LODI MEMORIAL HOSPITAL ASSOCIATION INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- LODI MEMORIAL HOSPITAL ASSOCIATION INC (EIN 94-1044474)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-10
- IRS object ID
- 202123149349306682
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-10T16:45:00-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941044474 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lodi Memorial Hospital Association Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LODI | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S Fairmont Avenue | AddressLine1Txt |
| City | Lodi | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952405118 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jason Whitney | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2021-10-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Jason | PersonFirstNm |
| Person Last | Whitney | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2021-10-21 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Lodi Memorial | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | John Bearman | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S Fairmont Avenue | AddressLine1Txt |
| City | Lodi | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952405118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $254,554,944 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/lodi-memorial/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1411 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $146,599 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,735,423 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,269,319 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $241,327,051 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $249,590,640 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,960,474 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,678,832 | CYInvestmentIncomeAmt |
| PY Other Revenue | $83,563 | PYOtherRevenueAmt |
| CY Other Revenue | -$28,800 | CYOtherRevenueAmt |
| PY Total Revenue | $246,106,511 | PYTotalRevenueAmt |
| CY Total Revenue | $254,509,991 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $100,085 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $201,593 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $102,001,240 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $95,682,754 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $442,598 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $143,924,606 | PYOtherExpensesAmt |
| CY Other Expenses | $156,262,298 | CYOtherExpensesAmt |
| PY Total Expenses | $246,025,931 | PYTotalExpensesAmt |
| CY Total Expenses | $252,146,645 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $80,580 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,363,346 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $239,446,881 | TotalAssetsBOYAmt |
| Total Assets EOY | $263,442,209 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $166,271,894 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $189,399,077 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $73,174,987 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $74,043,132 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $199,695,444 | ExpenseAmt |
| Grant | $201,593 | GrantAmt |
| Revenue | $249,590,640 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $199,695,444 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1411 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Todd Hofheins CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (39 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Larsen David - Former | ||||||||||
| Finance Officer, CCR thru 04/19 | 0.00 | 50.00 | Yes (X) | $0 | $3,202,560 | $614,651 | ||||
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | $0 | $2,358,378 | $54,819 | Yes (X) | Yes (X) | |||
| Wing Bill | ||||||||||
| Dir/Asst Secr/Vice Chair | 0.00 | 50.00 | $0 | $1,760,327 | $59,054 | Yes (X) | Yes (X) | |||
| Jahn Andrew | ||||||||||
| President, Care Division | 2.00 | 48.00 | $0 | $1,365,841 | $59,307 | Yes (X) | ||||
| Ferch Wayne | ||||||||||
| President, CCR | 8.33 | 41.67 | $0 | $1,298,607 | $49,186 | Yes (X) | ||||
| Nahapetian Arby - Care | ||||||||||
| Division Chief Medical Officer | 2.00 | 48.00 | $0 | $868,206 | $54,711 | Yes (X) | ||||
| Reppert Joseph | ||||||||||
| Former CFO/Asst Secr thru 08/19 | 0.00 | 0.00 | Yes (X) | $0 | $813,425 | $41,111 | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | $0 | $769,985 | $43,868 | Yes (X) | ||||
| Chen Steven | ||||||||||
| Finance Officer, CCR | 8.33 | 41.67 | $0 | $719,712 | $59,174 | Yes (X) | ||||
| Wolcott Daniel | ||||||||||
| President thru 12/20 | 50.00 | 0.00 | $0 | $695,987 | $59,307 | Yes (X) | ||||
| Gruzensky Denton | ||||||||||
| Reg HP Dir, CCR | 8.33 | 41.67 | $0 | $607,539 | $36,465 | Yes (X) | ||||
| Iris Patricia | ||||||||||
| Medical Officer | 8.33 | 41.67 | $0 | $492,077 | $44,664 | Yes (X) | ||||
| Hofheins Todd | ||||||||||
| CFO as of 08/20 | 0.00 | 50.00 | $0 | $469,107 | $13,281 | Yes (X) | ||||
| Whitney Jason | ||||||||||
| Treasurer | 50.00 | 0.00 | $0 | $360,067 | $59,032 | Yes (X) | ||||
| McCollough Brooke | ||||||||||
| Operations Executive | 0.00 | 50.00 | $0 | $340,523 | $62,515 | Yes (X) | ||||
| Grimm Mary | ||||||||||
| Patient Care Executive | 0.00 | 50.00 | $0 | $332,549 | $42,885 | Yes (X) | ||||
| Cook Becky - Ambulatory | ||||||||||
| & Physician Services Exec | 8.33 | 41.67 | $0 | $279,774 | $39,378 | Yes (X) | ||||
| Moreno Debbe | ||||||||||
| Former CNO thru 09/19 | 0.00 | 50.00 | Yes (X) | $0 | $278,436 | $30,401 | ||||
| Markovich Jennifer | ||||||||||
| Director, RN | 50.00 | 0.00 | $232,925 | $0 | $55,409 | Yes (X) | ||||
| Wagner Jack | ||||||||||
| Former Asst Secr thru 03/18 | 0.00 | 0.00 | Yes (X) | $0 | $269,387 | $13,558 | ||||
| Beck Atwater Sandra | ||||||||||
| Director Hospital Pharmacy | 50.00 | 0.00 | $229,028 | $0 | $46,100 | Yes (X) | ||||
| Carmody Thomas | ||||||||||
| Physician Assistant | 50.00 | 0.00 | $235,405 | $0 | $36,105 | Yes (X) | ||||
| Karagounis Timothy | ||||||||||
| Operations Executive | 50.00 | 0.00 | $228,830 | $0 | $32,964 | Yes (X) | ||||
| Pascua Helen | ||||||||||
| RN, First Assistant | 50.00 | 0.00 | $238,472 | $0 | $17,484 | Yes (X) | ||||
| Pickering Christine | ||||||||||
| Communication Dir, CCR | 8.33 | 41.67 | $0 | $182,763 | $63,138 | Yes (X) | ||||
| Spenst Brett | ||||||||||
| Interim President as of 12/20 | 50.00 | 0.00 | $0 | $113,171 | $7,910 | Yes (X) | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | $0 | $27,216 | $0 | Yes (X) | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | $0 | $26,971 | $0 | Yes (X) | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | $0 | $26,764 | $0 | Yes (X) | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | $0 | $26,160 | $0 | Yes (X) | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | $0 | $25,608 | $0 | Yes (X) | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | $0 | $23,359 | $0 | Yes (X) | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | $0 | $20,608 | $0 | Yes (X) | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | $0 | $20,608 | $0 | Yes (X) | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | $0 | $20,358 | $0 | Yes (X) | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | $0 | $15,441 | $0 | Yes (X) | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | $0 | $6,651 | $0 | Yes (X) | ||||
| Fehr Joy | ||||||||||
| Director | 0.00 | 4.00 | $0 | $108 | $0 | Yes (X) | ||||
| Philip Celeste | ||||||||||
| Director thru 04/20 | 0.00 | 4.00 | $0 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,164,660 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $17,818,273 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,696,477 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 330 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Regents of the University of California | |||||
| 1111 Franklin Street 12th floor | Oakland | CA | 94607 | Physician Professional Fees | $8,585,805 |
| CEP America - Anesthesia PC | |||||
| 2100 Powell Street Suite 900 | Emeryville | CA | 94608 | Physician Professional Fees | $3,057,394 |
| GE Precision Healthcare LLC | |||||
| PO Box 96483 | Chicago | IL | 60693 | Construction | $2,900,772 |
| Elekta Inc | |||||
| PO Box 404199 | Atlanta | GA | 30384 | Construction | $2,287,439 |
| NELCO Worldwide | |||||
| 2 Burlington Woods Drive Suite 300 | Burlington | MA | 01803 | Construction | $2,274,567 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 34 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,449,204 | GovernmentGrantsAmt |
| All Other Contributions | $820,115 | AllOtherContributionsAmt |
| Noncash Contributions | $543,000 | NoncashContributionsAmt |
| Total Contributions | $3,269,319 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient service revenue | 621400 | $226,144,500 | $226,144,500 | |
| CARES Act Revenue | 621990 | $16,482,998 | $16,482,998 | |
| 340B Pharmacy Revenue | 621400 | $2,210,402 | $2,063,803 | $146,599 |
| Related rental revenue | 621400 | $398,256 | $398,256 | |
| Premium revenue | 621990 | $300,476 | $300,476 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,054,008 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,054,008 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $249,590,640 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,678,832 | TotalRevenueColumnAmt |
| Exclusion | $1,678,832 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,713 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $40,090 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$27,377 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$27,377 | TotalRevenueColumnAmt |
| Exclusion | -$27,377 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $3,440 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $4,863 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,423 | TotalRevenueColumnAmt |
| Exclusion | -$1,423 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $254,509,991 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $249,444,041 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $146,599 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,650,032 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $201,593 | TotalAmt |
| Program Services | $201,593 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,615 | TotalAmt |
| Program Services | $373,615 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,734,763 | TotalAmt |
| Program Services | $69,520,015 | ProgramServicesAmt |
| Management And General | $5,871,306 | ManagementAndGeneralAmt |
| Fundraising | $343,442 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,460,408 | TotalAmt |
| Program Services | $3,278,900 | ProgramServicesAmt |
| Management And General | $164,872 | ManagementAndGeneralAmt |
| Fundraising | $16,636 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,605,826 | TotalAmt |
| Program Services | $10,165,803 | ProgramServicesAmt |
| Management And General | $395,401 | ManagementAndGeneralAmt |
| Fundraising | $44,622 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,508,142 | TotalAmt |
| Program Services | $5,131,648 | ProgramServicesAmt |
| Management And General | $353,469 | ManagementAndGeneralAmt |
| Fundraising | $23,025 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,287,690 | TotalAmt |
| Program Services | $336,724 | ProgramServicesAmt |
| Management And General | $21,950,966 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,550 | TotalAmt |
| Management And General | $164,550 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,611 | TotalAmt |
| Management And General | $30,611 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,292 | TotalAmt |
| Program Services | $15,292 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,223,192 | TotalAmt |
| Program Services | $38,887,304 | ProgramServicesAmt |
| Management And General | $11,327,231 | ManagementAndGeneralAmt |
| Fundraising | $8,657 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,440 | TotalAmt |
| Management And General | $15,440 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,264,327 | TotalAmt |
| Program Services | $579,294 | ProgramServicesAmt |
| Management And General | $679,856 | ManagementAndGeneralAmt |
| Fundraising | $5,177 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,124,833 | TotalAmt |
| Program Services | $2,618,267 | ProgramServicesAmt |
| Management And General | $6,506,566 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,981,649 | TotalAmt |
| Program Services | $4,217,014 | ProgramServicesAmt |
| Management And General | $764,635 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,348 | TotalAmt |
| Program Services | $72,178 | ProgramServicesAmt |
| Management And General | $46,170 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,980 | TotalAmt |
| Program Services | $26,865 | ProgramServicesAmt |
| Management And General | $51,115 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,012,574 | TotalAmt |
| Program Services | $4,012,574 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,028,419 | TotalAmt |
| Program Services | $8,981,519 | ProgramServicesAmt |
| Management And General | $46,900 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $743,069 | TotalAmt |
| Program Services | $742,069 | ProgramServicesAmt |
| Management And General | $1,000 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Patient care supplies | $30,635,434 | $28,328,732 | $2,305,663 | $1,039 |
| Hospital Medi-Cal Quali | $13,031,592 | $13,031,592 | ||
| Leased equipment expens | $591,610 | $589,830 | $1,780 | |
| UBI taxes | $3,000 | $3,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,912,688 | TotalAmt |
| Program Services | $8,581,616 | ProgramServicesAmt |
| Management And General | $1,331,072 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,146,645 | TotalAmt |
| Program Services | $199,695,444 | ProgramServicesAmt |
| Management And General | $52,008,603 | ManagementAndGeneralAmt |
| Fundraising | $442,598 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,010,058 | BOYAmt |
| EOY | $54,712,239 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,750 | BOYAmt |
| EOY | $12,258 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,272,151 | BOYAmt |
| EOY | $34,556,137 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,299,452 | BOYAmt |
| EOY | $4,136,078 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,008,686 | BOYAmt |
| EOY | $964,708 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $275,807,388 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $152,379,195 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,880,530 | BOYAmt |
| EOY | $123,428,193 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,977,126 | BOYAmt |
| EOY | $7,481,924 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,978,128 | BOYAmt |
| EOY | $38,150,672 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $239,446,881 | BOYAmt |
| EOY | $263,442,209 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,120,044 | BOYAmt |
| EOY | $22,091,369 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $19,085 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $426,046 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,151,850 | BOYAmt |
| EOY | $166,862,577 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $166,271,894 | BOYAmt |
| EOY | $189,399,077 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,003,285 | BOYAmt |
| EOY | $70,812,858 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,171,702 | BOYAmt |
| EOY | $3,230,274 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,174,987 | BOYAmt |
| EOY | $74,043,132 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $239,446,881 | BOYAmt |
| EOY | $263,442,209 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,363,346 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$1,495,201 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $15,292 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $15,292 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,171,700 | BeginningYearBalanceAmt |
| Contributions | $2,663,248 | ContributionsAmt |
| Other Expenditures | $2,604,674 | OtherExpendituresAmt |
| End Year Balance | $3,230,274 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $541,320 | BeginningYearBalanceAmt |
| Contributions | $2,659,952 | ContributionsAmt |
| Other Expenditures | $29,572 | OtherExpendituresAmt |
| End Year Balance | $3,171,700 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $602,023 | BeginningYearBalanceAmt |
| Contributions | $569,686 | ContributionsAmt |
| Other Expenditures | $630,389 | OtherExpendituresAmt |
| End Year Balance | $541,320 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $562,343 | BeginningYearBalanceAmt |
| Contributions | $689,003 | ContributionsAmt |
| Grants Or Scholarships | $3,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $41,917 | OtherExpendituresAmt |
| End Year Balance | $602,023 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $547,340 | BeginningYearBalanceAmt |
| Contributions | $148,830 | ContributionsAmt |
| Other Expenditures | $133,827 | OtherExpendituresAmt |
| End Year Balance | $562,343 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,973,938 | OtherCostOrOtherBasisAmt |
| Book Value | $9,973,938 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $191,643,204 | OtherCostOrOtherBasisAmt |
| Depreciation | $97,730,291 | DepreciationAmt |
| Book Value | $93,912,913 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,227,133 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,024,125 | DepreciationAmt |
| Book Value | $203,008 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,769,971 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,182,730 | DepreciationAmt |
| Book Value | $10,587,241 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,193,142 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,442,049 | DepreciationAmt |
| Book Value | $8,751,093 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $123,428,193 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from third-party payors | $26,964,939 |
| Receivables from related organizations | $10,943,050 |
| State Board of Pharmacy receivable | $116,726 |
| Other assets | $125,957 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $38,150,672 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Payable to related organizations | $139,950,168 |
| Other liabilities | $14,147,934 |
| Payables to third party payors | $12,764,475 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $166,862,577 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| Part X, Line 2: | The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $493,894 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $493,894 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,574,749 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $63,265,321 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,309,428 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $78,068,643 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $63,265,321 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,803,322 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05880 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $616,647 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $777 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $615,870 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $708,740 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $708,740 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,861,685 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $41,401 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,820,284 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05880 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,291 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,291 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,201,363 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $42,178 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,159,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06410 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $94,270,006 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $63,307,499 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $30,962,507 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12290 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,366 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $50,366 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,038 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,038 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,533 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,533 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $61,937 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $61,937 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,003,834 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $208,876 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $52,905,894 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $57,339,646 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,433,752 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 2 Lodi Outpatient Surgery Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Ambulatory Surgery Center | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.78000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 0.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.22000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | State LicenseStateLicenseNum | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Facility Reporting GroupFacilityReportingGroupCd | Address Line2USAddress/AddressLine2Txt | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lodi Memorial Hospital Association Inc dba AHLM | ||||||||||||
| 1 | 975 S Fairmont Ave | Lodi | CA | 95240 | www.adventisthealth.org/lodi-memorial/ | 030000056 | Yes (X) | Yes (X) | Yes (X) | A | ||
| Lodi Memorial Hospital - West dba AHLM | ||||||||||||
| 2 | 800 Lower Sacramento Road Acute | Lodi | CA | 95242 | www.adventisthealth.org/lodi-memorial/ | 030000056 | Yes (X) | Yes (X) | A | Phys | Outpatient departments at this campus | |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Facility Reporting Group - A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assessment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assessment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Section B | Facility Reporting Group A |
| Facility Reporting Group A consists of: | - Facility 1: Lodi Memorial Hospital Association, Inc. dba A, - Facility 2: Lodi Memorial Hospital - West dba AHLM |
| Facility Reporting Group - A Part V, Section B, line 5: | The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering from community members. Community input was provided by a broad range of community members using key informant interviews, focus groups, and surveys. Individuals with the knowledge, information, and expertise relevant to the health needs of the community were consulted. These individuals included representatives from local governmental and public health agencies as well as leaders, representatives, or members of underserved, low-income, and minority populations. Additionally, where applicable, other individuals with expertise of local health needs were consulted. Thirteen key informant interviews individuals representing diverse sectors in San Joaquin County including: public health, health care, community-based organizations, social services, education and government. Thirty-one community resident focus groups were conducted in geographic areas within San Joaquin County, including Stockton, Lodi, Tracy and Manteca. Nineteen groups were conducted in English, ten were conducted in Spanish, one was conducted in Tagalog and one was conducted in Cambodian. Participants were teens, adults, and older adults, who represented underserved, low-income, and varied ethnic communities.Secondary data sources include collected data on key health indicators, morbidity, mortality, and various social determinants of health from the Kaiser Permanente CHNA Data Platform, Health Places Index, American Community Survey and various other state and federal databases. |
| Facility Reporting Group - A Part V, Section B, line 6a: | Hospitals that participated in the 2019 CHNA process included Dameron Hospital, Kaiser Permanente, Sutter Health and Dignity Health St. Joseph's Medical Center. |
| Facility Reporting Group - A Part V, Section B, line 6b: | Other non-hospital facilities that participated in the 2019 CHNA process included Community Medical Centers, First 5 San Joaquin, Health Net, Health Plan of San Joaquin, San Joaquin County Public Health Services. |
| Facility Reporting Group - A Part V, Section B, line 11: | The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible, while ensuring the health and safety of those participating. Our 2019 CHNA identified three areas of significant need: Mental Health, Economic Security, and Obesity/Healthy Eating Active Living (HEAL)/Diabetes. Priority Need 1 - Mental Health - The goal is to improve trauma informed care by creating awareness of trauma and providing or connecting our patients with the proper resources to address trauma. Strategy 1.1 - Hire a substance use navigator in our emergency department. Activity 1.1 - Substance Use Navigator (SUN). AHLM applied for funds under the Behavioral Health Pilot Program (BHPP) to support a substance use navigator (SUN) in our emergency department (ED). This initiative is an important step toward reducing the severity of behavioral health issues impacting AHLM's service area, with a focus on substance use disorders (SUD) and specifically opioid use disorders (OUD). Specific outcomes to be achieved under this pilot project will include decreasing deaths from opioid-related overdoses, combat stigma surrounding opioid and other substance use disorders, and to improve the quality of care provided to patients with SUD/OUD. Other work around mental health included webinars through AHLM's collaboration with the American Heart Association and the Lodi Chamber of Commerce. These webinars included the following topics, "Supporting Mental Resilience for Good Heart Health During COVID-19 and "Transitioning Back to Work Amid COVID-19". Finally, in 2020 AHLM signed on to become a funding partner of the Unite Us platform to participate in the San Joaquin County's Connected Community Network (CCN). Priority Need 2 - Economic Security - The goal is to improve economic security in our county by improving career opportunities for our residents, increasing the supply of qualified workers to meet the needs of the healthcare industry, and improve the overall health of our local businesses. Strategy 1.1 - AHLM has partnered with Health Force Partners to improve career pathway opportunities for community residents and to increase the supply of skilled workers to meet the needs of dynamic healthcare industry in the Northern San Joaquin Valley. Strategy 1.2 - AHLM is also collaborating with the American Heart Association and the Lodi Chamber of Commerce's Health Value Action Team to provide our local businesses with a nationally successful program, the Workplace Health Solutions. The program will offer local businesses a suite of science-based, evidence-informed tools and services to help build a workplace culture of health. Activity 1.1 - Participation in the HOPE pilot program. AHLM launched its first cohort of the HOPE (Helping Our People Elevate) pilot program in January 2020. The HOPE program includes two parts. Part one includes Adventist Health taking incumbent workers who have met all requirements for the Delta's RN program and placed them into an 18-month accelerated AND program. The hospital provides the clinical instructor as well as an optional cost of living stipend for participants. The number of participants enrolled in the HOPE program included 11 students who are set to complete the program in May 2021. This program is open to the public and therefore meets the requirements to count towards community benefit efforts. Activity 1.2 - Health Careers Academy - The second part to the HOPE program is working with the Health Careers Academy to have a pilot fast track program for high school students. The students begin taking classes that count toward their AA degree and RN program prerequisite courses in their junior year of high school, and then continue classes through the summer. When they graduate their senior year of high school, they are nearly done (or are done) with their RN prerequisite and can enter the ADN program. The hospital provides the clinical instructor and employment as a student extern. The student commits to work at the hospital for a certain amount of time after that. Due to COVID-19, there has been a delay within part two of the program and with a goal to have high school students who have successfully completed their respective courses begin their externship in Fall 2021. Activity 1.3 - Partnership with American Health Association - AHLM's successful collaboration with the Lodi Chamber of Commerce's Healthy Lodi initiative and the American Heart Association allows continued work to address economic security. Together we worked with local HR Directors, Workplace Wellness Champions and other organizational leaders to help their employees learn more about working towards cardiovascular health. The American Heart Association's Workplace Health Solutions is a "science-based, evidence-informed package of tools and services to help build and maximize an effective workplace culture of health". Building a healthy work environment and promoting a healthy workforce can lead to improved efficiency, reduced absenteeism, and cost savings for both workers and employers. In 2020, 12 companies were recruited to the Workplace Health Solutions, Seven companies submitted 2020 data, nine champions were trained, and a total of three webinars were offered. We are working to elevate a culture of health for the 4,100 employees covered under Workplace Health Solutions. Building a healthy work environment and promoting a healthy workforce can lead to improved efficiency, reduced absenteeism, and cost savings for both workers and employers. Priority Need 3 - Obesity/Healthy Eating Active Living (HEAL)/Diabetes - the goal is to increase physical activity for all ages and establish programs in high-risk neighborhoods. Strategy 1 - Engage businesses and community organizations to improve facilities and offer programs for physical activity. Activity 1.1 - Convene a Community Faith Summit in 2020 to encourage cross-sector collaboration and improve parks and neighborhoods. The Community Faith Summit which was originally planned for 2020 was placed on hold due to the COVID-19 pandemic and was pushed to a virtual event in March 2021. This event served to gather faith-based organizations, school and city leaders to encourage cross-sector collaboration to impact our neighborhoods. The goal is that through inspiration and financial support through mini grants, these entities would create projects/initiatives in parks and neighborhoods that would target obesity/diabetes, as well as mental health and economic security/education. Activity 1.2 - Diabetes Among Friends - 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. Number of persons served: 52. Additional activities such as Healthy Choices did not take place in 2020 due to the size of the class and technical challenges experienced by participants who joined the virtual classes. AHLM will be partnering with English Oaks Seventh-Day Adventist Church to hold classes starting in 2021. Likewise, all events where blood pressure and blood glucose screenings are normally performed were placed on hold and will resume in 2021. |
| Part V, Section B, Line 11: | Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health Lodi Memorial 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. 1. Violence/Injury Prevention: Need is being addressed by others. 2. Access to Care: Need is being addressed by others. 3. Substance Abuse/Tobacco: Need is currently being addressed by others, however, if we are awarded the Behavioral Health Pilot Project grant, we will be able to address this need through hiring a Substance Use Navigator. 4. Asthma: AHLM does not have the resources necessary at this time to address this need. 5. Oral Health: Need is being addressed by others. 6. Climate and Health: Our hospital does not have the expertise to effectively address this need. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 17 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Lodi Outpatient Surgical Center | ||||
| 521 S Ham Lane Suite F | Lodi | CA | 95242 | Ambulatory Surgical Center |
| 2 - AHLM Wound & Hyperbaric Care | ||||
| 2415 W Vine Street Suite 106 | Lodi | CA | 95242 | Outpatient Clinic - Hyperbaric & Wound Care |
| 4 - AHLM Millsbridge Family Medicine | ||||
| 1901 W Kettleman Lane Suite 200 | Lodi | CA | 95242 | Community Clinic - Family Medicine |
| 5 - Galt Family and Specialty Care | ||||
| 387 Civic Drive | Galt | CA | 95632 | Outpatient Clinic - Family Medicine |
| 6 - Advanced Imaging Center at AHLM | ||||
| 1031 S Fairmont Avenue | Lodi | CA | 95240 | Outpatient Diagnostic Imaging |
| 7 - AHLM Pediatric Care | ||||
| 2415 W Vine Street Suite 100 | Lodi | CA | 95242 | Outpatient Clinic - Pediatric care |
| 8 - Urgent Care Clinic | ||||
| 1235 W Vine Street Suite 20 | Lodi | CA | 95240 | Outpatient Clinic - Urgent Care Services |
| 9 - Ham Lane Clinic - Fairmont Ave | ||||
| 845 S Fairmont Avenue Suite 8 | Lodi | CA | 95240 | Outpatient Clinic - Cardiology & Pulmonology |
| 10 - AHLM Family Medicine | ||||
| 2415 W Vine Street Suite 105 | Lodi | CA | 95242 | Outpatient Clinic - Family Medicine |
| 11 - AHLM OrthopedicsSports Medicine | ||||
| 1235 W Vine Street Suite 22 | Lodi | CA | 95240 | Community Clinic - Orthopedics & Sports Medicine |
| 12 - Adventist Health Home Health | ||||
| 800 S Lower Sacramento Road | Lodi | CA | 95242 | Home Care Services |
| 13 - AHLM West Pharmacy | ||||
| 2415 W Vine Street Suite 104 B | Lodi | CA | 95240 | Retail Pharmacy |
| 14 - AHLM Trinity Multi-Specialty Care | ||||
| 10200 Trinity Parkway Suite 102 | Stockton | CA | 95219 | Community Clinic - Multi-specialty Care |
| 15 - Ione Family Care Clinic | ||||
| 305 Preston Avenue | Ione | CA | 95640 | Outpatient Clinic - Family Medicine |
| 16 - AHLM Prenatal Care | ||||
| 2415 W Vine Street Suite 103 | Lodi | CA | 95242 | Outpatient Clinic - Prenatal Care |
| 17 - AHLM Occupational Medicine | ||||
| 800 S Lower Sacramento Road | Lodi | CA | 95242 | Outpatient Clinic - Occupational Medicine |
| 18 - AHLM Walter E Reiss Outreach Clinic | ||||
| 300 W Oak Street | Lodi | CA | 95240 | Free Clinic |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Specific Ratios of Costs to charges are utilized for each department. Where applicable the source of these ratios are the Medicare Cost Report. |
| 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 3: | The Hospital provided care to all who presented themselves in our emergency room, without asking for proof of insurance. The Hospital's uninsured population continues to increase. Uninsured patients are screened for Medicaid linkage, given assistance in applying for Medicaid and if ineligible for Medicaid are given information regarding the Hospital's Charity Care Policy and encouraged to apply for charity care. Often the information gathered in the Medicaid application will make this determination "automatic". If additional information is required, the Hospital attempts to contact the patient. Those that do not respond will be sent to a collection agency after 120 days and four statements. The Hospital estimates 21% of bad debt expense (calculated at cost) should be considered charity care. The Hospital's bad debt accounts are analyzed by a third party to determine this amount. |
| Part III, Line 4: | Costing methodology:Utilizing the previous costing methodology as outlined in response to Part I, Line 7, all patients are assigned a payor class (i.e. charity, self pay, Medicare, Medi-Cal, managed care). The cost by payor is a summation of all patients in the assigned payor class. The amounts written off as bad debt (assigned to a collection agency) are net of any applicable payments or discounts. Any payments received after an account is assigned to a collection agency reduce the bad debt expense in the period received.Uncompensated care and community benefit costs:Our policy is to provide service to all who require it, regardless of their ability to pay. As such, the Hospital provides substantial amounts of uncompensated care. When this care is provided to patients who lack financial resources and therefore are deemed medically indigent, it is classified as charity care. When it is provided to patients who have the means to pay, but decline to do so, it is classified as provision for uncollectible accounts. Some undetermined portion of the provision for uncollectible accounts represents care to indigent patients who the Hospital has been unable to identity as charity. Charity care charges are not reflected in net patient service revenues. In addition, we provide services to poor and underserved persons who cannot afford health care because of inadequate resources and/or are uninsured or underinsured, including patients insured under certain government-reimbursed public aid programs. Such programs pay providers amounts that are less than established charges for the services provided to the recipients and frequently the payments are less than the costs of rendering the services.Patient accounts receivable:Patient accounts receivable for services provided to patients covered under the Medicare and Medicaid (Medi-cal in California) programs, privately sponsored managed care programs for which payment is made based on terms defined under formal contracts, and other payors (including self-pay) are recorded at their estimated realizable value based on contractual billing rates or our standard billing rates for our non-contracted payors. The Hospital regularly reviews accounts and contracts and provide appropriate estimates of contractual allowances that are then netted against patient accounts receivable. The Hospital also provides an estimated allowance for uncollectible accounts based on the Hospital's evaluation of the aging of our patient accounts receivable, the Hospital's historical collection experience for each type of payor and other relevant factors.The Hospital's primary concentration of credit risk is patient accounts receivable, which consists of amounts owed by various governmental agencies, insurance companies and private patients. The Hospital grants credit without collateral to the Hospital's patients and third party payors. |
| Part III, Line 8: | The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the united states. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer. 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 52,905,894 Prior year settlements 1,079,779 Cost report reimbursable bad debts 723,498 Non-Cost Report Revenue 18,495,146 Estimates and accrual variances 456,429 Other (1,752,776) Total Medicare revenue 71,907,970*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. Allowable costs are calculated from information in the Medicare Cost Report and paid claim summaries obtained from the Medicare program. |
| Part III, Line 9b: | When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part VI, Line 2: | The Hospital's 2019 CHNA, the 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:https://www.adventisthealth.org/about-us/community-benefit/The two most recent Community Health Needs Assessments, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, Lodi Memorial Hospital Association, Inc. 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: | The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at:https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-Policy.pdfThese documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. |
| Part VI, Line 4: | Adventist Health Lodi Memorial considers San Joaquin County its primary service area as well as the city of Galt. San Joaquin County contains both rural and urban areas. Communities and cities maintain their unique geographic identities, separated by agriculture and open space lands. The county includes seven incorporated cities: Stockton, Tracy, Manteca, Lodi, Lathrop, Ripon and Escalon as well as many small well-established rural communities in the unincorporated areas.The demographic profile of San Joaquin county indicates a total population of 745,424 with 17.8% living in poverty and 24.9% of children living in poverty. Unemployment is 11.7% and the uninsured population is 11.7% as well. Of the population, 41.6% identify as Hispanic/Latino, 31.8% identify as White, 16.7% identify as Asian, 8.2% identify as Black, 5.3% identify as multiple races and 2.0% identify as Native American/Alaska Native. |
| 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 is 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 can 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, AHLM took additional actions: Adventist Health Lodi Memorial conducted four phases of COVID-19 testing outreach specifically to our Latino community members in both Lodi and Stockton. This was in response to the disproportionate incidences of COVID-19 rates amongst the Latino community. The first outreach event was held in a Lodi location considered a "hot spot" for COVID-19 cases. AHLM partnered with Rancho San Miguel on Friday, July 3rd, 2020 and administered 355 COVID tests outside of the grocery store in Lodi. The second outreach event was held within the parking lot of the First Baptist Church in Lodi and 105 people were tested. Free meals were provided, as well as education on disease prevention. The third testing event was held at a migrant farmworker's apartment site and approximately 80 individuals were tested. The fourth testing event was done in partnership with the City of Stockton. The City of Stockton awarded AHLM with a grant to conduct testing. Testing was held at the SJC Fairgrounds from September 18th through September 20th, 2020. Additionally, AHLM partnered with Dameron Hospital, as well as other hospitals and agencies such as Community Medical Centers, Dignity Health St. Joseph's Medical Center, Sutter Tracy Hospital, United Way, Catholic Charities, and many more. Together we sought to provide education to Latino farmworkers and their families on COVID-19 prevention and mitigation. COVID-19 testing was provided through Trident Care. During the three-day event, families were also given food boxes from donations made by the Salvation Army and the United Way. United Way also donated kits which included masks and hand sanitizers. Health Plan of San Joaquin hosted a booth to provide individuals with information about Medi-Cal enrollment. A total of 617 community members were tested at the SJC Fairgrounds. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CA Health Fund & Trust | |||||||
| 1215 K Street Ste 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $122,093 | Hlth srvs un/underinsured pt |
| American Heart Association | |||||||
| PO Box 50085 | Prescott | AZ | 86304 | 135613797 | 501(c)(3) | $50,000 | Walk for Good Heart |
| United Way of San Joaquin County | |||||||
| 777 N Pershing Avenue Suite B | Stockton | CA | 95203 | 941279805 | 501(c)(3) | $21,500 | Donation to HealthForce Partners |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Through the use of temporarily restricted accounts, we track and monitor the incoming receipts from grants and the utilization of grant funds. Each grant is tracked separately. Should the grantor agency require specific reports, we comply with their reporting requirements. The grants we monitor are specific to the grantor's needs and requests. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Larsen David - Former | ||||||||||||||
| Finance Officer, CCR thru 04/19 | $0 | $595,439 | $0 | $106,067 | $0 | $2,501,054 | $0 | $576,851 | $0 | $37,800 | $0 | $3,817,211 | $0 | $2,400,418 |
| Reiner Scott | ||||||||||||||
| Dir/Chair | $0 | $1,631,895 | $0 | $352,059 | $0 | $374,424 | $0 | $17,042 | $0 | $37,777 | $0 | $2,413,197 | $0 | $349,200 |
| Wing Bill | ||||||||||||||
| Dir/Asst Secr/Vice Chair | $0 | $1,458,328 | $0 | $279,883 | $0 | $22,116 | $0 | $17,042 | $0 | $42,012 | $0 | $1,819,381 | $0 | $0 |
| Jahn Andrew | ||||||||||||||
| President, Care Division | $0 | $992,796 | $0 | $210,574 | $0 | $162,471 | $0 | $17,042 | $0 | $42,265 | $0 | $1,425,148 | $0 | $0 |
| Ferch Wayne | ||||||||||||||
| President, CCR | $0 | $1,018,284 | $0 | $250,697 | $0 | $29,626 | $0 | $17,042 | $0 | $32,144 | $0 | $1,347,793 | $0 | $0 |
| Nahapetian Arby - Care | ||||||||||||||
| Division Chief Medical Officer | $0 | $648,088 | $0 | $107,260 | $0 | $112,858 | $0 | $12,449 | $0 | $42,262 | $0 | $922,917 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| Former CFO/Asst Secr thru 08/19 | $0 | $2,779 | $0 | $0 | $0 | $810,646 | $0 | $0 | $0 | $41,111 | $0 | $854,536 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $575,127 | $0 | $81,637 | $0 | $113,221 | $0 | $13,010 | $0 | $30,858 | $0 | $813,853 | $0 | $0 |
| Chen Steven | ||||||||||||||
| Finance Officer, CCR | $0 | $533,654 | $0 | $104,566 | $0 | $81,492 | $0 | $17,042 | $0 | $42,132 | $0 | $778,886 | $0 | $0 |
| Wolcott Daniel | ||||||||||||||
| President thru 12/20 | $0 | $510,921 | $0 | $98,950 | $0 | $86,116 | $0 | $17,042 | $0 | $42,265 | $0 | $755,294 | $0 | $0 |
| Gruzensky Denton | ||||||||||||||
| Reg HP Dir, CCR | $0 | $121,190 | $0 | $46,929 | $0 | $439,420 | $0 | $13,766 | $0 | $22,699 | $0 | $644,004 | $0 | $0 |
| Iris Patricia | ||||||||||||||
| Medical Officer | $0 | $374,313 | $0 | $72,568 | $0 | $45,196 | $0 | $17,042 | $0 | $27,622 | $0 | $536,741 | $0 | $0 |
| Hofheins Todd | ||||||||||||||
| CFO as of 08/20 | $0 | $297,756 | $0 | $66 | $0 | $171,285 | $0 | $0 | $0 | $13,281 | $0 | $482,388 | $0 | $0 |
| Whitney Jason | ||||||||||||||
| Treasurer | $0 | $286,032 | $0 | $46,008 | $0 | $28,027 | $0 | $17,042 | $0 | $41,990 | $0 | $419,099 | $0 | $0 |
| McCollough Brooke | ||||||||||||||
| Operations Executive | $0 | $274,568 | $0 | $43,988 | $0 | $21,967 | $0 | $15,550 | $0 | $46,965 | $0 | $403,038 | $0 | $0 |
| Grimm Mary | ||||||||||||||
| Patient Care Executive | $0 | $300,981 | $0 | $1,906 | $0 | $29,662 | $0 | $5,700 | $0 | $37,185 | $0 | $375,434 | $0 | $0 |
| Cook Becky - Ambulatory | ||||||||||||||
| & Physician Services Exec | $0 | $235,561 | $0 | $14,959 | $0 | $29,254 | $0 | $12,227 | $0 | $27,151 | $0 | $319,152 | $0 | $0 |
| Moreno Debbe | ||||||||||||||
| Former CNO thru 09/19 | $0 | $0 | $0 | $19,902 | $0 | $258,534 | $0 | $0 | $0 | $30,401 | $0 | $308,837 | $0 | $0 |
| Markovich Jennifer | ||||||||||||||
| Director, RN | $182,008 | $0 | $20,500 | $0 | $30,417 | $0 | $10,762 | $0 | $44,647 | $0 | $288,334 | $0 | $0 | $0 |
| Wagner Jack | ||||||||||||||
| Former Asst Secr thru 03/18 | $0 | $0 | $0 | $0 | $0 | $269,387 | $0 | $0 | $0 | $13,558 | $0 | $282,945 | $0 | $0 |
| Beck Atwater Sandra | ||||||||||||||
| Director Hospital Pharmacy | $219,873 | $0 | $9,155 | $0 | $0 | $0 | $12,970 | $0 | $33,130 | $0 | $275,128 | $0 | $0 | $0 |
| Carmody Thomas | ||||||||||||||
| Physician Assistant | $230,865 | $0 | $4,540 | $0 | $0 | $0 | $13,008 | $0 | $23,097 | $0 | $271,510 | $0 | $0 | $0 |
| Karagounis Timothy | ||||||||||||||
| Operations Executive | $198,387 | $0 | $29,009 | $0 | $1,434 | $0 | $11,471 | $0 | $21,493 | $0 | $261,794 | $0 | $0 | $0 |
| Pascua Helen | ||||||||||||||
| RN, First Assistant | $231,388 | $0 | $1,029 | $0 | $6,055 | $0 | $9,369 | $0 | $8,115 | $0 | $255,956 | $0 | $0 | $0 |
| Pickering Christine | ||||||||||||||
| Communication Dir, CCR | $0 | $154,923 | $0 | $22,769 | $0 | $5,071 | $0 | $9,073 | $0 | $54,065 | $0 | $245,901 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Gruzensky, Denton - severance payment - $419,587 Moreno, Debbe - severance payment - $257,371 Reppert, Joseph - severance payment - $809,806 Wagner, Jack - severance payment - $269,387 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Larsen, David - funding - $559,809 Larsen, David - vested distribution - $2,400,418 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 Wayne Ferch, Scott Reiner, Jack Wagner, 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 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| P Gill Obstetrics and Gynecology | |||
| >35% owned partnership by Parampal Gill, former board member | $71,665 | Physician professional service-OB Clinic | 0 |
| P Gill Obstetrics and Gynecology | |||
| >35% owned partnership by Parampal Gill, former board member | $301,950 | Physician professional service-Emergency room call | 0 |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $543,000 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Net book value | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Column (b): | FormAndLineReferenceDesc |
| Explanation | Column (b) reports the number of contributors. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | Adventist Health Lodi Memorial (AHLM) 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 AHLM, 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 AHLM 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. AHLM 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 $14,803,322. The following Inpatient services were provided to all our patients. These services included: - 975 Babies delivered - 1,124 Surgeries performed - 27,152 Patient days The following Outpatient services were provided to all our patients. These services included: - 42,339 Emergency department visits - 2,977 Outpatient Surgeries performed - 57,178 Outpatient visits - 139,184 Clinic visits AHLM 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 $16,159,185. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ |
| Form 990, Part VI, Section A, line 6 | The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The Hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, Section A, line 7a | The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. |
| Form 990, Part VI, Section A, line 7b | The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. |
| Form 990, Part VI, Section B, line 11b | This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Hospital'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 fees: Program service expenses 23,630,198. Management and general expenses 829,985. Fundraising expenses 0. Total expenses 24,460,183. Other medical professional fees: Program service expenses 40,989. Management and general expenses 9,419. Fundraising expenses 0. Total expenses 50,408. Consulting fees: Program service expenses 396,664. Management and general expenses 214,878. Fundraising expenses 0. Total expenses 611,542. Contract labor: Program service expenses 3,501,354. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,501,354. Repairs and maintenance: Program service expenses 426,277. Management and general expenses 2,165. Fundraising expenses 0. Total expenses 428,442. Cerner management fees: Program service expenses 0. Management and general expenses 8,162,909. Fundraising expenses 0. Total expenses 8,162,909. All other purchased services: Program service expenses 7,268,949. Management and general expenses 1,954,209. Fundraising expenses 8,657. Total expenses 9,231,815. Purchased medical services: Program service expenses 3,622,873. Management and general expenses 140,351. Fundraising expenses 0. Total expenses 3,763,224. Other professional fees non-medical: Program service expenses 0. Management and general expenses 13,315. Fundraising expenses 0. Total expenses 13,315. |
| Form 990, Part XI, line 9: | Change in investments of subsidiaries -1,495,201. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Artel LLC (dba Lodi Outpatient Surgery Center) | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 521 S Ham Lane Suite F | AddressLine1Txt |
| City | Lodi | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95240 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263513966 | EIN |
| Primary Activities | Ambulatory surgical centers | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Total Income | $2,324,955 | TotalIncomeAmt |
| End Of Year Assets | $1,265,570 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lodi Memorial Hospital Association Inc | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Delano | |||||||||||
| 1401 Garces Highway | Delano | CA | 93215 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Mendocino Coast | |||||||||||
| 700 River Drive | Fort Bragg | CA | 95437 | 845174585 | Hospital | CA | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| Adventist Health Physicians Network | |||||||||||
| 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 | 0 | N/A | |
| Adventist Health Tulare | |||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| 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 | |
| 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 | |
| San Joaquin Community Hospital | |||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Simi Valley Hospital and Health Care Services | |||||||||||
| 2975 N Sycamore Drive | Simi Valley | CA | 93065 | 956064971 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Sonora Community Hospital | |||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| St Helena Hospital | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Stone Point Health | |||||||||||
| 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC) | ||||||||||||||
| 1001 S Fairmont Avenue | Lodi | CA | 95240 | 943407786 | Diagnostic imaging / MRI outpatient treatment center | CA | Lodi Memorial Hospital Association Inc | Related | -$333,234 | $4,165,623 | 0 | 0 | 1.00000 | |
| Artel LLC (dba Lodi Outpatient Surgery Center) | ||||||||||||||
| 521 S Ham Lane Suite F | Lodi | CA | 95240 | 263513966 | Ambulatory surgical centers | CA | Lodi Memorial Hospital Association Inc | Related | $47,197 | $732,391 | 0 | 0 | 1.00000 | |
| Endoscopy Center of Lodi LLC | ||||||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 261243662 | Endoscopy services | CA | Artel LLC | Related | 0 | 0 | 1.00000 | |||
| Blue Zones LLC | ||||||||||||||
| 323 N Washington Avenue 2nd Floor | Minneapolis | MN | 55401 | 271603327 | Education | MN | 0 | 0 | N/A | |||||
| PVHR LLC dba Paradise Village | ||||||||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 260622555 | Real property rental | OR | 0 | 0 | N/A | |||||
| PVHR2 LLC dba Parkview at Paradise Village | ||||||||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 473300170 | Real property rental | OR | 0 | 0 | N/A | |||||
| WWGHR LLC | ||||||||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 810591221 | Rental | OR | 0 | 0 | N/A | |||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Delta Radiology Inc | ||||||||||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 941715690 | Radiology services | CA | Lodi Regional Health Systems Inc | C | $3,238,361 | $1,257,989 | 1.00000 | 0 | ||||||
| Lodi Regional Health Systems Inc | ||||||||||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 680398894 | Physician management and medical office building development & management | CA | Lodi Memorial Hospital Association Inc | C | $4,323,044 | $12,691,389 | 1.00000 | 0 | ||||||
| AdHealth Limited | ||||||||||||||||||
| Pure captive insurance | C | 0 | PO Box HM 2062 | Hamilton | BD | HM HX | BD | N/A | ||||||||||
| Adventist Health Plan Inc | ||||||||||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 463833261 | Health insurance | CA | C | 0 | N/A | |||||||||
| South Coast Medical Center | ||||||||||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 952037297 | Wind down after sale of hospital | CA | C | 0 | N/A | |||||||||
| Thrive Productions Inc | ||||||||||||||||||
| 323 N Washington Avenue | Minneapolis | CA | 55401 | 453369049 | Production company | MN | C | 0 | N/A | |||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | Yes (1) | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| Lodi Regional Health Systems Inc | |
| K | $94,451 |
| Lodi Regional Health Systems Inc | |
| O | $213,719 |
| Advanced Imaging Center at Lodi | |
| O | $703,896 |
| Artel LLC | |
| O | $1,123,773 |
| Delta Radiology Inc | |
| P | $620,376 |