2021-11-10T16:37:00-06:00 2020-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2020-01-01 770258013 Adventist Health Delano ADVE 9164060000 1401 Garces Hwy Delano CA 93215 Shane Cox Treasurer 9164060000 2021-10-22 1 Shane Cox 999009999 Tracy S Paglia P00366884 2099556100 2021-10-22 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z David Butler 1401 Garces Hwy Delano CA 93215 87398117 0 X www.adventisthealth.org/delano X 1990 CA Living God's love by inspiring health, wholeness, and hope. 14 12 736 8 2051184 0 0 32645 98130610 85393426 1350600 2913752 303353 -941706 99784563 87398117 0 1156627 0 0 41938585 40345467 0 0 123 39184219 44878213 81122804 86380307 18661759 1017810 174179222 197667914 38978207 36714633 135201015 160953281 X Living God's love by inspiring health, wholeness, and hope. 0 0 75904408 1156627 85393426 See Schedule O 75904408 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 98 0 1 736 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X Todd Hofheins CFO 9164060000 PO Box 619135 Roseville CA 95661 X Reiner Scott Dir/Chair 0.00 50.00 X X 0 2358378 54819 Wing Bill Dir/Asst Secr/Vice Chair 0.00 50.00 X X 0 1760327 59054 Jobe Meredith Secretary 0.00 50.00 X 0 769985 43868 Ghaffari Bahram President thru 12/19 0.00 0.00 X 0 736996 138 Butler David President 50.00 0.00 X 0 550904 59307 Hofheins Todd CFO as of 08/20 0.00 50.00 X 0 469107 13281 Hutcheson Walter Finance Officer 50.00 0.00 X 0 231360 50786 Datta Babita OB/GYN Physician 40.00 0.00 X 274651 0 4868 Monrian Terrence Pharmacy Director 40.00 0.00 X 246309 0 9032 Lee Mee Young Pharmacist 40.00 0.00 X 237216 0 11836 Khalil Samuel Pharmacist 40.00 0.00 X 210460 0 18722 Meng Bryant Pharmacist 40.00 0.00 X 209433 0 10504 Wade Evelyn Chief Nursing Officer thru 07/20 40.00 0.00 X 0 167981 18208 Freedman John Director 0.00 4.00 X 0 27216 0 Davis Andrew Director 0.00 4.00 X 0 26971 0 Reiner Richard Director 0.00 4.00 X 0 26764 0 Cherry Robert Director 0.00 4.00 X 0 26160 0 Innocent Larry Director 0.00 4.00 X 0 25608 0 Graham Ricardo Director 0.00 4.00 X 0 23359 0 Heinrich Kerry Director 0.00 4.00 X 0 20608 0 Woodson Marc Director 0.00 4.00 X 0 20608 0 Ocampo Lucy Director 0.00 4.00 X 0 20358 0 Banks David Director 0.00 4.00 X 0 15441 0 Salazar Velino Director 0.00 4.00 X 0 6651 0 Fehr Joy Director 0.00 4.00 X 0 108 0 Philip Celeste Director thru 04/20 0.00 4.00 X 0 0 0 1178069 7284890 354423 79 1 1 0 Cerner Corporation 2800 Rockcreek Parkway North Kansas City MO 64117 IT support / purchased services 1836746 Comfort Anesthesia Associates Inc 11704 Nantwick Court Bakersfield CA 93311 Professional services anesthesia 1334178 Quest Imaging PO Box 21178 Bakersfield CA 93390 Biomedical equipment R&M 896257 Team Physicians of California Medical Gr PO Box 634850 Cincinnati OH 452634850 Professional services ER physicians 546667 Westways Staffing Services Inc 500 City Parkway W Suite 130 Orange CA 92868 Professional fees 493064 18 32645 32645 Patient service revenue 621400 82600309 80549125 2051184 CARES Act revenue 621990 2400586 2400586 Related rental revenue 621400 183483 183483 Dietary revenue 621400 175167 175167 340B Pharmacy revenue 621400 9872 9872 24009 24009 85393426 2913752 2913752 904 0 904 904 3723 0 3723 3723 Loss on debt refinancing 900099 -946333 -946333 -946333 87398117 83342242 2051184 1972046 X 1156627 1156627 32135510 27355169 4780341 945131 846565 98566 5004685 4151391 853294 2260141 1967857 292284 542409 542409 88529 88529 7027 7027 12268211 9588493 2679718 213907 213907 294636 185620 108893 123 7265405 7175737 89668 1176025 1175958 67 27312 11041 16271 29402 20712 8690 476248 476248 5432947 5329303 103644 1561707 1561707 Medical/non-medical sup 9948169 9757583 190586 Quality Assurance Fees 4291260 4291260 Rental/leases costs equ 474362 463269 11093 Bad debts 69236 69236 711421 382841 328580 86380307 75904408 10475776 123 29798125 0 27159923 112172683 8415803 10761207 1464823 1436409 852863 458595 154840923 100165872 37489430 54675051 42438879 91151 76845 26468225 18087124 174179222 197667914 11556013 9395469 4385901 8204 19187500 0 3848793 27310960 38978207 36714633 X 135201015 160953281 135201015 160953281 174179222 197667914 X 1017810 6085 24728371 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7027 7027 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. 9120000 9120000 81919349 47369812 34549537 62379217 52161727 10217490 1422357 634333 788024 54675051 Receivables from third-party payors 17401260 Receivables from related organizations 273714 Other assets 267880 Other receivables 144270 18087124 Payables to related organizations 17992712 Payables to third-party payors 7588703 Other liabilities 1729545 27310960 X Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2020 and 2019, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2016 in major tax jurisdictions. 1 1 1 X 1 X 1 1 1 0 1 1 374446 374446 0.00430 21519927 22652028 0 0.00000 21894373 22652028 374446 0.00430 165002 165002 0.00190 159728 159728 0.00180 22118 22118 0.00030 346848 346848 0.00400 22241221 22652028 721294 0.00830 349564 349564 0.00400 349564 349564 0.00400 1 1192601 226713 8544094 9879052 -1334958 X 1 1 1 1 Adventist Health Delano 1401 Garces Hwy Delano CA 93215 https://www.adventisthealth.org/delano 120000180 X X X Adventist Health Delano 1 0 1 1 X X X X X X X X X 19 1 1 0 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 19 1 See Sch H Part VI - Needs Assesment 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X 1 X 0 0 Adventist Health Delano Part V, Section B, Line 2: Adventist Health System/West entered into an affiliation agreement with Central California Foundation for Health dba: Delano Regional Medical Center, located in Delano, California, to become the sole member of Adventist Health Delano. This agreement was effective December 31, 2019. This acquisition allowed the System the ability to provide expanded healthcare services in the Delano, California, market. Adventist Health Delano Part V, Section B, Line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data. 3. Data gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews.Community Survey: The Kern County Community Benefit Collaborative hospital representatives developed a plan for distribution of a survey to engage community residents. The survey was available in an electronic format through a Survey Monkey link, and in a paper copy format. The electronic and paper surveys were available in English and Spanish. The surveys were available from November 2018 to January 2019 and during this time, 1,114 usable surveys were collected. The hospitals distributed the surveys to their clients, in hospital waiting rooms and service sites, and through social media, including posting the survey link on hospital Facebook pages. The survey was also distributed to community partners who made them available to their clients. A written introduction to the survey questions explained the purpose of the survey and assured participants the survey was voluntary, and that they would remain anonymous. For community members who were illiterate, an agency staff member read the survey introduction and questions to the client in his/her preferred language and marked his/her responses on the survey. The survey included the following: demographics, biggest health issues in the community, greatest needs facing children and families, where residents and their families receive routine health care services, problems faced accessing health care, mental health care, dental care or supportive services, what would make it easier to obtain care, types of support or services needed in the community, and safety concerns in the community.Targeted Interviews: Interviews were used to gather information and opinions, by phone, from persons who represent the community served by the hospital. Interview participants were asked to share their perspectives on a number of topics related to the identified preliminary health needs in the community area. Given shared community areas, the Kern County Community Benefit Adventist Health Bakersfield 14 Collaborative hospitals worked together to conduct the interviews. Forty-one (41) interviews were completed from October 2018 through March 2019. Secondary data were collected from a variety of local, county and state sources to present a community profile, social determinants of health, health care access, birth indicators, leading causes of death, acute and chronic disease, health behaviors, mental health, substance use and misuse, and preventive practices. When available, data sets are presented in the context of Kern County and California to help frame the scope of an issue, as it relates to the broader community. Sources of data include: the U.S. Census American Community Survey, California Department of Public Health, California Health Interview Survey, Kern County Public Health Department, Healthy Kern County, County Health Rankings, California Department of Education, California Office of Statewide Health Planning and Development and California Department of Justice, among others. Adventist Health Delano Part V, Section B, Line 6a: The Kern County Community Benefit Collaborative convened area hospitals and included these partners:Adventist Health Bakersfield and Adventist Health Tehachapi Valley Hospitals, Delano Regional Medical Center, Dignity Health Bakersfield, Mercy and Memorial Hospitals, Kaiser Permanente Kern County, Kern Medical, and Valley Children's Healthcare. Adventist Health Delano 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: Access to Health Care, Food Insecurity, Chronic Disease (Including Overweight and Obesity). Priority Need 1 - Access to Health Care - The goal is to increase coverage and access to health care for the medically underserved. Strategy 1 - Partner to make a collective impact on removing barriers for care, while providing accessibility and care coordination for our vulnerable populations. Activity 1.1 - Provide financial assistance through free and discounted care for health care services, consistent with the hospital's financial assistance policy - Adventist Health Delano actively participated in several key community collaboratives to promote wellness and promote coverage with access to health care services for medically underserved within the Delano community. Additionally, Adventist Health Delano also successfully brought awareness of the financial assistance policy. Activity 1.2 - Bring Adventist Health clinicians and services to community events - Due to the COVID-19 pandemic this event was placed on hold and will pick back up when it is safe to do so. Activity 1.3 - Vaccinations Clinics - Number of persons served with free Flu vaccine: 800. Additional Activities - Adventist Health Delano accepted invitations and actively participated in virtual events providing awareness and health education regarding the COVID-19 pandemic. In partnership with Kern County Public Health, California Farmworkers Foundation, City of Delano, and several community organizations, Adventist Health Delano facilitated over 20 community COVID-19 safety programs for the community at large. Priority Need 2 - Chronic Disease (Including Overweight and Obesity) - The goal is to reduce the impact of chronic disease on health and increase the focus on prevention and treatment education. Strategy 1 - Partner to make a collective impact on removing barriers for care, while providing education and resources to manage chronic disease. Activity 1.1 - Diabetes Workshops focused on prevention and disease self-management, health lifestyles, nutrition, and physical activity - The diabetes wellness workshop provided an opportunity to connect wellness experts to our community to provide education and initiatives on living a healthier life. A total of 26 community members without a primary care provider were referred to an Adventist Health services for follow up and continuum of care. At the end of 2020, 18 of the 26 patients remained with their primary care provider and became established patients within the Adventist Health network. Activity 1.2 - Population Health Outreach Events and Education - Due to COVID-19 this program has been placed on hold and will resume once it is safe to do so. Priority Need 3 - Food Insecurity - The goal is to increase access to healthy, affordable food to reduce the impact of food insecurity in the community. Activity 1.1 - Promote screening for food insecurity at strategic intake points including the ED and local health clinics and provide information on food resources & Activity 1.2 - Offer sign-up assistance for public programs that increase access to food. These two activities coincide. Adventist Health Delano addressed food insecurity by providing access and pathways to reduce the impact of hunger in the community. In addition, education outreach about public programs was also offered. Adventist Health Delano provided over 160 referrals to local partners to assist community members with food insecurity. Activity 1.3 - Participate in Waste Hunger not Food Kern County - Over 2,600 meals repurposed to community organizations.Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health Delano 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. Taking existing hospital and community resources into consideration, AH Delano will not directly address the remaining health needs identified in the CHNA: housing and homelessness, mental health, economic insecurity, substance use and misuse, environmental pollution, sexually transmitted infections, violence and injury, dental care, birth indicators, Alzheimer's disease, unintentional injuries and preventive practices. Adventist Health Delano does not have the resources to address all the health needs present in the community. Therefore, it will concentrate on those health needs that can most effectively be addressed given the organization's areas of focus and expertise. 4 1 - AH Delano Women's Health - RHC 1201 Jefferson Street Delano CA 93215 Rural Health Clinic 2 - AH Delano Wasco Plaza 2300 7th Street Wasco CA 93280 Rural Health Clinic 3 - AH Delano Prompt Care - RHC 1201 Jefferson 12th Avenue Entrance Delano CA 93215 Rural Health Clinic 4 - AH Delano Wound Care 1519 Garces Highway Suite 103 Delano CA 93215 Hospital Based Clinic Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. Part II, Community Building Activities: The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities that we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020 Adventist Health completed the acquisition of Blue Zones as the first step toward reaching this goal. By partnering with Blue Zones, we are able to gain ground in shifting the balance from healthcare - treating people once they are ill - to transformative well-being - changing the way communities live, work and play. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part III, Line 2: Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3: The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information, those accounts would have been reclassified from bad debt expense to charity care. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8: The Medicare cost report apportions the Hospital's costs based on inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The healthcare "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 8,544,094Prior Year Settlements 16,783Cost Report Reimbursable Bad Debts 299,885Non-cost report revenue 761,846Estimates and Accrual Variances (371,463)Other 461,791 Total Medicare Revenue 9,712,936*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Part III, Line 9b: When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest Part VI, Line 2: The Hospital's 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 Assessment, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, Adventist Health Delano 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: The service area includes a small city and surrounding suburbs, small towns and rural agricultural areas. The diverse population includes Hispanic/Latino (81.5%), White (8.0%), Black/African American (5.6%), Asian (3.6%), American Indian/Alaska Native and Native Hawaiian/Pacific Islander (0.2%) and (0.9%) classified as other. Of the area populations, 55.6% are male and 44.4% are female. Children and youth, ages 0-17, make up 31.1% of the population, 62.4% are adults, ages 18-64, and 6.6% of the population are seniors, 65 and over. The service area has a higher percentage of children, ages 0-17, and seniors, ages 65 and older.Seniors living alone may be isolated and lack adequate support systems. In the service area 11.6% of seniors are living alone. Among the service area, 2.5% are veterans. About 48.2% of residents in Kern County speak a non-English language, and 21.9% of the population is foreign-born. Of the foreign-born, 67.4% are not citizens.The federal poverty level (FPL) was set at an annual income of $11,880 for one person and $24,300 for a family of four. Among residents in the service area, 29.0% are at or below 100% of the federal poverty level (FPL) and 62.8% are low-income (200% of FPL or below). Of these residents, 44.5% of children under 18 years of age are living in poverty. The U.S. Department of Agriculture (USDA) defines food insecurity as limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire these foods in socially-acceptable ways. Among the population in Kern County, 13.6% experienced food insecurity during the past year. Among children in Kern County, 25% lived in households that experienced food insecurity at some point in the year. The rate of food insecurity is higher in Kern County than in the state. Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache are soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population; 2. Factors that cause the present outcomes distribution; and 3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2. Improve care quality and patient safety, and 3. Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States CA Part VI - Other Information: In 2020, Adventist Health as a system took the following actions in response to the needs created or exacerbated by COVID-19: Adventist Health as a system directed "Community Strength Fund grants" to each hospital to support community partners' immediate response to COVID-19; Adventist Health as a system directed "Community Integration Catalyst" funds to each hospital to support internal new or expanded community well-being programming and innovation as an immediate response to COVID-19; began offering more virtual health care visits to keep community members safe and healthy; developed an online symptom tracker to help community members determine if they may have COVID-19 or some other flu type illness and what steps to take; partnered with MaskUp, a collaboration of 100 leading health systems representing thousands of hospitals across the U.S. joining to create messages for the betterment of the communities they serve.Locally, Adventist Health Delano took these additional actions: - Provided and donated over 50,000 masks to community organizations and partners. - Provided free community COVID-19 screening and education to community members. - Assisted local employers and organizations with resources, tools, and guidance around COVID-19 through seminars and collateral. 1 CA Health Fund & Trust 1215 K Street 800 Sacramento CA 95814 941498697 501(c)(3) 1156627 Uninsured/Underinsured Grant 1 0 Part I, Line 2: 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. X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Dir/Chair 0 1631895 0 352059 0 374424 0 17042 0 37777 0 2413197 0 349200 Wing Bill Dir/Asst Secr/Vice Chair 0 1458328 0 279883 0 22116 0 17042 0 42012 0 1819381 0 0 Jobe Meredith Secretary 0 575127 0 81637 0 113221 0 13010 0 30858 0 813853 0 0 Ghaffari Bahram President thru 12/19 0 120208 0 160937 0 455851 0 0 0 138 0 737134 0 0 Butler David President 0 415385 0 71168 0 64351 0 17042 0 42265 0 610211 0 0 Hofheins Todd CFO as of 08/20 0 297756 0 66 0 171285 0 0 0 13281 0 482388 0 0 Hutcheson Walter Finance Officer 0 208615 0 0 0 22745 0 8965 0 41821 0 282146 0 0 Datta Babita OB/GYN Physician 274651 0 0 0 0 0 346 0 4522 0 279519 0 0 0 Monrian Terrence Pharmacy Director 244010 0 0 0 2299 0 1036 0 7996 0 255341 0 0 0 Lee Mee Young Pharmacist 237216 0 0 0 0 0 3878 0 7958 0 249052 0 0 0 Khalil Samuel Pharmacist 210460 0 0 0 0 0 3431 0 15291 0 229182 0 0 0 Meng Bryant Pharmacist 209433 0 0 0 0 0 3358 0 7146 0 219937 0 0 0 Wade Evelyn Chief Nursing Officer thru 07/20 0 167981 0 0 0 0 0 4335 0 13873 0 186189 0 0 Part I, Lines 4a-b 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. Ghaffari, Bahram - severance payment - $455,851 Select executives agreed to participate in CAP-EX in place of a traditional insurance SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life participants are Scott Reiner and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for non-vested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Reiner, Scott - $349,200 Form 990, Part III, Line 4a: Adventist Health Delano (AHDL) 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 AHDL, 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 AHDL 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. AHDL 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 $374,446. The following Inpatient services were provided to all our patients. These services included: - 502 Babies delivered - 523 Surgeries performed - 24,913 Patient days The following Outpatient services were provided to all our patients. These services included: - 22,838 Emergency department visits - 452 Outpatient Surgeries performed - 29,961 Clinic visits AHDL 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 $346,848. 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. 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 corporation's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, corporate officers, key employees, and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the market president immediately. The System General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The System General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System General Counsel retains the COIs for all individuals. Copies for the officers and key employees' COIs are kept in their personnel files. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. Form 990, Part VI, Section B, line 15 The Hospital's Board of Directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital Presidents and Finance Officers, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital Presidents and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital President has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital (incentive potential is industry norm). Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. Form 990, Part VI, Section C, line 19 The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. Form 990, Part VII: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 4,937,796. Management and general expenses 1,564,150. Fundraising expenses 0. Total expenses 6,501,946. Other professional medical fees: Program service expenses 11,085. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,085. Consulting and other management fees: Program service expenses 25,779. Management and general expenses 105,254. Fundraising expenses 0. Total expenses 131,033. Other non-medical professional fees: Program service expenses 0. Management and general expenses 1,821. Fundraising expenses 0. Total expenses 1,821. Contract labor: Program service expenses 1,602,749. Management and general expenses 16,030. Fundraising expenses 0. Total expenses 1,618,779. Purchased medical services: Program service expenses 1,215,540. Management and general expenses 205,975. Fundraising expenses 0. Total expenses 1,421,515. Repairs and maintenance: Program service expenses 1,463,543. Management and general expenses 36,876. Fundraising expenses 0. Total expenses 1,500,419. Other purchased services: Program service expenses 332,001. Management and general expenses 749,612. Fundraising expenses 0. Total expenses 1,081,613. Form 990, Part XI, line 9: Change in Net Assets Due to Affiliation 24,742,677. Change in Investment in Subsidiary -14,306. 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 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 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health 0 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 0 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 Blue Zones LLC 323 N Washington Avenue 2nd Floor Minneapolis MN 55401 271603327 Education MN N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Real property rental OR N/A 0 0 PVHR2 LLC dba Parkview at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Real property rental OR N/A 0 0 WWGHR LLC 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Rental OR N/A 0 0 Delano Health Associates Inc 1401 Garces Hwy Delano CA 93215 770340007 Winding down/discontinued operations CA Adventist Health Delano C 1 76845 1.00000 1 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037297 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 323 N Washington Avenue Minneapolis CA 55401 453369049 Production company MN N/A C 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 Delano Health Associates Inc S 800000 Cash transferred