2019-11-12T13:30:36-06:00 2018-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2018-01-01 941279779 St Helena Hospital STHE 9164060000 10 Woodland Road St Helena CA 94574 Kevin Lang Treasurer 9164060000 2019-11-06 1 Tracy S Paglia P00366884 2099556100 2019-11-06 172.9.161.112 2019-11-06 23:41:00 PS P F565611BDA9E00D03FA055086BAA92DB14EC1355 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2018 2020-03-31 21:24:44Z Adventist Health St Helena Steven Herber 10 Woodland Road St Helena CA 94574 249331799 0 1071 X www.adventisthealth.org/st-helena/ X 1898 CA Living God's love by inspiring health, wholeness and hope. 12 10 1499 127 1336367 -299791 1049443 5821270 253205905 242718082 147603 654474 321739 74114 254724690 249267940 513318 141337 0 0 100681085 92476556 0 0 1212444 154566847 163788332 255761250 256406225 -1036560 -7138285 209570504 207231740 87422422 94388581 122148082 112843159 X Living God's love by inspiring health, wholeness and hope. 0 0 205675589 141337 242718082 See Schedule O 205675589 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1499 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X Jay Lipps VP System Controller 9167465932 PO Box 619135 Roseville CA 95661 X Banks David Director 0.00 4.00 X 0 27620 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 Director thru 12/2018 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 Director thru 07/2018 0.00 4.00 X 0 3625 0 Reiner Richard Director 0.00 4.00 X 0 27964 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 2458436 44472 Rippey Wesley Director thru 05/2018 0.00 50.00 X 0 623943 47568 Salazar Velino Director 0.00 4.00 X 0 1542 0 Wing Bill Dir/Vice Chair/Asst Secr 0.00 50.00 X X 0 1875311 49315 Herber Steven MD President 50.00 0.00 X 0 715351 25525 Jobe Meredith Secretary 0.00 50.00 X 0 666615 38328 Kares Tim Treasurer 50.00 0.00 X 0 196327 0 Wagner Jack Asst Secretary thru 03/2018 0.00 50.00 X 0 1332908 34076 Byrnes John Medical Officer, NCR 10.00 40.00 X 0 501269 14905 Eller Jeff President, NCR 10.00 40.00 X 0 1176550 38127 Lang Kevin Finance Officer, NCR 10.00 40.00 X 0 563108 0 Lendaris Antonia SH Reg CNO 0.00 50.00 X 0 342200 27275 Lonto Robert VP HR, NCR 10.00 40.00 X 0 359348 46556 Reppert Joseph CFO 0.00 50.00 X 0 953615 46846 Ahmad Helaluddin Pharmacy Director 50.00 0.00 X 264152 0 27437 Barnes Geoffrey Manager, Cardiovascular 50.00 0.00 X 280506 0 32064 Hasso Ruth RN 50.00 0.00 X 248435 0 32772 Lyons Susan Dix Foundation President 50.00 0.00 X 243053 0 37265 Nonescan Cindy RN 50.00 0.00 X 246292 0 52202 Chilton Harold Former COO thru 09/2017 0.00 50.00 X 0 612398 38665 McDonald Edward Former Treas/Asst Secr thru 07/207 0.00 0.00 X 0 338302 20694 1282438 12900554 654092 248 1 1 0 Adventist Health CMG Inc 821 South St Helena Hwy Suite 208 St Helena CA 94574 Physician services 9073690 Acute Medical Providers Inc PO Box 94760 Oklahoma City OK 73143 Physician services 2807862 Barton Associates Inc PO Box 417844 Boston MA 02241 Contract labor/nursing 1876519 Cnpa Advertising Services Inc 2701 K Street Sacramento CA 95816 Advertising/marketing 1044456 Sound Inpatient Physicians Inc PO Box 74936 Los Angeles CA 90074 Physician services 880219 53 5521108 300162 5821270 Patient service revenue 621110 236866296 235529929 1336367 Other revenue 900099 3776641 3776641 Rental income 531120 1186081 1186081 Dietary 722210 889064 889064 242718082 582534 582534 71940 0 71940 71940 71940 137973 63859 74114 74114 249267940 241381715 1336367 728588 X 141337 141337 68526 68526 75209697 63255727 11156190 797780 1808211 1437811 328084 42316 9979127 8588712 1265970 124445 5410995 4611237 726864 72894 12822830 462973 12359857 1001839 1001839 407060 407060 25345 25345 63233636 53162370 9975595 95671 2025018 2025018 1000416 592314 387287 20815 10687609 2634401 8023989 29219 9042379 7751988 1289688 703 292206 150668 131525 10013 54128 41662 9849 2617 1579899 1579896 3 8083193 8023394 59799 210230 44146 166084 Patient care supplies 43444953 43434096 10611 246 Quality assurance fees 9306608 9306608 Rental/lease costs 436389 430904 5485 134594 118869 15725 256406225 205675589 49518192 1212444 191586 71219 20444911 29686706 26356314 24003471 4666073 5317398 831593 1044188 242665967 154705077 87857460 87960890 6137742 5362721 63084825 53785147 209570504 207231740 15754847 19563963 330006 0 71337569 74824618 87422422 94388581 X 90724303 84902554 31423779 27940605 122148082 112843159 209570504 207231740 X -7138285 -2166638 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25345 25345 0 Part II-B, Line 1: The Hospital is a member of industry associations. A portion of the membership dues is used for lobbying purposes. 31423779 3296920 -455682 4324413 29940604 12255343 1049443 30008379 15379 11874007 31423779 11794102 3901050 18350 3458159 12255343 10554992 5424873 -228210 3957553 11794102 9066916 3282190 -4891 1789223 10554992 0.06680 0.18850 0.74470 0 1 1 425124 425124 145503548 86711007 58792541 19980202 11993239 7986963 65085461 56000831 9084630 11671632 11671632 87960890 Interest in Foundation 29556701 Receivables from third-party payors 17015760 Receivables from related organizations 5430586 Other receivables 1782100 53785147 Payables to related organizations 53284047 Payables to third-party payors 15973364 Workers' compensation liability 3731371 Other liabilities 1835836 74824618 Part V, Line 4: Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. 1 1 X 1 X 1 X 1 1 1 0 1 1 2343725 2343725 0.00910 2343725 2343725 0.00910 576282 2700 573582 0.00220 320964 320964 0.00130 12717427 862023 11855404 0.04620 51000 51000 0.00020 13665673 864723 12800950 0.04990 16009398 864723 15144675 0.05900 1 0 0 81343886 93003565 -11659679 X 1 1 2 1 St Helena Hospital 10 Woodland Road St Helena CA 94574 www.adventisthealth.org/sthelena 110000073 X X X A 2 SHH Center for Behavioral Health 525 Oregon Street Vallejo CA 94590 www.adventisthealth.org/sthelena 110000042 X Acute Psychiatric Hospital A Facility Reporting Group - A 0 0 1 X X X X X X X X X 16 1 1 1 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 18 1 See Sch H Part VI - Needs Assesment 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: St. Helena Hospital, - Facility 2: SHH Center for Behavioral Health Facility Reporting Group - A Part V, Section B, line 5: The 2016 CHNA data collection process can be summarized as follows: Review of prior CHNA reporting effortsCollection of most recently available demographic, socioeconomic and health indicator dataData gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews.Community Surveys: Analysis of over 150 health indicators from publicly available data sources such as the California Health Interview Survey, American Community Survey, and the California Healthy Kids Survey. Secondary data were organized by a framework developed from Kaiser Permanente's list of potential health needs, and expanded to include a broad list of needs relevant to Napa County.Community Focus Groups: A total of four focus groups were conducted in English and Spanish, reaching 47 residents, representing populations identified as having worse health outcomes or at risk for worse health outcomes.Key Informant Interviews: were conducted with 18 individuals selected from the local public health department, as well as leaders, representatives, and members of medically underserved, low-income, minority populations, and those with a chronic disease. Other individuals from various sectors with expertise in local health needs were also consulted. Facility Reporting Group - A Part V, Section B, line 6a: The Hospital conducted the 2016 CHNA in collaboration with Kaiser Permanente and St. Joseph Health Queen of the Valley Medical Center. Facility Reporting Group - A Part V, Section B, line 6b: St. Helena Hospital partnered with the Napa County Department of Public Health, the Napa County Health & Human Services Agency, and the Live Healthy Napa County organization to prepare the 2016 Community Health Needs Assessment. Facility Reporting Group - A Part V, Section B, line 11: Our 2016 CHNA identified five areas of significant needs: mental health, obesity & diabetes, access to primary health & dental care, cancers, and access to shelter for the homeless. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1 - Mental Health - the main goals: to increase access to mental health services and to increase awareness and interventions for youth. Interventions:1. Partnered with Mentis - a community partner that focuses on providing bilingual professional mental health services to people throughout the county of every age, stage and income level. Through the partnership we have been able to implement the Teens Caf, a group peer and professional support program, serving over 300 teens on the St. Helena High School campus. Mentis' School-Based Program works closely with the Napa, Calistoga, Howell Mountain and St. Helena school districts to provide counseling to children and teens in elementary, middle and high schools struggling with depression, violence, and family conflicts that are causing emotional, behavioral and academic problems. Mentis' therapists work closely with the student and their families to address and resolve problems that are having a significant impact on high risk youth in Napa County. 2. Provide inpatient mental health care for seniors thought a dedicated senior behavioral health unit for those in need. 3. Increased outpatient mental health services by expanding available appointments and hours. Transitioned Dr. Haycraft from part-time inpatient hospital and part-time outpatient clinic setting to full-time clinic setting allowing for additional appointments in clinic and increasing access to immediate mental health resources. 936 patient visits in 2018. 4. Provided community education from an expert psychologist in gun violence to address community fears and help heal after a tragic gun violence incident in the community. In response to the horrific and tragic gun violence incident that occurred at the Yountville Veterans Home in early 2018, Adventist Health St. Helena held a free communitywide presentation and education session in English and Spanish led by expert psychologist Dr. Amy Barnhorst. Approximately 80 community members attended. Dr. Barnhorst addressed the current status and capabilities of our mental health system, gun control and how mental health actually relates to gun violence in the United States. She also discussed healing after such event and resources that are available in the community to all members. Priority Need 2 - Obesity & Diabetes - the main goals: increase accessibility to healthy, affordable foods, increase opportunities for physical activity, and increase education about healthy eating and active living. Interventions:1. Provide access to fresh, locally grown fruit and vegetables to employees and community members. Through local growers, Adventist Health St. Helena sourced farm fresh produce for a monthly farmers' market available onsite at Caf 1878. Employees and community members receive food demonstrations and have the option to purchase farm fresh produce once a month. Total number of community members served - 480.2. Sponsored and participated in Wellness Fair for St Helena Unified School District. Adventist Health St. Helena worked together with the St. Helena Unified School District to put together a wellness curriculum that teaches students about mind, body and spirit health. The day's events included education on health snacks, sleep, exercise interventions, prevention of tobacco use and importance of hydration. The day was attended by more than 285 students and was very successful in teaching children how to make healthy choices for their long-term health.3. Utilize physicians, integrative medicine specialists, and nutritionists to educate community on health-related topics. Adventist Health St. Helena proudly sponsored a series of educational events that helped to educate the public on variety of health topics taught by physicians and dietitians. The Awaken Series is one example of many in which we brought subject matter experts to the community on prevention and quality of life topics as it relates to cancer. The Awaken Series served a total of 90 community members in 2018. In addition, we sponsored a monthly senior health education series in Calistoga that highlights different health-related and self-care topics presented by specialists in each field. 4. Include prenatal and early life nutrition as a topic in prenatal programs. Adventist Health St. Helena extended prenatal and early life nutrition into its curriculum of its series of twenty free child birth education classes offered over the year. This program reaches more than 260 mothers and fathers and teaches them the importance of prenatal health and good nutrition to optimize the health of both the expectant mother and their newly born child.5. Enhance diabetes education program to accommodate more of the community, including Spanish speaking patients. Adventist Health St. Helena provided 47 residents in our community with access to a free four-week diabetes education class in St. Helena. The free class series helps participants learn how to make simple lifestyle choices that can make all the difference. Plus, participants have an opportunity to meet one on one with a registered dietitian where they work together to tailor a plan around the participant's health and lifestyle. 6. Provide free community exercise programs to encourage physical fitness and weight management. Together with the City of St. Helena Parks and Recreation department, we were able to introduce a free exercise class where more than 30 community members gathered in the park on a weekly basis, encouraging community members to get outside, get moving and take control of their health. Priority Need 3 - Access to Primary Health & Dental Care - the main goals: to expand accessibility and increase awareness of resources. Interventions:1. Recruited seven physicians into the network to provide specialty services, including urology, cardiology, cardiac electrophysiology and psychiatry. Number of community members served - 4,242. 2. Launched Dare to C.A.R.E program providing free heart and vascular screening for seniors Adventist Heart & Vascular Institute launched Dare to C.A.R.E, a free screening for those who qualify to detect carotid artery disease, abdominal aortic aneurysm, renal artery disease and extremity artery disease. This ultrasound screening provides the public with education about the unrecognized risks of vascular disease. Countless lives can be saved by teaching people about vascular disease and options they have for pre-emptive treatment. Number of Community Members Served: there were a total of 21 screenings completed in 2018 in Calistoga, CA. 3. Provide specialty care and surgical services to low-income, uninsured patients. Adventist Health St. Helena is a proud partner of Operation Access. Together with other community partners we are able to provide quality specialty care for low-income, uninsured patients. This work improves individual lives as well as the community as a whole. The physicians who provide services includes Abhishek Choudhary, MD, Gastroenterology, Stephanie Kekulawela, MD, General Surgery John H. Kirk, MD, Gynecology, Eugene Lam, MD, Gastroenterology Mark Potter, MD, General Surgery Andreas Sakopoulos, MD, Cardiothoracic Surgery and Huber Anesthesiology Group. Six physician volunteers provided 37 surgical and diagnostic procedures for 30 individuals at Adventist Health St. Helena. Of those who benefited from the services, 97% of the patients were very satisfied with their experience and 96% reported improved health, 90% reported that it improved their ability to work and 93% reported that it improved their quality of life. Part V, Section B, Line 11 (continuation): Priority need 4 - Cancers - the main goals: to increase access to cancer detection services and related support services and to increase awareness and interventions to prevent cancer. Interventions: 1. Partnered with zero prostate cancer to promote education and awareness of prostate cancer prevention and treatment to approximately 3,600 community members. Adventist Health St. Helena's Martin O'Neil Cancer Center is a proud sponsor of the Zero Prostate Cancer Napa Valley, where a team of staff members, physicians and community members participate in a 5k or 10k walk/run to raise awareness and promote prostate cancer screening. All proceeds provide research for new treatments, free prostate cancer testing, and education for men and families about prostate cancer. 2. Held first-ever Turkey Trot to promote the importance of early hereditary cancer screening and educate the community on the AHEAD (Adventist Health Early All-Around Detection) Program for early detection and treatment of genetic cancers. Founded by Dr. Candace Westgate, an obstetrician and gynecologist, our AHEAD Program sponsored the first-ever Turkey Trot in St. Helena promoting health, community and the importance of early hereditary cancer screening for genetic cancers. The event shared great enthusiasm with more than 150 participants in the first year.3. Community-wide education through the Awaken series: the Martin-O'Neil Cancer Center held community-wide education and support programs throughout 2018 that focused on topics like self-awareness and the importance of genetic screening. During the genetic cancer discussion, 40 participants were made aware of genetic screenings available to them. Community members served - 248Priority need 5 - access to shelter for the homeless - intervention:1. Adventist Health St. Helena is proud to support and be a part of Catholic Charities Shelter and Housing Department's initiative to operate the Nightingale Center, a medical respite center for patients from Queen of the Valley and Adventist Health St. Helena Hospital. The Center is designed to help patients who have no place to go to continue with their recovery. The Nightingale House will help patients to be released to a safe and stable environment to minimize recidivism. This facility will have 11 beds to provide temporary on-site residential medical care. Estimated number of community members served - 336.Priority Areas Not Addressed:Taking existing hospital and community resources into consideration, St. Helena Hospital Napa Valley will not directly address the remaining health needs identified in the CHNA including: education, economic and housing insecurity, and substance use. The hospital cannot address all the health needs present in the community, therefore, it will focus efforts on the health needs that can most effectively be addressed given the organization's areas of focus and expertise. St. Helena Hospital Napa Valley will look for partnership opportunities that address needs not selected where it can appropriately contribute to address those needs, or where those needs align with current strategy and priorities. 6 1 - St Helena Cardiac Rehabilitation 999 Adams Street St Helena CA 94574 Outpatient clinic 2 - St Helena Coon Joint Replacement Instit 6 Woodland Road Suite 202 St Helena CA 94574 Outpatient 1206(d) clinic 3 - St Helena Deer Park Pharmacy 6 Woodland Road Suite 202 St Helena CA 94574 Outpatient pharmacy 4 - St Helena Hospital dba Adventist Health V 525 Oregon Street Vallejo CA 94590 Behavioral health 5 - St Helena Lifestyle Medicine Institute 6 Woodland Road St Helena CA 94574 Lifestyle medicine 6 - St Helena Physical Therapy 1030 Main Street Suite 100 St Helena CA 94574 Outpatient clinic Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. Part II, Community Building Activities: The Hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part III, Line 2: Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3: The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8: The Medicare cost report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments 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 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 81,343,886Prior Year Settlements 460,002Cost Report Reimbursable Bad Debts 683,915Estimates and Accrual Variances (175,289)Other 6,071,294Total Medicare Revenue 88,383,808*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Part III, Line 9b: When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest Part VI, Line 2: The Hospital's 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), that includes the 2016 Update are posted on the hospital's website at: https://www.adventisthealth.org/about-us/community-benefit/ The CHNA, Implementation Strategy and the and the CHPs are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/In addition to the CHNA, our Hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level? Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact.Committee/Board Participation includes: Children and Weight Coalition of Napa Valley, Pacific Union College, Martin-O'Neil Cancer Center, Leukemia and Lymphoma Society, St. Helena Chamber of Commerce, etc. Part VI, Line 3: The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at: https://www.adventisthealth.org/patient-resources/financial-assistanceThese 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: St. Helena Hospital Napa Valley service area is comprised primarily of communities in Napa and Solano counties. The major communities are the upper valley cities of St. Helena and Calistoga. The demographics of the communities we serve are wide scope, including urban, suburban, and rural, and from all income levels. Although we primarily serve those in the Napa and Solano counties, our destination services also bring us patients from larger and further demographics. Napa county is an aging county and has substantial disparities in socioeconomic status. These issues present challenges for the health of its residents. Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "Triple Aim." The "Triple Aim" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities. Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy.Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy-even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population;2) Factors that cause the present outcomes distribution; and3) 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, and3) Advance care coordination across the health care continuum.We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The Hospital is a member of Adventist Health 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, Reports Filed With States CA 1 Aldea Children & Family Services 1546 First Street Napa CA 94559 942159248 501(c)(3) 5000 Suicide Prevention Conference sponsorship CA Health Fund & Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 90837 Health services un/underinsured patients Collabria Care 414 S Jefferson Street Napa CA 94559 680393144 501(c)(3) 10000 Gala and Palliative Care Conference sponsorship Mentis 709 Franklin Street Napa CA 94567 941236934 501(c)(3) 7000 Teens Connect sponsorship St Helena Chamber of Commerce 657 Main Street St Helena CA 94574 940830930 501(c)(6) 10500 Plantinum investment renewal UpValley Family Centers 1440 Spring Street St Helena CA 94574 800023012 501(c)(3) 13000 Lunch and Learn Senior Program V Foundation 154 Main Street St Helena CA 94574 475304184 501(c)(3) 5000 V Foundation Wine Celebration Fundraiser 6 1 X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Dir/Chair 0 1339257 0 747881 0 371298 0 16682 0 27790 0 2502908 0 289242 Rippey Wesley Director thru 05/2018 0 565539 0 0 0 58404 0 20249 0 27319 0 671511 0 0 Wing Bill Dir/Vice Chair/Asst Secr 0 1015353 0 603273 0 256685 0 16682 0 32633 0 1924626 0 191758 Herber Steven MD President 0 406782 0 154839 0 153730 0 0 0 25525 0 740876 0 56218 Jobe Meredith Secretary 0 419684 0 111013 0 135918 0 16682 0 21646 0 704943 0 59224 Kares Tim Treasurer 0 187292 0 0 0 9035 0 0 0 0 0 196327 0 0 Wagner Jack Asst Secretary thru 03/2018 0 180671 0 414342 0 737895 0 11182 0 22894 0 1366984 0 0 Byrnes John Medical Officer, NCR 0 346875 0 25000 0 129394 0 0 0 14905 0 516174 0 0 Eller Jeff President, NCR 0 699892 0 344777 0 131881 0 16682 0 21445 0 1214677 0 118827 Lang Kevin Finance Officer, NCR 0 563108 0 0 0 0 0 0 0 0 0 563108 0 0 Lendaris Antonia SH Reg CNO 0 245352 0 48234 0 48614 0 16682 0 10593 0 369475 0 14500 Lonto Robert VP HR, NCR 0 254747 0 60037 0 44564 0 16682 0 29874 0 405904 0 0 Reppert Joseph CFO 0 686470 0 152446 0 114699 0 16682 0 30164 0 1000461 0 0 Ahmad Helaluddin Pharmacy Director 220681 0 0 0 43471 0 15804 0 11633 0 291589 0 0 0 Barnes Geoffrey Manager, Cardiovascular 265530 0 14450 0 526 0 15994 0 16070 0 312570 0 0 0 Hasso Ruth RN 242739 0 0 0 5696 0 12112 0 20660 0 281207 0 0 0 Lyons Susan Dix Foundation President 240157 0 0 0 2896 0 0 0 37265 0 280318 0 0 0 Nonescan Cindy RN 243528 0 0 0 2764 0 14937 0 37265 0 298494 0 0 0 Chilton Harold Former COO thru 09/2017 0 367529 0 71750 0 173119 0 16682 0 21983 0 651063 0 53306 McDonald Edward Former Treas/Asst Secr thru 07/207 0 21099 0 0 0 317203 0 1047 0 19647 0 358996 0 0 Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. McDonald, Edward - severance payment - $302,307 Wagner, Jack - severance payment - $598,810 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. Chilton, Harold - $53,306 Eller, Jeff - $118,827 Herber, Steven - $56,218 Jobe, Meredith - $59,224 Lendaris, Antonia - $14,500 Reiner, Scott - $289,242 Wing, Bill - $191,758 Herber Timothy Family member of Officer, S. Herber 53408 Employment 0 Lendaris Maria Family member of Key EE, A. Lendaris 15118 Employment 0 Form 990, Part III, Line 4a St. Helena Hospital dba Adventist Health St Helena (AHSH) 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 of AHSH, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does AHSH 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. AHSH 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 $2,343,725. The following Inpatient services that were provided to all our patients. These services included: - 86 Babies delivered - 1,842 Surgeries performed - 45,039 Patient days The following Outpatient services that were provided to all our patients. These services included: - 7,699 Emergency department visits - 4,095 Outpatient surgeries performed - 45,440 Outpatient visits - 59,173 Clinic visits AHSH 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 $12,800,951. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ Form 990, Part VI, Section A, line 6 The Hospital is organized as a public benefit corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit public benefit corporation that operates as a public charity. The Hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Section A, line 7a The Hospital's Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. Form 990, Part VI, Section A, line 7b The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11b This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Hospital's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The Corporate General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The Corporate General Counsel reviews all the disclosures on the board and Corporate employees' COIs. Corporate General Counsel retains the COIs for the board members. The officers and key employees' COIs are kept in their personnel files. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. Form 990, Part VI, Section B, line 15 The Hospital Board of Directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital 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, Section C, line 19 The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. Form 990, Part VII: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors receive compensation when their employment agreements with their employers allow such payments. For those whose employers do not allow accepting compensation for board service, the funds are directly distributed to charitable organizations as mandated by their employment agreements. In addition, amounts paid for taxable benefits are also reported. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 18,994,479. Management and general expenses 1,460,820. Fundraising expenses 0. Total expenses 20,455,299. Other medical professional fees: Program service expenses 3,454,088. Management and general expenses 39,240. Fundraising expenses 0. Total expenses 3,493,328. Consulting and other management fees: Program service expenses 609,980. Management and general expenses 372,542. Fundraising expenses 27,219. Total expenses 1,009,741. Other professional fees non-medical: Program service expenses 253,428. Management and general expenses 114,884. Fundraising expenses 0. Total expenses 368,312. Contract labor: Program service expenses 2,809,721. Management and general expenses 252,970. Fundraising expenses 0. Total expenses 3,062,691. Purchased medical services: Program service expenses 16,830,634. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,830,634. Repairs and maintenance: Program service expenses 2,045,872. Management and general expenses 2,669. Fundraising expenses 0. Total expenses 2,048,541. All other purchased services: Program service expenses 8,164,168. Management and general expenses 2,178,381. Fundraising expenses 68,452. Total expenses 10,411,001. Revenue cycle fees: Program service expenses 0. Management and general expenses 5,554,089. Fundraising expenses 0. Total expenses 5,554,089. Form 990, Part XI, line 9: Change in interest in Foundation -2,197,540. Split-interest agreements - change in value 30,902. Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated health system CA 501(c)(3) Line 10 N/A 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health 0 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued operations CA 501(c)(3) Line 1 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Acute care hospital CA 501(c)(3) Line 3 Fremont-Rideout Health Group 0 Saint Helena Hospital Foundation 10 Woodland Road St Helena CA 94574 201384250 Fundraising and investment management CA 501(c)(3) Line 12a, I N/A 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital & Health Care Services 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Fremont-Rideout Health Group 0 Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 0 Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 0 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 South Coast Medical PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 0 0 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 0