2019-11-12T10:58:40-08:00 2018-12-31 800519547 THE ACCOUNTANCY LLP 330 N BRAND BLVD STE 200 GLENDALE CA 912032361 990 2018-01-01 956064971 Simi Valley Hosp & Hlth Care Serv dba Adventist Health Simi Valley SIMI 8059556000 2975 N Sycamore Dr Simi Valley CA 93065 Swenson Jennifer President 2019-11-12 true S Clement P01218012 8185475701 X 2018 2020-03-31 21:24:44Z Jennifer Swenson 154989729 false false 1071 X www.adventisthealth.org/simi-valley X 1960 CA Living Gods love by inspiring health, wholeness and hope. 12 10 1065 150 0 634781 1696580 12378687 141651097 142184326 39911 26724 12020 47395 143399608 154637132 522063 233298 0 69675553 70442615 0 162952 77577089 82048500 147774705 152724413 -4375097 1912719 183950616 177558588 143436465 135820651 40514151 41737937 Living Gods love by inspiring health, wholeness and hope. false false 123114822 233298 142184326 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/ 123114822 true false false true false false false false false true true false false true true false false true false false false false false false false false true true true false true false false false false false false false false true false true false false false false false true false false false true 0 0 true 1065 true true true false false false false false false 0 false false false false false false false false false false false false X 12 10 false false false false true true true true true false false true true true true true true true true true true CA X Jay Lipps 9164061092 PO Box 619135 Roseville CA 95661 X Banks David Director 0.00 4.00 X 0 27260 0 Cherry Robert Director 0.00 4.00 X 0 25126 0 Davis Andrew Director 0.00 4.00 X 0 24002 0 Freedman John Director 0.00 4.00 X 0 718 0 Gabriel Melody Dir Thru 12/18 0.00 4.00 X 0 20464 0 Graham Ricardo Director 0.00 4.00 X 0 1442 0 Heinrich Kerry Director 0.00 4.00 X 0 20485 0 Innocent Larry Director 0.00 4.00 X 0 31885 0 Pedersen James Dir Thru 7/18 0.00 4.00 X 0 3625 0 Reiner Richard Director 0.00 4.00 X 0 27964 0 Rippey Wesley Dir Thru 5/18 0.00 50.00 X 0 623943 47568 Salazar Velino Director 0.00 4.00 X 0 1542 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 2458436 44472 Wing Bill Dir/VCh/AsstSec 0.00 50.00 X X 0 1875310 49315 Wagner Jack A Sec Thru 3/18 0.00 50.00 X 0 1332907 34076 Anderson Brian Treas/Asst Sec 50.00 0.00 X 0 324656 37608 Jobe Meredith Secretary 0.00 50.00 X 0 666615 38328 Swenson Jennifer President 50.00 0.00 X 0 606164 51198 Reppert Joseph CFO 0.00 50.00 X 0 953615 46846 Wehtje Ronald Finance Officer SCR 12.50 37.50 X 0 833628 37770 Zachary Beth President SCR 12.50 37.50 X 0 1310581 42365 Jahn Andrew President SCR 12.50 37.50 X 0 1116118 59339 Nahapetian Arby Medical Officer SCR 12.50 37.50 X 0 966535 51169 Burke James Medical Officer SCR 12.50 37.50 X 0 314198 22044 Dingilian John CMO 50.00 0.00 X 0 346825 46740 Esparza Caroline COO/CNO 50.00 0.00 X 0 363800 401 Werner William VP Support Services 50.00 0.00 X 0 292067 48266 Ferrier Cory Business Development Exec 50.00 0.00 X 0 27521 401 Carol Deamer Dir Pharmacy 50.00 0.00 X 210235 0 11898 Percival Kathleen Admin Director 50.00 0.00 X 183757 0 19985 Fernandes Shalini RN 50.00 0.00 X 182014 0 34748 Brodetsky Elena Pharm Coordinator 50.00 0.00 X 179672 0 9891 Nakamura Bridget Director IT 50.00 0.00 X 176450 0 29779 Crabtree Susan Dir HR 0.00 50.00 X 0 170533 28283 Svolos Ann Marie Dir Risk Mgmt 0.00 50.00 X 0 162788 38235 Fargo Roland SVP Reg Physician OPS 0.00 50.00 X 0 597899 32932 932128 15528652 863657 196 true true false Medical Solutions Inc 1010 N 102 Street Ste 300 Omaha NE 68114 Medical Services 1073866 Intensive Care Medical Inc 1177 Roadrunner Way Simi Valley CA 93065 Medical Services 862038 Sodexo Inc 9801 Washington Blvd Gathersburg MD 20878 Dietary Services 537182 CA Cardiovascular Thoracic Surgeons 168 N Brent St Ventura CA 93003 Medical Services 435770 Extracorporeal Stat LLC 22637 La Quilla Drive Chatsworth CA 91311 Dialysis Services 429329 21 50589 12301003 27095 12378687 Dietary 722210 184372 184372 Other Program Services 900099 420997 420997 Patient Service Revenue 621110 140826405 140826405 Rent 531120 752552 752552 142184326 349769 349769 22722 22722 0 0 345767 -345767 -345767 -345767 0 0 54225 6830 47395 47395 0 154637132 142184326 74119 233298 233298 0 0 0 0 0 56086539 51733646 4221400 131493 2062886 1985017 76318 1551 8305952 7930104 355279 20569 3987238 3776691 202119 8428 7738220 754658 6983562 106650 106650 1385 1385 0 0 0 7212436 5332672 1879764 417265 417265 641479 440830 200649 6771296 1991481 4779815 0 5124006 4025303 1097792 911 279195 141021 138174 0 48198 37925 10273 3539525 3539525 0 8109425 8090027 19398 61129 61129 Pt care supplies 16009093 15985921 23172 Qlty assurance (hospital) fee 8498549 8498549 Revenue Cycle Fees 7936175 -36913 7973088 Purchased services 7202245 5977881 1224364 2352229 2198792 153437 152724413 123114822 29446639 162952 497825 0 10849436 5530605 0 19229380 19113372 0 0 0 2297752 2693642 661841 564677 223978055 98528975 130014123 125449080 2044663 2019735 100121 100121 2227323 2227323 2210459 2210459 13817693 17649574 183950616 177558588 9010007 10451469 12342529 51927 1950000 1950000 120133929 123367255 143436465 135820651 X 39579326 40922512 934825 815425 40514151 41737937 183950616 177558588 X 1912719 -688933 X false true X true false X false false false false false false false false false false true 21301 21301 false false Part II-B, Line 1i - Other Activities Description The organization belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 934825 216897 -6401 329896 815425 1796958 1327885 -1132209 1057809 934825 3471458 2049302 -1648602 2075200 -22471 3178248 54691 288054 49535 3471458 2829912 88226 322286 62176 3178248 1.00000 false true true 6378566 6378566 171127382 65300791 105826591 2419880 1918209 501671 36734647 27755609 8979038 7317580 3554366 3763214 125449080 Sycamore, Aspen, Oncure 2328032 C Interest in SVH Foundation 1520419 Investment in ASV 2328032 OTHER ASSETS 175000 Other Receivables 15969 Receivable from 3rd Party Payors 896351 Receivables from Related Organizations 12713803 17649574 Other Liabilities 917921 Payables to Related Organizations 119465091 Workers Comp Payable 2984243 123367255 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. true true X true X true X true true true false true true 1043582 1043582 0.00680 36684884 18976955 17707929 0.11590 37728466 18976955 18751511 0.12270 825406 10077 815329 0.00530 192015 192015 0.00130 8588951 2377785 6211166 0.04070 274476 1 274475 0.00180 9880848 2387863 7492985 0.04910 47609314 21364818 26244496 0.17180 57324 57324 0.00040 3863 3863 10373 10373 0.00010 61814 61814 0.00040 4482 4482 3322 3322 141178 141178 0.00090 true 535390 17079 38464064 45380558 -6916494 X true true Aspen Surgery Venture LLC Ambulatory surgery center 0.72500 0.27500 1 1 Simi Valley Hospital 2975 N Sycamore Dr Simi Valley CA 93065 See Form 990, Pg 1, Item J 050000216 X X X false false true X X X X X X X X X 16 true false false true X See Sch H Part VI - Needs Assessment X true 18 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X true X false X X X X true X false false 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. 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 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 true American Heart Assn 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 7437 0 Donation Boys & Girls Club of Simi Vly 2850 Lemon Dr Simi Valley C Simi Valley CA 93063 952811018 501(c)(3) 6000 0 Donation CA Hlth Fund & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 58871 0 Hlth svcs uninsured/underinsured pt Moorpark Chamber Of Commerce PO Box 296 Moorpark CA 93063 501(c)(6) 10600 0 Donation Rotary Club Of Simi Sunrise 5005 E Los Angeles Ave Simi Valley CA 93063 770392570 501(c)(4) 5430 0 Donation 2 3 Additional Supplemental Information 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. X true true X X X X true true false false false false false false false false Anderson Brian Treas/Asst Sec 250066 26069 48522 16649 20959 362265 Brodetsky Elena Pharm Coordinator 177172 100 2400 9855 36 189563 Burke James Medical Officer SCR 273216 40982 18504 3540 336242 Carol Deamer Dir Pharmacy 204684 100 5451 11714 184 222133 Crabtree Susan Dir HR 71329 99204 9180 19103 198816 Dingilian John CMO 287114 29629 30082 16682 30058 393565 Esparza Caroline COO/CNO 264305 26939 72556 401 364201 Fargo Roland SVP Reg Physician OPS 379174 95874 122851 10964 21968 630831 Fernandes Shalini RN 178588 3426 10615 24133 216762 Jahn Andrew President SCR 672558 157741 285819 16682 42657 1175457 Jobe Meredith Secretary 419684 111013 135918 16682 21646 704943 Nahapetian Arby Medical Officer SCR 557553 165709 243273 16682 34487 1017704 Nakamura Bridget Director IT 169909 500 6041 9676 20103 206229 Percival Kathleen Admin Director 180478 3279 10037 9948 203742 Reiner Scott Dir/Chair 1339257 747881 371298 16682 27790 2502908 Reppert Joseph CFO 686470 152446 114699 16682 30164 1000461 Rippey Wesley Dir Thru 5/18 565539 58404 20249 27319 671511 Svolos Ann Marie Dir Risk Mgmt 153104 9684 5821 32414 201023 Swenson Jennifer President 395159 91732 119273 16682 34516 657362 Wagner Jack A Sec Thru 3/18 180671 414342 737894 11182 22894 1366983 Wehtje Ronald Finance Officer SCR 525772 154336 153520 16682 21088 871398 Werner William VP Support Services 215956 23359 52752 14167 34099 340333 Wing Bill Dir/VCh/AsstSec 1015353 603273 256685 16682 32633 1924626 Zachary Beth President SCR 191196 270398 848987 16682 25683 1352946 Part I, Line 1a: Relevant information in regards to selections on 1a. Denise Anderson Officer Spouse 29540 Employment false Henry Linda Key EE Sister 59434 Employment false Grant Swenson Officer Spouse 138250 Employment false Sandra Werner Key EE Spouse 298311 Employment false Joyce Newmyer Key EE-Sister IL 1166597 Employment false Brent Wagner Son of Officer 82281 Employment false Cambria Wehtje-Sim Dghtr-Fmr Ofcr 89784 Employment false Carol Jobe Officer's Spouse 4429 Employment false Schedule L, Part V Supplemental Information 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. 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 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 ASPEN SURGERY VENTURE LLC 2975 SYCAMORE DRIVE SIMI VALLEY CA 93065 263913327 SURGERY CENTER CA SIMI VALLEY HOSPITAL false true 0.69000 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false false false false false true false false false false true false false true false true true true false false