UNITED COM-SERVE: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- UNITED COM-SERVE (EIN 94-3015356)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-11-07
- IRS object ID
- 202513119349302211
- Schema version
- 2024v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-11-07T09:54:52-06:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Tilly Advisory Group LP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2882 Prospect Park Dr Ste 300 | AddressLine1Txt |
| City | Rancho Cordova | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95670 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 943015356 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | United Com-Serve | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIT | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 726 Fourth Street | AddressLine1Txt |
| City | Marysville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Greg Jackson | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2025-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lauren A Haverlock | PreparerPersonNm |
| PTIN | P00545829 | PTIN |
| Phone | 9165038100 | PhoneNum |
| Preparation | 2025-10-25 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Chris Champlin | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 726 Fourth Street | AddressLine1Txt |
| City | Marysville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,279,789 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/rideout/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1985 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness, and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 261 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $26,563 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,475,609 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $25,548,702 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,478,568 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,730,039 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,040 | PYOtherRevenueAmt |
| CY Other Revenue | $1,048 | CYOtherRevenueAmt |
| PY Total Revenue | $30,982,780 | PYTotalRevenueAmt |
| CY Total Revenue | $30,279,789 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,184,810 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,469,956 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,786,088 | PYOtherExpensesAmt |
| CY Other Expenses | $15,781,389 | CYOtherExpensesAmt |
| PY Total Expenses | $30,970,898 | PYTotalExpensesAmt |
| CY Total Expenses | $32,251,345 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $11,882 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,971,556 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $76,313,365 | TotalAssetsBOYAmt |
| Total Assets EOY | $74,126,457 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $24,849,845 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,634,493 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $51,463,520 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $49,491,964 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Living God's love by inspiring health, wholeness, and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $21,453,286 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $21,460,910 | RevenueAmt |
| Desc | The Fountains is a 145-bed skilled nursing facility and serves as a continuing care provider for patients requiring rehabilitation services subsequent to acute care hospital stay and as a long-term care provider. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,553,963 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,554,870 | RevenueAmt |
| Desc | The Courtyard is a 54-bed assisted living community for seniors who require assistance to maintain their highest level of independence. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,532,377 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,532,922 | RevenueAmt |
| Desc | The Gardens is a 44-bed assisted living community providing Alzheimer's and dementia residents with a safe and nurturing home environment with personal attention from professional caregivers. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $25,539,626 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 261 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | John Beaman CFO | PersonNm |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Adventist Health Way | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Heinrich Kerry | ||||||||||
| Dir/Chair/CEO | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $3,974,195 | $57,975 | |||
| Hofheins Todd | ||||||||||
| Dir/Vice Chair/COO | 0.00 | 50.50 | Yes (X) | Yes (X) | $0 | $2,407,675 | $65,992 | |||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Beaman John | ||||||||||
| CFO/Assistant Secretary | 0.00 | 50.50 | Yes (X) | $0 | $1,980,861 | $79,808 | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.50 | Yes (X) | $0 | $1,221,104 | $57,975 | ||||
| Champlin Christopher | ||||||||||
| President | 9.00 | 39.00 | Yes (X) | $0 | $938,333 | $57,975 | ||||
| Thordarson Heidar | ||||||||||
| Treasurer | 9.00 | 39.00 | Yes (X) | $0 | $550,840 | $57,975 | ||||
| Stevens Eric - President | ||||||||||
| N Coast Service Area as of 07/24 | 0.00 | 50.50 | $0 | $1,886,146 | $57,975 | Yes (X) | ||||
| Heard Alexander | ||||||||||
| Medical Officer thru 04/24 | 2.00 | 48.00 | $0 | $678,715 | $79,808 | Yes (X) | ||||
| Spencer Lindsey | ||||||||||
| Operations Executive | 2.00 | 48.00 | $0 | $603,528 | $79,808 | Yes (X) | ||||
| Gordon Cyndy | ||||||||||
| Patient Care Executive | 0.00 | 50.00 | $0 | $499,057 | $47,724 | Yes (X) | ||||
| Oliver Robin | ||||||||||
| Business Development Executive | 2.00 | 48.00 | $0 | $409,380 | $79,617 | Yes (X) | ||||
| Pannu Devinder | ||||||||||
| Director, RN, Extended Care | 40.00 | 0.00 | $206,577 | $0 | $36,534 | Yes (X) | ||||
| Miceli Joseph - Administrator | ||||||||||
| Skilled Nursing Facility | 40.00 | 0.00 | $210,609 | $0 | $31,874 | Yes (X) | ||||
| Bottger Ofelia | ||||||||||
| RN | 40.00 | 0.00 | $195,224 | $0 | $31,738 | Yes (X) | ||||
| Kaur Paramjit | ||||||||||
| RN | 40.00 | 0.00 | $180,874 | $0 | $42,149 | Yes (X) | ||||
| Gill Narjeet | ||||||||||
| RN | 40.00 | 0.00 | $158,157 | $0 | $41,170 | Yes (X) | ||||
| Wing Bill | ||||||||||
| Former Dir/Chair thru 01/22 | 0.00 | 0.00 | $0 | $273,263 | $0 | Yes (X) | ||||
| Nahapetian Arby - Former Care | ||||||||||
| Division Medical Officer thru 02/22 | 0.00 | 50.00 | $0 | $1,759,258 | $79,808 | Yes (X) | ||||
| Jahn Andrew - Former Care | ||||||||||
| Division President thru 02/22 | 0.00 | 50.00 | $0 | $693,217 | $59,411 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $951,441 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $17,928,794 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,045,316 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 21 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Sodexo Inc and Affiliates | |||||
| PO Box 360170 | Pittsburgh | PA | 152516170 | Staffing | $2,378,076 |
| Intergro Rehab Services Inc | |||||
| PO Box 69268 | Baltimore | MD | 212649268 | Medical services | $1,158,683 |
| California Emergency Physicians Medical | |||||
| 2100 Powell St Ste 400 | Emeryville | CA | 94608 | Medical services | $250,986 |
| Mission Linen Supply | |||||
| 1340 W 7th Street | Chico | CA | 95928 | Linen services | $121,572 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 623000 | $25,512,276 | $25,512,276 |
| Dietary service revenue | 621400 | $8,065 | $8,065 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,361 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,361 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $25,548,702 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,730,039 | TotalRevenueColumnAmt |
| Exclusion | $4,730,039 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,048 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,048 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,048 | TotalRevenueColumnAmt |
| Exclusion | $1,048 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,279,789 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $25,548,702 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,731,087 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,239,417 | TotalAmt |
| Program Services | $10,213,976 | ProgramServicesAmt |
| Management And General | $2,025,441 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $536,284 | TotalAmt |
| Program Services | $447,537 | ProgramServicesAmt |
| Management And General | $88,747 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,794,993 | TotalAmt |
| Program Services | $2,242,888 | ProgramServicesAmt |
| Management And General | $552,105 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $899,262 | TotalAmt |
| Program Services | $736,754 | ProgramServicesAmt |
| Management And General | $162,508 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,031,525 | TotalAmt |
| Management And General | $3,031,525 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,721,216 | TotalAmt |
| Program Services | $5,668,995 | ProgramServicesAmt |
| Management And General | $52,221 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,460 | TotalAmt |
| Program Services | $73,088 | ProgramServicesAmt |
| Management And General | $53,372 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,653 | TotalAmt |
| Program Services | $101,319 | ProgramServicesAmt |
| Management And General | $663,334 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $831,520 | TotalAmt |
| Program Services | $828,326 | ProgramServicesAmt |
| Management And General | $3,194 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,791 | TotalAmt |
| Program Services | $288 | ProgramServicesAmt |
| Management And General | $3,503 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,457 | TotalAmt |
| Program Services | $409 | ProgramServicesAmt |
| Management And General | $4,048 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $934,755 | TotalAmt |
| Program Services | $934,755 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $958,668 | TotalAmt |
| Program Services | $958,668 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,969 | TotalAmt |
| Program Services | $175,969 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient care supplies | $2,051,593 | $2,032,305 | $19,288 |
| Leased equipment expens | $60,975 | $49,757 | $11,218 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,115,807 | TotalAmt |
| Program Services | $1,074,592 | ProgramServicesAmt |
| Management And General | $41,215 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,251,345 | TotalAmt |
| Program Services | $25,539,626 | ProgramServicesAmt |
| Management And General | $6,711,719 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,523,234 | BOYAmt |
| EOY | $61,613,888 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,061,695 | BOYAmt |
| EOY | $2,735,530 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $141,025 | BOYAmt |
| EOY | $128,204 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $34,179,565 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,162,532 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,975,702 | BOYAmt |
| EOY | $9,017,033 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $611,709 | BOYAmt |
| EOY | $631,802 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,313,365 | BOYAmt |
| EOY | $74,126,457 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,241,091 | BOYAmt |
| EOY | $2,247,522 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,300 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,605,454 | BOYAmt |
| EOY | $22,386,971 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,849,845 | BOYAmt |
| EOY | $24,634,493 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,463,520 | BOYAmt |
| EOY | $49,491,964 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,463,520 | BOYAmt |
| EOY | $49,491,964 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,313,365 | BOYAmt |
| EOY | $74,126,457 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,971,556 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rideout Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941387866 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (1) | MajorityDirTrstSupportedOrgInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,111,122 | OtherCostOrOtherBasisAmt |
| Book Value | $1,111,122 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,911,841 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,096,208 | DepreciationAmt |
| Book Value | $7,815,633 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,432,465 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,432,465 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,724,137 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,633,859 | DepreciationAmt |
| Book Value | $90,278 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,017,033 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $22,122,856 |
| Other liabilities | $264,115 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $22,386,971 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2024 and 2023, no such assets or liabilities were recorded. The System currently files Form 990 (Informational Return of Organizations Exempt From Income Taxes) and Form 990-T (Exempt Organization Business Income Tax Return) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2021 in major tax jurisdictions. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Heinrich Kerry | ||||||||||||||
| Dir/Chair/CEO | $0 | $2,342,000 | $0 | $1,586,113 | $0 | $46,082 | $0 | $13,296 | $0 | $44,679 | $0 | $4,032,170 | $0 | $0 |
| Hofheins Todd | ||||||||||||||
| Dir/Vice Chair/COO | $0 | $1,474,000 | $0 | $888,115 | $0 | $45,560 | $0 | $13,296 | $0 | $52,696 | $0 | $2,473,667 | $0 | $0 |
| Beaman John | ||||||||||||||
| CFO/Assistant Secretary | $0 | $1,261,000 | $0 | $698,818 | $0 | $21,043 | $0 | $13,296 | $0 | $66,512 | $0 | $2,060,669 | $0 | $0 |
| Stevens Eric - President | ||||||||||||||
| N Coast Service Area as of 07/24 | $0 | $1,196,000 | $0 | $495,682 | $0 | $194,464 | $0 | $13,296 | $0 | $44,679 | $0 | $1,944,121 | $0 | $0 |
| Nahapetian Arby - Former Care | ||||||||||||||
| Division Medical Officer thru 02/22 | $0 | $1,111,000 | $0 | $458,435 | $0 | $189,823 | $0 | $13,296 | $0 | $66,512 | $0 | $1,839,066 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $796,100 | $0 | $281,132 | $0 | $143,872 | $0 | $13,296 | $0 | $44,679 | $0 | $1,279,079 | $0 | $0 |
| Champlin Christopher | ||||||||||||||
| President | $0 | $690,000 | $0 | $155,763 | $0 | $92,570 | $0 | $13,296 | $0 | $44,679 | $0 | $996,308 | $0 | $0 |
| Heard Alexander | ||||||||||||||
| Medical Officer thru 04/24 | $0 | $508,587 | $0 | $97,870 | $0 | $72,258 | $0 | $13,296 | $0 | $66,512 | $0 | $758,523 | $0 | $0 |
| Jahn Andrew - Former Care | ||||||||||||||
| Division President thru 02/22 | $0 | $281,190 | $0 | $407,001 | $0 | $5,026 | $0 | $55,610 | $0 | $3,801 | $0 | $752,628 | $0 | $0 |
| Spencer Lindsey | ||||||||||||||
| Operations Executive | $0 | $459,988 | $0 | $88,601 | $0 | $54,939 | $0 | $13,296 | $0 | $66,512 | $0 | $683,336 | $0 | $0 |
| Thordarson Heidar | ||||||||||||||
| Treasurer | $0 | $425,591 | $0 | $77,747 | $0 | $47,502 | $0 | $13,296 | $0 | $44,679 | $0 | $608,815 | $0 | $0 |
| Gordon Cyndy | ||||||||||||||
| Patient Care Executive | $0 | $365,054 | $0 | $71,266 | $0 | $62,737 | $0 | $13,296 | $0 | $34,428 | $0 | $546,781 | $0 | $0 |
| Oliver Robin | ||||||||||||||
| Business Development Executive | $0 | $315,240 | $0 | $61,074 | $0 | $33,066 | $0 | $13,296 | $0 | $66,321 | $0 | $488,997 | $0 | $0 |
| Wing Bill | ||||||||||||||
| Former Dir/Chair thru 01/22 | $0 | $0 | $0 | $0 | $0 | $273,263 | $0 | $0 | $0 | $0 | $0 | $273,263 | $0 | $0 |
| Pannu Devinder | ||||||||||||||
| Director, RN, Extended Care | $191,740 | $0 | $12,365 | $0 | $2,472 | $0 | $9,587 | $0 | $26,947 | $0 | $243,111 | $0 | $0 | $0 |
| Miceli Joseph - Administrator | ||||||||||||||
| Skilled Nursing Facility | $195,574 | $0 | $13,613 | $0 | $1,422 | $0 | $9,779 | $0 | $22,095 | $0 | $242,483 | $0 | $0 | $0 |
| Bottger Ofelia | ||||||||||||||
| RN | $191,807 | $0 | $3,417 | $0 | $0 | $0 | $9,673 | $0 | $22,065 | $0 | $226,962 | $0 | $0 | $0 |
| Kaur Paramjit | ||||||||||||||
| RN | $177,522 | $0 | $3,352 | $0 | $0 | $0 | $9,044 | $0 | $33,105 | $0 | $223,023 | $0 | $0 | $0 |
| Gill Narjeet | ||||||||||||||
| RN | $158,073 | $0 | $84 | $0 | $0 | $0 | $8,071 | $0 | $33,099 | $0 | $199,327 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The filing organization did not compensate its top management official, any officers or key employees during the tax year. Compensation was determined and paid by a related organization using one or more methods reported in Line 3. |
| Part I, Lines 4a-b | Severance payments are made based upon agreements between certain qualifying employees and Adventist Health System/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Jahn, Andrew - $15,065 Wing, Bill - severance payment - $271,535 Select executives agreed to participate in CAP-EX in place of a traditional insurance SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life participants are John Beaman, Kerry Heinrich, Todd Hofheins, Andrew Jahn, and Bill Wing. 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. The plan was frozen for new non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2024 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The sole member of the Organization is Rideout Memorial Hospital, a California nonprofit public benefit corporation. |
| Form 990, Part VI, Section A, line 7a | Each individual who is a director of the board of Stone Point Health shall automatically be a director of United Com-Serve, and shall serve as a director of United Com-Serve until such time as that person is no longer a director of Stone Point Health. |
| Form 990, Part VI, Section A, line 7b | The sole corporate member, Rideout Memorial Hospital, 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 Corporate Finance Officer and Market Financial Officer, and shared by electronic communication with the Corporation'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 corporate 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 market president or the System Chief Legal Officer/General Counsel immediately. The System Chief Legal Officer/General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders 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 System Chief Legal Officer/General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System Chief Legal Officer/General Counsel retains the COIs for all individuals. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. |
| Form 990, Part VI, Section C, line 19 | The Organization does not make its governing documents, conflict of interest policy, or financial statements available to the public. |
| Form 990, Part VII, Section A: | Board compensation is for Adventist Health System/West Board of Directors only - not the Organization's Board of Directors. |
| Form 990, Part IX, line 11g | Other medical professional fees: Program service expenses 1,497,490. Management and general expenses 7,350. Fundraising expenses 0. Total expenses 1,504,840. Consulting and other management fees: Program service expenses 50,582. Management and general expenses 26,501. Fundraising expenses 0. Total expenses 77,083. Physician professional fees: Program service expenses 336,586. Management and general expenses 0. Fundraising expenses 0. Total expenses 336,586. Contract labor: Program service expenses 199,695. Management and general expenses 0. Fundraising expenses 0. Total expenses 199,695. Purchased medical services: Program service expenses 3,291,911. Management and general expenses 1,663. Fundraising expenses 0. Total expenses 3,293,574. Repairs and maintenance: Program service expenses 122,886. Management and general expenses 10,289. Fundraising expenses 0. Total expenses 133,175. Other professional fees Non-medical: Program service expenses 4,590. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,590. All other purchased services: Program service expenses 165,255. Management and general expenses 6,418. Fundraising expenses 0. Total expenses 171,673. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (30 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Delano | |||||||||||
| 1401 Garces Hwy | Delano | CA | 93215 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Foundation | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 680002188 | Charitable foundation | CA | 501(c)(3) | Line 7 | 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 Mendocino Coast | |||||||||||
| 700 River Drive | Fort Bragg | CA | 95437 | 845174585 | Hospital | CA | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| Adventist Health Physicians Network | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| Adventist Health Tulare | |||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 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 | |
| Mid-Columbia Medical Center | |||||||||||
| 1700 E 19th Street | The Dalles | OR | 97058 | 930386936 | Hospital | OR | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| Mid-Columbia Health Foundation | |||||||||||
| 1700 E 19th Street | The Dalles | OR | 97058 | 930854433 | Charitable foundation | OR | 501(c)(3) | Line 7 | Mid-Columbia Medical Center | 0 | |
| Northwest Medical Foundation of Tillamook | |||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | Line 3 | 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 | |||||||||||
| 726 Fourth Street | Marysville | CA | 95901 | 941387866 | Hospital | CA | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| St Helena Hospital | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| San Joaquin Community Hospital | |||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Sierra Vista Hospital Inc | |||||||||||
| 1010 Murray Avenue | San Luis Obispo | CA | 93405 | 952588614 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Simi Valley Hospital and 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 | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 823763347 | Supporting organization | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Twin Cities Community Hospital Inc | |||||||||||
| 1100 Las Tablas Road | Templeton | CA | 93465 | 752918765 | Hospital | CA | 501(c)(3) | Line 3 | 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 | |
| Western Health Resources | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | Line 10 | Adventist Health SystemWest | 0 | |
| White Memorial Medical Center | |||||||||||
| 1720 E 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| FRD Management Company LLC | |||||||||
| PO Box 2128 | Marysville | CA | 95901 | 943335136 | Operation of cancer center | CA | N/A | 0 | 0 |
| Blue Legacy Ventures LLC | |||||||||
| 1010 NE 2nd Avenue | Miami | FL | 33132 | 871254649 | Real property rental | FL | N/A | 0 | 0 |
| Blue Zones LLC | |||||||||
| 200 Southdale Center | Edina | MN | 55435 | 271603327 | Education | MN | N/A | 0 | 0 |
| PAR LLC DBA CherryWood Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 931262371 | Senior housing | OR | N/A | 0 | 0 |
| PVHR LLC DBA Paradise Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 260622555 | Senior housing | OR | N/A | 0 | 0 |
| PVHR2 LLC DBA Parkview Memory Care at Paradise Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 473300170 | Senior housing | OR | N/A | 0 | 0 |
| WWGHR LLC DBA Wheatland Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 810591221 | Senior housing | OR | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AdHealth Limited | ||||||||||||||
| PO Box HM 2062 | Hamilton | BD | HM HX | Pure captive insurance | BD | N/A | C | 0 | ||||||
| Adventist Health Plan Inc | ||||||||||||||
| Health insurance | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 463833261 | CA | |||||
| South Coast Medical Center | ||||||||||||||
| Wind down after sale of hospital | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 952037291 | CA | |||||
| Thrive Productions Inc | ||||||||||||||
| Production company | N/A | C | 0 | 200 Southdale Center | Edina | MN | 55435 | 453369049 | MN | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |