2022-11-11T16:05:02-08:00 2021-12-31 800519547 THE ACCOUNTANCY LLP 500 N Brand Blvd Fl 20 Glendale CA 91203 990 2021-01-01 832351753 Adventist Health Tulare ADVE 5596880821 869 N Cherry St Tulare CA 93274 Haydock Timothy Treasurer 2022-11-11 true Haydock Timothy 999009999 S Clement P01218012 8185475701 X 2 AAL1 IAL1 FAL1 2021 2022-09-23 18:48:47Z Kofl Andrea 869 N Cherry St Tulare CA 93274 35430687 false 1071 X www.adventisthealth.org/tulare X 2018 CA Living Gods love by inspiring health, wholeness and hope. 14 11 398 0 191583 124092 63706641 35198021 139156 97880 0 64037380 35419993 19399 50650 0 24676057 28258530 0 148321 40793827 53752669 65489283 82061849 -1451903 -46641856 69567437 47090498 79212987 103377904 -9645550 -56287406 Living Gods love by inspiring health, wholeness and hope. false false 66317837 50650 35419993 Adventist Health Tulare (AHTR) provides quality medical health care 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 Adventist Health Tulare, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths 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 will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Adventist Health Tulare 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.AHTR 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 $22,636,835.The following Inpatient services that were provided to all our patients. These services included:395 Surgeries performed9,288 Patient days The following Outpatient services that were provided to all our patients. These services included:26,563 Emergency department visits1,871 Outpatient Surgeries performed13,645 Outpatient VisitsAHTR recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2021 was $1,873,045.Adventist Healths mission statement of Living Gods 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 Gods image has experienced the best health today, hope for tomorrow, and Gods love that endures forever.Website for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ 66317837 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false true false false false false false false true false false false true 0 0 true 398 true false false false false false false false 0 false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true true true false CA X John Beaman 9164060000 PO Box 619135 Roseville CA 95661 X Reiner Scott CEO thru 12/21 0.00 50.00 X X 0 2940088 62418 Wing Bill Dir/Asst Sec/VC 0.00 50.00 X X 0 2459079 76222 Jahn Andrew President, Care Division 2.00 48.00 0 1848683 72937 Hofheins Todd CFO 0.00 50.00 X 0 1319147 59910 Nahapetian Arby Care Division Chief Medical Officer 2.00 48.00 0 1058113 78302 Kofl Andrea President 10.00 40.00 X 0 1033401 56796 Jobe Meredith Secretary 0.00 50.00 X 0 932705 59761 Gavini Frank Medical Officer, CVN 10.00 40.00 0 974582 0 Larsen David Finance Officer, CCR thru 4/19 0.00 50.00 0 876757 67250 Stevens Eric Care Division Operations Executive 2.00 48.00 0 884611 49992 Chen Steven Former Finance Officer, CCR 2/20 0.00 50.00 0 779689 73789 Spenst Brett Care Division Finance Officer 2.00 48.00 0 786101 45300 Haydock Timothy Treas/A Sec 10.00 40.00 X 0 541141 72905 Ferch Wayne Former President, CCR thru 2/20 0.00 0.00 0 586112 18351 Ayala Raul Medical Officer, CVN Clinics 10.00 40.00 0 528284 26925 Kaur Gurvinder Medical Officer, CVN 10.00 40.00 0 496219 29566 Taggart Laurie Patient Care Executive 10.00 40.00 0 429070 56573 Reyna Sonja Bus Dev Exec 10.00 40.00 0 439126 42606 Ammon Edward Foundation Executive 10.00 40.00 0 313560 55547 Pickering Christine Communication Dir, CCR 10.00 40.00 0 313948 46375 Garcia Rosa RN, Nurse Lead 50.00 0.00 285592 0 66265 McGowan John Associate Patient Care Executive 10.00 40.00 0 246050 58769 Dodd Randal Former President thru 5/20 0.00 0.00 0 272822 28416 Pereira Sheri Associate Patient Care Executive 10.00 40.00 0 229620 58020 Heinrich Kerry-CEO Elect1121 Director 0.00 50.00 X X 0 282697 2627 Plata Nina Former Population Hlth Ex thru 6/20 0.00 0.00 0 229909 43192 Santiago Emilio RN, House Supvsr 50.00 0.00 186833 0 48591 Price Jason RN Nurse Lead 50.00 0.00 188252 0 35947 Ng Mankwong Pharmacist 50.00 0.00 178453 0 39517 Aflague Stefanie Pharmacist, Charge 50.00 0.00 184997 0 23074 Reppert Joseph Former CFO/Asst Secr thru 8/19 0.00 0.00 0 179119 11442 Freedman John VC/Chair 8/21 0.00 4.00 X X 0 26435 0 Banks David Director 0.00 4.00 X 0 26159 0 Cherry Robert Director 0.00 4.00 X 0 26159 0 Davis Andrew Director 0.00 4.00 X 0 26159 0 Innocent Larry Director 0.00 4.00 X 0 26159 0 Reiner Richard Director 0.00 4.00 X 0 26159 0 Graham Ricardo Chair thru 8/21 0.00 4.00 X X 0 19545 0 Woodson Marc Director 0.00 4.00 X 0 15909 0 Salazar Velino Director 0.00 4.00 X 0 6058 0 Ocampo Lucy Director 0.00 4.00 X 0 159 0 Fehr Joy Director 0.00 4.00 X 0 114 0 Newton Bradford Dir/VChair 8/21 0.00 4.00 X X 0 0 0 1024127 21179648 1467385 77 true true false Comfort Anesthesia Associates Inc 11704 Nantwick Ct Bakersfield CA 93311 Physician Services 2266811 Galen Inpatient Physicians Inc 2100 Powell St Suite 400 Emeryville CA 94608 Physician Services 1408606 Radiology Medical Group of WMMC PO Box 86348 Los Angeles CA 90086 Physician Services 1167472 Central Valley Critical Care Medicine APC 5211 W Goshen Ave PMB 326 Visalia CA 93261 Physician Services 810853 CEP America California 2100 Powell St Ste 900 Emeryville CA 94608 Physician Services 772521 21 124092 124092 CARES Act Income 722514 374548 374548 Dietary/Cafeteria Revenue 279519 279519 Other Program Services 900099 613334 613334 Patient Care Services 900099 33863589 33863589 Revenue from Related Orgs 59971 59971 7060 7060 35198021 108574 108574 0 0 0 10694 -10694 -10694 -10694 0 0 0 0 35419993 35187327 108574 X 50650 50650 0 0 0 0 0 23010545 21226308 1674065 110172 763665 704156 55839 3670 2918337 2695585 208501 14251 1565983 1450082 107849 8052 8496425 8496425 92359 92359 0 0 0 0 14347504 14165744 177540 4220 10000 10000 408555 298447 110108 2434514 620607 1813907 0 4106064 1704444 2393778 7842 67215 63009 4123 83 0 3518 3518 2707396 2707396 0 3994538 3953343 41195 123605 123605 Patient Care Supplies 9090250 9090219 31 Quality Assurance 6583026 6583026 Equipment Rentals 801137 764201 36936 Other Expenses 486563 113497 373066 0 82061849 66317837 15595691 148321 0 0 0 31624421 14905377 0 0 0 1642529 1839878 376390 118169 23667925 11340971 13643375 12326954 0 0 0 303000 303000 21977722 17597120 69567437 47090498 6933112 10457609 11293 144335 4020 72264562 92775960 79212987 103377904 X -9645550 -56293406 6000 -9645550 -56287406 69567437 47090498 -46641856 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 9819 9819 false false Part II-B, Line 1i - Other Activities Description The organization belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Part IV - Additional Information 124092 118092 6000 10425 191583 202008 11673 1248 10425 1.00000 false true true 904979 904979 688549 107108 581441 22074397 11233863 10840534 12326954 Other Receivables 2215919 Receivables from Related Organizations 98586 Receivables from Third Parties 15282615 17597120 Cash Overdraft 44257528 Other Liabilities 4257657 Payables to Related Organizations 44260775 92775960 X Part V, Line 4: Intended uses of the endowment fund. 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 : FIN48 Footnote 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 2017 in major tax jurisdictions. true true X true X true X true true true false true true 68625 68625 0.00080 41805948 19237738 22568210 0.27500 41874573 19237738 22636835 0.27580 125840 125840 0.00150 9151657 3579682 5571975 0.06790 9277497 3579682 5697815 0.06940 51152070 22817420 28334650 0.34520 147 147 474 474 91183 91183 0.00110 91804 91804 0.00110 true 673297 193838 12237555 13642023 -1404468 X true true 1 1 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 See Form 990, Pg 1, Item J 106540816 X X X false false true X X X X X X X X X 19 true true false true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 19 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X X true X false X X X X true X false false Facility: - 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. Primary data was collected through key informant interviews, focus groups, and an online survey. Key informants and focus groups were purposefully chosen to represent medically under-served, low-income, or minority populations in our community. Their input provided insights on how to better direct our resources and form partnerships. Nearly 700 (680 total) people were surveyed to obtain input from the community in the form of 48 key informant interviews, 24 focus groups (with a total of 284 participants), and 348 online survey participants (including a Spanish option).Community Survey: The online survey was distributed to partner organizations that were not represented by key informants and advertised to the general public via a public service announcement hosted on Univision's Arriba Valle Central" show. Additional written comments on the previous CHNA were solicited on each hospital's website using a unique link. To date no written comments were received. Community Focus Groups: Focus group participants were end-users of programs and services provided by hospitals participating in this CHNA. Populations represented by focus group members included low-income (rural and urban) populations, homeless, seniors, youth, Hmong and Spanish speaking, LGBTQ+, and parents.Key Informant Interviews: Key informant interviews comprised key leaders in our community from an array of agencies, including those that serve children, homeless populations, LGBTQ+, veterans, seniors, tribal populations, African Americans, and Hmong and Spanish speaking populations. Other participating organizations represented public health agencies, law enforcement, health care organizations, funders, and school districts. Secondary data sources include publicly reported state and nationally recognized data sources such as Community Commons, California Department of Public Health, County Health Rankings & Roadmaps, and California Environmental Protection Agencys Office of Environmental Health Hazard Assessment. When feasible, health metrics have been further compared to averages for state or national benchmarks, such as Healthy People 2020 objectives. Facility: - Part V, Section B, Line 6a Beginning in 2011, the Hospital Council of Northern and Central California initiated a four-county (Fresno, Kings, Madera, and Tulare) community health needs assessment (CHNA) process, working collaboratively with 15 hospitals across the Central Valley region. Participating hospitals are: Adventist Health Hanford, Adventist Health Reedley, Adventist Health Selma, Clovis Community Medical Center, Coalinga Regional Medical Center (Closed), Community Regional Medical Center (includes Community Behavioral Health Center), Kaiser Permanente: Fresno Service Area, Kaweah Delta Health Care District, Madera Community Hospital, San Joaquin Valley Rehabilitation Hospital, Sierra View Medical Center, Saint Agnes Medical Center, Tulare Regional Medical Center (Adventist Health oversees the operations of the hospital. Doors opened to the public October 15, 2018.), Valley Childrens Healthcare. Facility: - 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 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 five areas of significant need: Access to Care, Obesity/ Healthy Eating Active Living (HEAL)/ Diabetes, Mental Health, Economic Security/Homelessness, Maternal & Infant Health. Our overall goal is to improve the health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1- Access to Care- The goal is to improve the overall health and wellness of our communities through provisions of services, community collaboration and innovation. Strategy 1- Improving access to care through increased health awareness and access to needed services. Activity 1.1- Transportation to clinic appointments. Due to COVID-19, in person clinic appointments decreased significantly, as did the requirement for transportation. Telehealth visits greatly increased which allowed patients the opportunity to receive care in the comfort of their own home to protect their safety and well-being. This increased our access to care efforts and allowed our providers the ability to reach patients throughout our network. Telehealth visits continued throughout 2021 and are expected to become a permanent access to care option for our patients into the future. Adventist Health Tulare has yet to secure a transportation vendor. Due to COVID-19 and transportation restrictions the local foundation was not able to distribute passes in 2021. Activity 1.2- Provider Recruitment- Due to the nature of our network, providers were added under Hanford/Selma and Reedley license. Additional Activities included the Central Valley Networks Mobile Medical Unit, Pop-up Clinics, and Education Outreach. Due to COVID-19 all programs were postponed and limited for 2021. Priority Need 2- Obesity/ Healthy Eating Active Living (HEAL)/Diabetes- The goal is to create healthy communities through expansion of preventative programs and chronic disease support. Strategy 1- Through a focus on educational activities, work to empower communities to understand the importance of healthy eating and exercise to live a healthier life. Activity 1.1- Diabetes self-management classes. These classes consist of a five-week diabetes self-management education (DSME) curriculum that is available in English and Spanish from Scripps Whittier Diabetes Institute. This program is approved as a (DSME) Program by the American Diabetes Association and covers all diabetes self-management topics including understanding blood sugars, nutrition, physical activity, medication management, stress management, foot care, ongoing screening tests and exams, etc. Due to staffing shortages and COVID-19, all (DSME) classes we placed on hold indefinitely. Additional Activities included educational sessions and outreach events through partnerships with local community organizations. Due to COVID-19 all outreach and education events planned for 2021 are currently on hold. Priority Need 3- Mental Health- The goal is to increase access to behavioral health services for vulnerable populations. Strategy 1- to enhance provider and community partners knowledge of factors influencing behavioral health to support referrals to appropriate behavioral health resources. Activity 1.1- Provide mental health education to external Adventist Health partner organizations and community members. Due to COVID-19, all events planned for 2021 have been postponed indefinitely. It is our intention to restart education events in 2022. Priority Need 4- Economic Security/ Homelessness- The goal is to address social needs and social determinants of health, to allow for a healthy foundation for communities to build a healthy life. Strategy 1- Partner with county and local programs to have a greater impact on creating access to shelter and housing. Activity 1.1- Recuperative Board and Care (Lighthouse Rescue Mission)- Lighthouse Rescue Mission is a 90-day program geared to help out homeless or inadequate housed patients. Patients who are homeless and have substance abuse or mental health issues receive wrap-around care while they heal. Due to Project Room Key, implemented by California to address COVID risk in the homeless population, most homeless individuals found temporary housing in local hotels. Therefore, there were fewer homeless hospital admissions requiring a recuperative room and board program. Number of homeless members accepting discharge to the recuperative board and care program: 5. Additional Activities included student externships & internships and Inspire Hope resource distributions. Student internships and externships opportunities continued within our network and a total of 618 students were able to complete their academic requirements and provide much needed support within departments across our network. Through our partnership with World Vision, our Inspire Hope program continued to provide distribution as the need in our communities continued and increased due to the pandemic. Additionally, the homeless discharge planning process, as required by SB 1152, ensures that all homeless patients who come to the hospital for care are provided with and connected to any and all needed resources, the total number of persons served included 71 individuals.Priority Need 5- Maternal and Infant Health- The goal is to increase overall health and wellness. Strategy 1- Provide educational materials and host educational sessions. Activity 1.1- Provide free car safety seat checks to the community. Although program participation was reduced or limited due to COVID-19, during 2021 our hospital network was able to certify three associates and in return provided car seat education and car seat safety checks to families that needed them. Additional activities included birthing and breastfeeding classes. Due to limited resources and program participants, space was limited. A total of 4 individuals participated in classes throughout 2021. Both virtual and limited in-person sessions are expected to continue in 2022. Tulare Toxicology Lab 800 E Merritt Avenue Suite 107 Tulare CA 93274 Reference Lab-Toxicology Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense 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 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 - Methodology of Estimated Amount & Rationale for Including in Community Benefit 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 - Bad Debt Expense The system-wide combined audited financial statements do not contain a footnote describing bad debt expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals 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 evolving 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 too 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 - Provisions On Collection Practices For Qualified Patients 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 incomeX 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 - Needs Assessment 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 Community Benefit | Roseville, California | Adventist Health. The two most recent Community Health Needs Assessment, two most recent Implementation Strategy reports and the most recent Community Health Plan Update are also available on the Adventist Health Corporate website at Community Benefit | Roseville, California | Adventist Health. 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 - Patient Education of Eligibility for Assistance 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 - Community Information According to the U.S. Geological Survey, the Central Valley, also known as the Great Valley of California, covers about 20,000 square miles and is one of the more notable structural depressions in the world. Occupying a central position in California, it is bounded by the Cascade Range to the north, the Sierra Nevada to the east, the Tehachapi Mountains to the south, and the Coast Ranges and San Francisco Bay to the west. The Central Valley can be divided into two large parts: the northern one-third, known as the Sacramento valley and the southern two-thirds is called the San Joaquin Valley. The San Joaquin Valley can be split further into the San Joaquin Basin and the Tulare Basin. The hospitals participating in this assessment are nestled in the heart of Central Valley, within four contiguous countiesFresno, Kings, Madera, and Tulare. Using fewer than 1% of U.S. farmland, the Central Valley supplies 8% of U.S. agricultural output (by value) and produces 1/4 of the nation's food, including 40% of the nation's fruits, nuts, and other table foods. The Central Valley is also home to the raisin capital of the world, Selma, CA.In 2016, approximately 1,722,556 people lived in the four-county region. Fresno County comprised the largest portion. Of this population, the majority identify as Hispanic or Latino, in every county. Kings County has the largest population of veterans at 10%. The median household income ranges from $42,789 to $47,241 across the four counties.Tulare County has the largest percent of unemployed adults (8.7%) in the region and young people not in school and not working (10.7%). Comparatively, the averages for the state are 4.3% and 7.7%, respectively. Fresno County has the highest percentage of total population and children under age 18 living under the 100% of the federal poverty level, while Tulare County has the largest population that receives both SNAP benefits and public assistance income. Between 2014 and 2018, Fresno and Madera Counties experienced a 17% decrease in the total homeless population (from 2,592 to 2,144). In contrast, Visalia, Kings, and Tulare Counties experienced a 27% increase (from 763 to 967). Part VI, Line 4 - Community Building Activities The hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020, Adventist Health acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be able to gain ground in shifting the balance from healthcare treating people once they are ill to transformative well-being changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint, and as we enter 2022 these projects are active. Blue Zones widens our impact from only reaching our hospitals communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part VI, Line 5 - Promotion of Community Health Our hospitals mission is, Living Gods 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 todays 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 healthyeven 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 - Affilated Health Care System 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 can provide support through remote services such as tele pharmacy 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 - States Filing of Community Benefit Report CA Part VI - Additional Information Identified Needs from CHNA, Not Addressed and Why (Based on 2020 (FY 2019) CHP Update)No hospital can address all the health needs identified in its community. Adventist Health Tulare is committed to serving the community by adhering to its mission, and using its skills, expertise, and resources to provide a range of community benefit programs. Climate Change: We feel that this is not our area of expertise and while we are willing to partner with organization who are engaging in activities to address Climate Change, this is not a top priority at this time. Substance Abuse/Tobacco- will be addressed through Mental Health, Access to Care, and Healthy Eating Active Living (HEAL). Oral Health- will be addressed through Access to Care. Asthma- will be addressed through Access to Care. CVD/Stroke- will be addressed through Access to Care and HEAL. HIV/AIDS/STIs- will be addressed through Access to Care and Maternal/Infant Health. Cancer- will be address through Access to Care and HEAL. Violence/Injury Prevention- will be address through Economic Security/Homelessness, Access to Care and Maternal/Infant Health. Other Items: In FY2021, Adventist Health Hanford/Selma continued to offer the following actions in response to the needs created or exacerbated by COVID-19: Continued virtual healthcare visits to keep community members safe and healthy; continued their online symptom tracker and was part of a communitywide effort to vaccinate eligible community members. Primary website address: See Form 990, Pg. 1, Item JNeeds Assessment website: See Sch H Part VI - Needs AssessmentFAP website: See Sch H Part VI-Patient Education false CA Hlth Fund & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 50650 0 Funds Transfer Uninsured/Underinsured Patients 0 1 X X X X true true false false false false false false false Aflague Stefanie Pharmacist, Charge 182250 74 2673 6260 16814 208071 Ammon Edward Foundation Executive 232542 54306 26712 12579 42968 369107 Ayala Raul Medical Officer, CVN Clinics 421397 42412 64475 11644 15281 555209 Chen Steven Former Finance Officer, CCR 2/20 515000 183275 81414 11644 62145 853478 Dodd Randal Former President thru 5/20 272822 28416 301238 Ferch Wayne Former President, CCR thru 2/20 585289 823 18351 604463 Garcia Rosa RN, Nurse Lead 285535 57 11507 54758 351857 Gavini Frank Medical Officer, CVN 974582 974582 Haydock Timothy Treas/A Sec 395000 96721 49420 11644 61261 614046 Heinrich Kerry-CEO Elect1121 Director 138538 123000 21159 2627 285324 Hofheins Todd CFO 999600 116549 202998 11644 48266 1379057 Jahn Andrew President, Care Division 1044420 600285 203978 11644 61293 1921620 Jobe Meredith Secretary 616324 169142 147239 14609 45152 992466 Kaur Gurvinder Medical Officer, CVN 433461 76 62682 11644 17922 525785 Kofl Andrea President 624000 263477 145924 11644 45152 1090197 Larsen David Finance Officer, CCR thru 4/19 567118 201820 107819 11644 55606 944007 McGowan John Associate Patient Care Executive 203940 40122 1988 9313 49456 304819 Nahapetian Arby Care Division Chief Medical Officer 700000 222478 135635 11644 66658 1136415 Ng Mankwong Pharmacist 178323 74 56 6221 33296 217970 Pereira Sheri Associate Patient Care Executive 190040 38123 1457 9592 48428 287640 Pickering Christine Communication Dir, CCR 247193 28551 38204 11227 35148 360323 Plata Nina Former Population Hlth Ex thru 6/20 229909 43192 273101 Price Jason RN Nurse Lead 168123 14715 5414 6515 29432 224199 Reiner Scott CEO thru 12/21 1801000 1112062 27026 11644 50774 3002506 Reppert Joseph Former CFO/Asst Secr thru 8/19 179119 11442 190561 Reyna Sonja Bus Dev Exec 318365 76477 44284 11644 30962 481732 Santiago Emilio RN, House Supvsr 186758 75 6819 41772 235424 Spenst Brett Care Division Finance Officer 734400 38124 13577 11644 33656 831401 Stevens Eric Care Division Operations Executive 749000 76 135535 16336 33656 934603 Taggart Laurie Patient Care Executive 317090 73605 38375 11644 44929 485643 Wing Bill Dir/Asst Sec/VC 1440800 991833 26446 11644 64578 2535301 Arnold Plata Spouse of Key EE 20832 Employment false Schedule L, Part V Supplemental Information Additional information regarding interested persons listed above:1. Arnold Plata is the husband of Key Employee, Nina Plata. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder 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, Line 7a: How Members or Shareholders Elect Governing Body The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 11b: Form 990 Review Process This Form 990, including all supporting schedules, was prepared by a public accounting firm, reviewed by the System Controller and market Finance Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital 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, Line 15a: Compensation Review & Approval Process - CEO, Top Management The Organization's Board of Directors has established a Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital presidents and finance officers that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital president has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital. (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, Line 15b: Compensation Review and Approval Process for Officers and Key Employees See Line 15a explanation. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available 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. Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated Health System CA 501(c)(3) 10 Adventist Health SystemWest false Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Medical Center-Tehachap 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 12b2 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) 3 Adventist Health SystemWest false Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Hospital CA 501(c)(3) 12b2 Stone Point Health false Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Northwest Medical Fdtn of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Hospital CA 501(c)(3) 3 Fremont-Rideout Health Group false St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Simi Valley Hospital and Health Care Ser 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) 12b2 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled nursing/asstd living/home health CA 501(c)(3) 12b2 Fremont-Rideout Health Group false Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital WA 501(c)(3) 3 Adventist Health SystemWest false Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home care CA 501(c)(3) 10 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Delano PO Box 460 Delano CA 93216 770258013 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 845174585 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA AHSWest C-Corp false false false false false true false false false false false false false true false true true true true true Adventist Health SystemWest e 44260775 Notes Payable Adventist Health SystemWest m 10360091 Operating Exp Adventist Health SystemWest o 12953126 Compensation Adventist Health SystemWest s 44257528 Cash Mgt Funds