SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES (EIN 95-6064971)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-11-12
- IRS object ID
- 201903169349303430
- Schema version
- 2018v3.1
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-11-12T10:58:40-08:00 | ReturnTs |
| Tax Period End | 2018-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 800519547 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ACCOUNTANCY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 N BRAND BLVD STE 200 | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 912032361 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956064971 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hosp & Hlth Care Serv | BusinessNameLine1Txt |
| Business Name Line2 | dba Adventist Health Simi Valley | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SIMI | BusinessNameControlTxt |
| Phone | 8059556000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1Txt |
| City | Simi Valley | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93065 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Swenson Jennifer | PersonNm |
| Person Title | President | PersonTitleTxt |
| Signature | 2019-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | S Clement | PreparerPersonNm |
| PTIN | P01218012 | PTIN |
| Phone | 8185475701 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-03-31 21:24:44Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jennifer Swenson | PrincipalOfficerNm |
| Gross Receipts | $154,989,729 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/simi-valley | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1960 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living Gods love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1065 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $634,781 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,696,580 | PYContributionsGrantsAmt |
| CY Contributions Grants | $12,378,687 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $141,651,097 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $142,184,326 | CYProgramServiceRevenueAmt |
| PY Investment Income | $39,911 | PYInvestmentIncomeAmt |
| CY Investment Income | $26,724 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,020 | PYOtherRevenueAmt |
| CY Other Revenue | $47,395 | CYOtherRevenueAmt |
| PY Total Revenue | $143,399,608 | PYTotalRevenueAmt |
| CY Total Revenue | $154,637,132 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $522,063 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $233,298 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $69,675,553 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $70,442,615 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $162,952 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $77,577,089 | PYOtherExpensesAmt |
| CY Other Expenses | $82,048,500 | CYOtherExpensesAmt |
| PY Total Expenses | $147,774,705 | PYTotalExpensesAmt |
| CY Total Expenses | $152,724,413 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,375,097 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,912,719 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $183,950,616 | TotalAssetsBOYAmt |
| Total Assets EOY | $177,558,588 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $143,436,465 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $135,820,651 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,514,151 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $41,737,937 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Living Gods love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $123,114,822 | ExpenseAmt |
| Grant | $233,298 | GrantAmt |
| Revenue | $142,184,326 | RevenueAmt |
| Desc | Simi Valley Hosp & Hlth Care Serv dba Adventist Health Simi Valley (AHSV) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay.Although reimbursement for services rendered is critical to the operation and stability Adventist Health Simi Valley, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Adventist Health Simi Valley provide low cost care to individuals covered by government-programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits.AHSV recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2018 was $18,751,510.The following Inpatient services that were provided to all our patients. These services included:528 Babies delivered1,064 Surgeries performed26,155 Patient days The following Outpatient services that were provided to all our patients. These services included:35,768 Emergency department visits2,098 Outpatient Surgeries performed50,875 Outpatient visits 50,271 Clinic visitsAHSV recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2018 was $7,492,985.Adventist Healths mission statement of Living Gods love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in Gods image has experienced the best health today, hope for tomorrow, and Gods love that endures forever.Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ | Desc |
| Total Program Service Expenses | $123,114,822 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1065 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jay Lipps | PersonNm |
| Phone | 9164061092 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $27,260 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $25,126 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $24,002 | $0 | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $718 | $0 | ||||
| Gabriel Melody | ||||||||||
| Dir Thru 12/18 | 0.00 | 4.00 | Yes (X) | $0 | $20,464 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,442 | $0 | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,485 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $31,885 | $0 | ||||
| Pedersen James | ||||||||||
| Dir Thru 7/18 | 0.00 | 4.00 | Yes (X) | $0 | $3,625 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $27,964 | $0 | ||||
| Rippey Wesley | ||||||||||
| Dir Thru 5/18 | 0.00 | 50.00 | Yes (X) | $0 | $623,943 | $47,568 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,542 | $0 | ||||
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | $0 | $2,458,436 | $44,472 | Yes (X) | |||
| Wing Bill | ||||||||||
| Dir/VCh/AsstSec | 0.00 | 50.00 | Yes (X) | $0 | $1,875,310 | $49,315 | Yes (X) | |||
| Wagner Jack | ||||||||||
| A Sec Thru 3/18 | 0.00 | 50.00 | Yes (X) | $0 | $1,332,907 | $34,076 | ||||
| Anderson Brian | ||||||||||
| Treas/Asst Sec | 50.00 | 0.00 | $0 | $324,656 | $37,608 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | $0 | $666,615 | $38,328 | Yes (X) | ||||
| Swenson Jennifer | ||||||||||
| President | 50.00 | 0.00 | $0 | $606,164 | $51,198 | Yes (X) | ||||
| Reppert Joseph | ||||||||||
| CFO | 0.00 | 50.00 | $0 | $953,615 | $46,846 | Yes (X) | ||||
| Wehtje Ronald | ||||||||||
| Finance Officer SCR | 12.50 | 37.50 | $0 | $833,628 | $37,770 | Yes (X) | ||||
| Zachary Beth | ||||||||||
| President SCR | 12.50 | 37.50 | $0 | $1,310,581 | $42,365 | Yes (X) | ||||
| Jahn Andrew | ||||||||||
| President SCR | 12.50 | 37.50 | $0 | $1,116,118 | $59,339 | Yes (X) | ||||
| Nahapetian Arby | ||||||||||
| Medical Officer SCR | 12.50 | 37.50 | $0 | $966,535 | $51,169 | Yes (X) | ||||
| Burke James | ||||||||||
| Medical Officer SCR | 12.50 | 37.50 | $0 | $314,198 | $22,044 | Yes (X) | ||||
| Dingilian John | ||||||||||
| CMO | 50.00 | 0.00 | $0 | $346,825 | $46,740 | Yes (X) | ||||
| Esparza Caroline | ||||||||||
| COO/CNO | 50.00 | 0.00 | $0 | $363,800 | $401 | Yes (X) | ||||
| Werner William | ||||||||||
| VP Support Services | 50.00 | 0.00 | $0 | $292,067 | $48,266 | Yes (X) | ||||
| Ferrier Cory | ||||||||||
| Business Development Exec | 50.00 | 0.00 | $0 | $27,521 | $401 | Yes (X) | ||||
| Carol Deamer | ||||||||||
| Dir Pharmacy | 50.00 | 0.00 | $210,235 | $0 | $11,898 | Yes (X) | ||||
| Percival Kathleen | ||||||||||
| Admin Director | 50.00 | 0.00 | $183,757 | $0 | $19,985 | Yes (X) | ||||
| Fernandes Shalini | ||||||||||
| RN | 50.00 | 0.00 | $182,014 | $0 | $34,748 | Yes (X) | ||||
| Brodetsky Elena | ||||||||||
| Pharm Coordinator | 50.00 | 0.00 | $179,672 | $0 | $9,891 | Yes (X) | ||||
| Nakamura Bridget | ||||||||||
| Director IT | 50.00 | 0.00 | $176,450 | $0 | $29,779 | Yes (X) | ||||
| Crabtree Susan | ||||||||||
| Dir HR | 0.00 | 50.00 | $0 | $170,533 | $28,283 | Yes (X) | ||||
| Svolos Ann Marie | ||||||||||
| Dir Risk Mgmt | 0.00 | 50.00 | $0 | $162,788 | $38,235 | Yes (X) | ||||
| Fargo Roland | ||||||||||
| SVP Reg Physician OPS | 0.00 | 50.00 | $0 | $597,899 | $32,932 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $932,128 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $15,528,652 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $863,657 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 196 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Medical Solutions Inc | |||||
| 1010 N 102 Street Ste 300 | Omaha | NE | 68114 | Medical Services | $1,073,866 |
| Intensive Care Medical Inc | |||||
| 1177 Roadrunner Way | Simi Valley | CA | 93065 | Medical Services | $862,038 |
| Sodexo Inc | |||||
| 9801 Washington Blvd | Gathersburg | MD | 20878 | Dietary Services | $537,182 |
| CA Cardiovascular Thoracic Surgeons | |||||
| 168 N Brent St | Ventura | CA | 93003 | Medical Services | $435,770 |
| Extracorporeal Stat LLC | |||||
| 22637 La Quilla Drive | Chatsworth | CA | 91311 | Dialysis Services | $429,329 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $50,589 | RelatedOrganizationsAmt |
| Government Grants | $12,301,003 | GovernmentGrantsAmt |
| All Other Contributions | $27,095 | AllOtherContributionsAmt |
| Total Contributions | $12,378,687 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Dietary | 722210 | $184,372 | $184,372 |
| Other Program Services | 900099 | $420,997 | $420,997 |
| Patient Service Revenue | 621110 | $140,826,405 | $140,826,405 |
| Rent | 531120 | $752,552 | $752,552 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $142,184,326 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $349,769 | TotalRevenueColumnAmt |
| Exclusion | $349,769 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,722 | TotalRevenueColumnAmt |
| Exclusion | $22,722 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $345,767 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$345,767 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$345,767 | TotalRevenueColumnAmt |
| Exclusion | -$345,767 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $54,225 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $6,830 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,395 | TotalRevenueColumnAmt |
| Exclusion | $47,395 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $154,637,132 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $142,184,326 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $74,119 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,298 | TotalAmt |
| Program Services | $233,298 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,086,539 | TotalAmt |
| Program Services | $51,733,646 | ProgramServicesAmt |
| Management And General | $4,221,400 | ManagementAndGeneralAmt |
| Fundraising | $131,493 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,062,886 | TotalAmt |
| Program Services | $1,985,017 | ProgramServicesAmt |
| Management And General | $76,318 | ManagementAndGeneralAmt |
| Fundraising | $1,551 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,305,952 | TotalAmt |
| Program Services | $7,930,104 | ProgramServicesAmt |
| Management And General | $355,279 | ManagementAndGeneralAmt |
| Fundraising | $20,569 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,987,238 | TotalAmt |
| Program Services | $3,776,691 | ProgramServicesAmt |
| Management And General | $202,119 | ManagementAndGeneralAmt |
| Fundraising | $8,428 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,738,220 | TotalAmt |
| Program Services | $754,658 | ProgramServicesAmt |
| Management And General | $6,983,562 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,650 | TotalAmt |
| Management And General | $106,650 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,385 | TotalAmt |
| Management And General | $1,385 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,212,436 | TotalAmt |
| Program Services | $5,332,672 | ProgramServicesAmt |
| Management And General | $1,879,764 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $417,265 | TotalAmt |
| Program Services | $417,265 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $641,479 | TotalAmt |
| Program Services | $440,830 | ProgramServicesAmt |
| Management And General | $200,649 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,771,296 | TotalAmt |
| Program Services | $1,991,481 | ProgramServicesAmt |
| Management And General | $4,779,815 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,124,006 | TotalAmt |
| Program Services | $4,025,303 | ProgramServicesAmt |
| Management And General | $1,097,792 | ManagementAndGeneralAmt |
| Fundraising | $911 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,195 | TotalAmt |
| Program Services | $141,021 | ProgramServicesAmt |
| Management And General | $138,174 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,198 | TotalAmt |
| Program Services | $37,925 | ProgramServicesAmt |
| Management And General | $10,273 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,539,525 | TotalAmt |
| Program Services | $3,539,525 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,109,425 | TotalAmt |
| Program Services | $8,090,027 | ProgramServicesAmt |
| Management And General | $19,398 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,129 | TotalAmt |
| Program Services | $61,129 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Pt care supplies | $16,009,093 | $15,985,921 | $23,172 |
| Qlty assurance (hospital) fee | $8,498,549 | $8,498,549 | |
| Revenue Cycle Fees | $7,936,175 | -$36,913 | $7,973,088 |
| Purchased services | $7,202,245 | $5,977,881 | $1,224,364 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,352,229 | TotalAmt |
| Program Services | $2,198,792 | ProgramServicesAmt |
| Management And General | $153,437 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,724,413 | TotalAmt |
| Program Services | $123,114,822 | ProgramServicesAmt |
| Management And General | $29,446,639 | ManagementAndGeneralAmt |
| Fundraising | $162,952 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $497,825 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,849,436 | BOYAmt |
| EOY | $5,530,605 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,229,380 | BOYAmt |
| EOY | $19,113,372 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,297,752 | BOYAmt |
| EOY | $2,693,642 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $661,841 | BOYAmt |
| EOY | $564,677 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $223,978,055 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $98,528,975 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $130,014,123 | BOYAmt |
| EOY | $125,449,080 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,044,663 | BOYAmt |
| EOY | $2,019,735 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,121 | BOYAmt |
| EOY | $100,121 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,227,323 | BOYAmt |
| EOY | $2,227,323 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,210,459 | BOYAmt |
| EOY | $2,210,459 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,817,693 | BOYAmt |
| EOY | $17,649,574 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $183,950,616 | BOYAmt |
| EOY | $177,558,588 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,010,007 | BOYAmt |
| EOY | $10,451,469 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,342,529 | BOYAmt |
| EOY | $51,927 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,950,000 | BOYAmt |
| EOY | $1,950,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,133,929 | BOYAmt |
| EOY | $123,367,255 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,436,465 | BOYAmt |
| EOY | $135,820,651 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,579,326 | BOYAmt |
| EOY | $40,922,512 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $934,825 | BOYAmt |
| EOY | $815,425 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,514,151 | BOYAmt |
| EOY | $41,737,937 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $183,950,616 | BOYAmt |
| EOY | $177,558,588 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,912,719 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$688,933 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed Section4955 Tax | false | Form4720FiledSection4955TaxInd |
| Correction Made | false | CorrectionMadeInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $21,301 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $21,301 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1i - Other Activities Description | FormAndLineReferenceDesc |
| Explanation | The organization belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $934,825 | BeginningYearBalanceAmt |
| Contributions | $216,897 | ContributionsAmt |
| Investment Earnings Or Losses | -$6,401 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $329,896 | OtherExpendituresAmt |
| End Year Balance | $815,425 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,796,958 | BeginningYearBalanceAmt |
| Contributions | $1,327,885 | ContributionsAmt |
| Investment Earnings Or Losses | -$1,132,209 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,057,809 | OtherExpendituresAmt |
| End Year Balance | $934,825 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,471,458 | BeginningYearBalanceAmt |
| Contributions | $2,049,302 | ContributionsAmt |
| Investment Earnings Or Losses | -$1,648,602 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,075,200 | OtherExpendituresAmt |
| End Year Balance | -$22,471 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,178,248 | BeginningYearBalanceAmt |
| Contributions | $54,691 | ContributionsAmt |
| Investment Earnings Or Losses | $288,054 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $49,535 | OtherExpendituresAmt |
| End Year Balance | $3,471,458 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,829,912 | BeginningYearBalanceAmt |
| Contributions | $88,226 | ContributionsAmt |
| Investment Earnings Or Losses | $322,286 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $62,176 | OtherExpendituresAmt |
| End Year Balance | $3,178,248 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,378,566 | OtherCostOrOtherBasisAmt |
| Book Value | $6,378,566 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $171,127,382 | OtherCostOrOtherBasisAmt |
| Depreciation | $65,300,791 | DepreciationAmt |
| Book Value | $105,826,591 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,419,880 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,918,209 | DepreciationAmt |
| Book Value | $501,671 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,734,647 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,755,609 | DepreciationAmt |
| Book Value | $8,979,038 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,317,580 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,554,366 | DepreciationAmt |
| Book Value | $3,763,214 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $125,449,080 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Sycamore, Aspen, Oncure | Desc |
| Book Value | $2,328,032 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Interest in SVH Foundation | $1,520,419 |
| Investment in ASV | $2,328,032 |
| OTHER ASSETS | $175,000 |
| Other Receivables | $15,969 |
| Receivable from 3rd Party Payors | $896,351 |
| Receivables from Related Organizations | $12,713,803 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $17,649,574 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Other Liabilities | $917,921 |
| Payables to Related Organizations | $119,465,091 |
| Workers Comp Payable | $2,984,243 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $123,367,255 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: Intended uses of the endowment fund. | FormAndLineReferenceDesc |
| Explanation | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,043,582 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,043,582 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,684,884 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,976,955 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,707,929 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11590 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,728,466 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,976,955 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,751,511 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12270 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $825,406 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,077 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $815,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $192,015 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $192,015 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,588,951 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,377,785 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,211,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04070 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $274,476 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $274,475 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,880,848 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,387,863 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,492,985 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04910 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,609,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,364,818 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $26,244,496 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17180 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,324 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $57,324 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,863 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,863 | NetCommunityBenefitExpnsAmt |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,373 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,373 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $61,814 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $61,814 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,482 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,482 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,322 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,322 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $141,178 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $141,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $535,390 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $17,079 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $38,464,064 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $45,380,558 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$6,916,494 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Aspen Surgery Venture LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Ambulatory surgery center | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.72500 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.27500 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1Txt |
| City | Simi Valley | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93065 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | See Form 990, Pg 1, Item J | WebsiteAddressTxt |
| State License | 050000216 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assessment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Sch H Part VI-Patient Education | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Sch H Part VI-Patient Education | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Sch H Part VI-Patient Education | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Facility: - Part V, Section B, Line 5 | The 2016 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.Data gathering was accomplished by using a community survey and conducting key stakeholder interviews.Community Survey: Each of the stakeholder interviewees was sent a link to an electronic survey (Survey Monkey) in advance of the interview. The stakeholders were asked to rank each identified health need. The percentage of responses were noted as those that identified the need as having severe or very severe impact on the community, had worsened over time, and had a shortage or absence of resources available in the community.Targeted Interviews: Fifteen interviews were completed during June and July 2016, with people who represent the broad interests of the community served by the hospital. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, and minority populations, or regional, state or local health or other departments or agencies that have current data or other information relevant to the health needs of the community served by the hospital facility. |
| Facility: - Part V, Section B, Line 11 | Our 2016 CHNA identified four areas of significant needs: access to health care, cancer, diabetes, and mental health & substance abuse. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1-Access to Health Care main goal - to increase coverage and access to health care services for the medically underserved by: providing financial assistance through both free and discounted care for health care services, consistent with the hospitals financial assistance policy; providing education and information to increase knowledge about free or low cost health insurance options; partnering with the Free Clinic of Simi Valley to support the provision of health care services to those in our community who are uninsured or underinsured (through this partnership, hospital employees provide administrative and clinical training for the Free Clinic staff; we also offer free mammograms, lab services and imaging services for clinic patients). Interventions:1.COPE Health Scholars Program. Health Scholars are individuals who want to pursue healthcare careers and are at least 18 years old. They pay a small fee to the COPE programs and are enrolled and participate in rotations throughout the hospital and other service areas. AHSV provides funding to be a host site. 80 students enrolled2.Moorpark College Healthcare Professions. AHSV provides clinical rotations for nursing and EMT students. 142 students enrolled3. Simi Institute for Adult Education 66 students received clinical training at AHSV 4. College of the Canyons sent 58 nursing students though clinical training at AHSV.5. Diagnostic Screenings for Uninsured via The Free Clinic of Simi Valley 1,226 community members served with lab and radiology screenings including CT, Mammography, PSA testing, Ultrasound, X-Ray and lung cancer. 6. Free flu shots at the annual Tooth Fairy Run for 100 people.7. Facilitated healthy food preparations demonstrations and samples for over 400 people.8. Provided breast health education, early childhood development education, heart and stroke prevention and awareness education along with 2-step CPR training for 400 community members9. The recruitment spend of $500,000 for Dr. Perez who is a Geriatric Medicine Specialist to fill the need in our community for medical care focused on the needs of our seniors. Priority Need 2-Cancer main goal to reduce the impact of cancer and increase the focus on disease prevention and treatment education, accomplished through: partnering with local physicians to provide free skin cancer screenings to the community; providing free mammograms to patients of the Free Clinic of Simi Valley; offering a number of sources for education and screening to encourage prevention and early detection; offering monthly support groups open to the community for women diagnosed with breast cancer. Interventions:1.Cancer Care Navigators 300 patients received free support.2.Cancer Support Group Funding 35 support group members received additional classes and resources from hospital funding.3.Mammograms for Uninsured via The Free Clinic of Simi Valley 38 women served.4.Cancer Survivors Picnic June 2018 100 community members served.5.Sponsor of ACS Relay for Life Walk/Run - we create teams and provide education, outreach and health promoting gifts.6.Preparing Lung Cancer Screening for January 2018 Launch - invested in software, technology, and education for lung cancer screening, physician outreach and education on patients who qualify for the screening. 46 lung cancer screenings were performed in 2018. 7.Pampered in Pink 2018, free community education and outreach event 400 community members served.Priority Need 3-Diabetes main goal to reduce the impact of diabetes and increase the focus on disease prevention and treatment education, by: partnering with the Simi Valley YMCA to provide a Diabetes Prevention Program to the community to help people with prediabetes eat healthier, increase their physical activity, and lose weight; provide free blood glucose screenings in the community for those who might be at risk for diabetes; providing diabetes prevention education at community events and through social media. Interventions: 1.YMCA and Diabetes Prevention Program AHSV promotes and refers individuals to the YMCA diabetes program. Number of individuals enrolled at this time is unavailable. 2. AHSV provides financial support for Diabetes Undone and SiMi Fit programs facilitated at the Sim Valley Seventh-day Adventist Church. Two cohorts of 25 people went through Diabetes Undone in 2018 and achieved reductions in blood pressures, reduction in insulin dependence and in some cases, people were no longer pre-diabetic. Several individuals reversed their chronic conditions and were removed from medications. 3. AHSV worked with the Simi Valley Education Foundation leadership team to re-design the relationship and change from being a sponsor for their Gala to invest $5,000 in an enhancement grant that was designed specifically to address our four priority areas outlined in the CHIP: Cancer, Access to Care, Substance/Mental Health, Obesity/Diabetes. The $5,000 grant received 108 applications. Seven schools were funded including two high schools, one middle school, three elementary schools and one independent learning academy. Grants ranged from $100 to $2,812. The schools each write a written evaluation of the project and how it met criteria for the CHNA/CHIP and affected their students. Highlights include: Social Emotional Learning project helping students to learn life skills and become resilient. It helps them with goal setting, planning, coping with stress, attitude and other success habits. Another project was 3-D Model to study the physical brain and how neurons operate (mental health). A gardening project for healthy eating habits was established. A performing arts project was completed that was designed to improve self-awareness and self-esteem (mental health). Research project and presentation on the effects of chemical and drugs on mental health and physical health (substance abuse education) and provided supplementary funding for medical training topics for the students interested in healthcare careers (access to care). AHSV is committed to this enhancement grant and would like to expand it in the future with more funding and more wrap-around support for the teachers and students who apply for funding and receive grants. 4. Healthy Kids Fun Zone Moorpark Country Days - provided a sponsorship to make the Kids Zone free to all who attended. This gave less privileged families access to the bungee jump, rock climbing wall, bounce house, obstacle course and other fun activities that get kids moving and inspired to be more active. AHSV also provided health education, gifts, blood pressure screenings, water stations and 2-step CPR training. 5. Cash donation to Simi Valley Boys and Girls club provided health fresh fruit and vegetables to take home to families. Priority Need 4-Mental Health & Substance Abuse main goal to increase access to mental health care resources and services through: partnering with the Simi Valley Unified School District; collaborating with the Drug Enforcement Agency and community partners to educate the community about opioid misuse; supporting at least one pain management class for community members living with chronic pain; recruiting psychiatrists to offer services in our community, offering insurance to Covered California subscribers; supporting the Every 15 Minutes program that is designed to dramatically instill teens with the potentially dangerous consequences of drinking alcohol while driving. Interventions:1.Every Fifteen Minutes program in collaboration with Simi Valley High School and Royal High School - provides funding for reenactment of driving under the influence.2.For the Troops initiative provides sponsorships that help support programs for PTSD in veterans.3.Psychiatric Care AHSV recruitment of two physicians to Simi Valley in behavioral health.4.Free Drug Teen Drug Testing offered free drug testing to our community through our school system.Priority Areas Not Addressed:Taking existing hospital and community resources into consideration, Simi Valley Hospital will not directly address the remaining health needs identified in the CHNA including: cardiovascular disease, obesity, and preventive practices. Since the hospital cannot address all the health needs present in the community, it will concentrate on those health needs that can most effectively be addressed given the organizations areas of focus and expertise. Simi Valley Hospital will look for partnership opportunities that address needs not selected where it can appropriately contribute to addressing those needs, or where those needs align with current strategy and priorities. |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Aspen Outpatient Center | ||||
| 2750 N Sycamore Dr | Simi Valley | CA | 93065 | Outpatient Imaging & Surgery |
| Nancy Reagan Breast Center | ||||
| 2750 N Sycamore Dr | Simi Valley | CA | 93065 | Outpatient Women's Imaging |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7 - Explanation of Costing Methodology | The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient charges |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio 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 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. |
| Part III, Line 4 - Bad Debt Expense | The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments too many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue 38,464,064Prior Year Settlements (184,852)Cost Report Reimbursable Bad Debts 377,379Estimates and Accrual Variances (230,119)Other 1,922,504) __________Total Medicare Revenue 36,503,968*Note: The Medicare Cost Report Revenue includes the patient co-pay and deductible amounts, but not the bad-debt reimbursement. Adding the bad-debt reimbursement would have duplicated the revenue and deductible amounts. |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part VI, Line 2 - Needs Assessment | The hospital's 2016 CHNA, the 2019 Community Health Plan (CHP) Update for fiscal year 2018, the 2018 Community Health Plan (CHP) Update for fiscal year 2017, and the 2016 Implementation Strategy (adopted in May 2017), which includes the 2016 CHP Update, are posted on the hospital's website at https://www.adventisthealth.org/about-us/community-benefit/The CHNA, Implementation Strategy and the CHPs are also available on the Adventist Health Corporate website at https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. In order to accomplish the many important systemic goals that are underway in our community, we have been in partnership with multiple not-for-profits to provide quality care to the underserved; some of our partners are: The Free Clinic of Simi Valley, Ventura County Healthcare Agency, Healthcare Foundation for Ventura County, County Social Services, Adult Protective Services, Ventura County Behavioral Health, Rotary Club of Simi Sunrise, Simi Valley Senior Center, Community Coalition United, Simi Valley YMCA, The Moorpark Education Foundation, The Moorpark Community College, and the list goes on. Simi Valley Hospital knows that only working together we can achieve the necessary health improvements to create the communities that allow each member to have safe and healthy places to live, learn, work, play, and pray. |
| Part VI, Line 3 - Patient Education of Eligibility for Assistance | The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at https://www.adventisthealth.org/patient-resources/financial-assistance/These documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. |
| Part VI, Line 4 - Community Information | Simi Valley Hospital is located in Simi Valley, CA. The hospital service area includes the cities of Simi Valley and Moorpark in Ventura County. Inpatient hospital acute admission data indicate that the majority of admissions come from Simi Valley and Moorpark. The population of the Simi Valley Hospital service area is approximately 165,000. In the service area, 23.8% of the population is children and youth, 64.9% are adults, and 11.3% are seniors. Whites make up 61.7% of the population, 25.4% are Hispanic or Latinos, 8.3% are Asians, and the remaining 4.6% are other ethnicities. Among area residents, 6.8% are at or below 100% of the federal poverty level (FPL) and 17.7% are at or below 200% of FPL (low-income). These poverty levels are less than county and state rates. |
| Part VI, Line 4 - Community Building Activities | The hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. |
| Part VI, Line 5 - Promotion of Community Health | Our hospitals mission is, Living Gods love by inspiring health, wholeness and hope. Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the triple aim. The Triple Aim concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given todays state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. |
| Part VI, Line 6 - Affilated Health Care System | The hospital is a member of Adventist Health System/West, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as tele pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7 - States Filing of Community Benefit Report | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| American Heart Assn | ||||||||
| 7272 Greenville Ave | Dallas | TX | 75231 | 135613797 | 501(c)(3) | $7,437 | $0 | Donation |
| Boys & Girls Club of Simi Vly | ||||||||
| 2850 Lemon Dr Simi Valley C | Simi Valley | CA | 93063 | 952811018 | 501(c)(3) | $6,000 | $0 | Donation |
| CA Hlth Fund & Trust | ||||||||
| 1215 K St Ste 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $58,871 | $0 | Hlth svcs uninsured/underinsured pt |
| Moorpark Chamber Of Commerce | ||||||||
| PO Box 296 | Moorpark | CA | 93063 | 501(c)(6) | $10,600 | $0 | Donation | |
| Rotary Club Of Simi Sunrise | ||||||||
| 5005 E Los Angeles Ave | Simi Valley | CA | 93063 | 770392570 | 501(c)(4) | $5,430 | $0 | Donation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 3 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Additional Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Grants are donations made to US tax exempt organizations, Government Entities and Civic organizations who are community partners, known to us, and present a valid purpose for their donation request. It is anticipated that no further monitoring is required. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (24 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Anderson Brian | ||||||||||||
| Treas/Asst Sec | $250,066 | $26,069 | $48,522 | $16,649 | $20,959 | $362,265 | ||||||
| Brodetsky Elena | ||||||||||||
| Pharm Coordinator | $177,172 | $100 | $2,400 | $9,855 | $36 | $189,563 | ||||||
| Burke James | ||||||||||||
| Medical Officer SCR | $273,216 | $40,982 | $18,504 | $3,540 | $336,242 | |||||||
| Carol Deamer | ||||||||||||
| Dir Pharmacy | $204,684 | $100 | $5,451 | $11,714 | $184 | $222,133 | ||||||
| Crabtree Susan | ||||||||||||
| Dir HR | $71,329 | $99,204 | $9,180 | $19,103 | $198,816 | |||||||
| Dingilian John | ||||||||||||
| CMO | $287,114 | $29,629 | $30,082 | $16,682 | $30,058 | $393,565 | ||||||
| Esparza Caroline | ||||||||||||
| COO/CNO | $264,305 | $26,939 | $72,556 | $401 | $364,201 | |||||||
| Fargo Roland | ||||||||||||
| SVP Reg Physician OPS | $379,174 | $95,874 | $122,851 | $10,964 | $21,968 | $630,831 | ||||||
| Fernandes Shalini | ||||||||||||
| RN | $178,588 | $3,426 | $10,615 | $24,133 | $216,762 | |||||||
| Jahn Andrew | ||||||||||||
| President SCR | $672,558 | $157,741 | $285,819 | $16,682 | $42,657 | $1,175,457 | ||||||
| Jobe Meredith | ||||||||||||
| Secretary | $419,684 | $111,013 | $135,918 | $16,682 | $21,646 | $704,943 | ||||||
| Nahapetian Arby | ||||||||||||
| Medical Officer SCR | $557,553 | $165,709 | $243,273 | $16,682 | $34,487 | $1,017,704 | ||||||
| Nakamura Bridget | ||||||||||||
| Director IT | $169,909 | $500 | $6,041 | $9,676 | $20,103 | $206,229 | ||||||
| Percival Kathleen | ||||||||||||
| Admin Director | $180,478 | $3,279 | $10,037 | $9,948 | $203,742 | |||||||
| Reiner Scott | ||||||||||||
| Dir/Chair | $1,339,257 | $747,881 | $371,298 | $16,682 | $27,790 | $2,502,908 | ||||||
| Reppert Joseph | ||||||||||||
| CFO | $686,470 | $152,446 | $114,699 | $16,682 | $30,164 | $1,000,461 | ||||||
| Rippey Wesley | ||||||||||||
| Dir Thru 5/18 | $565,539 | $58,404 | $20,249 | $27,319 | $671,511 | |||||||
| Svolos Ann Marie | ||||||||||||
| Dir Risk Mgmt | $153,104 | $9,684 | $5,821 | $32,414 | $201,023 | |||||||
| Swenson Jennifer | ||||||||||||
| President | $395,159 | $91,732 | $119,273 | $16,682 | $34,516 | $657,362 | ||||||
| Wagner Jack | ||||||||||||
| A Sec Thru 3/18 | $180,671 | $414,342 | $737,894 | $11,182 | $22,894 | $1,366,983 | ||||||
| Wehtje Ronald | ||||||||||||
| Finance Officer SCR | $525,772 | $154,336 | $153,520 | $16,682 | $21,088 | $871,398 | ||||||
| Werner William | ||||||||||||
| VP Support Services | $215,956 | $23,359 | $52,752 | $14,167 | $34,099 | $340,333 | ||||||
| Wing Bill | ||||||||||||
| Dir/VCh/AsstSec | $1,015,353 | $603,273 | $256,685 | $16,682 | $32,633 | $1,924,626 | ||||||
| Zachary Beth | ||||||||||||
| President SCR | $191,196 | $270,398 | $848,987 | $16,682 | $25,683 | $1,352,946 | ||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a: Relevant information in regards to selections on 1a. | FormAndLineReferenceDesc |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (8 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Denise Anderson | |||
| Officer Spouse | $29,540 | Employment | false |
| Henry Linda | |||
| Key EE Sister | $59,434 | Employment | false |
| Grant Swenson | |||
| Officer Spouse | $138,250 | Employment | false |
| Sandra Werner | |||
| Key EE Spouse | $298,311 | Employment | false |
| Joyce Newmyer | |||
| Key EE-Sister IL | $1,166,597 | Employment | false |
| Brent Wagner | |||
| Son of Officer | $82,281 | Employment | false |
| Cambria Wehtje-Sim | |||
| Dghtr-Fmr Ofcr | $89,784 | Employment | false |
| Carol Jobe | |||
| Officer's Spouse | $4,429 | Employment | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part V Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Additional information regarding interested persons listed above:1. Denise Anderson is the wife of Brian Anderson, an officer of the board.2. Linda Henry is the daughter of Adventist Health board member, Wesley Rippey.3. Grant Swenson is the husband of Jennifer Swenson, President of AH Simi Valley.4. Sandra Werner is the wife of William Werner, a Key Employee.5. Joyce Newmeyer, a Key Employee of Adventist Health, is the sister of William Werner, a Key Employee of AH Simi Valley.6. Brent Wagner is the son of former Adventist Health CFO, Jack Wagner.7. Cambria Wehtje-Sim is the daughter of former officer Rodney Wehtje.8. Carol Jobe is the wife of Meredith Jobe, an officer of Adventist Health. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | The hospital is organized as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit public charity. The hospital bylaws define its board of directors to be the same individuals who are members of Adventist Health System/West board of directors. |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. |
| Form 990, Part VI, Line 11b: Form 990 Review Process | This Form 990, including all supporting schedules, was prepared by a public accounting firm, reviewed by the System Controller and market Finance Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | During the first quarter of each year, the annual conflict of interest questionnaireis sent to board members, hospital officers, key employees and department directorsfor completion and signature. The questionnaire is accompanied by a letter ofexplanation, to illustrate examples of a conflict and to remind the recipient thatif any perceived conflict should arise before the next annual questionnaire, he/sheis to notify the CEO immediately.The Corporate General Counsel distributes, collects, and reviews for signatures theCOIs for all applicable Corporate employees and the board. In addition, thehospitals administration is responsible for keeping record to ensure allhospital-based individuals with director and above positions have submitted theirCOIs. The Corporate General Counsel reviews all the disclosures on the board andCorporate employees COIs. Corporate General Counsel retains the COIs for the boardmembers. The officers and key employees COIs are kept in their personnel files.Further inquiries on any potential significant conflicts are made as needed.Conflicts are documented and reviewed with the Board. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | See explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The hospital board of directors has established a Compensation Committee to overseethe executive compensation program. This committee is composed of independentdirectors with no conflicts of interest. The committee performs the followingfunctions: recommends a total compensation philosophy to the board; assurescompliance with the board-approved philosophy; meets annually to reviewcomparability data from outside consultants; recommends any adjustments to currentexecutive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annualgoals; recommends appropriate incentive awards to the board for approval; follows adiligent process that meets regulatory requirements for a rebuttable presumption ofreasonableness; records committee deliberations and decisions in timely minutes;selects, engages and supervises any consultant hired to advise and providecomparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital CEO has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital. (Incentive potential is industry norm) Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy available upon request, but does file monthly/quarterly summary financial reports with the state health planning agency. |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | BOY Net Asset Adjustment = -$282916 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | Change in interest - Aspen Surgery Center = -$248082 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Change in interest - Foundation = $62217 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | JV Distributions = -$228000 |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | Loss on Investments = -$57977 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | TRANSFERS = $65825 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health SystemWest | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated Health System | CA | 501(c)(3) | 10 | NA | false |
| Adventist Health Clearlake Hospital Inc | ||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Health Medical Ctr Tehachapi | ||||||||||
| 1100 Magellan Dr | Tehachapi | CA | 93561 | 812240617 | Hospoital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Health Physicians Network | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical Foundation | CA | 501(c)(3) | 12b2 | Adventist Health SystemWest | false |
| Adventist Health So CA Medical Fdtn | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 954424391 | Discontinued Operations | CA | 501(c)(3) | 12b2 | Adventist Health SystemWest | false |
| Castle Medical Center | ||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Feather River Hospital | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Fremont- Rideout Health Group | ||||||||||
| 898 Plumas Street | Yuba City | CA | 95991 | 942917251 | Acute Care Hospital | CA | 509(A)(3) | 12b2 | Adventist Health SystemWest | false |
| Glendale Adventist Medical Center | ||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Hanford Community Hospital | ||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Lodi Memorial Hospital Assn Inc | ||||||||||
| 975 So Fairmont Ave | Lodi | CA | 95240 | 941044474 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Northwest Medical Fdtn of Tillamook | ||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Foundation | OR | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Paradise Valley Hospital | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 951816034 | Discontinued Operations | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Portland Adventist Medical Center | ||||||||||
| 10123 SE Market Street | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Reedley Community Hospital | ||||||||||
| 372 Cypress Ave | Reedley | CA | 95370 | 453220509 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Rideout Memorial Hospital | ||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 941387866 | Acute Care Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| St Helena Hospital | ||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SustemWest | false |
| San Joaquin Community Hospital | ||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Sonora Community Hospital | ||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Stone Point Health | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 823763347 | Supporting Organization | CA | 501(C)(3) | 12b2 | Adventist Health SystemWest | false |
| Ukiah Adventist Hospital | ||||||||||
| 275 Hospital Drive | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| United Com-Serve | ||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled Nursing/Assisted Living/Hm Care | CA | 501(c)(3) | 12b2 | Fremont Rideout Health Group | false |
| Walla Walla General Hospital | ||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital | WA | 501(c)(3) | 3 | Advenstist Health System West | false |
| Western Health Resources | ||||||||||
| PO Box 61935 | Roseville | CA | 95661 | 953867863 | Home Care | CA | 501(C)(3) | 10 | Adventist Health SystemWest | false |
| White Memorial Medical Center | ||||||||||
| 1720 Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(C)(3) | 3 | Adventist Health SystemWest | false |
| Willits Hospital Inc | ||||||||||
| 1 Marcela Drive | Willits | CA | 95490 | 680108919 | Hospital | 501(C)(3) | 3 | Adventist Health SystemWest | false | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASPEN SURGERY VENTURE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 SYCAMORE DRIVE | AddressLine1Txt |
| City | SIMI VALLEY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93065 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263913327 | EIN |
| Primary Activities | SURGERY CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIMI VALLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (true) | GeneralOrManagingPartnerInd |
| Ownership | 0.69000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Coast Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 952037291 | EIN |
| Primary Activities | Wind down after sale of hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C Corp | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |