2020-11-16T11:25:59-08:00 2019-12-31 800519547 THE ACCOUNTANCY LLP 500 N Brand Blvd Fl 20 Glendale CA 91203 990 2019-01-01 832351753 Adventist Health Tulare ADVE 5596880821 869 N Cherry St Tulare CA 93274 Haydock Timothy Treasurer 2020-11-16 true S Clement P01218012 8185475701 X 2019 2022-09-23 18:48:47Z Randy Dodd 39472822 false 1071 X www.adventisthealth.org/tulare X 2018 CA Living Gods love by inspiring health, wholeness and hope. 14 12 395 0 11674 39319942 141160 0 39472776 0 0 18066527 0 104301 29436118 47502645 -8029869 49896460 57926329 -8029869 X Living Gods love by inspiring health, wholeness and hope. false false 40859843 39319896 Adventist Health Tulare (AHTR) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay.Although reimbursement for services rendered is critical to the operation and stability Adventist Health Tulare, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Adventist Health Tulare low cost care to individuals covered by government-programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits.AHTR recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2019 was $31,493.The following Inpatient services that were provided to all our patients. These services included:127 Surgeries performed2,575 Patient days The following Outpatient services that were provided to all our patients. These services included:21,140 Emergency department visits632 Outpatient Surgeries performedAHTR recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2019 was $2,612,572.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/ 40859843 true false false true false false false false false true true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 0 0 true 395 true false false false false false false false 0 false false false false false false false X 14 12 false false false false true true true true true false false true true true true true true true true false CA X Jay Lipp 9164061092 PO Box 619135 Roseville CA 95661 X Ferch Wayne President, CCR 10.00 40.00 0 4448122 47838 Reiner Scott Dir/Chair 0.00 50.00 X X 0 1995696 53734 Wing Bill Dir/A Sec/CFO 0.00 50.00 X X 0 1572254 46583 Reppert Joseph A/Sec thru 8/19 0.00 50.00 X 0 1209069 57565 Larsen David Finance Officer, CCR thru 4/28/2019 10.00 40.00 0 777379 57220 Wagner Jack Former A Secr 0.00 50.00 0 778453 29189 Jobe Meredith Secretary 0.00 50.00 X 0 730385 45909 Chen Steven Finance Officer, CCR 10.00 40.00 0 671517 59363 Kofl Andrea President, CVN 10.00 40.00 X 0 673752 48741 Gavini Frank Medical Officer, CVN 10.00 40.00 0 545796 0 Renteria Adalberto Medical Officer, CCR 10.00 40.00 0 481385 43990 Ayala Raul Medical Officer, CVN Clinics 10.00 40.00 0 490379 0 Haydock Timothy Treas/A Sec 10.00 40.00 X 0 401337 59270 Dodd Randal President 0.00 50.00 X 0 379173 53731 Taggart Laurie Patient Care Exec 10.00 40.00 0 322486 46711 Gruzensky Denton Reg HP Dir, CCR 10.00 40.00 0 321342 45976 Reyna Sonja Bus Dev Exec 10.00 40.00 0 332223 34561 Plata Nina Population Health Exec 10.00 40.00 0 301245 58405 Pickering Christine Communiaction Dir, CCR 10.00 40.00 0 163858 30977 Garcia Rosa Pharmacy Dir 50.00 0.00 118355 0 19802 Riley Celeste Pharmacist 50.00 0.00 99312 0 0 Boggess Marjorie RN House Superviso 50.00 0.00 81562 0 11195 Warren Joshua Pharmacist 50.00 0.00 72311 0 16619 Ng Mankwong Pharmacist 50.00 0.00 45572 0 8576 Reiner Richard Director 0.00 4.00 X 0 28588 0 Davis Andrew Director 0.00 4.00 X 0 28246 0 Cherry Robert Director 0.00 4.00 X 0 26315 0 Heinrich Kerry Director 0.00 4.00 X 0 20102 0 Innocent Larry Director 0.00 4.00 X 0 18852 0 Woodson Marc Director 0.00 4.00 X 0 15000 0 Graham Ricardo Director 0.00 4.00 X 0 8848 0 Banks David Director 0.00 4.00 X 0 6382 0 Freedman John Director 0.00 4.00 X 0 2367 0 Salazar Velino Director 0.00 4.00 X 0 553 0 Philip Celeste Director 0.00 4.00 X 0 0 0 Ocampo Lucy Director 0.00 4.00 X 0 0 0 417112 16751104 875955 10 true true false Paramount Anesthesia Associates Inc 11704 Nantwick Ct Bakersfield CA 93311 Profession Fees 1542242 CEP America California 2100 Powell St Suite 400 Emeryville CA 94608 Profession Fees 1448290 Galen Inpatient Physicians Inc 2100 Powell St Suite 400 Emeryville CA 94608 Profession Fees 670488 Fastaff LLC PO Box 911452 Denver CO 80291 Profession Fees 578113 Central Valley Critical Care Medicine APC 5211 W Goshen Ave PMB 326 Visalia CA 93291 Profession Fees 551447 13 11674 11674 Dietary 722514 85570 85570 Patient Care Services 900099 39234372 39234372 39319942 141206 141206 0 0 0 46 -46 -46 -46 0 0 0 0 39472776 39319896 141206 X 0 0 0 0 0 0 14760020 13261854 1414994 83172 203065 201532 1216 317 2024582 1801225 212115 11242 1078860 977835 94803 6222 93143 15619 77524 37158 36945 213 0 0 0 0 0 25934 25934 338787 301922 36388 477 2349122 2327822 21300 0 2044867 1450931 593936 66614 57674 8940 0 7020 4625 2395 641484 641484 0 1457893 1440768 17125 74028 74028 Purchased Services 6879436 6879276 160 Patient Care Supplies 3739989 3723197 16316 476 Loss on Acquisition 3370000 3370000 Quality Assurance 3059592 3059592 5251051 4603514 647537 47502645 40859843 6538501 104301 0 0 0 17104930 0 0 0 1501695 416339 20636369 3133835 17502534 0 0 0 303000 13067962 0 49896460 9019899 51735 48854695 0 57926329 X -8040294 10425 0 -8029869 0 49896460 -8029869 X false true X true false X false false false false false false false false false false true 2364 2364 false false Part II-B, Line 1i - Other Activities Description The organization belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. 11673 1248 10425 1.00000 false true true 1464160 1464160 19172209 3133835 16038374 17502534 Other Assets 14235 Other Receivables 3636540 Receivables from Related Organizations 4985828 Receivables from Third Parties 4431359 13067962 Cash Mgt Advances 32641843 Other Liabilities 8249334 Payables to Related Organizations 7963518 48854695 X Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. Part X : FIN48 Footnote The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 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. true true X true X true X true true true false true true 31493 31493 0.00070 31493 31493 0.00070 11900 11900 0.00030 3091498 491826 2599672 0.05470 1000 1000 3104398 491826 2612572 0.05500 3135891 491826 2644065 0.05570 144 144 479 479 25206 25206 0.00050 25829 25829 0.00050 true 6029463 9667795 -3638332 X true true 1 1 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 See Form 990, Pg 1, Item J 106540816 X X X A true true true X X X X X X X X X 19 true true false true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 19 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X X true X false X X X X true X false false Facility: - Part V, Section B, Line 2 Yes Facility: - Part V, Section B, Line 5 The 2019 CHNA data collection process can be summarized as follows: 1. review of prior CHNA reporting efforts; 2. collection of most recently available demographic, socioeconomic and health indicator data; 3. Data gathering from community members. Primary data was collected through key informant interviews, focus groups, and an online survey. Key informants and focus groups were purposefully chosen to represent medically under-served, low-income, or minority populations in our community. Their input provided insights on how to better direct our resources and form partnerships. Nearly 700 (680 total) people were surveyed to obtain input from the community in the form of 48 key informant interviews, 24 focus groups (with a total of 284 participants), and 348 online survey participants (including a Spanish option).Community Survey: The online survey was distributed to partner organizations that were not represented by key informants and advertised to the general public via a public service announcement hosted on Univision's Arriba Valle Central" show. Additional written comments on the previous CHNA were solicited on each hospital's website using a unique link. To date no written comments were received. Community Focus Groups: Focus group participants were end-users of programs and services provided by hospitals participating in this CHNA. Populations represented by focus group members included low-income (rural and urban) populations, homeless, seniors, youth, Hmong and Spanish speaking, LGBTQ+, and parents.Key Informant Interviews: Key informant interviews comprised key leaders in our community from an array of agencies, including those that serve children, homeless populations, LGBTQ+, veterans, seniors, tribal populations, African Americans, and Hmong and Spanish speaking populations. Other participating organizations represented public health agencies, law enforcement, health care organizations, funders, and school districts. Secondary data sources include publicly reported state and nationally recognized data sources such as Community Commons, California Department of Public Health, County Health Rankings & Roadmaps, and California Environmental Protection Agencys Office of Environmental Health Hazard Assessment. When feasible, health metrics have been further compared to averages for state or national benchmarks, such as Healthy People 2020 objectives. Facility: - Part V, Section B, Line 6a Adventist Health Hanford, Adventist Health Reedley, Adventist Health Selma, Clovis Community Medical Center, Coalinga Regional Medical Center (Closed), Community Regional Medical Center (includes Community Behavioral Health Center), Kaiser Permanente: Fresno Service Area, Kaweah Delta Health Care District, Madera Community Hospital, San Joaquin Valley Rehabilitation Hospital, Sierra View Medical Center, Saint Agnes Medical Center, Tulare Regional Medical Center (Adventist Health oversees the operations of the hospital. Doors opened to the public October 15, 2018.), Valley Childrens Healthcare. Facility: - Part V, Section B, Line 11 Tulare Regional Medical Center declared bankruptcy on 10/26/2017 and was closed to the community. It re-opened on October 15, 2018 after the Tulare Healthcare Districts board of directors leased the facility to Adventist Health and Adventist Health began managing the Districts operations. CDPH reinstated the Districts hospital license at the time as well. Both parties submitted a change of ownership application with CDPH and CMS which was approved and became effective March 15, 2019. As a new member of the Adventist Health family, Adventist Health Tulare, completed and adopted a CHNA in December 2019, which informed the development of an Implementation Strategy. The Implementation Strategy will guide future community benefit activities to focus on identified community needs. In the absence of a formal CHNA prior to December of 2019, Adventist Health Tulare leadership relied on its leaderships knowledge of the community and needs of the patients being served to guide community benefit activities. The following interventions were instituted by AH Tulare as they were re-establishing their presence in the community. 1. Physician Recruitment: Adventist Health Tulare focused efforts on bringing additional primary care services to meet growing community need. Although there were no new physicians added during 2019, this priority will be a major focus in 2020 as we expand services and programs within the community. 2. The homeless discharge planning process, as required by SB 1152, ensures that all homeless patients who come to the hospital for care are provided with and connected to any and all needed resources. This includes providing meals, clothing, and connections with local case management programs and shelters. Number of Community Members Served: 713. Adventist Health Tulare realizes that in order to make a meaningful impact on our communities, we must work with community partner agencies who are connected with the people who live in Tulare County and who do the work every day to make an impact. Only by supporting these organizations and partnering with them on joint projects will be all be successful together. However, before we can start building a healthier future for Tulare, we must first develop working relationships with these community partners. As such, much effort in 2019 went to development of community connections. Priority Areas Not Addressed:As a regional medical center Tulare participated in past local area hospitals collaborative CHNA processes. Tulare Regional Medical Center joined the most recent CHNA collaborative in 2018 once they re-opened under Adventist Health Management. With the approved change of ownership and name change to Adventist Health Tulare, the hospital facility approved the 2019 CHNA on October 17, 2019. Therefore, there were no adopted priority health needs to address or not address throughout 2019. Tulare Toxicology Lab 800 E Merritt Avenue Suite 107 Tulare CA 93274 Reference Lab-Toxicology Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL Revenue Rec. *Medicare Cost Report Revenue $6,029,463 Prior Year Settlements 434,347 Cost Report Reimbursable Bad Debts 143,377 Estimates and Accrual Variances 197,391 Other (2,153,725) ___________ Total Medicare Revenue $4,650,853*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Part VI, Line 2 - Needs Assessment The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) Update for fiscal year 2019, and the 2020 Implementation Strategy (adopted in May 2020), are available on the Adventist health Corporate website at https://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 According to the U.S. Geological Survey, the Central Valley, also known as the Great Valley of California, covers about 20,000 square miles and is one of the more notable structural depressions in the world. Occupying a central position in California, it is bounded by the Cascade Range to the north, the Sierra Nevada to the east, the Tehachapi Mountains to the south, and the Coast Ranges and San Francisco Bay to the west. The Central Valley can be divided into two large parts: the northern one-third, known as the Sacramento valley and the southern two-thirds is called the San Joaquin Valley. The San Joaquin Valley can be split further into the San Joaquin Basin and the Tulare Basin. The hospitals participating in this assessment are nestled in the heart of Central Valley, within four contiguous countiesFresno, Kings, Madera, and Tulare. Using fewer than 1% of U.S. farmland, the Central Valley supplies 8% of U.S. agricultural output (by value) and produces 1/4 of the nation's food, including 40% of the nation's fruits, nuts, and other table foods. The Central Valley is also home to the raisin capital of the world, Selma, CA.In 2016, approximately 1,722,556 people lived in the four-county region. Fresno County comprised the largest portion. Of this population, the majority identify as Hispanic or Latino, in every county. Kings County has the largest population of veterans at 10%. The median household income ranges from $42,789 to $47,241 across the four counties.Tulare County has the largest percent of unemployed adults (8.7%) in the region and young people not in school and not working (10.7%). Comparatively, the averages for the state are 4.3% and 7.7%, respectively. Fresno County has the highest percentage of total population and children under age 18 living under the 100% of the federal poverty level, while Tulare County has the largest population that receives both SNAP benefits and public assistance income. Between 2014 and 2018, Fresno and Madera Counties experienced a 17% decrease in the total homeless population (from 2,592 to 2,144). In contrast, Visalia, Kings, and Tulare Counties experienced a 27% increase (from 763 to 967). Part VI, Line 4 - Community Building Activities The hospital is involved in numerous community building activities which promote the health of the 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 are soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6 - Affilated Health Care System The hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area can provide support through remote services such as tele pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7 - States Filing of Community Benefit Report CA X X X X true true false false false false false false false Ayala Raul Medical Officer, CVN Clinics 490379 490379 Chen Steven Finance Officer, CCR 472282 90908 108327 16782 42581 730880 Dodd Randal President 265000 47746 66427 16173 37558 432904 Ferch Wayne President, CCR 932651 191401 3324070 16782 31056 4495960 3180848 Gavini Frank Medical Officer, CVN 545796 545796 Gruzensky Denton Reg HP Dir, CCR 232276 41926 47140 15932 30044 367318 Haydock Timothy Treas/A Sec 295749 46604 58984 16782 42488 460607 Jobe Meredith Secretary 524870 65461 140054 16782 29127 776294 Kofl Andrea President, CVN 475048 75240 123464 16782 31959 722493 Larsen David Finance Officer, CCR thru 4/28/2019 536325 110451 130603 16782 40438 834599 Pickering Christine Communiaction Dir, CCR 146846 11637 5375 8397 22580 194835 Plata Nina Population Health Exec 231939 33695 35611 13697 44708 359650 Reiner Scott Dir/Chair 1510024 420315 65357 16782 36952 2049430 Renteria Adalberto Medical Officer, CCR 481385 16352 27638 525375 Reppert Joseph A/Sec thru 8/19 581409 187572 440088 16782 40783 1266634 Reyna Sonja Bus Dev Exec 247327 34020 50876 14930 19631 366784 Taggart Laurie Patient Care Exec 243635 34215 44636 15771 30940 369197 Wagner Jack Former A Secr 778453 29189 807642 Wing Bill Dir/A Sec/CFO 1200390 318717 53147 16782 29801 1618837 Arnold Plata Spouse of Key EE 70638 Employment false Linda Henry Key EE Sister 65157 Employment false Ferch Josiah Key EE Son 62021 Employment false Schedule L, Part V Supplemental Information Additional information regarding interested persons listed above:1. Arnold Plata is the husband of Key Employee, Nina Plata.2. Linda Henry is the sister of Former Adventist Health board member and current Key Employee, Wesley Rippey.3. Josiah Ferch is the son of Key Employee Wayne Ferch.4. Brent Wagner is the son of Former Adventist Health CFO, Jack Wagner. 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. Form 990, Part IX, Line 24e: Other Expenses Equipment Rentals : Column (A) - Total = $1518129; Column (B) - Program Services = $1500783; Column (C) - Management & General = $17346; Column (D) - Fundraising = $0 Form 990, Part IX, Line 24e: Other Expenses Other Expenses : Column (A) - Total = $65389; Column (B) - Program Services = $25262; Column (C) - Management & General = $40127; Column (D) - Fundraising = $0 Form 990, Part IX, Line 24e: Other Expenses Rental/Leases: Column (A) - Total = $1513041; Column (B) - Program Services = $922977; Column (C) - Management & General = $590064; Column (D) - Fundraising = $0 Form 990, Part IX, Line 24e: Other Expenses Revenue Cycle Fees: Column (A) - Total = $2154492; Column (B) - Program Services = $2154492; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 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 Center-Tehachap 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 12b2 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) 3 Adventist Health SystemWest false Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Accute Care Hospital CA 501(c)(3) 12b2 Stone Point Health false Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Northwest Medical Fdtn of Tillamoo 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Accute Care Hospital CA 501(c)(3) 3 Fremont-Rideout Health Group false St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Simi Valley Hospital and Health Care Ser 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) 12b2 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled nursing/asstd living/home health CA 501(c)(3) 12b2 Fremont-Rideout Health Group false Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital WA 501(c)(3) 3 Adventist Health SystemWest false Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home care CA 501(c)(3) 10 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) 3 N/A false Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Delano PO Box 460 Delano CA 93216 770258013 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA AHSWest C-Corp false false false false false true false false false false false false false false false true true true false true Adventist Health SystemWest e 7963518 Loan Balance Adventist Health SystemWest o 180934 Compensation Adventist Health SystemWest p 23634 Operating Exp Adventist Health SystemWest s 32717189 Cash Mgt Funds