WILLITS HOSPITAL INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- WILLITS HOSPITAL INC (EIN 68-0108919)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-10
- IRS object ID
- 202033159349304373
- Schema version
- 2019v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-10T15:04:30-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680108919 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Willits Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WILL | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Marcela Drive | AddressLine1Txt |
| City | Willits | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 954905769 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Judson Howe | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2020-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2020-10-29 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 172.9.161.112 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-29 | IPDt |
| IP Tm | 19:38:41 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Howard Memorial | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jason Wells | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Marcela Drive | AddressLine1Txt |
| City | Willits | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 954905769 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $80,040,574 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/howard-memorial/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 404 | TotalEmployeeCnt |
| Total Volunteers | 44 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $18,340 | PYContributionsGrantsAmt |
| CY Contributions Grants | $371,562 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $68,303,892 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $78,672,061 | CYProgramServiceRevenueAmt |
| PY Investment Income | $451,233 | PYInvestmentIncomeAmt |
| CY Investment Income | $941,641 | CYInvestmentIncomeAmt |
| PY Other Revenue | $19,393 | PYOtherRevenueAmt |
| CY Other Revenue | $16,454 | CYOtherRevenueAmt |
| PY Total Revenue | $68,792,858 | PYTotalRevenueAmt |
| CY Total Revenue | $80,001,718 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $193,307 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $99,996 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $29,903,777 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $31,554,237 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $37,840,625 | PYOtherExpensesAmt |
| CY Other Expenses | $44,548,496 | CYOtherExpensesAmt |
| PY Total Expenses | $67,937,709 | PYTotalExpensesAmt |
| CY Total Expenses | $76,202,729 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $855,149 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,798,989 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $100,980,950 | TotalAssetsBOYAmt |
| Total Assets EOY | $114,727,720 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $35,804,625 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $45,763,032 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $65,176,325 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $68,964,688 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $61,265,076 | ExpenseAmt |
| Grant | $99,996 | GrantAmt |
| Revenue | $78,672,061 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $61,265,076 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 404 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jay Lipps VP System Controller | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (32 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $1,995,696 | $53,734 | |||
| Wing Bill | ||||||||||
| Dir/Asst Secretary/CFO | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $1,572,254 | $46,583 | |||
| Reppert Joseph | ||||||||||
| CFO/Asst Secr thru 08/2019 | 0.00 | 50.00 | Yes (X) | $0 | $1,209,069 | $57,565 | ||||
| Eller Jeff | ||||||||||
| President, NCR | 10.00 | 40.00 | $0 | $1,172,082 | $40,197 | Yes (X) | ||||
| McDonald Edward | ||||||||||
| Former Treas/Asst Secr thru 07/2017 | 0.00 | 0.00 | $0 | $1,034,618 | $13,010 | Yes (X) | ||||
| Lang Kevin | ||||||||||
| Finance Officer, NCR | 10.00 | 40.00 | $0 | $1,038,744 | $0 | Yes (X) | ||||
| Wagner Jack | ||||||||||
| Former Asst Secr thru 03/18 | 0.00 | 0.00 | $0 | $778,475 | $29,189 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | Yes (X) | $0 | $730,385 | $45,909 | ||||
| Byrnes John | ||||||||||
| Medical Officer, NCR | 10.00 | 40.00 | $0 | $718,300 | $29,813 | Yes (X) | ||||
| Wells Jason | ||||||||||
| President | 50.00 | 0.00 | Yes (X) | $0 | $534,382 | $57,479 | ||||
| Charpentier Paul | ||||||||||
| Physician | 50.00 | 0.00 | $510,388 | $0 | $43,914 | Yes (X) | ||||
| Lonto Robert | ||||||||||
| Reg HP Dir, NCR | 10.00 | 40.00 | $0 | $388,199 | $58,409 | Yes (X) | ||||
| Howe Judson | ||||||||||
| Treasurer | 50.00 | 0.00 | Yes (X) | $0 | $351,467 | $54,951 | ||||
| Givens Linda | ||||||||||
| Patient Care Exec | 0.00 | 50.00 | $0 | $267,717 | $39,268 | Yes (X) | ||||
| Bodensteiner Cindy | ||||||||||
| RN, First Assistant | 50.00 | 0.00 | $242,616 | $0 | $41,367 | Yes (X) | ||||
| Niderost Gregory | ||||||||||
| Certified RN Anesthetist | 50.00 | 0.00 | $233,076 | $0 | $41,650 | Yes (X) | ||||
| Radell Raymond | ||||||||||
| Certified RN Anesthetist | 50.00 | 0.00 | $228,814 | $0 | $44,858 | Yes (X) | ||||
| Buckingham Amy | ||||||||||
| Director, RN | 50.00 | 0.00 | $232,349 | $0 | $40,219 | Yes (X) | ||||
| Barash Ace | ||||||||||
| Medical Officer | 50.00 | 0.00 | $0 | $221,607 | $0 | Yes (X) | ||||
| Kinney Jill | ||||||||||
| Admin Dir Marketing & Comm, NCR | 10.00 | 40.00 | $0 | $181,700 | $21,349 | Yes (X) | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $28,588 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $28,246 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,315 | $0 | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,102 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $18,852 | $0 | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $15,000 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $8,848 | $0 | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $6,382 | $0 | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $2,367 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $553 | $0 | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Philip Celeste | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,447,243 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $12,349,948 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $759,464 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 86 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Pacific Redwood Medical Services Inc | |||||
| 242 Hospital Drive Suite B | Ukiah | CA | 95482 | Professional & medical services | $3,528,088 |
| Radiology Medical Group MAG VII | |||||
| PO Box 86348 | Los Angeles | CA | 90086 | Professional & medical services | $874,624 |
| Management Health Systems LLC | |||||
| 1580 Sawgrass Corporate Pkwy Suite | Sunrise | FL | 33323 | Staffing | $482,919 |
| Samuel J Thibodeaux CRNA | |||||
| 404 S Barnes Street | Ukiah | CA | 95482 | Professional services | $325,852 |
| Tedd Dawson MD | |||||
| 1196 S Main Street | Willits | CA | 95490 | Professional & medical services | $291,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $371,562 | AllOtherContributionsAmt |
| Total Contributions | $371,562 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621110 | $78,103,177 | $78,103,177 |
| Dietary service revenue | 722513 | $327,581 | $327,581 |
| Other program revenue | 900099 | $164,664 | $164,664 |
| Rental Income | 900002 | $76,639 | $76,639 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $78,672,061 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $941,641 | TotalRevenueColumnAmt |
| Exclusion | $941,641 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $55,310 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $38,856 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,454 | TotalRevenueColumnAmt |
| Exclusion | $16,454 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $80,001,718 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $78,672,061 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $958,095 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,996 | TotalAmt |
| Program Services | $99,996 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,598,820 | TotalAmt |
| Program Services | $22,347,301 | ProgramServicesAmt |
| Management And General | $2,251,519 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $941,135 | TotalAmt |
| Program Services | $931,435 | ProgramServicesAmt |
| Management And General | $9,700 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,314,984 | TotalAmt |
| Program Services | $4,007,565 | ProgramServicesAmt |
| Management And General | $307,419 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,699,298 | TotalAmt |
| Program Services | $1,597,854 | ProgramServicesAmt |
| Management And General | $101,444 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,210,588 | TotalAmt |
| Program Services | $751,256 | ProgramServicesAmt |
| Management And General | $4,459,332 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,069 | TotalAmt |
| Management And General | $157,069 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297 | TotalAmt |
| Management And General | $297 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,932 | TotalAmt |
| Program Services | $7,932 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,602,971 | TotalAmt |
| Program Services | $10,897,283 | ProgramServicesAmt |
| Management And General | $4,705,688 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $637 | TotalAmt |
| Program Services | $637 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $387,609 | TotalAmt |
| Program Services | $282,511 | ProgramServicesAmt |
| Management And General | $105,098 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,992,877 | TotalAmt |
| Program Services | $808,538 | ProgramServicesAmt |
| Management And General | $2,184,339 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,844,992 | TotalAmt |
| Program Services | $2,556,846 | ProgramServicesAmt |
| Management And General | $288,146 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,275 | TotalAmt |
| Program Services | $120,408 | ProgramServicesAmt |
| Management And General | $77,867 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,324 | TotalAmt |
| Program Services | $86,650 | ProgramServicesAmt |
| Management And General | $5,674 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $898,838 | TotalAmt |
| Program Services | $891,660 | ProgramServicesAmt |
| Management And General | $7,178 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,819,769 | TotalAmt |
| Program Services | $4,809,971 | ProgramServicesAmt |
| Management And General | $9,798 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient care supplies | $10,316,977 | $10,170,262 | $146,715 |
| Rental/leases costs equ | $634,684 | $632,040 | $2,644 |
| Quality Assurance Fees | $74,575 | $74,575 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,082 | TotalAmt |
| Program Services | $190,356 | ProgramServicesAmt |
| Management And General | $117,726 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,202,729 | TotalAmt |
| Program Services | $61,265,076 | ProgramServicesAmt |
| Management And General | $14,937,653 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,782 | BOYAmt |
| EOY | $3,245 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,826,214 | BOYAmt |
| EOY | $21,615,696 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $26,959 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,589,228 | BOYAmt |
| EOY | $8,699,065 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,110,295 | BOYAmt |
| EOY | $1,127,418 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,137 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $94,872,112 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $31,640,661 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,620,020 | BOYAmt |
| EOY | $63,231,451 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,030,934 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,671,340 | BOYAmt |
| EOY | $20,023,886 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,980,950 | BOYAmt |
| EOY | $114,727,720 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,704,831 | BOYAmt |
| EOY | $7,627,346 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,099,794 | BOYAmt |
| EOY | $38,135,686 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,804,625 | BOYAmt |
| EOY | $45,763,032 | 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 | $64,718,821 | BOYAmt |
| EOY | $68,466,797 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $457,504 | BOYAmt |
| EOY | $497,891 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,176,325 | BOYAmt |
| EOY | $68,964,688 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,980,950 | BOYAmt |
| EOY | $114,727,720 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,798,989 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$10,626 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,932 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,932 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $457,504 | BeginningYearBalanceAmt |
| Contributions | $371,562 | ContributionsAmt |
| Grants Or Scholarships | $303,063 | GrantsOrScholarshipsAmt |
| Other Expenditures | $28,113 | OtherExpendituresAmt |
| End Year Balance | $497,890 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $444,982 | BeginningYearBalanceAmt |
| Contributions | $21,103 | ContributionsAmt |
| Other Expenditures | $8,581 | OtherExpendituresAmt |
| End Year Balance | $457,504 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $418,702 | BeginningYearBalanceAmt |
| Contributions | $48,938 | ContributionsAmt |
| Grants Or Scholarships | $6,086 | GrantsOrScholarshipsAmt |
| Other Expenditures | $16,572 | OtherExpendituresAmt |
| End Year Balance | $444,982 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $418,342 | BeginningYearBalanceAmt |
| Contributions | $15,061 | ContributionsAmt |
| Other Expenditures | $14,701 | OtherExpendituresAmt |
| End Year Balance | $418,702 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $54,936 | BeginningYearBalanceAmt |
| Contributions | $552,853 | ContributionsAmt |
| Other Expenditures | $189,447 | OtherExpendituresAmt |
| End Year Balance | $418,342 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $60,257,249 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,719,063 | DepreciationAmt |
| Book Value | $46,538,186 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,734,925 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,228,664 | DepreciationAmt |
| Book Value | $15,506,261 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,879,938 | OtherCostOrOtherBasisAmt |
| Depreciation | $692,934 | DepreciationAmt |
| Book Value | $1,187,004 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $63,231,451 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from third-party payers | $10,287,494 |
| Receivables from related organizations | $9,715,403 |
| Other receivables | $20,989 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $20,023,886 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $26,045,295 |
| Lease liabilities | $9,438,917 |
| Payables to third-party payors | $2,651,474 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $38,135,686 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| Part X, Line 2: | The principal operations of the System is exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 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 (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $969,173 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $969,173 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01270 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,442,646 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,536,630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,906,016 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,411,819 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,536,630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,875,189 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06400 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $179,799 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $179,799 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,888 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $31,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $69,850 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $69,850 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $281,537 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $281,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,693,356 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,536,630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,156,726 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06770 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,547 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,547 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,069,821 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $380,381 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $29,551,314 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $28,868,386 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $682,928 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| 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 | Frank R Howard Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Marcela Dr | AddressLine1Txt |
| City | Willits | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95490 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.adventisthealth.org/howard-memoria | WebsiteAddressTxt |
| State License | 110000013 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Frank R Howard Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assessment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assessment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Frank R. Howard Memorial Hospital | Part V, Section B, Line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts;2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering accomplished by using a widely-distributed community health survey and conducting key informant interviews and written surveys. Community Health Survey: Community Health Survey was provided to Mendocino County residents online as well as in hardcopy format. A total of 1,324 residents completed the Community Health Survey; 1,276 were completed in English and 48 in Spanish; 94 were completed by Native Americans, mostly from the Round Valley area.Key Informant Interviews and written surveys: 34 key stakeholders in the community, including representatives of county and city government, private businesses, health and human services, hospitals and clinics, community-based organizations and nonprofits, law enforcement, children and youth services, education, media, geography, and racial/ethnic groups, among others. Interviews were conducted in person or by phone. Some questions were also provided in hardcopy format for written response. While an effort was made to have diverse representation, the opinions provided by the key informants are not necessarily representative of the county as a whole. Key Leader Survey of 56 formal and informal leaders in the community that was provided online. Together with the Key Informant Interviews, a total of 90 key informants/leaders in Mendocino County participated.These key stakeholders were selected by the workgroup because they would provide a unique perspective on the health of the community, health care delivery systems in place and overall conditions that influence health behaviors.Secondary data sources included publicly available state and nationally recognized data sources. Data on key health indicators, morbidity, mortality, and various social determinants of health were collected from the US Government Accountability office, California Department of Social Services, California Department of Public Health, US Department of Health and Human Services, HealthyPeople2020, Centers for Disease Control and Prevention, and the American Heart Association. |
| Frank R. Howard Memorial Hospital | Part V, Section B, Line 6a: Adventist Health Howard Memorial Hospital partnered with Adventist Health Ukiah Valley to produce the 2019 CHNA. |
| Frank R. Howard Memorial Hospital | Part V, Section B, Line 6b: Adventist Health Howard Memorial Hospital collaborated with the Mendocino County Health and Human Services Agency Public Health Branch, Healthy Mendocino, Redwood Community Services, Mendocino Coast Clinics, Mendocino Community Health Clinics, Alliance for Rural Community Health and North Coast Opportunities to prepare the 2019 Community Health Needs Assessment. |
| Frank R. Howard Memorial Hospital | Part V, Section B, Line 11: Our 2016 CHNA identified four areas of significant needs: mental health, childhood obesity and family wellness, economic development/poverty, and access to health care. 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 - Mental health - main goal: to increase awareness about mental illness and resources in the community, increase access to mental health providers and improve prevention for mental health conditions. Interventions:1. SafeRx Coalition Mendocino - The relationship between opioid abuse and depression is bi-directional, meaning that suffering from one increases the risk of the other. Reducing opioid use is an important part of the strategy when it comes to mental health. That's why in 2019, we partnered with community agencies as part of the Mendocino Safe Rx Coalition, an opioid reduction program. Safe Rx Mendocino takes a community approach to the safe management of prescription painkillers in our county thru prevention, education, treatment and collaboration. As part of this work, we worked closely to develop and implement medication prescribing guidelines, held drug-take back events and offered safe medication disposal and education to the community. Number of community members served: 150.2. Medication-Assisted Treatment Program for Addiction - Combines behavioral therapy and medications to treat substance use disorders. In 2018, we started offering a Suboxone program, designed to help those recovering from opioid dependency. This program is available in the AHHM Emergency Department, inpatient and at Adventist Redwood Clinic, our California Bridge Clinic. Number of community members served: 150.3. QPR Workshops - Working with a contract facilitator, Adventist Health Howard Memorial sponsored community and staff workshops to teach the principles of Question, Persuade, Refer (QPR). The QPR mission is to reduce suicidal behaviors and save lives by providing innovative, practical and proven suicide prevention training. Partnering with Mendocino County Public Health, AHHM also provided space for "Train the Trainer" sessions which allowed partner agencies and community members to teach workshops to new employees and others interested in learning the principles of QPR. Number of community members served with QPR Workshops: 34.Priority Need 2 - Childhood obesity and family wellness - main goal: to promote healthy lifestyles and improve education on healthy diet and physical activity to increase the percentage of children and adults living at healthy weight. Metrics for fifth grade students at a healthy or under-weight saw an increase from 52.4% in 2018 to 58.2% in 2019. Mendocino County saw a slight decrease in the number of seventh graders who were physically fit from 58.1% in 2018 to 57.5% in 2018. This, along with an increase in metrics for ninth grade students at a healthy or under-weight from 60.2% in 2018 to 58.5% in 2019 indicates a shift in overall health among our youth.Interventions:1. Morning Mile Program at Blosser Lane Elementary School is a pilot program in collaboration with the Willits Unified School District. The Morning Mile is a national before school running/walking program originating in Florida designed to help tackle childhood obesity by giving kids the opportunity to be active every day. Every day, before school starts, students, parents and school staff, walk or run laps around school, measured for distance. Six laps around the loop is exactly a mile and students aim to get more than that. At the end of the school year, almost 60% of the 328 students have put in their miles. Students, staff and guests have combined almost 1,200 miles. Number of community members served: 3002. Inspiring Wellness though the Commonwealth Garden and Roots Restaurant: Commonwealth Garden is a five-acre organic garden with a 50+ tree orchard and a 3,000 square foot greenhouse that grows produce for hospital patients and for use in Roots. Roots Restaurant is Howard Memorial's farm to fork restaurant which is open to staff, patients and their family members and the community. Roots serves fresh and healthy meals, which in turn inspires conversations about healthy eating and wellness and serves as an example to community members that eating healthy does not have to be bland or expensive. Food offered is always affordable and always includes a vegetarian option. The restaurant design also lends itself to the message of wellness, with its open concept and community members can see exactly how their food is prepared to allow them to replicate the healthy recipes at home. Roots serves 150+ meals a day, including staff and community members. Extra produce is donated to the Willits Senior Center and the Food Bank. In 2019, we donated 2,000 pounds of produce to these two organizations. Number of meals served (excluding inpatient): 200,000.3. Free Diabetes Support Group Meetings - this once a month seminar series offers participants and their family members education and strategies to manage their diabetes. Different topics focus on exercise, healthy eating, managing complications and more. Number of community members served: 143.4. Free CPR/AED Classes and Epi-Pen Training for Willits Unified School District Staff - To improve health outcomes and prevent mortality from cardiac arrests, we offered free CPR training for community members in 2019. Taught by AHHM staff, the three-hour class is accredited by American Heart Association and teaches adult and child CPR and AED use, infant CPR, and how to relieve choking in adults, children and infants. The hands-on course is for anyone with limited or no medical training who needs the certification as part of job requirements or for those who just want to learn how to save a life. Responding to a need from the schools, AHHM staff also provided training to Willits Unified School District staff on responding to seizures, administering Epi-Pen and Glucagon to students to make sure students get the necessary help and medical response in a timely manner. Number of community members served: 30.5. Complete Health Improvement Program (CHIP) -Based on principle of the Lifestyle Medicine Institute, CHIP is a nine-week program which uses videos and live sessions to help participants create goals and achieve better health and wellness. Offered free to the community and staff, the program is aimed at helping participants lose weight, lower their A1C, lower blood pressure and find more enjoyment in life. Number of community members served: 91.Priority Need 3 - Economic development/poverty - main goal is to provide indirect support to promote economic development by collaborating with community organizations. Interventions:1. Mendocino College Physical Therapy Assistant Program - Based on the need for qualified physical therapy assistants, Adventist Health Physical Therapy team joined an advisory council at Mendocino College to explore the creation of a new program to meet this need. The Physical Therapy Assistant (PTA) Program is designed to prepare graduates to meet the requirements to practice as a physical therapist assistant in a variety of health care settings. The program is a total of 68 credit-hours, including general education requirements, and can be completed in five semesters. There are five public and eight private schools in California that offer accredited PTA programs. Only one of these schools, Sacramento City College, is in the Northern region of California. This program will provide access to this health care career path. |
| Part V, Line 11: | Priority Need 4 - Access to health care - main goal: to improve access to care and reduce wait times for appointments or number of residents going out of the area to get care. In 2019, there was an increase in adults with private health insurance to 63.4% from a 2018 prior value of 62.1%. Interventions:1. Free Mammogram Screenings Health Screenings for early disease diagnosis and to improve access. AHHM offered free mammogram screenings and breast health education during Ladies Night Out events and targeted to Native American population to provide access to critical health screenings. Number of community members served: 72.2. Back to School Fair and Free Sports Physicals - Hosted back to school fair to make sure children are healthy and have what they need to start the school year. We offered free screenings and other services including dental screening and fluoride application, vision screening, blood sugar screenings, free haircuts and backpacks. To encourage physical activity and participation in sports and prevent injuries, we offered 398 free sports physicals. Often parents face a challenge in scheduling a timely appointment for their child's sports physical due to a lack of providers and the costs involved to afford the exam. Physicians perform exams to verify the health of the child to play sports as well as the detection any underlying health issues which would preclude participation in sports. Number of community members served: 865.Priority Areas Not Addressed: Housing - Although this is a major priority for economic development overall, the hospital feels we do not have the resources, nor the capacity or competency to address this need. Having said that, we feel this will be indirectly addressed through efforts/interventions addressing poverty/economic development. Childhood trauma - Although children and their well-being are very important, this need will not be addressed in this plan due to lack of resources and expertise/competency to truly be able to address the need. However, there are other agencies/organizations in the community who have the expertise and are already working on interventions on this priority area. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
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 |
|---|---|---|---|---|
| 1 - Adventist Health Howard Memorial - RHC | ||||
| 3 Marcela Drive Suite C | Willits | CA | 95490 | RHC |
| 2 - Adventist Health Howard Memorial - Retai | ||||
| 3 Marcela Drive Suite B | Willits | CA | 95490 | Retail Pharmacy |
| 3 - Adventist Health Howard Memorial - OP P | ||||
| 3 Marcela Drive Suite D | Willits | CA | 95490 | O/P Physical Therapy |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. |
| Part II, Community Building Activities: | The hospital is involved in numerous community building activities which promote the health of the 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 III, Line 2: | Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. |
| Part III, Line 3: | The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. 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: | The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8: | The Medicare cost report apportions the Hospital's costs 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 29,551,314 Cost Report Reimbursable Bad Debts 813,071 Estimates and Accrual Variances 1,422,922 Other (1,099,476) Subtotal - Amount reported in Pt III, line 5 30,687,831 Total Medicare Revenue 30,687,831 *Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. |
| Part III, Line 9b: | When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part VI, Line 2: | The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) Update for fiscal year 2019, and the 2016 Implementation Strategy (adopted in May 2017), that includes the 2016 CHP, are posted on the hospital's website at:https://www.adventisthealth.org/howard-memorial/about-us/community-benefit/The two most recent Community Health Needs Assessments, two most recent Implementation Strategy reports and the and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/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: | 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: | Howard Memorial Hospital is located in the city of Willits, Mendocino County which has a population of approximately 5,100 within the city limits and over 28,000 in the hospital's service area. Howard Hospital primarily serves the people of northern Mendocino County.According to 2018 data from the U.S. Census Bureau, Mendocino County has an estimated population of 87,580, slightly lower than the 87,869 reported in the 2014 U.S. Census data. More than one-half (55%) of the population live in urban areas, while 45% live in rural communities, on farms or ranches. The proportion of residents who are ages 65 years and over make up 21.7% of the county population, higher than the proportion in the state with 14.5%.In 2018, the county's population was 76% White, 22% Hispanic, 4% Native American, 1% Asian, 0.7% African American, 0.6% Pacific Islander, and 15.4% Two or More Races. Between 2010 and 2060, the Hispanic/Latino population is expected to increase from 19,802 to 37,293 or to 37% of the county population, while Whites will decrease from 60,449 to 48,450 (to 48% of the county population).In the most recent data, nearly one-quarter of adults in Mendocino County ages 25 and older (22%) had a bachelor's degree or higher, and 7% had less than a high school diploma (compared to 31% and 10%, respectively, for California as a whole). Also in 2017, the median household income in Mendocino County, at $47,656, was 36% lower than that of the state ($74,605), compared to 2014 when the median household income in Mendocino County was 29% lower than the state.The 2019 County Health Rankings estimate that about 27% of the county population lives in substandard housing, i.e., without a kitchen or adequate plumbing, or lives in crowded conditions. In addition to substandard or crowded housing, over one-half of Mendocino County residents who rent (52%) pay more than a third (35%) of their total income for rent. |
| Part VI, Line 5: | Our hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population.2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. |
| Part VI, Line 6: | The hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7, Reports Filed With States | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CA Health Fund & Trust | |||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $12,751 | Health services un/underinsured patients |
| Rotary Club of Willits | |||||||
| PO Box 787 | Willits | CA | 95490 | 270725026 | 501(c)(4) | $14,220 | General support |
| Mendocino College Foundation | |||||||
| 1000 Hensley Creek Road | Ukiah | CA | 95482 | 680040876 | 501(c)(3) | $31,625 | Nursing program |
| Mendocino County Soccer Association | |||||||
| PO Box 1137 | Ukiah | CA | 95482 | 465292113 | 501(c)(3) | $6,000 | Donation for Mendocino County Soccer Program |
| Mountain Vista FarmNew Vistas Recovery Inc | |||||||
| 3020 Warm Springs Road | Glen Ellen | CA | 95442 | 680120557 | $16,900 | Contributed to rehabilitation of 30 days treatment for individual patients | |
| 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 | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Annual assistance is provided with no reporting required by recipient. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (20 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||||||
| Dir/Chair | $0 | $1,510,024 | $0 | $420,315 | $0 | $65,357 | $0 | $16,782 | $0 | $36,952 | $0 | $2,049,430 | $0 | $0 |
| Wing Bill | ||||||||||||||
| Dir/Asst Secretary/CFO | $0 | $1,200,390 | $0 | $318,717 | $0 | $53,147 | $0 | $16,782 | $0 | $29,801 | $0 | $1,618,837 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| CFO/Asst Secr thru 08/2019 | $0 | $581,409 | $0 | $187,572 | $0 | $440,088 | $0 | $16,782 | $0 | $40,783 | $0 | $1,266,634 | $0 | $0 |
| Eller Jeff | ||||||||||||||
| President, NCR | $0 | $868,316 | $0 | $193,574 | $0 | $110,192 | $0 | $16,782 | $0 | $23,415 | $0 | $1,212,279 | $0 | $0 |
| McDonald Edward | ||||||||||||||
| Former Treas/Asst Secr thru 07/2017 | $0 | $0 | $0 | $0 | $0 | $1,034,618 | $0 | $0 | $0 | $13,010 | $0 | $1,047,628 | $0 | $891,740 |
| Lang Kevin | ||||||||||||||
| Finance Officer, NCR | $0 | $0 | $0 | $0 | $0 | $1,038,744 | $0 | $0 | $0 | $0 | $0 | $1,038,744 | $0 | $0 |
| Wagner Jack | ||||||||||||||
| Former Asst Secr thru 03/18 | $0 | $0 | $0 | $0 | $0 | $778,475 | $0 | $0 | $0 | $29,189 | $0 | $807,664 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $524,870 | $0 | $65,461 | $0 | $140,054 | $0 | $16,782 | $0 | $29,127 | $0 | $776,294 | $0 | $0 |
| Byrnes John | ||||||||||||||
| Medical Officer, NCR | $0 | $493,269 | $0 | $77,663 | $0 | $147,368 | $0 | $1,523 | $0 | $28,290 | $0 | $748,113 | $0 | $0 |
| Wells Jason | ||||||||||||||
| President | $0 | $398,135 | $0 | $69,586 | $0 | $66,661 | $0 | $16,782 | $0 | $40,697 | $0 | $591,861 | $0 | $0 |
| Charpentier Paul | ||||||||||||||
| Physician | $502,055 | $0 | $8,333 | $0 | $0 | $0 | $5,600 | $0 | $38,314 | $0 | $554,302 | $0 | $0 | $0 |
| Lonto Robert | ||||||||||||||
| Reg HP Dir, NCR | $0 | $273,824 | $0 | $52,858 | $0 | $61,517 | $0 | $16,764 | $0 | $41,645 | $0 | $446,608 | $0 | $0 |
| Howe Judson | ||||||||||||||
| Treasurer | $0 | $266,973 | $0 | $31,461 | $0 | $53,033 | $0 | $13,329 | $0 | $41,622 | $0 | $406,418 | $0 | $0 |
| Givens Linda | ||||||||||||||
| Patient Care Exec | $0 | $200,671 | $0 | $27,706 | $0 | $39,340 | $0 | $11,525 | $0 | $27,743 | $0 | $306,985 | $0 | $0 |
| Bodensteiner Cindy | ||||||||||||||
| RN, First Assistant | $224,970 | $0 | $14,733 | $0 | $2,913 | $0 | $14,678 | $0 | $26,689 | $0 | $283,983 | $0 | $0 | $0 |
| Niderost Gregory | ||||||||||||||
| Certified RN Anesthetist | $226,319 | $0 | $150 | $0 | $6,607 | $0 | $13,640 | $0 | $28,010 | $0 | $274,726 | $0 | $0 | $0 |
| Radell Raymond | ||||||||||||||
| Certified RN Anesthetist | $228,664 | $0 | $150 | $0 | $0 | $0 | $15,053 | $0 | $29,805 | $0 | $273,672 | $0 | $0 | $0 |
| Buckingham Amy | ||||||||||||||
| Director, RN | $207,004 | $0 | $15,898 | $0 | $9,447 | $0 | $14,726 | $0 | $25,493 | $0 | $272,568 | $0 | $0 | $0 |
| Barash Ace | ||||||||||||||
| Medical Officer | $0 | $0 | $0 | $0 | $0 | $221,607 | $0 | $0 | $0 | $0 | $0 | $221,607 | $0 | $0 |
| Kinney Jill | ||||||||||||||
| Admin Dir Marketing & Comm, NCR | $0 | $161,220 | $0 | $12,898 | $0 | $7,582 | $0 | $8,890 | $0 | $12,459 | $0 | $203,049 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Lines 4a-b | Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. McDonald, Edward - severance payment - $125,961 Reppert, Joseph - severance payment - $194,953 Wagner, Jack - severance payment - $778,453 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. McDonald, Edward - distribution - $861,740 A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. McDonald, Edward - $47,940 |
| Part II: | Kevin Lang, Finance Officer, NCR was paid through an unrelated organization KJL, Inc. that was reported on Form 1099. Compensation paid is reported in Form 990, Part VII, Section A and Schedule J, Part II. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | Willits Hospital, Inc dba Adventist Health Howard Memorial (AHHM) 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 Howard Memorial, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does Adventist Health Howard Memorial 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. AHHM 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 $4,875,188. The following Inpatient services that were provided to all our patients. These services included: - 703 Surgeries performed - 7,409 Patient days The following Outpatient services that were provided to all our patients. These services included: - 14,538 Emergency department visits - 651 Outpatient Surgeries performed - 32,393 Outpatient visits - 17,238 Clinic visits AHHM 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 $281,537. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ |
| Form 990, Part VI, Section A, line 4 | The Hospital made changes to their Article 8.1, Execution of Legal Documents, to include more signature authority. |
| Form 990, Part VI, Section A, line 6 | The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation that operates as a public charity. The Hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, Section A, line 7a | The Hospital's Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. |
| Form 990, Part VI, Section A, line 7b | The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. |
| Form 990, Part VI, Section B, line 11b | This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Hospital's Board of Directors prior to filing. |
| Form 990, Part VI, Section B, line 12c | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the 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, Section B, line 15 | The Hospital's Board of Directors has established a Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital presidents and finance officers that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital 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, Section C, line 19 | The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. |
| Form 990, Part VII: | In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors receive compensation when their employment agreements with their employers allow such payments. For those whose employers do not allow accepting compensation for board service, the funds are directly distributed to charitable organizations as mandated by their employment agreements. In addition, amounts paid for taxable benefits are also reported. |
| Form 990, Part IX, line 11g | Physician professional fees: Program service expenses 7,567,927. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,567,927. Consulting and other management fees: Program service expenses 0. Management and general expenses 352,459. Fundraising expenses 0. Total expenses 352,459. Repairs and maintenance: Program service expenses 517,092. Management and general expenses 0. Fundraising expenses 0. Total expenses 517,092. All other purchased services: Program service expenses 2,362,318. Management and general expenses 935,939. Fundraising expenses 0. Total expenses 3,298,257. Revenue cycle fees: Program service expenses 0. Management and general expenses 3,417,290. Fundraising expenses 0. Total expenses 3,417,290. Purchased medical services: Program service expenses 449,946. Management and general expenses 0. Fundraising expenses 0. Total expenses 449,946. |
| Form 990, Part XI, line 9: | Change in Foundation interest -10,626. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (27 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Delano | |||||||||||
| PO Box 460 | Delano | CA | 93216 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Physicians Network | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| Adventist Health Tulare | |||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Fremont-Rideout Health Group | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 942917251 | Acute care hospital | CA | 501(c)(3) | Line 12b, II | Stone Point Health | 0 | |
| Glendale Adventist Medical Center | |||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Hanford Community Hospital | |||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Lodi Memorial Hospital Association Inc | |||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 941044474 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Northwest Medical Foundation of Tillamook | |||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Paradise Valley Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 951816034 | Discontinued operations | CA | 501(c)(3) | Line 1 | Adventist Health SystemWest | 0 | |
| Portland Adventist Medical Center | |||||||||||
| 10123 SE Market Street | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Reedley Community Hospital | |||||||||||
| 372 Cypress Avenue | Reedley | CA | 93654 | 453220509 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Rideout Memorial Hospital | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 941387866 | Acute care hospital | CA | 501(c)(3) | Line 3 | Fremont-Rideout Health Group | 0 | |
| St Helena Hospital | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| San Joaquin Community Hospital | |||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Simi Valley Hospital & Health Care Services | |||||||||||
| 2975 N Sycamore Drive | Simi Valley | CA | 93065 | 956064971 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Sonora Community Hospital | |||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Stone Point Health | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 823763347 | Supporting organization | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Ukiah Adventist Hospital | |||||||||||
| 275 Hospital Drive | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| United Com-Serve | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled nursing/assisted living/home health | CA | 501(c)(3) | Line 12b, II | Fremont-Rideout Health Group | 0 | |
| Walla Walla General Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital - closed July 2017 | WA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Western Health Resources | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | Line 10 | Adventist Health SystemWest | 0 | |
| White Memorial Medical Center | |||||||||||
| 1720 Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
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 NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |