2021-11-10T16:47:42-06:00 2020-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2020-03-17 845174585 Adventist Health Mendocino Coast ADVE 9164060000 700 River Drive Fort Bragg CA 95437 Warrent Tetz Treasurer 9164060000 2021-10-22 1 Warrent Tetz 999009999 Tracy S Paglia P00366884 2099556100 2021-10-22 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z X Judson Howe 700 River Drive Fort Bragg CA 95437 28140651 0 X https://www.adventisthealth.org/mendocino X 2020 CA Living God's love by inspiring health, wholeness and hope. 3 2 336 7 0 0 8820 28131784 47 0 28140651 5543 0 12338199 0 0 16517724 28861466 -720815 37569132 38289947 -720815 X Living God's love by inspiring health, wholeness and hope. 0 0 19401816 5543 28131784 See Schedule O 19401816 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 92 0 1 336 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Todd Hofheins CFO 9164060000 PO Box 619135 Roseville CA 95661 X Reiner Scott Vice Chair 0.00 50.00 X 0 2358378 54819 Wing Bill Director/Chair 0.00 50.00 X X 0 1760327 59054 Jobe Meredith Secretary 0.00 50.00 X 0 769985 43868 Parker Bessant Medical Officer 15.00 35.00 X 0 467110 23740 Howe Judson - Finance Officer/President as of 12/20 0.00 50.00 X 0 384707 58172 Leach Judy President thru 12/20 50.00 0.00 X 0 358886 39489 Spencer Lindsey Operations Executive 0.00 50.00 X 0 324872 56876 Givens Linda Chief Nursing Officer 0.00 50.00 X 0 318042 42720 Miller William Medical Director-Hospitalist 20.00 0.00 X 257462 0 30819 Leister Lois F Pharmacy Director 40.00 0.00 X 198329 0 27862 Thompson Stephanie Housei Supervisor 40.00 0.00 X 171621 0 25031 Ra Jean Pharmacist 40.00 0.00 X 179416 0 8971 Louis Michael Pharmacist 40.00 0.00 X 169242 0 17724 Reiner Richard Director 0.00 4.00 X 0 26764 0 Innocent Larry Director 0.00 4.00 X 0 25608 0 976070 6794679 489145 54 0 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Locum Ortho/Oncology 404201 Atlas Medstaff LLC PO Box 735860 Dallas TX 75373 RN Registry 323725 Kermen John 45241 Mar Vista Drive Mendocino CA 95460 Anesthesiology Coverage 291199 Premier Emergency Physicians 7032 Collection Center Drive Chicago IL 60693 ED Physician Coverage 288661 Comphealth Medical Staffing PO Box 972651 Dallas TX 75397 Locum Clinic PA 260116 9 8820 8820 8820 Patient service revenue 621110 27055809 27055809 Other program services 900099 1017775 1017775 Premium revenue 900099 58200 58200 28131784 47 47 28140651 28131784 0 47 X 5543 5543 9533746 5719379 3814367 360036 237088 122948 1751919 1487389 264530 692498 434681 257817 586 471 115 107938 107938 24 24 386 386 7971895 5751427 2220468 198160 198160 190384 136106 54278 1018291 865502 152789 1546295 426563 1119732 19648 3190 16458 40739 22915 17824 213890 213890 282634 276429 6205 Patient care supplies 3741463 3601047 140416 Rent/lease cost equipme 226919 219810 7109 958472 958472 28861466 19401816 9459650 0 0 14217442 0 1106705 0 196489 8572188 813180 0 7759008 0 14289488 0 37569132 0 6165592 0 5000 0 25109152 0 7010203 0 38289947 X 0 -720815 0 -720815 0 37569132 -720815 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 386 386 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. 59211 59211 8512977 813180 7699797 7759008 Other receivables 13687101 Receivables from related organizations 602387 14289488 Other liabilities 5927543 Payables to related organizations 1082660 7010203 X Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2020 and 2019, 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 2016 in major tax jurisdictions. 1 1 X 1 X 1 X 1 1 1 0 1 1 462 462 0.00000 4727032 4375976 351056 0.01220 4727494 4375976 351518 0.01220 12794 12794 0.00040 12794 12794 0.00040 4740288 4375976 364312 0.01260 685842 685842 0.02380 685842 685842 0.02380 1 39768 11885 17184031 16788450 395581 X 1 1 1 1 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 adventisthealth.org/mendocino 110000040 X X X Adventist Health Mendocino Coast 1 0 1 1 X X X X X X X X X 19 1 1 1 1 X See Sch H, Part VI - Needs Assessment X See Sch H, Part VI - Needs Assessment X 1 19 1 See Sch H, Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X Sch H, Part VI-Patient Educ X Sch H, Part VI-Patient Educ X Sch H, Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Adventist Health Mendocino Coast Part V, Section B, Line 2: Adventist Health System/West entered into a lease agreement with Adventist Health Mendocino Coast, located in Fort Bragg, California. Stone Point Health, an affiliate of Adventist Health System/West became the sole member of Adventist Health Mendocino Coast. This agreement was effective July 1, 2020. This lease agreement allowed Adventist Health System/West the ability to provide expanded healthcare services in the Fort Bragg, California, market. Adventist Health Mendocino Coast Part V, Section B, Line 5: Due to Adventist Health Mendocino Coast being a district hospital prior to the affiliation with Adventist Health System/West, community information is being reported from Adventist Health Ukiah Valley's CHNA. 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 accomplished by using a widely-distributed community health survey and conducting key informant interviews and written surveys. Community Health Survey: Community Health Survey was provided to Mendocino County residents online as well as in hardcopy format. A total of 1,324 residents completed the Community Health Survey; 1,276 were completed in English and 48 in Spanish; 94 were completed by Native Americans, mostly from the Round Valley area.Key Informant Interviews and written surveys: 34 key stakeholders in the community, including representatives of county and city government, private businesses, health and human services, hospitals and clinics, community-based organizations and nonprofits, law enforcement, children and youth services, education, media, geography, and racial/ethnic groups, among others. Interviews were conducted in person or by phone. Some questions were also provided in hardcopy format for written response. While an effort was made to have diverse representation, the opinions provided by the key informants are not necessarily representative of the county as a whole. Key Leader Survey of 56 formal and informal leaders in the community that was provided online. Together with the Key Informant Interviews, a total of 90 key informants/leaders in Mendocino County participated.These key stakeholders were selected by the workgroup because they would provide a unique perspective on the health of the community, health care delivery systems in place and overall conditions that influence health behaviors. Secondary data sources included publicly available state and nationally recognized data sources. Data on key health indicators, morbidity, mortality, and various social determinants of health were collected from the US Government Accountability office, California Department of Social Services, California Department of Public Health, US department of Health and Human Services, HealthyPeople2020, Centers for Disease Control and Prevention, and the American Heart Association. Adventist Health Mendocino Coast Part V, Section B, Line 6a: Due to Adventist Health Mendocino Coast being a district hospital prior to the lease agreement with Adventist Health System/West, community information is being reported from Adventist Health Ukiah Valley's CHNA. Adventist Health Ukiah Valley partnered with Adventist Health Howard Memorial Hospital to produce the 2019 CHNA. Adventist Health Mendocino Coast Part V, Section B, Line 6b: Due to Adventist Health Mendocino Coast being a district hospital prior to the lease agreement with Adventist Health System/West, community information is being reported from Adventist Health Ukiah Valley's CHNA. Ukiah Valley Medical Center collaborated with the Mendocino County Health and Human Services Agency Public Health Branch, Healthy Mendocino, Redwood Community Services, Mendocino Coast Clinics, Mendocino Community Health Clinics, Alliance for Rural Community Health and North Coast Opportunities to prepare the 2019 Community Health Needs Assessment. Adventist Health Mendocino Coast 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.Prior to 2020, Adventist Health Mendocino Coast was a district hospital therefore did not participate in a formal Community Health Needs Assessment (CHNA). In the absence of a CHNA, hospital leadership mimicked the priority health needs of Adventist Health Ukiah Valley. This includes addressing mental health, substance abuse, and workforce development. In addition, there are currently no reporting metrics at this time. With the approved lease agreement to Adventist Health Mendocino Coast, the hospital facility continued to mimic Adventist Health Ukiah Valley's priority health needs. However, there are no metrics to report at this time. 3 1 - AJ Gray Building 775 River Drive Fort Bragg CA 95437 Home health, Foundation, and IT offices 2 - North Coast Family Health Center 721 River Drive Fort Bragg CA 95437 Clinic 3 - Ophthalmologist Clinic 721 River Drive Fort Bragg CA 95437 Ophthalmology Clinic Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. Part 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 completed the acquisition of Blue Zones as the first step toward reaching this goal. By partnering with Blue Zones, we are 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. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part III, Line 2: Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3: The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information, those accounts would have been reclassified from bad debt expense to charity care. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8: The Medicare cost report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, 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.Reconciliation of Medicare Revenue from the Hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue 17,184,031Prior Year Settlements 2,940Cost Report Reimbursable Bad Debts 223,554Non-cost report revenue 0Estimates and Accrual Variances (2,087,011)Other 653,905Total Medicare Revenue 15,977,419*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. 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 2021 Community Health Plan (CHP) Update for fiscal year 2020 are posted on the Hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/Prior to 2020, Adventist Health Mendocino Coast was classified as a district hospital therefore did not participate in a Community Health Needs Assessment cycle. 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: Due to Adventist Health Mendocino Coast being a district hospital prior to the lease agreement with Adventist Health System/West, community information is being reported from Adventist Health Ukiah Valley's CHNA. The Hospital's primary service area, however, consists of nearly the entire rural county, which spans over 3,500 square miles. Small, geographically isolated communities make up a large part of the county's nearly 88,000 residents. According to 2018, data from the U.S. Census Bureau, Mendocino County has an estimated population of 87,580, slightly lower than the 87,869 reported in the 2014 U.S. census data. More than one-half (55%) of the population live in urban areas, while 45% live in rural communities, on farms or ranches. The proportion of residents who are ages 65 years and over make up 21.7% of the county population, higher than the proportion in the state with 14.5%.In 2018, the county's population was 76% White, 22% Hispanic, 4% Native American, 1% Asian, 0.7% African American, 0.6% Pacific Islander, and 15.4% two or more races. Between 2010 and 2060, the Hispanic/Latino population is expected to increase from 19,802 to 37,293 or to 37% of the county population, while Whites will decrease from 60,449 to 48,450 (to 48% of the county population). In the most recent data, nearly one-quarter of adults in Mendocino County ages 25 and older (22%) had a bachelor's degree or higher, and 7% had less than a high school diploma (compared to 31% and 10%, respectively, for California as a whole). Also in 2017, the median household income in Mendocino County, at $47,656, was 36% lower than that of the state ($74,605), compared to 2014 when the median household income in Mendocino County was 29% lower than the state. Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache are soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population; 2. Factors that cause the present outcomes distribution; and 3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2. Improve care quality and patient safety, and 3. Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States CA Part VI, Other Information: In 2020, Adventist Health as a system took the following actions in response to the needs created or exacerbated by COVID-19: Adventist Health as a system directed "Community Strength Fund grants" to each hospital to support community partners' immediate response to COVID-19; Adventist Health as a system directed "Community Integration Catalyst" funds to each hospital to support internal new or expanded community well-being programming and innovation as an immediate response to COVID-19; began offering more virtual health care visits to keep community members safe and healthy; developed an online symptom tracker to help community members determine if they may have COVID-19 or some other flu type illness and what steps to take; partnered with MaskUp, a collaboration of 100 leading health systems representing thousands of hospitals across the U.S. joining to create messages for the betterment of the communities they serve.Locally, Adventist Health Mendocino Coast took these additional actions: Funded the Coastal Street Medicine Program Coordinator Position. The program served 262 homeless patients in 2020. The program coordinator secured grant funding from the Arlene & Michael Rosen Foundation to expand Coastal Street Medicine capacity by on boarding a case manager in partnership with Hospitality Center. Coastal Street Medicine organized and provided surveillance testing for COVID-19. The program procured and distributed PPE to homeless individuals, those living in shelter or transitional housing and front-line workers. Distributed face masks to Mendocino County Youth Project, Project Sanctuary, Redwood Community Services, Action Network Family Resource Center and Manchester Point Arena Rancheria. Provided $10,000 to the Fort Bragg Food Bank to meet food insecurity needs during the pandemic. Partnered with Mendocino County Health & Human Services Advocacy & Collaboration Team, Project Sanctuary, Redwood Community Services and First 5 Mendocino to create a bilingual informational flyer to be distributed to community members which included tips and resources numbers for mental health, substance use, domestic and child abuse. Flyers were distributed at grocery stores, food distribution sites, schools and other public locations. Facilitated the creation of the COVID-19 Work Group to provide health equity advocacy for the Latino population in Mendocino County which led to Mendocino County funding the Promotores de Salud six-month pilot. This program, operated by Nuestra Alianza de Willits, provided Spanish-speaking community health workers to provide linguistically and culturally appropriate COVID-19 information to Latinos. X X X X 0 1 0 0 0 0 0 0 0 Reiner Scott Vice Chair 0 1631895 0 352059 0 374424 0 17042 0 37777 0 2413197 0 349200 Wing Bill Director/Chair 0 1458328 0 279883 0 22116 0 17042 0 42012 0 1819381 0 0 Jobe Meredith Secretary 0 575127 0 81637 0 113221 0 13010 0 30858 0 813853 0 0 Parker Bessant Medical Officer 0 362465 0 42502 0 62143 0 1171 0 22569 0 490850 0 0 Howe Judson - Finance Officer/President as of 12/20 0 315645 0 45538 0 23524 0 16116 0 42056 0 442879 0 0 Leach Judy President thru 12/20 0 289448 0 34453 0 34985 0 17042 0 22447 0 398375 0 0 Spencer Lindsey Operations Executive 0 267913 0 33748 0 23211 0 15023 0 41853 0 381748 0 0 Givens Linda Chief Nursing Officer 0 252658 0 38715 0 26669 0 13528 0 29192 0 360762 0 0 Miller William Medical Director-Hospitalist 239779 0 100 0 17583 0 12873 0 17946 0 288281 0 0 0 Leister Lois F Pharmacy Director 189094 0 150 0 9085 0 9916 0 17946 0 226191 0 0 0 Thompson Stephanie Housei Supervisor 117219 0 150 0 54252 0 4949 0 20082 0 196652 0 0 0 Ra Jean Pharmacist 155571 0 1150 0 22695 0 8971 0 0 0 188387 0 0 0 Louis Michael Pharmacist 157082 0 150 0 12010 0 8462 0 9262 0 186966 0 0 0 Part I, Line 4b 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 Scott Reiner 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 non-vested 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. Reiner, Scott - $349,200 Form 990, Part III, Line 4a Adventist Health Mendocino Coast (AHMC) 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 of AHMC, 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 will be considered when individuals who need health care cannot afford to pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does AHMC 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. AHMC 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 2020 was $351,518. The following Inpatient services were provided to all our patients. These services included: - 34 Surgeries performed - 2,174 Patient days The following Outpatient services were provided to all our patients. These services included: - 4,182 Emergency department visits - 442 Outpatient Surgeries performed - 20,732 Outpatient visits - 13,343 Clinic visits AHMC 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 2020 was $12,794. 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 sole member of the Hospital is Stone Point Health, a California nonprofit public benefit corporation. Form 990, Part VI, Section A, line 7a Each individual who is a director of the board of Stone Point Health shall automatically be a director of Adventist Health Mendocino Coast, and shall serve as a director of Adventist Health Mendocino Coast until such time as that person is no longer a director of Stone Point Health. Form 990, Part VI, Section A, line 7b The sole corporate member, Stone Point Health, 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 Controller 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 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 Compensation 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 Presidents and 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: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 1,605,801. Management and general expenses 1,684,761. Fundraising expenses 0. Total expenses 3,290,562. Consulting and other management fees: Program service expenses 10,846. Management and general expenses 62,546. Fundraising expenses 0. Total expenses 73,392. Contract labor: Program service expenses 2,532,481. Management and general expenses 264,311. Fundraising expenses 0. Total expenses 2,796,792. Purchased medical services: Program service expenses 332,063. Management and general expenses 0. Fundraising expenses 0. Total expenses 332,063. Repairs and maintenance: Program service expenses 393,998. Management and general expenses 3,241. Fundraising expenses 0. Total expenses 397,239. All other purchased services: Program service expenses 876,238. Management and general expenses 205,609. Fundraising expenses 0. Total expenses 1,081,847. 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 Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated health system CA 501(c)(3) Line 10 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health 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 PO Box 619135 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 989 Plumas Street Yuba City CA 95991 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 0 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital 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 PO Box 619135 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 989 Plumas Street Yuba City CA 95991 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health 0 Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 0 Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 0 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Blue Zones LLC 323 N Washington Avenue 2nd Floor Minneapolis MN 55401 271603327 Education MN 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 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037297 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 323 N Washington Avenue Minneapolis CA 55401 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1