2018-12-25T23:52:26-08:00 2017-12-31 California Wildfires DR-4407 and IRS CA-2018-13 800519547 THE ACCOUNTANCY LLP 330 N BRAND BLVD STE 200 GLENDALE CA 912032361 990 2017-01-01 956064971 Simi Valley Hosp & Hlth Care Serv dba Adventist Health Simi Valley SIMI 8059556000 2975 N Sycamore Dr Simi Valley CA 93065 Brian Anderson Treasurer 2018-12-25 true S Clement P01218012 8185475701 X 2017 2019-02-21 02:37:17Z Jennifer Swenson 143708635 false false X www.adventisthealth.org/simi-valley X 1960 CA Living Gods love by inspiring health, wholeness and hope. 14 10 1066 256 1405790 620462 2452935 1696580 147181681 141651097 1542077 39911 1663 12020 151178356 143399608 -1156 522063 0 68530429 69675553 0 408645 78022271 77577089 146551544 147774705 4626812 -4375097 176440001 183950616 220503078 143436465 -44063077 40514151 Living Gods love by inspiring health, wholeness and hope. false false 122616631 522063 140211423 In support of the hospital's mission statement, Simi Valley Hospital & Health Care Services (SVHHCS) 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 Simi Valley Hospital, 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 community and our patients in a new definition of a 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: 1.providing free care and/or subsidized care 2.providing care to persons covered by governmental programs at below cost 3.providing health/wellness activities and community education programsNot only does SVHHCS provide low-cost care to individuals covered by government programs and those unable to afford health care, but it also helps patients find and access private and governmental resources for health care benefits. SVHHCS recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed value of providing care to these patients in 2017 was $34,099,644.The following statistics related to patient services are available for tax year 2017:Ancillary visits - 54,108General admissions - 6,999Emergency room visits - 36,336Emergency room admissions - 5,867Surgery cases (inpatient & outpatient) - 3,656Deliveries - 598Number of patient days - 26,769GMLOS (Geometric Mean Length of Stay) - 23,363Discharges - 6,999 SVHHCS 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: Simi Valley Free ClinicChild Birth ClassesBreastfeeding ClassesNewborn ClassesBreastfeeding Support GroupSiblings ClassesNutrition ClassesBreast Cancer EducationHeart Health EducationCommunity CPR ClassesProstate Cancer Screenings for Men in the CommunityLifeline ProgramCommunity Flu ClinicsGrief Recovery Support GroupLook Good Feel Better Support GroupStroke & Brain Injury Support GroupCOPE HealthStericycleVisit our website, at https://www.adventisthealth.org/simi-valley-hospital/pages/default.aspx, for more information about Simi Valley Hospital and Health Services. 122616631 true true 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 false false false false false false false false true false false false true 150 0 true 1066 true true true false false false false false false 0 false false false false false false false false false false X 14 10 false false false false true false true true true false false true true true true true true true true true true X Brian Anderson 8059556215 2975 N Sycamore Dr Simi Valley CA 93065 X Banks David Director 0.00 4.00 X 0 1553 0 Cherry Robert Director 0.00 4.00 X 0 11550 0 Davis Andrew Director 0.00 4.00 X 0 10600 0 Freedman John Director 0.00 4.00 X 0 1133 0 Gabriel Melody Director 0.00 4.00 X 0 1203 0 Graham Ricardo Director 0.00 4.00 X 0 2074 0 Heinrich Kerry Director 0.00 4.00 X 0 15866 0 Innocent Larry Director 0.00 4.00 X 0 17608 0 Pedersen James Director 0.00 4.00 X 0 2101 0 Reiner Richard Director 0.00 4.00 X 0 19819 0 Rippey Wesley Director 0.00 4.00 X 0 118116 0 Salazar Velino Director 0.00 4.00 X 0 1928 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 1982804 53885 Wing Bill Dir/VCh/AsstSec 0.00 50.00 X X 0 1460244 52693 Jobe Meredith Secretary 0.00 50.00 X 0 654239 42313 Wagner Jack Asst Secretary 0.00 50.00 X 0 1070403 37117 Swenson Jennifer President 50.00 0.00 X 0 551166 58260 Anderson Brian Treas/Asst Sec 50.00 0.00 X 0 321447 44971 Zachary Beth President SCR 0.00 50.00 X 0 3531840 49519 Wehtje Ronald Finance Officer SCR 0.00 50.00 X 0 698178 36965 Nahapetian Arby Reg CMO SCR 0.00 50.00 X 0 880809 58321 Fargo Roland SVP Reg Phys Ops SCR 0.00 50.00 X 0 563956 44025 Esparza Caroline COO/CNO 50.00 0.00 X 0 361150 49389 Werner William VP Support Srvs 50.00 0.00 X 0 278023 57402 Dingilian John CMO 50.00 0.00 X 0 300818 58530 Bercier-Gorcey Joan Dir Nursing 40.00 0.00 X 254447 0 41297 Deamer Carol Dir Pharmacy 40.00 0.00 X 220442 0 13059 Nakamura Bridget Dir IT/CIS 40.00 0.00 X 186041 0 32449 Crabtree Susan Dir HR 40.00 0.00 X 179517 0 35815 Svolos Ann Marie Dir Risk Mgmt 40.00 0.00 X 171686 0 41214 Rebok Douglas Former Asst Sec 0.00 0.00 X 0 120028 6244 Wehtje Rodney Former Asst Treasurer 0.00 0.00 X 0 249427 23299 1012133 13228083 836767 58 true true false Intensive Care Medical Inc 1177 Roadrunner Way Simi Valley CA 93065 Medical Services 769927 Sodexo Inc 9801 Washington Blvd Gathersburg MD 20878 Dietary Services 465105 Studer Group 350 W Cedar St Ste 300 Pensacola FL 32502 Consulting Services 374825 CA Cardiovascular Thoracic Surgeons 168 N Brent St Ventura CA 93003 Medical Services 368450 Extracorporeal Stat LLC 22637 La Quilla Drive Chatsworth CA 91311 Dialysis Services 311831 19 1324185 372395 1696580 Dietary 722210 452545 418661 33884 Management Fees 561000 568867 568867 Other Program Services 900099 374165 374165 Patient Service Revenue 621110 139761257 138991679 769578 Rent 531120 494263 426918 67345 141651097 73583 73583 0 0 0 188942 222614 -33672 -33672 -33672 0 0 98433 86413 12020 12020 0 143399608 140211423 1405790 85815 522063 522063 0 0 0 0 0 55514675 50433985 4821115 259575 2297226 2297226 7893947 6611302 1238263 44382 3969705 3645892 305877 17936 0 147920 147920 0 0 0 0 5171926 3561154 1596274 14498 373597 373597 856635 321408 526495 8732 7529249 7458895 57184 13170 0 4266667 3908862 355071 2734 274850 178299 92569 3982 0 86395 31309 54842 244 4171111 4171111 0 7585534 7561873 23661 213256 213256 Pt care supplies 16293153 16293153 Purchased services 14964377 200727 14724044 39606 Qlty assurance (hospital) fee 14118032 14118032 Other expenses 1524387 1088084 432517 3786 0 147774705 122616631 24749429 408645 209849 497825 935613 10849436 0 19539462 19229380 0 0 0 2416627 2297752 821132 661841 221615490 91501246 133417115 130114244 1523187 2044663 0 3183634 2227323 2210459 2210459 12182923 13817693 176440001 183950616 12740073 9010007 12711224 12342529 1950000 195051781 120133929 220503078 143436465 X -45860034 39579326 1796957 934825 -44063077 40514151 176440001 183950616 X -4375097 88952325 X false true X true false X false false false false false false false false false false true 11327 11327 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. 1796958 1327885 -1132209 1057809 934825 3471458 2049302 -1648602 2075200 1796958 3178248 54691 288054 49535 143306 2829912 88226 322286 62176 3178248 2635714 136310 148137 90249 2829912 1.00000 false false false 6378565 6378565 100121 165011739 59937203 105174657 2419880 1787452 632428 37006030 26573807 10432223 10699155 3202784 7496371 130114244 Sycamore, Aspen, Oncure 2227323 C Interest in SVH Foundation 4638530 Other Receivables 840152 Receivables from Related Organizations 8339011 Receivables from Third-Party Payors 13817693 Income Taxes Payable 104494 Other Liabilities 917922 Payables to Related Organizations 111677466 Payables to third-party payors 5238594 Workers Comp Payable 2195453 120133929 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 730058 730058 0.00490 38484493 19279810 19204683 0.13000 39214551 19279810 19934741 0.13490 552412 69171 483241 0.00330 167217 167217 0.00110 3096035 1958622 1137413 0.00770 430831 430831 0.00290 4246495 2027793 2218702 0.01500 43461046 21307603 22153443 0.14990 6985 6985 83893 83893 0.00060 80697 80697 0.00050 5788 5788 4292 4292 181655 181655 0.00110 true 609760 44391 39360124 45380558 -6020434 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 Simi Valley Hospital 1 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 See Sch H Part VI - Needs Assessment X true 17 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 X true X false X X X X true X false false Part V, Line 5 - Account Input from Persons Who Represent the Community 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. Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why Simi Valley Hospital has chosen not to actively address some of the health needs identified in their Community Health Needs Assessment. These include: autism, Social Determinants of Health, tobacco use and transportation. Taking existing hospital and community resources into consideration, SVH will concentrate on those health needs that we can most effectively address given our areas of focus and expertise. Therefore, the hospitals charitable resources will be allocated to the selected priority health needs as defined in this document. Aspen Outpatient Center 2750 N Sycamore Dr Simi Valley CA 93065 Outpatient Imaging & Surgery Child Development Center 1900 E Los Angeles Ave Simi Valley CA 93065 Outpatient Pediatric Therapy Nancy Reagan Breast Center 2750 Sycamore Dr Simi Valley CA 93065 Outpatient Women's Imaging Wood Ranch Imaging Center 124 Macaw Ln Simi Valley CA 93065 Outpatient 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 as reported in the system-wide audited combined financial statements. 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 (638,412)Cost Report Reimbursable Bad Debts 343,770Estimates and Accrual Variances 116,482Other (202,603)Subtotal - Amount reported in Pt III, Line 5 39,360,124Amounts included in Part I, Lines f and g -Total Medicare Revenue 39,360,124*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 2017 Community Health Plan (CHP) Update/Annual Report, and the 2016 Implementation Strategy (adopted in May 2017), known as the 2017 Community Health Plan (Implementation Strategy) & 2016 Update/Annual Report, are posted on the hospital's website at https://www.adventisthealth.org/simi-valley/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/simi-valley/patient-resources/financial-services/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, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7 - States Filing of Community Benefit Report CA true CA Hlth Fnd & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 478709 0 Hlth srvs uninsured/underinsured pt Simi Valley Educational Found PO Box 1439 Simi Valley CA 93062 501(c)(3) 5500 0 Donation Simi Valley Highschool 5400 Cochran St Simi Valley CA 93063 5079 0 Donation 3 0 X X X X true true false false false false false false false false Anderson Brian Treas/Asst Sec 235548 45221 40678 16356 28615 366418 11832 Bercier-Gorcey Joan Dir Nursing 234114 16107 4226 15620 25677 295744 Crabtree Susan Dir HR 155941 16132 7444 10138 25677 215332 Deamer Carol Dir Pharmacy 185328 19592 15522 12890 169 233501 Dingilian John CMO 264399 36419 16356 42174 359348 Esparza Caroline COO/CNO 239891 49076 72183 16356 33033 410539 30210 Fargo Roland SVP Reg Phys Ops SCR 360074 76840 127042 10956 33069 607981 42716 Jobe Meredith Secretary 395752 98614 159873 16356 25957 696552 60017 Nahapetian Arby Reg CMO SCR 535805 114043 230961 16356 41965 939130 81073 Nakamura Bridget Dir IT/CIS 162285 17284 6472 10320 22129 218490 Rebok Douglas Former Asst Sec 120028 6244 126272 120028 Reiner Scott Dir/Chair 1184750 324119 473935 16356 37529 2036689 406467 Svolos Ann Marie Dir Risk Mgmt 146987 15963 8736 6441 34773 212900 Swenson Jennifer President 370487 106322 74357 16356 41904 609426 Wagner Jack Asst Secretary 755988 221735 92680 11160 25957 1107520 Wehtje Rodney Former Asst Treasurer 158863 90564 213 23086 272726 79970 Wehtje Ronald Finance Officer SCR 490826 90579 116773 11008 25957 735143 Werner William VP Support Srvs 206873 43289 27861 15487 41915 335425 Wing Bill Dir/VCh/AsstSec 953512 273121 233611 16356 36337 1512937 172851 Zachary Beth President SCR 768341 221735 2541764 16426 33093 3581359 2479514 Denise Anderson Officer Spouse 30000 Employment false Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders Part VI, Line 7aThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors.Part VI, Line 7bThe 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 The completed Form 990 is shared with members of the corporation's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board prior to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The corporate internal audit staff review these questionnaires and disclosures each year during the audit process. 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 Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital 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 executives with midpoints set at the median of the peer group and having a 50 percent spread (about 20% above and below midpoint) from minimum to maximum. The system CEO and Sr Vice Presidents (Executive Cabinet) have a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other executives have a maximum potential incentive of 25 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 Change in interest - Aspen Surgery Center = -$323365 Other Changes In Net Assets Or Fund Balances - Other Decreases Change in interest - Foundation = -$965333 Other Changes In Net Assets Or Fund Balances - Other Increases Other transfers = $138000 Other Changes In Net Assets Or Fund Balances - Other Increases Transfers from related orgs = $90103023 ADVENTIST HEALTH SYSTEMWEST 2100 Douglas Blvd Roseville CA 95661 953484589 SUPPORT AND MANAGE SYSTEM-WIDE ACTIVITIES CA 501(c)(3) 1 NA false ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Ave 18 at Hwy 53 Clearlake CA 95422 680395149 HOSPITAL CA 501(c)(3) 3 Adventist Health SystemWest false CASTLE MEDICAL CENTER 640 Ulukahiki St Kailua HI 96734 990107330 HOSPITAL HI 501(c)(3) 1 Adventist Health SystemWest false FEATHER RIVER HOSPITAL 5974 Pentz Rd Paradise CA 95969 941101228 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false GLENDALE ADVENTIST MEDICAL CENTER 1509 Wilson Ter Glendale CA 91206 951816017 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false HANFORD COMMUNITY HOSPITAL 450 Greenfield Ave Hanford CA 93230 940535360 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false NORTHWEST MEDICAL FOUNDATION OF TILLAMOO 1000 Third St Tillamook OR 97141 930622075 HOSPITAL OR 501(c)(3) 1 Adventist Health SystemWest false PARADISE VALLEY HOSPITAL 2100 Douglas Blvd Roseville CA 95661 951816034 WIND DOWN AFTER SALE OF HOSPITAL FACILITIES CA 501(c)(3) 1 Adventist Health SystemWest false PORTLAND ADVENTIST MEDICAL CENTER 10123 SE Market St Portland OR 97216 930429015 HOSPITAL OR 501(c)(3) 1 Adventist Health SystemWest false ST HELENA HOSPITAL 10 Woodland Rd St Helena CA 94574 941279779 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false SAN JOAQUIN COMMUNITY HOSPITAL 2615 Chester Ave Bakersfield CA 93301 952294234 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false Simi Valley Hospital Foundation 2975 N Sycamore Dr Simi Valley CA 93065 912135595 FUNDRAISING FOR HOSPITAL CA 501(c)(3) 11a, I Western Health Resources false SONORA COMMUNITY HOSPITAL 1000 Greenley Rd Sonora CA 95370 941415069 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false UKIAH ADVENTIST HOSPITAL 275 Hospital Dr Ukiah CA 95482 941639901 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false WALLA WALLA GENERAL HOSPITAL 1025 S Second Ave Walla Walla WA 99362 910617726 HOSPITAL WA 501(c)(3) 1 Adventist Health SystemWest false WHITE MEMORIAL MEDICAL CENTER 1720 Cesar E Chavez Ave Los Angeles CA 90033 952282647 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false WILLITS HOSPITAL INC 1 Marcela Dr Willits CA 95490 680108919 HOSPITAL CA 501(c)(3) 1 Adventist Health SystemWest false Adventist Health Physicians Network 2100 Douglas Blvd Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 11b, II Adventist Health SystemWest false Reedley Community Hospital 372 W Cypress Ave Reedley CA 93654 453220509 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Western Health Resources 2100 Douglas Blvd Roseville CA 95661 953867863 Home care CA 501(c)(3) 1 Adventist Health SystemWest false Lodi Memorial Hospital Association Inc 975 S Fairmont Ave Lodi CA 95240 941044474 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Hlth Medical Ctr Tehachapi 115 W E St Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false ASPEN SURGERY VENTURE LLC 2975 SYCAMORE DRIVE SIMI VALLEY CA 93065 263913327 SURGERY CENTER CA SIMI VALLEY HOSPITAL Related -139624 1632805 false true 0.69000 South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false false false true false true false false false false true false false true false true true true false false The reporting organization, a member of Adventist Health (System), is requesting abatement of late filing penalties due to extraordinary events occurring within the System caused by the Camp Fire in Butte County, California that erupted on November 8, 2018. On November 12, 2018, President Donald J Trump issued a Presidential Major Disaster Declaration. We request that the relief provided by the Internal Revenue Service in CA-2018-13 under IRC 7508A and Regulation 301.7508A-1 be applied to the reporting organization. The System experienced a catastrophic loss to the hospital in Paradise and multiple other buildings. Included in that loss was the building that housed critical information technology infrastructure. The morning following the start of the fire, the information technology area experienced System-wide loss of service over the following two weeks. The IT function had to make changes to accommodate the losses to infrastructure due to the fire. Tax software was not functional through November 30, 2018. During 2017 the System transitioned to an Enterprise Resource Planning cloud-based system and adopted a shared services model. This change resulted in the loss of personnel knowledgeable about the organizational structure, activities, and financial reporting of the entity. The ability to aggregate data consistent with prior years' reporting was challenging. More time was required to ensure reporting was in alignment with the tax format. Inquiry and reassignment of accounts was needed as we became aware of the constraints in the new ERP environment from within which we obtained the reporting data. Rebalancing of the income statement and net assets was critical and took extensive effort to complete.