevention and treatment education. Through education outreach, blood sugar testing kits and glucose strips were distributed to individuals with diabetes, who could not afford or access these monitoring resources through local community-based clinics. Priority Need 3 - Food Insecurity - The goal is to increase access to healthy, affordable food to reduce the impact of food insecurity in the community. Activity 1.1 - Promote screening for food insecurity at strategic intake points including the ED and local health clinics and provide information on food resources & Activity 1.2 - Offer sign-up assistance for public programs that increase access to food. These two activities coincide. Adventist Health Delano addressed food insecurity by providing access and pathways to reduce the impact of hunger in the community. In addition, education outreach about public programs was also offered. Adventist Health Delano provided over 230 referrals to local partners to assist community members with food insecurity. Activity 1.3 - Participate in Waste Hunger not Food Kern County - Over 5,200 meals provided to local homeless navigation center providing a warm meal to local unsheltered community members. Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health Delano is committed to serving the community by adhering to its mission, and using its skills, expertise and resources to provide a range of community benefit programs. Taking existing hospital and community resources into consideration, AH Delano will not directly address the remaining health needs identified in the CHNA: housing and homelessness, mental health, economic insecurity, substance use and misuse, environmental pollution, sexually transmitted infections, violence and injury, dental care, birth indicators, Alzheimer's disease, unintentional injuries and preventive practices. Adventist Health Delano does not have the resources to address all the health needs present in the community. Therefore, it will concentrate on those health needs that can most effectively be addressed given the organization's areas of focus and expertise. Adventist Health Delano Part V, Section B, Line 13h: Patients who do not meet the income criteria, may be eligible for financial assistance based on essential living expenses and resources. The following two (2) qualifications must both apply:1. Essential living expenses: Exceed fifty percent (50%) of the household income; and2. Resources: The patient's excess medical expenses (the amount that allowable medical expenses are greater than 50% of annual household income) must be greater than available qualifying assets. 4 1 - AH Delano Prompt Care - RHC 1201 Jefferson Street Delano CA 93215 Rural health clinic 2 - AH Delano Women's Health - RHC 1201 Jefferson Street Delano CA 93215 Rural health clinic 3 - AH Delano Wasco Plaza 2300 7th Street Wasco CA 93280 Rural health clinic 4 - AH Delano Wound Care 1519 Garces Highway Suite 103 Delano CA 93215 Hospital based clinic Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 134,416. Part II, Community Building Activities: The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020, Adventist Health acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be able to gain ground in shifting the balance from healthcare - treating people once they are ill - to transformative well-being - changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint, and as we enter 2022 these projects are active. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part III, Line 2: Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3: The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information, those accounts would have been reclassified from bad debt expense to charity care. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8: The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer. Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals. For further information, please refer to Schedule H, Part III, Section B. Part III, Line 9b: When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest Part VI, Line 2: The Hospital's 2019 CHNA, the 2022 Community Health Plan (CHP) Update for fiscal year 2021, and the 2020 Implementation Strategy adopted in 2020 are posted on the Hospital's website at: https://www.adventisthealth.org/about-us/community-benefit/The most recent Community Health Needs Assessment, most recent Implementation Strategy report and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, our hospitals support local partners to augment our own efforts, and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of the regions we serve. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community. Part VI, Line 3: The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at: https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-Policy.pdfThese documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The Hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. Part VI, Line 4: The service area includes a small city and surrounding suburbs, small towns and rural agricultural areas. The diverse population includes Hispanic/Latino (81.5%), White (8.0%), Black/African American (5.6%), Asian (3.6%), American Indian/Alaska Native and Native Hawaiian/Pacific Islander (0.2%) and (0.9%) classified as other. Of the area populations, 55.6% are male and 44.4% are female. Children and youth, ages 0-17, make up 31.1% of the population, 62.4% are adults, ages 18-64, and 6.6% of the population are seniors, 65 and over. The service area has a higher percentage of children, ages 0-17, and seniors, ages 65 and older.Seniors living alone may be isolated and lack adequate support systems. In the service area 11.6% of seniors are living alone. Among the service area, 2.5% are veterans. About 48.2% of residents in Kern County speak a non-English language, and 21.9% of the population is foreign-born. Of the foreign-born, 67.4% are not citizens.The federal poverty level (FPL) was set at an annual income of $11,880 for one person and $24,300 for a family of four. Among residents in the service area, 29.0% are at or below 100% of the federal poverty level (FPL) and 62.8% are low-income (200% of FPL or below). Of these residents, 44.5% of children under 18 years of age are living in poverty. The U.S. Department of Agriculture (USDA) defines food insecurity as limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire these foods in socially-acceptable ways. Among the population in Kern County, 13.6% experienced food insecurity during the past year. Among children in Kern County, 25% lived in households that experienced food insecurity at some point in the year. The rate of food insecurity is higher in Kern County than in the state. Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache are soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population; 2. Factors that cause the present outcomes distribution; and 3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2. Improve care quality and patient safety, and 3. Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States CA Part VI - Other Information: In 2021, Adventist Health Delano took the following actions in response to the needs created or exacerbated by COVID-19: Continued with offering virtual health care visits to keep community members safe and healthy, continued their online symptom tracker, participated in a communitywide effort to vaccinate eligible community members. Additionally, Adventist Health Delano provided and donated over 200,000 masks to community organizations and partners, provided free COVID-19 screening, assisted local employers and organizations with resources, tools, and guidance around COVID-19 through seminars, collateral, and access to testing sites. 1 CA Health Fund & Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 366691 0 Health uninsured/underinsured pt 1 0 Part I, Line 2: Through the use of temporarily restricted accounts, we track and monitor the incoming receipts from grants and the utilization of grant funds. Each grant is tracked separately. Should the grantor agency require specific reports, we comply with their reporting requirements. The grants we monitor are specific to the grantor's needs and requests. X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Chair/CEO thru 12/21 0 1801000 0 1112062 0 27026 0 11644 0 50774 0 3002506 0 0 Wing Bill Dir/Asst Secr/Vice Chair 0 1440800 0 991833 0 26446 0 11644 0 64578 0 2535301 0 0 Jahn Andrew Care Division President 0 1044420 0 600285 0 203978 0 11644 0 61293 0 1921620 0 0 Hofheins Todd CFO 0 999600 0 116549 0 202998 0 11644 0 48266 0 1379057 0 0 Nahapetian Arby Care Division Chief Medical Officer 0 700000 0 222478 0 135635 0 11644 0 66658 0 1136415 0 0 Eller Jeff Vice Chair/AHDL 0 531828 0 547897 0 20413 0 0 0 22996 0 1123134 0 0 Jobe Meredith Secretary 0 616324 0 169142 0 147239 0 14609 0 45152 0 992466 0 0 Stevens Eric Care Division Operations Executive 0 749000 0 76 0 135535 0 16336 0 33656 0 934603 0 0 Spenst Brett Care Division Finance Officer 0 734400 0 38124 0 13577 0 11644 0 33656 0 831401 0 0 Butler David President 0 444092 0 165028 0 71703 0 11644 0 61293 0 753760 0 0 Ghaffari Bahram President thru 12/19 0 0 0 0 616927 0 0 0 0 0 616927 0 0 0 Cox Shane Finance Officer as of 11/21 0 364154 0 85853 0 54772 0 12958 0 70638 0 588375 0 0 Longo James Compliance Officer/IS Director 0 340628 0 101456 0 48713 0 12193 0 45364 0 548354 0 0 Van Housen Heather Chief Nursing Officer as of 05/21 0 309111 0 84320 0 41180 0 11644 0 57191 0 503446 0 0 Cantrell Misty Chief Nursing Officer thru 05/21 0 316697 0 57037 0 27761 0 14241 0 82915 0 498651 0 0 Hutcheson Walter Treasurer/Asst Secr/Finance Officer 0 233712 0 48223 0 28034 0 12768 0 75748 0 398485 0 0 Monrian Terrence Pharmacy Director 231687 0 20669 0 11021 0 12009 0 35442 0 310828 0 0 0 Lee Mee Young Pharmacist 250062 0 3477 0 5950 0 8473 0 32219 0 300181 0 0 0 Heinrich Kerry Dir/CEO Elect as of 11/21 0 138538 0 123000 0 21159 0 0 0 2627 0 285324 0 0 Meng Bryant Pharmacist 228132 0 3410 0 0 0 6894 0 30971 0 269407 0 0 0 Khalil Samuel Pharmacist 206991 0 3410 0 0 0 7392 0 43244 0 261037 0 0 0 Rouhotas Louie Admin Director, Operations 174111 0 14302 0 2933 0 6565 0 32963 0 230874 0 0 0 Wade Evelyn Dir/Patient Care Exec thru 04/21 0 112167 0 54367 0 19991 0 0 0 19851 0 206376 0 0 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. Ghaffari, Bahram - severance payment - $616,927 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. Longo, James - participant, no activity in 2021 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 Jeff Eller, Todd Hofheins, Andrew Jahn, Scott Reiner, Brett Spenst, and Bill Wing. Form 990, Part III, Line 4a: Adventist Health Delano (AHDL) provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of AHDL, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following coverage will be considered when individuals who need health care cannot afford to pay: - Free care and/or subsidized care - Care to persons covered by governmental programs at/or below cost - Health/wellness activities and community education programs Not only does AHDL provide low-cost care to individuals covered by government programs, and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHDL recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2021 was $306,890. The following Inpatient services were provided to all our patients: - 526 babies delivered - 538 surgeries performed - 25,776 patient days The following Outpatient services were provided to all our patients: - 25,914 emergency department visits - 620 outpatient surgeries performed - 30,200 clinic visits AHDL recognizes it has an obligation to provide human services above and beyond its role as a healing facility. Schedule H provides more details on the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2021 was $1,076,932. Adventist Health's mission statement of living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry, as represented by the life of Jesus Christ, and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs, and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ Form 990, Part VI, Section A, line 6 The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The Hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Section A, line 7a The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. Form 990, Part VI, Section A, line 7b The sole corporate member, Adventist Health System/West, 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 System Senior Finance Officer and Market Finance 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, hospital 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 Hospital'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. Copies for the officers and key employees' COIs are kept in their personnel files. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. Form 990, Part VI, Section B, line 15 The Hospital'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 Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. Form 990, Part VII: Board compensation is for Adventist Health System/West Board of Directors only - not Hospital Board of Directors. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 8,363,801. Management and general expenses 588,484. Fundraising expenses 0. Total expenses 8,952,285. Contract labor: Program service expenses 7,980,944. Management and general expenses 1,400. Fundraising expenses 0. Total expenses 7,982,344. Other purchased services: Program service expenses 3,965,302. Management and general expenses 271,273. Fundraising expenses 0. Total expenses 4,236,575. Purchased medical services: Program service expenses 595,739. Management and general expenses 92,740. Fundraising expenses 0. Total expenses 688,479. Repairs and maintenance: Program service expenses 182,944. Management and general expenses 10,533. Fundraising expenses 0. Total expenses 193,477. Consulting and other management fees: Program service expenses 90,768. Management and general expenses 72,253. Fundraising expenses 0. Total expenses 163,021. Other non-medical professional fees: Program service expenses 20,325. Management and general expenses 48,122. Fundraising expenses 0. Total expenses 68,447. Other professional medical fees: Program service expenses 32,838. Management and general expenses 0. Fundraising expenses 0. Total expenses 32,838. Form 990, Part XI, line 9: Change in investment in subsidiary -3,742. 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 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 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 and 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 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 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 United Com-Serve 726 Fourth Street Marysville CA 95901 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health 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 Blue Legacy Venture 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 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 931262371 Real property rental OR N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Real property rental OR N/A 0 0 PVHR2 LLC dba Parkview at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Real property rental OR N/A 0 0 WWGHR LLC 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Rental OR N/A 0 0 Delano Health Associates Inc 1401 Garces Hwy Delano CA 93215 770340007 Winding down/discontinued operations CA Adventist Health Delano C 1 1.00000 1 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 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 Delano Health Associates Inc S 73103 Change in due to/due from