2021-11-16T09:42:49-08:00 2020-12-31 800519547 THE ACCOUNTANCY LLP 500 N Brand Blvd Fl 20 Glendale CA 91203 990 2020-01-01 832351753 Adventist Health Tulare ADVE 5596880821 869 N Cherry St Tulare CA 93274 Haydock Timothy Treasurer 2021-11-16 true Haydock Timothy 999009999 S Clement P01218012 8185475701 X 2 AAL1 IAL1 FAL1 2020 2022-09-23 18:48:47Z Randy Dodd 64037380 false 1071 X www.adventisthealth.org/tulare X 2018 CA Living Gods love by inspiring health, wholeness and hope. 14 12 424 16 0 11674 191583 39319942 63706641 141160 139156 0 39472776 64037380 19399 0 18066527 24676057 0 132517 29436118 40793827 47502645 65489283 -8029869 -1451903 49896460 69567437 57926329 79212987 -8029869 -9645550 Living Gods love by inspiring health, wholeness and hope. false false 58841564 19399 63706647 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 2020 was $43,180.The following Inpatient services that were provided to all our patients. These services included:335 Surgeries performed6,637 Patient days The following Outpatient services that were provided to all our patients. These services included:22,474 Emergency department visits1,557 Outpatient Surgeries performedAHTR 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 $207,249.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.Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ 58841564 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 false false false false false false false true false false false true 0 0 true 424 true false false false false false false false 0 false false false false false false false X 14 12 false false false false true true true true true false false true true true true true true true true false CA X Todd Hofheins 9164061092 PO Box 619135 Roseville CA 95661 X Reiner Scott Director/CEO 0.00 50.00 X X 0 2358378 54819 Wing Bill Dir/Pres/A Sec 0.00 50.00 X X 0 1760327 59054 Jahn Andrew President, Care Division 2.00 48.00 0 1365841 59307 Ferch Wayne President, CCR 10.00 40.00 0 1298607 49186 Nahapetian Arby Care Division Chief Medical Officer 2.00 48.00 0 868206 54711 Kofl Andrea President 10.00 40.00 X 0 842089 49411 Reppert Joseph Former CFO/Asst Secr thru 8/19 0.00 0.00 0 813425 41111 Jobe Meredith Secretary 0.00 50.00 X 0 769985 43868 Chen Steven Finance Officer, CCR 10.00 40.00 0 719712 59174 Gavini Frank Medical Officer, CVN 10.00 40.00 0 705913 0 Gruzensky Denton Reg HP Dir, CCR 10.00 40.00 0 607539 36465 Haydock Timothy FO/Treas/A Sec 10.00 40.00 X 0 450636 59159 Hofheins Todd CFO as of 8/20 0.00 4.00 X 0 469107 13281 Dodd Randal President 0.00 50.00 X 0 391086 51286 Ayala Raul Medical Officer, CVN Clinics 10.00 40.00 0 395542 11866 Renteria Adalberto Medical Officer, CCR 10.00 40.00 0 389409 15879 Reyna Sonja Bus Dev Exec 10.00 40.00 0 365958 37289 Taggart Laurie Patient Care Executive 10.00 40.00 0 348257 48705 Garcia Rosa RN, Nurse Lead 50.00 0.00 301728 0 60580 Plata Nina Population Health Exec 10.00 40.00 0 309955 52093 Ammon Edward Foundation Executive 10.00 40.00 0 289280 50711 McGowan John Associate Patient Care Executive 10.00 40.00 0 240701 48845 Pereira Sheri Associate Pt Care 50.00 0.00 231662 0 55082 Wagner Jack Former Asst Secr thru 3/18 0.00 50.00 0 269387 13558 Pickering Christine Communication Dir, CCR 10.00 40.00 0 182763 63138 Boggess Marjorie RN House Superviso 50.00 0.00 184991 0 32717 Fucillo Richard MRI Technologist 50.00 0.00 197101 0 1553 Aflague Stefanie Pharmacist, Charge 50.00 0.00 181110 0 8621 Freedman John Vice Chair 0.00 4.00 X 0 27216 0 Davis Andrew Director 0.00 4.00 X 0 26971 0 Reiner Richard Director 0.00 4.00 X 0 26764 0 Cherry Robert Director 0.00 4.00 X 0 26160 0 Innocent Larry Director 0.00 0.00 X 0 25608 0 Graham Ricardo Chair 0.00 4.00 X 0 23359 0 Heinrich Kerry Director 0.00 4.00 X 0 20608 0 Woodson Marc Director 0.00 4.00 X 0 20608 0 Ocampo Lucy Director 0.00 4.00 X 0 20358 0 Banks David Director 0.00 4.00 X 0 15441 0 Salazar Velino Director 0.00 4.00 X 0 6651 0 Fehr Joy Director 0.00 4.00 X 0 108 0 Philip Celeste Director 0.00 0.00 X 0 0 0 1096592 16451955 1131469 61 true true false Paramount Anesthesia Associates Inc 11704 Nantwick Ct Bakersfield CA 93311 Physician Services 2302261 Galen Inpatient Physicians Inc 2100 Powell St Suite 400 Emeryville CA 94608 Physician Services 1105357 CEP America California 2100 Powell St Suite 400 Emeryville CA 94608 Physician Services 1031591 Fastaff LLC PO Box 911452 Denver CO 80291 Nursing Registry 1011518 Healthcare Resource Group Inc 12610 E Mirabeau Pkwy Ste 800 Spokane Valley WA 99216 Billing Management Svcs 947051 23 191583 191583 CARES Act Income 722514 781592 781592 Dietary/Cafeteria Revenue 190906 190906 Other Program Services 900099 532630 532630 Patient Care Services 900099 62196965 62196965 Revenue from Related Orgs 4548 4548 63706641 139150 139150 0 0 0 6 6 6 6 0 0 0 0 64037380 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false false false false false false true 8011 8011 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. 10425 191583 202008 11673 1248 10425 1.00000 false true true 387188 387188 688547 61204 627343 20136984 7508140 12628844 13643375 Other Assets Other Receivables 3255292 Receivables from Related Organizations 284269 Receivables from Third Parties 18438161 21977722 Cash Overdraft 62238346 Liabilities to 3rd Party Payors 1200000 Other Liabilities 6477638 Payables to Related Organizations 2348578 72264562 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, 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. true true X true X true X true true true false true true 43180 43180 0.00070 43180 43180 0.00070 200936 200936 0.00310 5327199 3579682 1747517 0.02670 6000 6000 0.00010 5534135 3579682 1954453 0.02990 5577315 3579682 1997633 0.03060 662 662 87285 87285 0.00130 87947 87947 0.00130 true 787998 235505 7666103 13398192 -5732089 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 A false false true X X X X X X X X X 19 true true false true X See Form 990, Pg 1, Item J X See Sch H Part VI - Needs Assessment X true 20 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 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 to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible, while ensuring the health and safety of those participating. Our 2019 CHNA identified 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 the remainder of 2020 and are expected to become a permanent access to care option for our patients into the future. The local foundation, though not reflected in this report, was able to provide transportation passes to 20 people. 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 for 2020.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 education 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 in 2020. A new virtual offering of classes will be offered to our patients and communities starting in 2021. 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 2020 during and after March were postponed indefinitely. 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 2020 during and after March were postponed indefinitely. It is our intention to restart education events and outreach once the COVID-19 surges are under control and vaccination efforts have reached a safe level to ensure ongoing safety of participants and our community. 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 program 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: 4. Additional Activities included student externships & internships and Inspire Hope resource distributions. Student internships and externships opportunities within our network were greatly reduced due to safety protocols and different school program restrictions. A total of 88 students were still able to complete their academic requirements and provide much needed support within departments across our network. As part of the CARES Act, Adventist Health partnered with the USDA Farmers to Families Food Box Program to distribute food boxes throughout the Hanford communities. Through our partnership with World Vision our Inspire Hope program continued to provide distributions as the need in our communities continued and increased due to the pandemic. 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. Due to COVID-19, all events planned for 2020 during and after March were postponed indefinitely. Staff that were due to be trained (and re-trained) as car seat safety technicians in 2020 with the intent to offer this resource across our network were not able to be trained and certified. All 2020 training opportunities were cancelled due to COVID. It is our goal to engage training classes for our staff starting in 2021 and will be offering this service at our hospital birth centers across our network by the end of 2021. Additional Activities include Birth and Breastfeeding Classes. Birthing classes were initially cancelled at the start of the pandemic and then transitioned to a virtual format for the safety and well-being of program participants. A total of 30 people participated in classes in 2020. Both virtual and in person classes will continue into 2021. Tulare Toxicology Lab 800 E Merritt Avenue Suite 107 Tulare CA 93274 Reference Lab-Toxicology 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. 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 Revenue Rec. *Medicare Cost Report Revenue $ 7,666,103 Non-Cost Report Revenue 2,488,884 Estimates and Accrual Variances (415,348) Other 415,348 ___________ Total Medicare Revenue $10,154,987*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 VI, Line 2 - Needs Assessment The hospital's 2019 CHNA, the 2021 Community Health Plan (CHP) Update for fiscal year 2020, 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 Updates 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, Adventist Health Tulare supports 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 our region. 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 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 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 FY2020, 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.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 19399 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 178456 71 2583 8621 189731 Ammon Edward Foundation Executive 221629 41020 26631 13524 37187 339991 Ayala Raul Medical Officer, CVN Clinics 177648 71 217823 11866 407408 Boggess Marjorie RN House Superviso 183293 71 1627 32717 217708 Chen Steven Finance Officer, CCR 533654 104566 81492 17042 42132 778886 Dodd Randal President 156860 62328 171898 14059 37227 442372 Ferch Wayne President, CCR 1018284 250697 29626 17042 32144 1347793 Fucillo Richard MRI Technologist 197066 35 1553 198654 Garcia Rosa RN, Nurse Lead 301656 72 13130 47450 362308 Gavini Frank Medical Officer, CVN 705913 705913 Gruzensky Denton Reg HP Dir, CCR 121190 46929 439420 13766 22699 644004 Haydock Timothy FO/Treas/A Sec 343632 68923 38081 17042 42117 509795 Hofheins Todd CFO as of 8/20 297756 66 171285 13281 482388 Jahn Andrew President, Care Division 992796 210574 162471 17042 42265 1425148 Jobe Meredith Secretary 575127 81637 113221 13010 30858 813853 Kofl Andrea President 587803 128954 125332 17042 32369 891500 McGowan John Associate Patient Care Executive 204174 34622 1905 12892 35953 289546 Nahapetian Arby Care Division Chief Medical Officer 648088 107260 112858 12449 42262 922917 Pereira Sheri Associate Pt Care 192857 32979 5826 10473 44609 286744 Pickering Christine Communication Dir, CCR 154923 22769 5071 9073 54065 245901 Plata Nina Population Health Exec 112866 40341 156748 14218 37875 362048 Reiner Scott Director/CEO 1631895 352059 374424 17042 37777 2413197 Renteria Adalberto Medical Officer, CCR 389409 15879 405288 Reppert Joseph Former CFO/Asst Secr thru 8/19 2779 810646 41111 854536 Reyna Sonja Bus Dev Exec 271635 57425 36898 17042 20247 403247 Taggart Laurie Patient Care Executive 262630 56568 29059 16664 32041 396962 Wagner Jack Former Asst Secr thru 3/18 269387 13558 282945 Wing Bill Dir/Pres/A Sec 1458328 279883 22116 17042 42012 1819381 Arnold Plata Spouse of Key EE 74115 Employment false Linda Henry Key EE Sister 45396 Employment false Ferch Josiah Key EE Son 73707 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.2. Linda Henry is the sister of Former Adventist Health board member and current Key Employee, Wesley Rippey.3. Josiah Ferch is the son of Key Employee Wayne Ferch. 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. Other Changes In Net Assets Or Fund Balances - Other Decreases Transfer to related entity = -$163778 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 Accute Care 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 Tillamoo 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 Accute Care 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 So CA Medical Fdtn PO Box 619135 Roseville CA 95661 954424391 Discontinued Operations CA 501(C)(3) 12b2 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 2348578 Notes Payable Adventist Health SystemWest o 179984 Compensation Adventist Health SystemWest r 32717189 Cash Mgt Funds