ST HELENA HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ST HELENA HOSPITAL (EIN 94-1279779)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-11
- IRS object ID
- 202223159349303062
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-11T10:27:05-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941279779 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Helena Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STHE | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Woodland Road | AddressLine1Txt |
| City | St Helena | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94574 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Warren Tetz | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2022-10-26 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Warren | PersonFirstNm |
| Person Last | Tetz | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2022-10-26 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health St Helena | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steven Herber | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Woodland Road | AddressLine1Txt |
| City | St Helena | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94574 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $280,606,531 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/st-helena/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1898 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 1350 | TotalEmployeeCnt |
| Total Volunteers | 21 | TotalVolunteersCnt |
| Total Gross UBI | $54,183 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $193,791 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,759,028 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $211,274,733 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $275,814,810 | CYProgramServiceRevenueAmt |
| PY Investment Income | $732,057 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,279 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,392,758 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $224,593,339 | PYTotalRevenueAmt |
| CY Total Revenue | $280,585,117 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $151,767 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $143,303 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $83,515,912 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $85,716,314 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $816,660 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $162,850,603 | PYOtherExpensesAmt |
| CY Other Expenses | $202,225,247 | CYOtherExpensesAmt |
| PY Total Expenses | $246,518,282 | PYTotalExpensesAmt |
| CY Total Expenses | $288,084,864 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$21,924,943 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,499,747 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $196,039,253 | TotalAssetsBOYAmt |
| Total Assets EOY | $215,115,689 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $130,337,597 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $180,307,992 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $65,701,656 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $34,807,697 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $236,646,068 | ExpenseAmt |
| Grant | $143,303 | GrantAmt |
| Revenue | $275,814,810 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $236,646,068 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1350 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | John Beaman CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Adventist Health Way | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||
| Chair/CEO thru 12/21 | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $2,940,088 | $62,418 | |||
| Wing Bill | ||||||||||
| Dir/Asst Secr/Vice Chair | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $2,459,079 | $76,222 | |||
| Jahn Andrew | ||||||||||
| Care Division President | 2.00 | 48.00 | $0 | $1,848,683 | $72,937 | Yes (X) | ||||
| Hofheins Todd | ||||||||||
| CFO | 0.00 | 50.00 | Yes (X) | $0 | $1,319,147 | $59,910 | ||||
| Nahapetian Arby | ||||||||||
| Care Division Chief Medical Officer | 2.00 | 48.00 | $0 | $1,058,113 | $78,302 | Yes (X) | ||||
| Eller Jeff | ||||||||||
| President, NCR | 7.00 | 43.00 | $0 | $1,100,138 | $22,996 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | Yes (X) | $0 | $932,705 | $59,761 | ||||
| Byrnes John - Former | ||||||||||
| Medical Officer, NCR thru 02/20 | 0.00 | 50.00 | $0 | $906,436 | $56,796 | Yes (X) | ||||
| Stevens Eric | ||||||||||
| Care Division Operations Executive | 2.00 | 48.00 | $0 | $884,611 | $49,992 | Yes (X) | ||||
| Herber Steven | ||||||||||
| President | 50.00 | 0.00 | Yes (X) | $0 | $764,186 | $67,250 | ||||
| Spenst Brett | ||||||||||
| Care Division Finance Officer | 2.00 | 48.00 | $0 | $786,101 | $45,300 | Yes (X) | ||||
| Lonto Robert | ||||||||||
| Former Reg HP Dir, NCR thru 02/20 | 0.00 | 50.00 | $0 | $415,896 | $72,696 | Yes (X) | ||||
| Mensch Deborah | ||||||||||
| Patient Care Executive | 50.00 | 0.00 | $0 | $374,293 | $49,293 | Yes (X) | ||||
| Blethen Elisa - Finance | ||||||||||
| Officer, Treas/Asst Secr thru 11/21 | 10.00 | 40.00 | $0 | $344,470 | $63,043 | Yes (X) | ||||
| Hasso Ruth | ||||||||||
| RN | 50.00 | 0.00 | $247,740 | $0 | $81,848 | Yes (X) | ||||
| Barnes Geoffrey | ||||||||||
| Supervisor, RN | 50.00 | 0.00 | $265,261 | $0 | $57,370 | Yes (X) | ||||
| Roberts Janice | ||||||||||
| Director, Cardiac Service Line | 50.00 | 0.00 | $243,652 | $0 | $53,645 | Yes (X) | ||||
| Heinrich Kerry | ||||||||||
| Dir/CEO Elect as of 11/21 | 0.00 | 50.00 | Yes (X) | $0 | $282,697 | $2,627 | ||||
| Gonzales Jerry | ||||||||||
| Director, Pharmacy | 50.00 | 0.00 | $248,554 | $0 | $36,766 | Yes (X) | ||||
| Jadid Lina | ||||||||||
| Pharmacy Coordinator | 50.00 | 0.00 | $253,255 | $0 | $21,981 | Yes (X) | ||||
| Lyons Timothy | ||||||||||
| Medical Officer | 50.00 | 0.00 | $270,000 | $0 | $0 | Yes (X) | ||||
| Reppert Joseph | ||||||||||
| Former CFO/Asst Secr thru 08/19 | 0.00 | 0.00 | $0 | $179,119 | $11,442 | Yes (X) | ||||
| Dickinson Elizabeth | ||||||||||
| Patient Care Executive thru 08/20 | 0.00 | 50.00 | $0 | $141,686 | $16,412 | Yes (X) | ||||
| Freedman John | ||||||||||
| Dir/Vice Chair/Chair as of 08/21 | 0.00 | 4.00 | Yes (X) | Yes (X) | $0 | $26,435 | $0 | |||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,159 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,159 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,159 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,159 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,159 | $0 | ||||
| Graham Ricardo | ||||||||||
| Dir/Chair thru 08/21 | 0.00 | 4.00 | Yes (X) | Yes (X) | $0 | $19,545 | $0 | |||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $15,909 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $6,058 | $0 | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $159 | $0 | ||||
| Fehr Joy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $114 | $0 | ||||
| Newton Bradford | ||||||||||
| Dir/Vice Chair as of 08/21 | 0.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,528,462 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $16,936,463 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,119,007 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 240 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| XL Construction | |||||
| 851 Buckeye Ct | Milpitas | CA | 95035 | Construction | $7,621,139 |
| Acute Medical Providers Inpatient Inc | |||||
| PO Box 94760 | Oklahoma City | OK | 73143 | Physicians | $2,698,572 |
| Barton Associates Inc | |||||
| PO Box 417844 | Boston | MA | 02241 | Physicians | $1,769,291 |
| Sound Inpatient Physicians Inc | |||||
| PO Box 74936 | Los Angeles | CA | 90074 | Physicians | $1,391,750 |
| Fastaff LLC | |||||
| PO Box 911452 | Denver | CO | 80291 | Physicians | $1,327,234 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 57 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $4,737,640 | RelatedOrganizationsAmt |
| All Other Contributions | $21,388 | AllOtherContributionsAmt |
| Total Contributions | $4,759,028 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient service revenue | 621110 | $225,296,057 | $225,241,874 | $54,183 |
| Premium revenue | 531120 | $28,564,625 | $28,564,625 | |
| 340B Pharmacy | 900099 | $5,242,862 | $5,242,862 | |
| CARES Act funding | 900099 | $3,289,196 | $3,289,196 | |
| Related rental revenue | 900099 | $1,469,720 | $1,469,720 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,952,350 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,952,350 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $275,814,810 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,693 | TotalRevenueColumnAmt |
| Exclusion | $32,693 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $21,414 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$21,414 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$21,414 | TotalRevenueColumnAmt |
| Exclusion | -$21,414 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $280,585,117 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $275,760,627 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $54,183 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,279 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,303 | TotalAmt |
| Program Services | $143,303 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,339 | TotalAmt |
| Program Services | $95,339 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,339,701 | TotalAmt |
| Program Services | $61,219,363 | ProgramServicesAmt |
| Management And General | $7,571,998 | ManagementAndGeneralAmt |
| Fundraising | $548,340 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,517,292 | TotalAmt |
| Program Services | $2,189,709 | ProgramServicesAmt |
| Management And General | $308,111 | ManagementAndGeneralAmt |
| Fundraising | $19,472 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,013,463 | TotalAmt |
| Program Services | $7,878,267 | ProgramServicesAmt |
| Management And General | $1,022,078 | ManagementAndGeneralAmt |
| Fundraising | $113,118 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,750,519 | TotalAmt |
| Program Services | $4,280,720 | ProgramServicesAmt |
| Management And General | $430,519 | ManagementAndGeneralAmt |
| Fundraising | $39,280 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,423,217 | TotalAmt |
| Program Services | $787,728 | ProgramServicesAmt |
| Management And General | $27,635,489 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,246 | TotalAmt |
| Management And General | $538,246 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,913 | TotalAmt |
| Program Services | $17,913 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,506,107 | TotalAmt |
| Program Services | $58,136,454 | ProgramServicesAmt |
| Management And General | $2,346,759 | ManagementAndGeneralAmt |
| Fundraising | $22,894 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,211 | TotalAmt |
| Management And General | $27,211 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $861,954 | TotalAmt |
| Program Services | $573,148 | ProgramServicesAmt |
| Management And General | $249,300 | ManagementAndGeneralAmt |
| Fundraising | $39,506 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,765,739 | TotalAmt |
| Program Services | $1,728,592 | ProgramServicesAmt |
| Management And General | $6,034,010 | ManagementAndGeneralAmt |
| Fundraising | $3,137 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,373,599 | TotalAmt |
| Program Services | $4,628,097 | ProgramServicesAmt |
| Management And General | $745,054 | ManagementAndGeneralAmt |
| Fundraising | $448 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,314 | TotalAmt |
| Program Services | $93,540 | ProgramServicesAmt |
| Management And General | $23,560 | ManagementAndGeneralAmt |
| Fundraising | $214 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,267 | TotalAmt |
| Program Services | $6,267 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,400,156 | TotalAmt |
| Program Services | $2,399,275 | ProgramServicesAmt |
| Management And General | $881 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,946,491 | TotalAmt |
| Program Services | $8,831,578 | ProgramServicesAmt |
| Management And General | $114,913 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $613,897 | TotalAmt |
| Program Services | $553,397 | ProgramServicesAmt |
| Management And General | $60,500 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| Patient care supplies | $61,286,052 | $61,262,816 | $23,236 | |
| Quality assurance fees | $11,389,114 | $11,386,383 | $2,731 | |
| Rental/lease costs | $478,343 | $476,656 | $57 | $1,630 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,473,627 | TotalAmt |
| Program Services | $9,957,523 | ProgramServicesAmt |
| Management And General | $3,509,146 | ManagementAndGeneralAmt |
| Fundraising | $6,958 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,084,864 | TotalAmt |
| Program Services | $236,646,068 | ProgramServicesAmt |
| Management And General | $50,622,136 | ManagementAndGeneralAmt |
| Fundraising | $816,660 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,045,638 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,755,008 | BOYAmt |
| EOY | $32,620,424 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,460,052 | BOYAmt |
| EOY | $6,094,993 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,112,308 | BOYAmt |
| EOY | $644,455 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $285,304,990 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $177,835,212 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,410,241 | BOYAmt |
| EOY | $107,469,778 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,256,006 | BOYAmt |
| EOY | $68,286,039 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,039,253 | BOYAmt |
| EOY | $215,115,689 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,110,183 | BOYAmt |
| EOY | $61,987,245 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,388 | BOYAmt |
| EOY | $222,700 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $110,206,026 | BOYAmt |
| EOY | $118,098,047 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $130,337,597 | BOYAmt |
| EOY | $180,307,992 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,537,762 | BOYAmt |
| EOY | $9,706,093 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,163,894 | BOYAmt |
| EOY | $25,101,604 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,701,656 | BOYAmt |
| EOY | $34,807,697 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,039,253 | BOYAmt |
| EOY | $215,115,689 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$7,499,747 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $23,700 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$29,565,423 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $6,147,511 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $17,913 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $17,913 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $23,344,620 | BeginningYearBalanceAmt |
| Contributions | $16,012,718 | ContributionsAmt |
| Investment Earnings Or Losses | $4,064,487 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,811,947 | OtherExpendituresAmt |
| End Year Balance | $39,609,878 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $21,759,518 | BeginningYearBalanceAmt |
| Contributions | $1,247,814 | ContributionsAmt |
| Investment Earnings Or Losses | $1,116,727 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $779,439 | OtherExpendituresAmt |
| End Year Balance | $23,344,620 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $29,940,604 | BeginningYearBalanceAmt |
| Contributions | $1,550,642 | ContributionsAmt |
| Investment Earnings Or Losses | $1,795,537 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $127,557 | GrantsOrScholarshipsAmt |
| Other Expenditures | $11,399,708 | OtherExpendituresAmt |
| End Year Balance | $21,759,518 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,423,779 | BeginningYearBalanceAmt |
| Contributions | $3,296,920 | ContributionsAmt |
| Investment Earnings Or Losses | -$455,682 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,324,413 | OtherExpendituresAmt |
| End Year Balance | $29,940,604 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $12,255,343 | BeginningYearBalanceAmt |
| Contributions | $1,049,443 | ContributionsAmt |
| Investment Earnings Or Losses | $30,008,379 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $15,379 | GrantsOrScholarshipsAmt |
| Other Expenditures | $11,874,007 | OtherExpendituresAmt |
| End Year Balance | $31,423,779 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.36630 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.63370 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $425,124 | OtherCostOrOtherBasisAmt |
| Book Value | $425,124 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $162,836,286 | OtherCostOrOtherBasisAmt |
| Depreciation | $101,540,251 | DepreciationAmt |
| Book Value | $61,296,035 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,300,817 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,419,511 | DepreciationAmt |
| Book Value | $27,881,306 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $79,742,763 | OtherCostOrOtherBasisAmt |
| Depreciation | $61,875,450 | DepreciationAmt |
| Book Value | $17,867,313 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $107,469,778 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Interest in Foundation | $37,814,215 |
| Other receivables | $19,418,051 |
| Receivables from third-party payors | $4,985,917 |
| Receivables from related organizations | $4,585,636 |
| Johnson Trust assets | $1,390,410 |
| Other assets | $91,810 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $68,286,039 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $73,154,537 |
| Payables to third-party payors | $19,461,763 |
| CARES Act accelerated payments | $13,887,853 |
| Other liabilities | $11,467,810 |
| Annuity payable | $126,084 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $118,098,047 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $456,778 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $456,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $456,778 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $456,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $478,706 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $478,706 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $293,806 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $293,806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,188,124 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,062,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,125,983 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06290 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $53,966 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $53,966 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,014,602 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,062,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,952,461 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06580 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,471,380 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,062,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,409,239 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06740 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,279,016 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,279,016 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,279,016 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,279,016 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $535,180 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $81,840 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $90,446,851 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $94,042,024 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,595,173 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | State LicenseStateLicenseNum | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Facility Reporting GroupFacilityReportingGroupCd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|---|---|
| St Helena Hospital | |||||||||||
| 1 | 10 Woodland Road | St Helena | CA | 94574 | www.adventisthealth.org/sthelena | 110000073 | Yes (X) | Yes (X) | Yes (X) | A | |
| Adventist Health Vallejo | |||||||||||
| 2 | 525 Oregon Street | Vallejo | CA | 94590 | www.adventisthealth.org/sthelena | 110000042 | Yes (X) | A | Acute Psychiatric Hospital | ||
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Facility Reporting Group - A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assesment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assesment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assesment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Section B | Facility Reporting Group A |
| Facility Reporting Group A consists of: | - Facility 1: St. Helena Hospital, - Facility 2: Adventist Health Vallejo |
| Facility Reporting Group - A 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 from community members. Data gathering was accomplished by engaging with community focus groups and conducting key stakeholder interviews. Focus group participants were end-users of programs and services provided by AHSH. Populations represented by focus group members included Promotoras, seniors, low-income, homeless/at-risk and representatives from the education sector. The majority of focus group participants live in Napa County, specifically in Santa Rosa, Yountville, St. Helena, and Calistoga. Key informant interviews consisted of key leaders in our community from an array of agencies, including those that serve children, homeless populations, seniors and community at large populations. Additionally, key informant interviews were conducted with representatives from the non-profit, educational, homeless, law enforcement, and faith-based sectors. The majority of the people interviewed serve residents in Napa County, specifically in in Santa Rosa, Yountville, St. Helena, and Calistoga. Additional localities identified for the service areas were Rutherford, Ronald Park, Deer Park and Hope Valley. Most key informants hold titles such as Executive Directors or Presidents, Superintendent, Mayor, and Head Pastor.A significant portion of secondary data for this assessment was collected through reports generated through CARES Engagement Network CHNA(https://engagementnetwork.org/assessment/). Other sources include California Department of Public Health, County Health Rankings & Road maps, and California Environmental Protection Agency's Office of Environmental Health Hazard Assessment. When feasible, health metrics have been further compared to estimates for the state or national benchmarks, such as the Healthy People 2020 objectives. |
| Facility Reporting Group - A Part V, Section B, line 6b: | St. Helena Hospital partnered with Abode Services, Napa Valley Unified School District-St. Helena School District, Rianda House and Up Valley Center to prepare the 2019 Community Health Needs Assessment. |
| Facility Reporting Group - A 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 four areas of significant need: Mental and Behavioral Health, Access to Health Care, Chronic Diseases, and Housing. Priority Need 1 - Mental and Behavioral Health - The goal is to reduce stigma of mental health for youth and seniors through education and engagement in the communities served by Adventist Health St. Helena & Vallejo. Strategy 1 - Stigma reduction through increased education and awareness. Strategy 1.2 - Advance existing peer and professional counseling to struggling youth.Strategy 1.3 - Increase awareness and resources for seniors to live safely in home. Activity 1.1 - Teens Connect - This Wellness Cafe is open to all and is considered a safe space for teens to discuss struggles as well as tools for managing stress and anxiety.Activity 1.2 - Aldea Children & Family Services at Boys and Girls Clubs - This program provides mental health, child welfare and support services for individuals who have barriers in receiving treatment. Activity 1.3 - Healthy Minds Healthy Aging - This program provides screening for cognitive, behavioral and psychosocial health issues. Due to the impact of COVID-19, our Teens Connect, Aldea Children & Family Services, and our Healthy Minds Healthy Aging programs have been placed on hold for the duration of 2021. Our hope is to revisit these programs in 2022. Priority Need 2 - Access to Health Care and Health - The goal is to increase access to quality, culturally competent health care and health to underinsured, uninsured and vulnerable in the community served by St. Helena and Vallejo. Strategy 1 - Identify and screen vulnerable community members providing education and resources for referrals to ongoing health management. Strategy 1.2 - Maintain and/or increase referrals for necessary diagnostic and surgical procedures for under or uninsured population. Activity 1.1 - Mobile Health Program - Our Mobile Health grant funded program was actively engaged within our community throughout 2021. As we seek to improve the health and well-being of our communities, bringing healthcare to the consumer and meeting people where they are is crucial. Due to the pandemic our focus included providing flu and COVID-19 vaccination clinics throughout Napa County. During 2021, our Mobile Health program provided more than 43,000 COVID-19 vaccine doses and targeted our seniors, farmworkers, teachers and essential workers including employees and patients from other hospitals, clinics and health plans. We look forward to continuing our mobile health program in 2022 and hope to increase our impact on those who need it most. Activity 1.2 - Operation Access - Due to the impacts of COVID-19 and high surges in early 2021, the Operation Access program was not able to serve patients in 2021. It is our hope that we will continue outreach and collaboration in 2022, to get much needed services to those who need them. Additional activities include our Blue Zones Project work. With Blue Zones coming into our community, we have been able to start the foundation of bringing awareness to access to healthcare and health through the following activities: We have set the goal of creating an environment in the Upper Napa Valley where healthy foods and beverages are embraced, universally accessible, and locally produced, with emphasis on food and nutrition insecure households. Our specific targets are for each city/town to adopt four policy/systems/environmental changes, complete three capacity building initiatives, and implement one marquee project. Another objective is to increase healthy food and beverage access with an emphasis on underserved community members. Our strategies to accomplish this are to: establish comprehensive adoption and use of food benefit programs at Calistoga farmers market, including universal SNAP/WIC acceptance, pilot produce Rx and market match; ensure timing of the farmers market works for the community, and that the community feels comfortable attending the market; (Calistoga) create a pilot Produce Rx program at St. Helena Farmers Market; ensure timing of the Farmer's Market events works for the community, and that the community feels comfortable attending the event; (St. Helena) establish food insecurity screening and referral through relevant healthcare providers and community-based programs; (Regional) establish accessible transportation to existing hunger relief sites, including free food pantries and churches, and/or expand mobile market access/delivery; and explore the expansion of public growing space such as vineyards and community gardens. (Calistoga, Regional) We've also included the objective of reducing the availability of and access to tobacco products, focusing on flavors. We plan to advocate for the implementation of a Tobacco Retail Licensing program, including prohibiting the retail sale of tobacco within a specified distance from youth areas and prohibiting the retail sale of flavored tobacco products. (Calistoga, St. Helena, Yountville) Additionally, we will also advocate for zoning reform to prohibit the retail sale of tobacco within a specified distance from youth areas (Calistoga, St. Helena, Yountville), as well as advocate for the passage of a flavor ban (Calistoga, St. Helena, Yountville).Priority Need 3 - Chronic Diseases - Heart Disease, Obesity/Diabetes, Cancer - The goal is to increase community's knowledge and ability to self-manage their disease. Strategy 1 - Local education and screening capacity addressing heart disease, obesity/diabetes and cancer through mobile screening program, local events, and disease specific screening opportunities. Strategy 1.2 - Educate community on prevention of chronic diseases. Activity 1.1 - Dare to C.A.R.E - Due to the COVID-19 pandemic, Dare to CARE was put on hold back in early 2020 and currently remains on hold throughout 2021. Activity 1.2 - 4-Weel Diabetes Education Course - With COVID-19 still actively present in 2021, there were limited number of community outreach and education classes. Total number of persons served in 2021 were nine. Activity 1.3 - AHEAD Hereditary Cancer Screening - Due to COVID-19 activities had to pivot direction. Number of participants screened: 1,455 with 171 directly affected and a total of 411 classified as being high risk and eligible for genetic testing. A total of 354 individuals agreed to testing and are currently pending results. Additional activities include our Blue Zones Project work. With Blue Zones coming into our community, we have been able to start the foundation to bring awareness around chronic disease - heart disease, obesity/diabetes and cancer priority through the following activities: working to decrease childhood obesity (Baseline, BMI) by increasing access to healthy fruits and vegetables, increasing walkability and physical activity opportunities in the community. This will effectively decrease the rates of all the above diseases. One of the key points of Blue Zones is that they have lower rates of chronic diseases and a higher quality of life, but this is due to the collective intervention and is difficult to attribute to just one thing. Optimizing food, tobacco, and built-environment policy is a high-impact, cost- effective strategy to reduce chronic disease and improve well-being. |
| Part V, Section B, Line 11, continuation: | Priority Need 4 - Housing and Homelessness - The goal is to have community collaboration to provide goods to individuals experiencing housing insecurity. Strategy 1 - Community Building Initiatives (CBI). Activity 1 - Inspire Hope/World Vision - This community-based initiative is designed to respond to the growing financial, housing and economic needs within our community. Throughout 2021, our local Inspire Hope Program met people where they are at and provided support through the following outlets: community members who have experienced big life changes due to the pandemic, have been impacted/displaced by local wildfires, and those who are unhoused and need basic essentials to survive. Some of the smallest donations are making a huge impact to those we are serving. Over 2021, we had an average of at least 25 active partners that worked collectively to get resources out to our community members. Additional activities include Blue Zones Projects. Additionally with Blue Zones coming into our community, we have been able to start the foundation of bringing awareness to housing and homeless priorities through the following activities: engaging in strategic conversations with the State around Veterans Home Workforce Housing Development and ADA/multimodal accessibility, and adopting policies or plans that will further the development of affordable and accessible housing to service Upper Napa Valley community needs by updating the housing elements of general plans as required for each community, while addressing the regional housing need projections for each and utilizing innovative housing solutions that best suit respective communities. We will also develop policies to require affordable and missing-middle housing, with a focus on workforce housing. We plan to activate the old fairgrounds to accommodate the community's need for additional green space, a community center, further parks programming, open multimodal connectivity, and access, and offer developable land for housing solutions. One way we will measure success is by the number of planned or contracted affordable and missing middle housing units (at x% AMI to align with city housing elements).Priorities not addressed: No hospital can address all the health needs identified in its community. Adventist Health St. Helena and Vallejo are 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. Significant needs that will not be directly addressed include 'Access to Health Foods' & 'Sexually Transmitted Diseases'. These needs will be addressed by other community organizations within the community. |
| 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AH St Helena - Martin ONeil Cancer Center | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Cancer treatment |
| 2 - Mental Health | ||||
| 913 Washington Street | Calistoga | CA | 94558 | Psych/mental health |
| 3 - AH St Helena - Cardiology | ||||
| 999 Adams Street | St Helena | CA | 94574 | Outpatient clinic |
| 4 - AH St Helena - Coon Joint Replacement Inst | ||||
| 6 Woodland Road | St Helena | CA | 94574 | Orthopedics |
| 5 - Occupational Medicine | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Job care |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 a 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 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 that 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. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. 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 from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. |
| 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, two most recent Implementation Strategy reports 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.pdf These 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: | St. Helena Hospital Napa Valley service area is comprised primarily of communities in Napa and Solano counties. The major communities are the upper valley cities of St. Helena and Calistoga. The demographics of the communities we serve are wide scope, including urban, suburban, and rural, and from all income levels. Although we primarily serve those in the Napa and Solano counties, our destination services also bring us patients from larger and further demographics including Lake County. Napa County has a population of 140,314 with a median household income of $88,457. At the end of the 2017 school year, testing for fourth graders found that far more students scored Not proficient or worse on standardized reading testing, than 'Proficient or better in Lake County (76.4%), this average was higher than AHSH PSA (72.6%) and Napa County (59.1%).Across the two-county region, Napa County has a lower percentage of populations receiving Public Assistance Income at 1.7% and SNAP benefits at 5.1% as compared to Lake County and the state estimate of 3.6% and 11.2%, respectively. Napa County demonstrated a higher proportion of woman receiving prenatal care and adequate care at 79.7% in comparison to Lake County at 68.5%. Notably, Napa County estimates meet the Healthy People 2020 performance target of 77.9% and 77.6%, respectively. AHSH PSA Medicare population has the lowest rates of depression (16.4%) and heart disease (24.4%) as compared to Lake County (16.6% and 25.8%, respectively). AHSH PSA had higher rates of diabetes as compared to Lake and Napa County (21.6% and 22.2%, respectively). Food insecurity averages in Lake County for the overall population (15.6%) and children (23.2%) are higher than reported averages for the state (11% and 18.1%, respectively). These averages are higher than Napa County. |
| 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 St. Helena continued the following actions in response to the needs created or exacerbated by COVID-19: Continued offering virtual healthcare visits; continued their online symptom tracker; and participated in a communitywide effort to vaccinate eligible community members. Additionally, the Hospital supported the county's public health department mobile health program in launching a testing initiative to reach agricultural workers and vineyard/winery support staff on a bi-weekly basis to meet them where they are. This allowed us to develop relationships, build trust and provide education on safety precautions to keep themselves and their families safe. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| California Health Fund & Trust | ||||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $76,008 | $0 | Hope Rising scholarship |
| Radiant Global Logistics Inc | ||||||||
| 700 S Renton Village Place 7th Fl | Renton | WA | 98057 | 043625550 | $19,795 | $0 | World Vision - Inspire Hope donations | |
| Zero Prostate Cancer Run | ||||||||
| 515 King Street Suite 420 | Alexandria | VA | 22314 | 593400922 | 501(c)(3) | $10,000 | $0 | Prostate Cancer Run |
| Napa Valley Vine Trail Coalition | ||||||||
| 3299 Claremont Way Suite 5 | Napa | CA | 94558 | 263426758 | 501(c)(3) | $7,500 | $0 | Wellness sponsor |
| UpValley Family Centers of Napa County | ||||||||
| 1440 Spring Street | St Helena | CA | 94574 | 800023012 | 501(c)(3) | $15,000 | $0 | Promotoras (health care workers) |
| Operation Access | ||||||||
| 1119 Market Street Suite 400 | San Francisco | CA | 94103 | 943180356 | 501(c)(3) | $15,000 | $0 | Hlth srvs un/underinsured pt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 5 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Grants are made to public charities. No formal monitoring of the grants is completed. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||||||
| Chair/CEO thru 12/21 | $0 | $1,801,000 | $0 | $1,112,062 | $0 | $27,026 | $0 | $11,644 | $0 | $50,774 | $0 | $3,002,506 | $0 | $0 |
| Wing Bill | ||||||||||||||
| Dir/Asst Secr/Vice Chair | $0 | $1,440,800 | $0 | $991,833 | $0 | $26,446 | $0 | $11,644 | $0 | $64,578 | $0 | $2,535,301 | $0 | $0 |
| Jahn Andrew | ||||||||||||||
| Care Division President | $0 | $1,044,420 | $0 | $600,285 | $0 | $203,978 | $0 | $11,644 | $0 | $61,293 | $0 | $1,921,620 | $0 | $0 |
| Hofheins Todd | ||||||||||||||
| CFO | $0 | $999,600 | $0 | $116,549 | $0 | $202,998 | $0 | $11,644 | $0 | $48,266 | $0 | $1,379,057 | $0 | $0 |
| Nahapetian Arby | ||||||||||||||
| Care Division Chief Medical Officer | $0 | $700,000 | $0 | $222,478 | $0 | $135,635 | $0 | $11,644 | $0 | $66,658 | $0 | $1,136,415 | $0 | $0 |
| Eller Jeff | ||||||||||||||
| President, NCR | $0 | $531,828 | $0 | $547,897 | $0 | $20,413 | $0 | $0 | $0 | $22,996 | $0 | $1,123,134 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $616,324 | $0 | $169,142 | $0 | $147,239 | $0 | $14,609 | $0 | $45,152 | $0 | $992,466 | $0 | $0 |
| Byrnes John - Former | ||||||||||||||
| Medical Officer, NCR thru 02/20 | $0 | $622,962 | $0 | $172,647 | $0 | $110,827 | $0 | $11,644 | $0 | $45,152 | $0 | $963,232 | $0 | $0 |
| Stevens Eric | ||||||||||||||
| Care Division Operations Executive | $0 | $749,000 | $0 | $76 | $0 | $135,535 | $0 | $16,336 | $0 | $33,656 | $0 | $934,603 | $0 | $0 |
| Herber Steven | ||||||||||||||
| President | $0 | $487,000 | $0 | $182,164 | $0 | $95,022 | $0 | $11,644 | $0 | $55,606 | $0 | $831,436 | $0 | $0 |
| Spenst Brett | ||||||||||||||
| Care Division Finance Officer | $0 | $734,400 | $0 | $38,124 | $0 | $13,577 | $0 | $11,644 | $0 | $33,656 | $0 | $831,401 | $0 | $0 |
| Lonto Robert | ||||||||||||||
| Former Reg HP Dir, NCR thru 02/20 | $0 | $291,699 | $0 | $86,172 | $0 | $38,025 | $0 | $11,661 | $0 | $61,035 | $0 | $488,592 | $0 | $0 |
| Mensch Deborah | ||||||||||||||
| Patient Care Executive | $0 | $265,800 | $0 | $20,221 | $0 | $88,272 | $0 | $13,540 | $0 | $35,753 | $0 | $423,586 | $0 | $0 |
| Blethen Elisa - Finance | ||||||||||||||
| Officer, Treas/Asst Secr thru 11/21 | $0 | $260,010 | $0 | $56,696 | $0 | $27,764 | $0 | $11,644 | $0 | $51,399 | $0 | $407,513 | $0 | $0 |
| Hasso Ruth | ||||||||||||||
| RN | $244,756 | $0 | $2,984 | $0 | $0 | $0 | $9,563 | $0 | $72,285 | $0 | $329,588 | $0 | $0 | $0 |
| Barnes Geoffrey | ||||||||||||||
| Supervisor, RN | $248,969 | $0 | $16,292 | $0 | $0 | $0 | $10,616 | $0 | $46,754 | $0 | $322,631 | $0 | $0 | $0 |
| Roberts Janice | ||||||||||||||
| Director, Cardiac Service Line | $215,183 | $0 | $25,478 | $0 | $2,991 | $0 | $9,646 | $0 | $43,999 | $0 | $297,297 | $0 | $0 | $0 |
| Heinrich Kerry | ||||||||||||||
| Dir/CEO Elect as of 11/21 | $0 | $138,538 | $0 | $123,000 | $0 | $21,159 | $0 | $0 | $0 | $2,627 | $0 | $285,324 | $0 | $0 |
| Gonzales Jerry | ||||||||||||||
| Director, Pharmacy | $218,998 | $0 | $24,630 | $0 | $4,926 | $0 | $7,931 | $0 | $28,835 | $0 | $285,320 | $0 | $0 | $0 |
| Jadid Lina | ||||||||||||||
| Pharmacy Coordinator | $253,180 | $0 | $75 | $0 | $0 | $0 | $10,043 | $0 | $11,938 | $0 | $275,236 | $0 | $0 | $0 |
| Lyons Timothy | ||||||||||||||
| Medical Officer | $0 | $0 | $0 | $0 | $270,000 | $0 | $0 | $0 | $0 | $0 | $270,000 | $0 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| Former CFO/Asst Secr thru 08/19 | $0 | $0 | $0 | $0 | $0 | $179,119 | $0 | $0 | $0 | $11,442 | $0 | $190,561 | $0 | $0 |
| Dickinson Elizabeth | ||||||||||||||
| Patient Care Executive thru 08/20 | $0 | $58,491 | $0 | $59,949 | $0 | $23,246 | $0 | $0 | $0 | $16,412 | $0 | $158,098 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | 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. Reppert, Joseph - severance payment - $179,957 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. 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. Jahn, Andrew - participant, no activity in 2021 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Herber Timothy | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of Officer, S. Herber | RelationshipDescriptionTxt |
| Transaction | $95,339 | TransactionAmt |
| Transaction | Employment compensation | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | St. Helena Hospital, dba Adventist Health St. Helena (AHSH), 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 AHSH, 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 AHSH 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. AHSH 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 $456,778. The following Inpatient services were provided to all our patients: - 1,210 surgeries performed - 39,124 patient days The following Outpatient services were provided to all our patients: - 6,457 emergency department visits - 4,706 outpatient surgeries performed - 45,170 outpatient visits - 70,774 clinic visits AHSH 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 $18,952,461. 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's 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 (Incentive 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 20,433,193. Management and general expenses 873,582. Fundraising expenses 0. Total expenses 21,306,775. Purchased medical services: Program service expenses 18,693,804. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,693,804. All other purchased services: Program service expenses 10,526,940. Management and general expenses 1,011,630. Fundraising expenses 21,971. Total expenses 11,560,541. Contract labor: Program service expenses 5,424,842. Management and general expenses 33,156. Fundraising expenses 0. Total expenses 5,457,998. Other medical professional fees: Program service expenses 2,230,548. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,230,548. Repairs and maintenance: Program service expenses 525,647. Management and general expenses 43,841. Fundraising expenses 923. Total expenses 570,411. Consulting and other management fees: Program service expenses 268,817. Management and general expenses 268,003. Fundraising expenses 0. Total expenses 536,820. Other professional fees non-medical: Program service expenses 32,663. Management and general expenses 116,547. Fundraising expenses 0. Total expenses 149,210. |
| Form 990, Part XI, line 9: | Change in interest in Foundation 5,842,883. Split-interest agreements - change in value 304,628. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Delano | |||||||||||
| 1401 Garces Highway | Delano | CA | 93215 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Mendocino Coast | |||||||||||
| 700 River Drive | Fort Bragg | CA | 95437 | 845174585 | Hospital | CA | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| Adventist Health Physicians Network | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| 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 | |
| Saint Helena Hospital Foundation | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 201384250 | Fundraising and investment management | CA | 501(c)(3) | Line 12a, I | 0 | N/A | |
| 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 | |
| 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| Blue Legacy Ventures LLC | |||||||||
| 1010 NE 2nd Avenue | Miami | FL | 33132 | 871254649 | Real property rental | FL | N/A | 0 | 0 |
| Blue Zones LLC | |||||||||
| 200 Southdale Center | Edina | MN | 55435 | 271603327 | Education | MN | N/A | 0 | 0 |
| PAR LLC | |||||||||
| 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AdHealth Limited | ||||||||||||||
| PO Box HM 2062 | Hamilton | BD | HM HX | Pure captive insurance | BD | N/A | C | 0 | ||||||
| Adventist Health Plan Inc | ||||||||||||||
| Health insurance | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 463833261 | CA | |||||
| South Coast Medical Center | ||||||||||||||
| Wind down after sale of hospital | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 952037291 | CA | |||||
| Thrive Productions Inc | ||||||||||||||
| Production company | N/A | C | 0 | 200 Southdale Center | Edina | MN | 55435 | 453369049 | MN | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | Yes (1) | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |