SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES (EIN 95-6064971)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-13
- IRS object ID
- 202023189349311287
- Schema version
- 2019v5.0
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-13T16:49:15-08:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 800519547 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ACCOUNTANCY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N Brand Blvd Fl 20 | AddressLine1Txt |
| City | Glendale | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956064971 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hosp and Hlth Care Services | BusinessNameLine1Txt |
| Business Name Line2 | dba Adventist Health Simi Valley | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SIMI | BusinessNameControlTxt |
| Phone | 8059556000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1Txt |
| City | Simi Valley | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93065 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Francis Owens | PersonNm |
| Person Title | Finance Officer | PersonTitleTxt |
| Signature | 2020-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | S Clement | PreparerPersonNm |
| PTIN | P01218012 | PTIN |
| Phone | 8185475701 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jennifer Swenson | PrincipalOfficerNm |
| Gross Receipts | $163,134,361 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/simi-valley | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1960 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living Gods love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1060 | TotalEmployeeCnt |
| Total Volunteers | 162 | TotalVolunteersCnt |
| Total Gross UBI | $401,108 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $997,784 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,378,687 | PYContributionsGrantsAmt |
| CY Contributions Grants | $120,338 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $142,184,326 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $162,441,558 | CYProgramServiceRevenueAmt |
| PY Investment Income | $26,724 | PYInvestmentIncomeAmt |
| CY Investment Income | $520,541 | CYInvestmentIncomeAmt |
| PY Other Revenue | $47,395 | PYOtherRevenueAmt |
| CY Other Revenue | $51,924 | CYOtherRevenueAmt |
| PY Total Revenue | $154,637,132 | PYTotalRevenueAmt |
| CY Total Revenue | $163,134,361 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $233,298 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $131,283 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $70,442,615 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $68,586,178 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $210,725 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $82,048,500 | PYOtherExpensesAmt |
| CY Other Expenses | $91,318,408 | CYOtherExpensesAmt |
| PY Total Expenses | $152,724,413 | PYTotalExpensesAmt |
| CY Total Expenses | $160,035,869 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,912,719 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,098,492 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $177,558,588 | TotalAssetsBOYAmt |
| Total Assets EOY | $193,427,233 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $135,820,651 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $147,733,714 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $41,737,937 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $45,693,519 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Living Gods love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $128,829,013 | ExpenseAmt |
| Grant | $131,283 | GrantAmt |
| Revenue | $162,068,950 | RevenueAmt |
| Desc | Simi Valley Hosp & Hlth Care Serv dba Adventist Health Simi Valley (AHSV) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay.Although reimbursement for services rendered is critical to the operation and stability Adventist Health Simi Valley, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Adventist Health Simi Valley 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.AHSV 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 2019 was $15,034758.The following Inpatient services that were provided to all our patients. These services included:472 Babies delivered1,151 Surgeries performed29,414 Patient days The following Outpatient services that were provided to all our patients. These services included:36,992 Emergency department visits2,156 Outpatient Surgeries performed51,925 Outpatient visits 43,870 Clinic visitsAHSV 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 2019 was $7,112,071.Adventist Healths mission statement of Living Gods love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in Gods image has experienced the best health today, hope for tomorrow, and Gods love that endures forever.Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ | Desc |
| Total Program Service Expenses | $128,829,013 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1060 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | 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 | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jay Lipps | PersonNm |
| Phone | 9164061092 | 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 (38 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Raffoul John | |||||||
| Finance Officer, SCR | 10.00 | 40.00 | $0 | $2,777,239 | $48,038 | ||
| Reiner Scott | |||||||
| Dir/Chair | 0.00 | 50.00 | $0 | $1,995,696 | $53,734 | Yes (X) | Yes (X) |
| Wing Bill | |||||||
| Dir/A Sec/CFO | 0.00 | 50.00 | $0 | $1,572,254 | $46,583 | Yes (X) | Yes (X) |
| Jahn Andrew | |||||||
| President, SCR | 10.00 | 40.00 | $0 | $1,254,944 | $59,912 | ||
| Reppert Joseph | |||||||
| A/Sec thru 8/19 | 0.00 | 50.00 | $0 | $1,209,069 | $57,565 | Yes (X) | |
| Nahapetian Arby | |||||||
| Medical Officer, SCR | 10.00 | 40.00 | $0 | $841,794 | $58,842 | ||
| Zachary Beth | |||||||
| President SCR thru 12/2019 | 10.00 | 40.00 | $0 | $840,555 | $47,667 | ||
| Wagner Jack | |||||||
| Former Asst Secr | 0.00 | 50.00 | $0 | $778,475 | $29,189 | ||
| Jobe Meredith | |||||||
| Secretary | 0.00 | 50.00 | $0 | $730,385 | $45,909 | Yes (X) | |
| Swenson Jennifer | |||||||
| President | 50.00 | 0.00 | $0 | $577,513 | $61,892 | Yes (X) | |
| Fargo Roland | |||||||
| Former Physician Ops Officer | 0.00 | 50.00 | $0 | $475,946 | $39,167 | ||
| Milatovic Natasa | |||||||
| Reg HR Dir, SCR | 10.00 | 40.00 | $0 | $459,205 | $49,980 | ||
| Dingilian John | |||||||
| Medical Officer | 50.00 | 0.00 | $0 | $381,619 | $58,586 | ||
| Esparza Caroline | |||||||
| COO/CNO | 0.00 | 50.00 | $0 | $344,846 | $48,001 | ||
| Burke James | |||||||
| Medical Officer, SCR | 10.00 | 40.00 | $0 | $336,072 | $39,227 | ||
| Anderson Brian | |||||||
| A Sec thru 5/19 | 50.00 | 0.00 | $0 | $316,605 | $32,046 | Yes (X) | |
| Werner William | |||||||
| VP Support Services | 50.00 | 0.00 | $0 | $281,493 | $55,996 | ||
| Owens Chip | |||||||
| Treas/A Sec | 50.00 | 0.00 | $0 | $267,414 | $54,649 | Yes (X) | |
| Wehtje Ronald | |||||||
| CFO SCR thru 03/2019 | 10.00 | 40.00 | $0 | $265,160 | $8,290 | ||
| Mallari Christopher | |||||||
| RN | 50.00 | 0.00 | $203,133 | $0 | $38,494 | ||
| Adamos Eugene | |||||||
| Pharmacist | 50.00 | 0.00 | $201,180 | $0 | $34,805 | ||
| Carol Deamer | |||||||
| Director, Pharmacy | 50.00 | 0.00 | $214,903 | $0 | $11,988 | ||
| Fernandes Shalini | |||||||
| RN | 50.00 | 0.00 | $188,890 | $0 | $37,439 | ||
| Ferrier Cory | |||||||
| Bus Dev Exec | 50.00 | 0.00 | $0 | $200,181 | $12,126 | ||
| Percival Kathleen | |||||||
| Admin Dir, Org Per | 50.00 | 0.00 | $187,015 | $0 | $21,038 | ||
| DavisWhitney | |||||||
| Comm Director, SCR | 10.00 | 40.00 | $0 | $149,648 | $28,730 | ||
| Reiner Richard | |||||||
| Director | 0.00 | 4.00 | $0 | $28,588 | $0 | Yes (X) | |
| Davis Andrew | |||||||
| Director | 0.00 | 4.00 | $0 | $28,246 | $0 | Yes (X) | |
| Cherry Robert | |||||||
| Director | 0.00 | 4.00 | $0 | $26,315 | $0 | Yes (X) | |
| Heinrich Kerry | |||||||
| Director | 0.00 | 4.00 | $0 | $20,102 | $0 | Yes (X) | |
| Innocent Larry | |||||||
| Director | 0.00 | 4.00 | $0 | $18,852 | $0 | Yes (X) | |
| Woodson Marc | |||||||
| Director | 0.00 | 4.00 | $0 | $15,000 | $0 | Yes (X) | |
| Graham Ricardo | |||||||
| Director | 0.00 | 4.00 | $0 | $8,848 | $0 | Yes (X) | |
| Banks David | |||||||
| Director | 0.00 | 4.00 | $0 | $6,382 | $0 | Yes (X) | |
| Freedman John | |||||||
| Director | 0.00 | 4.00 | $0 | $2,367 | $0 | Yes (X) | |
| Salazar Velino | |||||||
| Director | 0.00 | 4.00 | $0 | $553 | $0 | Yes (X) | |
| Philip Celeste | |||||||
| Director | 0.00 | 4.00 | $0 | $0 | $0 | Yes (X) | |
| Ocampo Lucy | |||||||
| Director | 0.00 | 4.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $995,121 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $16,211,366 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,079,893 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 191 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Siemens Medical Solutions | |||||
| 6700 Koll Center Pkwy 220 | Pleasanton | CA | 94566 | Medical Services | $1,307,108 |
| Jr Abbott Construction Inc | |||||
| 25 E California Blvd | Pasadena | CA | 91105 | Construction Services | $990,459 |
| Medical Solutions LLC | |||||
| 1010 N 102nd Street Suite 300 | Omaha | NE | 68114 | Medical Services | $926,048 |
| Intensive Care Medical Specialists Inc | |||||
| 1177 Roadrunner Way | Simi Valley | CA | 93065 | Medical Services | $744,126 |
| Sodexo Inc and Affiliates | |||||
| 9801 Washington Blvd | Gathersburg | MD | 20878 | Dietery Services | $569,754 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 37 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $120,338 | AllOtherContributionsAmt |
| Total Contributions | $120,338 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Dietary | 722514 | $209,475 | $209,475 | |
| Medical Office Rentals | 531120 | $1,189,977 | $788,869 | $401,108 |
| Other Revenue | 900099 | $274,456 | $274,456 | |
| Patient Care Services | 900099 | $160,767,650 | $160,767,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $162,441,558 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $468,291 | TotalRevenueColumnAmt |
| Exclusion | $468,291 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,750 | TotalRevenueColumnAmt |
| Exclusion | $23,750 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $28,500 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $28,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,500 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,500 | RelatedOrExemptFuncIncomeAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $51,924 | GrossSalesOfInventoryAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,924 | TotalRevenueColumnAmt |
| Exclusion | $51,924 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $163,134,361 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $162,068,950 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $401,108 | UnrelatedBusinessRevenueAmt |
| Exclusion | $543,965 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,283 | TotalAmt |
| Program Services | $131,283 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,539,880 | TotalAmt |
| Program Services | $51,996,256 | ProgramServicesAmt |
| Management And General | $3,384,510 | ManagementAndGeneralAmt |
| Fundraising | $159,114 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,067,777 | TotalAmt |
| Program Services | $2,031,830 | ProgramServicesAmt |
| Management And General | $29,806 | ManagementAndGeneralAmt |
| Fundraising | $6,141 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,027,702 | TotalAmt |
| Program Services | $6,575,103 | ProgramServicesAmt |
| Management And General | $431,841 | ManagementAndGeneralAmt |
| Fundraising | $20,758 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,950,819 | TotalAmt |
| Program Services | $3,789,668 | ProgramServicesAmt |
| Management And General | $150,134 | ManagementAndGeneralAmt |
| Fundraising | $11,017 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $312,558 | TotalAmt |
| Program Services | $84,371 | ProgramServicesAmt |
| Management And General | $228,187 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,097 | TotalAmt |
| Program Services | $17,499 | ProgramServicesAmt |
| Management And General | $119,598 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $462 | TotalAmt |
| Program Services | $462 | ProgramServicesAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,348,584 | TotalAmt |
| Program Services | $5,216,135 | ProgramServicesAmt |
| Management And General | $1,132,449 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,484 | TotalAmt |
| Program Services | $9,841 | ProgramServicesAmt |
| Management And General | $42,643 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $680,916 | TotalAmt |
| Program Services | $354,621 | ProgramServicesAmt |
| Management And General | $326,295 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,207,948 | TotalAmt |
| Program Services | $2,044,789 | ProgramServicesAmt |
| Management And General | $159,664 | ManagementAndGeneralAmt |
| Fundraising | $3,495 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,969,555 | TotalAmt |
| Program Services | $4,361,249 | ProgramServicesAmt |
| Management And General | $1,608,306 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,534 | TotalAmt |
| Program Services | $31,170 | ProgramServicesAmt |
| Management And General | $76,364 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,730 | TotalAmt |
| Program Services | $17,446 | ProgramServicesAmt |
| Management And General | $19,284 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,594,195 | TotalAmt |
| Program Services | $3,594,082 | ProgramServicesAmt |
| Management And General | $113 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,186,472 | TotalAmt |
| Program Services | $8,157,950 | ProgramServicesAmt |
| Management And General | $28,522 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Purchased services | $30,303,286 | $8,855,790 | $21,447,496 |
| Patient Care Supplies | $20,695,475 | $20,660,262 | $35,213 |
| Quality Assurance | $9,893,630 | $9,893,630 | |
| Revenue Cycle Fees | $1,567,164 | $1,567,164 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,224,318 | TotalAmt |
| Program Services | $1,005,576 | ProgramServicesAmt |
| Management And General | $208,542 | ManagementAndGeneralAmt |
| Fundraising | $10,200 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,035,869 | TotalAmt |
| Program Services | $128,829,013 | ProgramServicesAmt |
| Management And General | $30,996,131 | ManagementAndGeneralAmt |
| Fundraising | $210,725 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,530,605 | BOYAmt |
| EOY | $6,913,033 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,113,372 | BOYAmt |
| EOY | $24,514,027 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,693,642 | BOYAmt |
| EOY | $2,922,436 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,677 | BOYAmt |
| EOY | $644,528 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $241,884,104 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $107,872,420 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,449,080 | BOYAmt |
| EOY | $134,011,684 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,019,735 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,121 | BOYAmt |
| EOY | $100,121 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,227,323 | BOYAmt |
| EOY | $2,227,323 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,210,459 | BOYAmt |
| EOY | $2,210,459 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,649,574 | BOYAmt |
| EOY | $19,883,622 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,558,588 | BOYAmt |
| EOY | $193,427,233 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,451,469 | BOYAmt |
| EOY | $16,352,095 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,927 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,950,000 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,367,255 | BOYAmt |
| EOY | $131,381,619 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,820,651 | BOYAmt |
| EOY | $147,733,714 | 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 | $40,922,512 | BOYAmt |
| EOY | $44,996,201 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $815,425 | BOYAmt |
| EOY | $697,318 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,737,937 | BOYAmt |
| EOY | $45,693,519 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,558,588 | BOYAmt |
| EOY | $193,427,233 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,098,492 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $1,269,837 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$412,747 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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) |
|---|---|---|
| Form4720 Filed Section4955 Tax | false | Form4720FiledSection4955TaxInd |
| Correction Made | false | CorrectionMadeInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $24,601 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $24,601 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1i - Other Activities Description | FormAndLineReferenceDesc |
| Explanation | The organization 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 | $815,425 | BeginningYearBalanceAmt |
| Contributions | $229,369 | ContributionsAmt |
| Grants Or Scholarships | $35,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $249,339 | OtherExpendituresAmt |
| End Year Balance | $760,455 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $934,825 | BeginningYearBalanceAmt |
| Contributions | $216,897 | ContributionsAmt |
| Investment Earnings Or Losses | -$6,401 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $329,896 | OtherExpendituresAmt |
| End Year Balance | $815,425 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,796,958 | BeginningYearBalanceAmt |
| Contributions | $1,327,885 | ContributionsAmt |
| Investment Earnings Or Losses | -$1,132,209 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,057,809 | OtherExpendituresAmt |
| End Year Balance | -$36,359 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,471,458 | BeginningYearBalanceAmt |
| Contributions | $2,049,302 | ContributionsAmt |
| Investment Earnings Or Losses | -$1,648,602 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,075,200 | OtherExpendituresAmt |
| End Year Balance | $122,466 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,178,248 | BeginningYearBalanceAmt |
| Contributions | $54,691 | ContributionsAmt |
| Investment Earnings Or Losses | $288,054 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $49,535 | OtherExpendituresAmt |
| End Year Balance | $3,471,458 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.08300 | BoardDesignatedBalanceEOYPct |
| Term Endowment Balance EOY | 0.91700 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,378,566 | OtherCostOrOtherBasisAmt |
| Book Value | $6,378,566 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $171,356,910 | OtherCostOrOtherBasisAmt |
| Depreciation | $70,717,628 | DepreciationAmt |
| Book Value | $100,639,282 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,052,478 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,000,391 | DepreciationAmt |
| Book Value | $52,087 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $51,564,874 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,249,530 | DepreciationAmt |
| Book Value | $20,315,344 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,531,276 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,904,871 | DepreciationAmt |
| Book Value | $6,626,405 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $134,011,684 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Sycamore, Aspen, Oncure | Desc |
| Book Value | $2,227,324 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Investment in ASV | $2,149,934 |
| Investment in Fdtn | $1,570,536 |
| Other Assets | |
| Other Receivables | $37,336 |
| Receivables from Related Organizations | $11,967,712 |
| Receivables from Third Parties | $4,158,104 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $19,883,622 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Other Liabilities | $9,994,939 |
| Payables to Related Organizations | $121,386,680 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $131,381,619 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: Intended uses of the endowment fund. | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| Part X : FIN48 Footnote | The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2019 and 2018, 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 2015 in major tax jurisdictions. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $487,868 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $487,868 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,214,087 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,667,197 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,546,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09090 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,701,955 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,667,197 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,034,758 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09390 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,204,817 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,572 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,196,245 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $202,192 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $202,192 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,332,754 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,062,221 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,270,533 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03290 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $443,102 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $443,101 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,182,865 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,070,794 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,112,071 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04450 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,884,820 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,737,991 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $22,146,829 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13840 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,022 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,022 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,631 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,631 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,254 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,254 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,441 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,441 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,181 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,181 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,583 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,583 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $176,112 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $176,112 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,361,159 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $48,208 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $39,801,925 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $44,511,047 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,709,122 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Aspen Surgery Venture LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Ambulatory surgery center | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.72500 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.27500 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1Txt |
| City | Simi Valley | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93065 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | See Form 990, Pg 1, Item J | WebsiteAddressTxt |
| State License | 050000216 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | 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 (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0000 | 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 (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | 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 (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Sch H Part VI-Patient Education | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Sch H Part VI-Patient Education | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Sch H Part VI-Patient Education | 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 (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Facility: - Part V, Section B, Line 5 | The 2019 CHNA data collection process can be summarized as follows: 1. review of prior CHNA reporting efforts; 2. collection of most recently available demographic, socioeconomic and health indicator data; 3. Data gathering from community members. The CHNA findings result from the extensive analysis of primary and secondary data sources; over 241 indicators from national and state data sources were included in the secondary analysis and primary data was collected from community leaders, non-health professionals, community-based organizations, community members and populations with unmet health needs and/or populations experiencing health disparities. The main source for the secondary data, or data that has been previously collected by the government and other health agencies to inform health planning, is the Health Matters in Ventura County platform, a publicly available data platform.Community Survey: The Community Health Assessment Survey (2019) was designed and disseminated by the Ventura County Community Health Needs Assessment Collaborative. A total of 2,722 responses were collected. The sample size met the conditions of 95% confidence interval and had a margin of error of 1.88%. This was a convenience sample, which means results may be vulnerable to selection bias. The results are generalizable to the population of Ventura County.Of the total survey participants, 84.6% (N = 2303) completed the survey in English and 15.4% (N=419) completed the survey in Spanish.Key Informant and Focus Group Discussion Findings: Key informant interviews and focus group discussions help to develop a deeper understanding for the reasons behind the health data seen in the previous sections. It also served to identify the high priorities among VCCHNAC members and stakeholders. In the case of the key informants, the interviews touched upon many issues that were specific to their area of work, especially with vulnerable populations, whereas the focus group discussions with community members focused on age, race and/or gender issues related to accessing healthcare and barriers to access. |
| Facility: - Part V, Section B, Line 6a | The Ventura County CHNA Collaborative (VCCHNAC) is a formal, charter-bound partnership of seven health agencies that came together in June 2018 to participate in the development of a joint CHNA exercise and report. The agencies that constitute the VCCHNAC are: Adventist Health Simi Valley, Camarillo Health Care District, Clinicas Del Camino Real, Inc., Community Memorial Hospital, Ojai Valley Community Hospital, St. Johns Regional Medical Center, Dignity Health, St. Johns Pleasant Valley Hospital and Dignity Health. |
| Facility: - Part V, Section B, Line 11 | Our 2016 CHNA identified four areas of significant needs: access to health care, cancer, diabetes, and mental health & substance abuse. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1-Access to Health Care The overall goal is to increase availability and access to healthcare.Focus: Workforce Development & Training Metric -Interventions: 1. COPE Health Scholars Program, Number of Community Members Served: 1,057 Students. 2. Moorpark College School of Nursing and Allied Health, Number of Community Members Served: 141 Students. 2. The College of The Canyons School of Nursing, Number of Community Members Served: 47 Students. 3. Ventura College Paramedic Training, Number of Community Members Served: 24 Students. 4. Simi Institute for Careers EMT, Radiology, Lab, CAN, Number of Community Members Served: 68 Students. Total students served: 1,337Focus: Clinical Services for the Underserved - Interventions: 1. The Free Clinic of Simi Valley1,242 Patients Served, 55 Mammograms, 90 Diagnostic Radiology Tests, 1097 Diagnostic Lab Tests, 4 Lung Cancer Screening Tests, Supplies, EMR, $250,000 in support, Sponsorship of Fundraiser Events for The Free Clinic.Focus: Sports Medicine for High School Athletes- Interventions:1. Personal Trainers and Primary Care for Athletic Programs at Simi Valley and Moorpark High Schools, over 260 athletes screened, valued at $32,263 in 2019.Priority Need 2-Cancer main goal to increase early identification of cancer and support treatment of cancer. Interventions:1. Cancer Care NavigationAHSV provides full time cancer navigators to provide step by step help in navigating a cancer diagnosis. We provide this to anyone in our community regardless of where they receive their treatments. Number of patients served: 300 +2. Breast and Female Cancers Support Groups and EventsAHSV provides support group locations, staff, food, marketing and education materials for various support group activities on a weekly, monthly and annual basis. Program offers: Monthly support group, weekly crochet group, free camisoles for breast cancer patients, free wigs and scarves, grant funding for cancer patients, and Pampered In Pink Annual Education Event. Number of people served: 500 +3. Preventative ScreeningsAHSV provides free lung cancer screenings for patients of the Free Clinic of Simi Valley. Number of people served: 44. Preventative ScreeningsAHSV provides free breast cancer screenings for patients of the Free Clinic of Simi Valley. Number of people served: 55Priority Need 3-Diabetes/Obesity main goal to reduce the impact of diabetes and increase the focus on disease prevention and treatment education. Interventions: Focus: Providing Education and Activities for Kids in Our Communities1. AHSV Provided 9 Free Healthy Kids Fun Zones at sports events and community events in Simi Valley and Moorpark. Paired with education about healthy lifestyle choices and materials for parents, the fun zones encouraged all children attending events to enjoy physical activities such as the rock climbing wall, bungee jumpers, bounce houses, petting zoos and much more. Events typically charge for these activities making them out of reach for some families. Our funding and participation helps the fun zone to have more impact and purpose. Number of Community Members Served: Approximately 15,0002. Healthy Food Program with Simi Valley and Moorpark Boys and Girls Clubs. Number of Community Members Served: Unknown.3. Enhancement Grants with Simi Valley Education Foundation. Number of Community Members Served: 117Focus: Education and Weight Loss1. AHSV helped fund two cohorts of Diabetes Undone and SiMi Fit classes with the Simi Valley Seventh-day Adventist Church. 48 people participated and achieved weight loss and reduction in blood pressure and blood sugar levels.Priority Need 4-Mental Health & Substance Abuse main goal to connect with 1,000 Simi Valley and/or Moorpark Youth with Health Education. Interventions:Focus Area: Prevention1. Sponsorship of empathy program for junior high students in Simi Valley Unified School District. Number of Community Members Served: 8202. Funding and Hosting of Every 15 Minutes DUI Awareness Experience. Number of Community Members Served: 1,4003. Sponsorship of Sports Programs. Number of Community Members Served: Unknown 4. Provided 2 Personal Trainers for Simi Valley High and Royal High. Number of Community Members Served: 200+5. Provided Primary Care for Moorpark College Health Clinic. Number of Community Members Served: 500+b. Based on your 2019 CHP Update, please describe any significant needs that the hospital has been unable to address, and explain why.Priority Areas Not Addressed:Taking existing hospital and community resources into consideration, Simi Valley Hospital will not directly address the remaining health needs identified in the CHNA including: cardiovascular disease, obesity, and preventive practices. Since the hospital cannot address all the health needs present in the community, it will concentrate on those health needs that can most effectively be addressed given the organizations areas of focus and expertise. Simi Valley Hospital will look for partnership opportunities that address needs not selected where it can appropriately contribute to addressing those needs, or where those needs align with current strategy and priorities. |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Aspen Outpatient Center | ||||
| 2750 N Sycamore Dr | Simi Valley | CA | 93065 | Outpatient Imaging & Surgery |
| Child Development Center | ||||
| 1900 E Los Angeles Ave | Simi Valley | CA | 93065 | Outpatient Pediatric Therapy |
| Nancy Reagan Breast Center | ||||
| 2750 N Sycamore Dr | Simi Valley | CA | 93065 | Outpatient Women's Imaging |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7 - Explanation of Costing Methodology | 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 charges |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio is multiplied times the hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. |
| Part III, Line 4 - Bad Debt Expense | The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments too many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue $39,801,925Prior Year Settlements 443,171Cost Report Reimbursable Bad Debts 660,731Estimates and Accrual Variances 211,236Other (1,959,776) __________Total Medicare Revenue $39,157,287*Note: The Medicare Cost Report Revenue includes the patient co-pay and deductible amounts, but not the bad-debt reimbursement. Adding the bad-debt reimbursement would have duplicated the revenue and deductible amounts. |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low 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 - Needs Assessment | The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) Update for fiscal year 2019, and the 2020 Implementation Strategy, are posted on the hospital's website at https://www.adventisthealth.org/simi-valley/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 athttps://www.adventisthealth.org/about-us/community-benefit/In addition to the CHNA, our hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level? Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. |
| Part VI, Line 3 - Patient Education of Eligibility for Assistance | The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-Policy.pdf. These documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. |
| Part VI, Line 4 - Community Information | Located in southern California, Ventura County has a land area of 1,843.1 square miles, which encompasses 10 cities, 13 census-designated places, and 15 other unincorporated communities. According to 2019 Claritas Pop-Facts, Ventura County has a population of 859,967. The most populated zip codes are 93033 (Oxnard), 93065 (Simi Valley), 93030 (Oxnard), and 93063 (Simi Valley) with population totals of 83,972, 74,815, 62,482, and 56,653. The majority of the population is comprised of White (Non-Hispanic), with 41.4% of the population and Hispanics with 42.9% of the population. The Asian population accounts for 7.8% of the population, followed by two or more races with 3.5% of the population, Black or African American with 2.3% of the population, American Indian and Alaska Native with 1.9% of the population, and lastly Native Hawaiian and Other Pacific Islander with 0.3% of the population.In 2018, Ventura Countys population had a median age of 37.5 and a median household income of $81,972. In Ventura County, 50.5% of the population is female, 6.0% are below 5 years of age, 23.2% are below 18 years and 15.0% are 65 years and above. Among county residents, 42,012 have veteran status and 22.5% are foreign born. 38.6% of the people in Ventura County speak a non-English language, and 22.5% are foreign born. The median property value in Ventura County is $520,300 and the homeownership rate is 63.2%. The percent of households with a computer is 90.9% and with a broadband internet subscription is 85.1% (United States Census Bureau, 2018).Oxnard (93030, 93033 and 93036), Santa Paula (93060), Fillmore (93015), and Port Hueneme (93041) are the areas within the county that have the highest socioeconomic needs. In general, the areas of the county with higher socioeconomic needs (highlighted above) have a lower average life expectancy than the average of 82.0 years for Ventura County residents. Conversely, those areas with lower socioeconomic needs such as Oak Park (93777) and Thousand Oaks/Westlake (91361 and 91362) both have life expectancies of 85+ years. Barriers and disparities had the greatest impact among Black and African American populations, with disparities in 19 secondary data health indicators. The White population follows this with disparities in 16 indicators, and the Hispanic or Latino population, with disparities in 11 indicators. |
| Part VI, Line 4 - Community Building Activities | The hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. |
| Part VI, Line 5 - Promotion of Community Health | Our hospitals mission is, Living Gods love by inspiring health, wholeness and hope. Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the triple aim. The Triple Aim concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given todays state of health, where cost and heartache 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 healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. |
| Part VI, Line 6 - Affilated Health Care System | The hospital is a member of Adventist Health System/West, 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 tele pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7 - States Filing of Community Benefit Report | CA |
| Part VI - Additional Information | Part III Other community benefit 1. Breastfeeding and Early Infant Development: AHSV is a Baby-Friendly hospital, which means we have invested thousands of dollars each year for staff training, processes, community education and support for successful long-term breastfeeding.2. Human Trafficking Awareness and Education Initiative: Partnered with Soroptimist of Simi Valley, Simi Valley Police, Ventura County Sheriff and others to build a community outreach and education program to be launched in 2020. 3. AHSV Leaders participating on community-based organization boards: Boys & Girls Club of Simi Valley and Moorpark, Simi Valley Education Foundation, Simi Valley Chamber of Commerce, Moorpark Chamber of Commerce, Samaritan Center of Simi Valley, The Free Clinic of Simi Valley, Moorpark College, Ventura County Medical Resource Foundation, and The YMCA of Simi Valley.4. AHSV Leaders and Employees participating in CBO organizations: Every 15 Minutes, 2-Step CPR Training, First Five, Child Abuse Prevention Council, Rotary Club of Simi Valley, Kiwanis Club of Simi Valley, and Interfaith Council. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|
| Free Clinic Of Simi Valley | |||||||||
| 2060 Tapo St | Simi Valley | CA | 93063 | 237108154 | 501(c)(3) | $7,572 | $0 | Funds Transfer | Donation |
| National Health Foundation | |||||||||
| 515 South Figueroa Street | Los Angeles | CA | 90071 | 237314808 | 501(c)(3) | $7,000 | $0 | Funds Transfer | Donation |
| Rotary Club Of Simi Sunrise | |||||||||
| 5005 E Los Angeles Ave | Simi Valley | CA | 93063 | 770392570 | 501(c)(4) | $10,000 | $0 | Funds Transfer | Donation |
| Simi Valley Seventh Day Adven | |||||||||
| 1636 Sinaloa Rd | Simi Valley | CA | 93065 | 951816072 | 501(c)(3) | $10,000 | $0 | Funds Transfer | Donation |
| Simi Valley Unified School Di | |||||||||
| 101 W Cochran St | Simi Valley | CA | 93065 | Government Agency | $10,000 | $0 | Funds Transfer | Donation | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 2 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Additional Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Grants are donations made to US tax exempt organizations, Government Entities and Civic organizations who are community partners, known to us, and present a valid purpose for their donation request. It is anticipated that no further monitoring is required. | 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 (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (26 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Adamos Eugene | |||||||||||||
| Pharmacist | $161,550 | $39,630 | $8,118 | $26,687 | $235,985 | ||||||||
| Anderson Brian | |||||||||||||
| A Sec thru 5/19 | $97,101 | $24,502 | $195,002 | $13,864 | $18,182 | $348,651 | |||||||
| Burke James | |||||||||||||
| Medical Officer, SCR | $336,072 | $11,942 | $27,285 | $375,299 | |||||||||
| Carol Deamer | |||||||||||||
| Director, Pharmacy | $207,738 | $6,915 | $11,788 | $200 | $226,891 | $250 | |||||||
| DavisWhitney | |||||||||||||
| Comm Director, SCR | $129,567 | $16,429 | $3,652 | $7,838 | $20,892 | $178,378 | |||||||
| Dingilian John | |||||||||||||
| Medical Officer | $291,748 | $32,509 | $57,362 | $16,782 | $41,804 | $440,205 | |||||||
| Esparza Caroline | |||||||||||||
| COO/CNO | $260,896 | $25,524 | $58,426 | $16,782 | $31,219 | $392,847 | |||||||
| Fargo Roland | |||||||||||||
| Former Physician Ops Officer | $58,258 | $417,688 | $39,167 | $515,113 | |||||||||
| Fernandes Shalini | |||||||||||||
| RN | $186,446 | $10,766 | $26,673 | $226,329 | $2,444 | ||||||||
| Ferrier Cory | |||||||||||||
| Bus Dev Exec | $175,000 | $2,995 | $22,186 | $12,126 | $212,307 | ||||||||
| Jahn Andrew | |||||||||||||
| President, SCR | $811,125 | $201,952 | $241,867 | $16,782 | $43,130 | $1,314,856 | |||||||
| Jobe Meredith | |||||||||||||
| Secretary | $524,870 | $65,461 | $140,054 | $16,782 | $29,127 | $776,294 | |||||||
| Mallari Christopher | |||||||||||||
| RN | $201,333 | $8,115 | $30,379 | $241,627 | $1,800 | ||||||||
| Milatovic Natasa | |||||||||||||
| Reg HR Dir, SCR | $314,010 | $68,963 | $76,232 | $16,782 | $33,198 | $509,185 | |||||||
| Nahapetian Arby | |||||||||||||
| Medical Officer, SCR | $556,818 | $153,586 | $131,390 | $16,782 | $42,060 | $900,636 | |||||||
| Owens Chip | |||||||||||||
| Treas/A Sec | $219,292 | $41,087 | $7,035 | $15,937 | $38,712 | $322,063 | |||||||
| Percival Kathleen | |||||||||||||
| Admin Dir, Org Per | $185,558 | $1,207 | $9,858 | $11,180 | $208,053 | $250 | |||||||
| Raffoul John | |||||||||||||
| Finance Officer, SCR | $545,731 | $198,623 | $2,032,885 | $16,782 | $31,256 | $2,825,277 | $1,893,381 | ||||||
| Reiner Scott | |||||||||||||
| Dir/Chair | $1,510,024 | $420,315 | $65,357 | $16,782 | $36,952 | $2,049,430 | |||||||
| Reppert Joseph | |||||||||||||
| A/Sec thru 8/19 | $581,409 | $187,572 | $440,088 | $16,782 | $40,783 | $1,266,634 | |||||||
| Swenson Jennifer | |||||||||||||
| President | $401,466 | $54,532 | $121,515 | $16,782 | $45,110 | $639,405 | |||||||
| Wagner Jack | |||||||||||||
| Former Asst Secr | $778,475 | $29,189 | $807,664 | ||||||||||
| Wehtje Ronald | |||||||||||||
| CFO SCR thru 03/2019 | $209,145 | $300 | $55,715 | $8,290 | $273,450 | ||||||||
| Werner William | |||||||||||||
| VP Support Services | $215,710 | $21,544 | $44,239 | $14,377 | $41,619 | $337,489 | |||||||
| Wing Bill | |||||||||||||
| Dir/A Sec/CFO | $1,200,390 | $318,717 | $53,147 | $16,782 | $29,801 | $1,618,837 | |||||||
| Zachary Beth | |||||||||||||
| President SCR thru 12/2019 | $840,555 | $11,540 | $36,127 | $888,222 | |||||||||
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Denise Anderson | |||
| Officer Spouse | $20,764 | Employment | false |
| Henry Linda | |||
| Key EE Sister | $65,157 | Employment | false |
| Grant Swenson | |||
| Officer Spouse | $99,331 | Employment | false |
| Sandra Werner | |||
| Key EE Spouse | $320,732 | Employment | false |
| Joyce Newmyer | |||
| Key EE-Sister IL | $877,534 | Employment | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part V Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Additional information regarding interested persons listed above:1. Denise Anderson is the wife of Brian Anderson, an officer of the board.2. Linda Henry is the sister of Former Adventist Health board member and current Key Employee, Wesley Rippey.3. Grant Swenson is the husband of Jennifer Swenson, President of AH Simi Valley.4. Sandra Werner is the wife of William Werner, a Key Employee.5. Joyce Newmeyer, a Key Employee of Adventist Health, is the sister of William Werner, a Key Employee of AH Simi Valley. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit public benefit corporation that operates as a public charity. The Hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. |
| Form 990, Part VI, Line 11b: Form 990 Review Process | This Form 990, including all supporting schedules, was prepared by a public accounting firm, reviewed by the System Controller and market Finance Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately.The Corporate General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees 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 Corporate General Counsel reviews all the disclosures on the board and Corporate employees' COIs. Corporate General Counsel retains the COIs for the board members. The officers and key employees' COIs are kept in their personnel files. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | The hospital board of directors has established a Compensation Committee to overseethe executive compensation program. This committee is composed of independentdirectors with no conflicts of interest. The committee performs the followingfunctions: recommends a total compensation philosophy to the board; assurescompliance with the board-approved philosophy; meets annually to reviewcomparability data from outside consultants; recommends any adjustments to currentexecutive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annualgoals; recommends appropriate incentive awards to the board for approval; follows adiligent process that meets regulatory requirements for a rebuttable presumption ofreasonableness; records committee deliberations and decisions in timely minutes;selects, engages and supervises any consultant hired to advise and providecomparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs 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 CEO has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital. (Incentive potential is industry norm) Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | See Line 15b explanation. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy available upon request, but does file monthly/quarterly summary financial reports with the state health planning agency. |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | Change in minority interest - Aspen Surgery Cntr = -$24210 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | JV Distributions = -$100000 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | Loss from Non-Hospital investments = -$302112 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | Net Assets Released fr Restrictions = -$283285 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Net Assets Released From Restrictions Capital Addt'ns = $98599 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Other Adjustments = $33082 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Restricted Gifts & Grants = $165179 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (29 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health SystemWest | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated Health System | CA | 501(c)(3) | 10 | NA | false |
| Adventist Health Clearlake Hospital Inc | ||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Health Medical Ctr Tehachapi | ||||||||||
| 1100 Magellan Dr | Tehachapi | CA | 93561 | 812240617 | Hospoital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Health Physicians Network | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical Foundation | CA | 501(c)(3) | 12b2 | Adventist Health SystemWest | false |
| Adventist Health So CA Medical Fdtn | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 954424391 | Discontinued Operations | CA | 501(c)(3) | 12b2 | Adventist Health SystemWest | false |
| Castle Medical Center | ||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Feather River Hospital | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Fremont- Rideout Health Group | ||||||||||
| 898 Plumas Street | Yuba City | CA | 95991 | 942917251 | Acute Care Hospital | CA | 501(C)(3) | 12b2 | Stone Point Health | false |
| Glendale Adventist Medical Center | ||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Hanford Community Hospital | ||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Lodi Memorial Hospital Assn Inc | ||||||||||
| 975 So Fairmont Ave | Lodi | CA | 95240 | 941044474 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Northwest Medical Fdtn of Tillamook | ||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Paradise Valley Hospital | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 951816034 | Discontinued Operations | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Portland Adventist Medical Center | ||||||||||
| 10123 SE Market Street | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Reedley Community Hospital | ||||||||||
| 372 Cypress Ave | Reedley | CA | 95370 | 453220509 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Rideout Memorial Hospital | ||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 941387866 | Acute Care Hospital | CA | 501(c)(3) | 3 | Freemont Rideout Health Group | false |
| St Helena Hospital | ||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| San Joaquin Community Hospital | ||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Sonora Community Hospital | ||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Stone Point Health | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 823763347 | Supporting Organization | CA | 501(C)(3) | 12b2 | Adventist Health SystemWest | false |
| Ukiah Adventist Hospital | ||||||||||
| 275 Hospital Drive | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| United Com-Serve | ||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled Nursing/Assisted Living/Hm Care | CA | 501(c)(3) | 12b2 | Fremont Rideout Health Group | false |
| Walla Walla General Hospital | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital | WA | 501(c)(3) | 3 | Advenstist Health System West | false |
| Western Health Resources | ||||||||||
| PO Box 61935 | Roseville | CA | 95661 | 953867863 | Home Care | CA | 501(C)(3) | 10 | Adventist Health SystemWest | false |
| White Memorial Medical Center | ||||||||||
| 1720 Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(C)(3) | 3 | Adventist Health SystemWest | false |
| Willits Hospital Inc | ||||||||||
| 1 Marcela Drive | Willits | CA | 95490 | 680108919 | Hospital | CA | 501(C)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Health Delano | ||||||||||
| P O Box 460 | Delano | CA | 93216 | 770258013 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Health Tulare | ||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | HOSPITAL | CA | 501(c)(3) | 3 | Adventist Health System West | false |
| Simi Valley Hospital Foundation | ||||||||||
| 2975 N Sycamore Dr | Simi Valley | CA | 93065 | 912135595 | Fundraising for Hospital | CA | 501(c)(3) | 3 | Western Health Resources | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASPEN SURGERY VENTURE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 SYCAMORE DRIVE | AddressLine1Txt |
| City | SIMI VALLEY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93065 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263913327 | EIN |
| Primary Activities | SURGERY CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIMI VALLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (true) | GeneralOrManagingPartnerInd |
| Ownership | 0.69000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Coast Medical Center | BusinessNameLine1Txt |
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) |
|---|---|---|
| EIN | 952037291 | EIN |
| Primary Activities | Wind down after sale of hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AHSWest | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C-Corp | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Adventist Health SystemWest | ||
| e | $121,386,680 | Notes Payable |
| Adventist Health SystemWest | ||
| o | $1,851,655 | Compensation |
| Adventist Health SystemWest | ||
| p | $21,868,112 | Operating Exp |
| Adventist Health SystemWest | ||
| r | $96,876 | Cash Mgt Funds |
| Simi Valley Hospital Foundation | ||
| o | $157,987 | Compensation |
| Simi Valley Hospital Foundation | ||
| s | $137,678 | Fund Transfers |