2013-11-15T02:31:42-08:00 2012-12-31 990 2012-01-01 941415069 Sonora Community Hospital dba Sonora Regional Medical Center SONO 2095325000 1000 Greenley Rd Sonora CA 95370 Andrew Jahn 2013-11-15 2012 2016-02-25 16:41:14Z Jeff Eller 1000 Greenley Rd Sonora CA 95370 201508840 false false 1071 X www.sonoramedicalcenter.org X 1958 CA The hospital mission is to provide our community with physical, mental, and spiritual healing in a way that reflects God's love for all. 13 9 1414 168 102067 -135 1247651 687309 189247231 198435421 868911 1286881 135731 198042 191499524 200607653 72945 114003 0 90858325 92247186 0 302203 90450391 88679201 181381661 181040390 10117863 19567263 110165596 131911126 65549967 67728234 44615629 64182892 Our mission is to share God's love by providing physical, mental, and spiritual healing. false false 161887253 114003 Sonora Community Hospital (SCH) 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 SCH, the organization recognizes that not all individuals possess the ability to pay for essential medical services.SCH'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 programsNot only does SCH 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. SCH recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. Inpatient services in 2012 were provided to approximately 5,316 patients. These services included:- Babies: 533 deliveries- Surgeries: 2,843 hours- Radiology: 10,699 procedures - Laboratory tests: 128,580 tests Outpatient services in 2012 were provided to about 289,000 patients. Including:- Emergency room: 26,411 visits- Outpatient surgeries: 5,554 hours- Radiology procedures: 58,179 performed- Laboratory tests: 289,388 performed- Medical clinics: 161,025 visitsSonora Community Hospital provides home care services in its surrounding communities. These services include, but are not limited to:- Respiratory Care- Elderly Care- Geriatric Case Management- Ostomy & Wound Care- Diabetes Care- IV Home TherapySCH 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:Project HOPE, which stands for Health, Outreach, Prevention and Education- delivers dozens of free physicals and other services to indigent children and their parents at various locations throughout California's Tuolumne County with the help of volunteer nurses and physicians.Community Events - First aid stations at the local Mother Lode Fair, Home and Garden show and the Tuolumne Me-Wuk Health Fair. Exhibits at the Groveland Family Wellness Fair and the Tuolumne County Youth Health Fair. Close to 4,000 health screenings done at the annual Tuolumne County Health Fair.Health Education and Support ProgramsThe many support groups and health education classes conducted, including but not limited to:Cancer support group, Diabetes support group, Depression Recovery Program class, Spiritual Care training, CHIP Coronary Health Improvement Project, Epilepsy/Seizure Support Group, La Leche League, Childbirth Preparation Classes, Preparation for Cesarean Birth Classes, OakPlus Wellness Seminars, Quit for Life: Tobacco Cessation Classes, Lifeline Emergency Response ProgramMaintained and monitored up to 320 Lifeline Emergency Response Units. This 24-hour-a-day system offers immediate response to those whose physical condition could otherwise limit their ability to summon help.Spiritual SupportSCH's chaplains provided over 4,000 patient visits and over 1,500 hours of patient counseling, and provided over 300 hours of employee counseling, conducted memorial services and officiated at weddings.Community SupportSCH donated $15,260 to 28 community service organizations in 2012. 161887253 true true false true false false false false false true true false false false true false false true false false false false false false true false true true true true true false false false false false false false false false false false false false false false false true false false false false true 213 0 true 1414 true true false false false false true true false 0 false false false false false false false false false false X 13 9 true false false false true false true true true false false true true true true true true true true false X X Andrew Jahn 2095325000 1000 Greenley Rd Sonora CA 95370 X Helmuth Jones 0.00 1.00 X 0 1127 0 Larry Innocent 0.00 1.00 X 0 1273 0 Melody Gabriel 0.00 1.00 X 0 300 0 Scott Reiner 0.00 50.00 X X 0 915400 183744 Robert Carmen 0.00 50.00 X X 0 1814442 38864 Max Torkelsen 0.00 1.00 X 0 2233 0 Wesley Rippey 0.00 1.00 X 0 100406 0 Alan Reimche 0.00 1.00 X 0 2290 0 Meredith Jobe 0.00 1.00 X 0 318021 73755 Ricardo Graham 0.00 1.00 X 0 2556 0 Christine Friestad 0.00 1.00 X 0 2586 0 Ruthita Fike 0.00 1.00 X 0 695 0 Lynn Creitz 0.00 1.00 X 0 4052 0 Larry Caviness 0.00 1.00 X 0 3245 0 Charles Dickinson 0.00 1.00 X 0 3085 0 Bill Wing 0.00 50.00 X 0 665195 154613 Andrew Jahn 50.00 0.00 X 0 240348 38676 Jeff Eller 50.00 0.00 X 0 535195 106562 Rodney Wehtje 0.00 50.00 X 0 534490 210115 Douglas Rebok 0.00 50.00 X 0 872315 159731 Rick Dodds 50.00 0.00 X 0 181905 33502 Pauline Campbell 50.00 0.00 X 0 174745 41326 Julie Kline 50.00 0.00 X 0 282935 62796 Jeph Solo 55.00 0.00 X 200528 0 16691 Jacquie Cituk 50.00 0.00 X 194602 0 32200 David Schwartz 44.00 0.00 X 187552 0 9734 John Frank 40.00 0.00 X 176157 0 24804 Susan Shinkai 40.00 0.00 X 176012 0 18982 Larry Dodds 0.00 0.00 X 0 78842 18492 934851 6737681 1224587 126 true true false Sierra Cardiology Med Assoc 900 Greenely Rd Ste 911 Sonora CA 95370 Medical Group 2475977 Sound Physicians 1123 Pacific Ave Tacoma WA 98402 Medical Group 1471645 Greenley Oaks Ear Nose & Throat 795 Morning Star Dr Sonora CA 95370 Medical Group 833841 Sonora Anesthesia Services PO Box 845 Sonora CA 95370 Medical Group 1053168 Sierra Emergency Medical Group PO Box 4685 Sonora CA 95370 Medical Group 3120051 71 27200 19954 640155 687309 Rent - Medical Offices 531120 220286 220286 Other Revenue 900099 292357 292357 Dietary 722210 458382 458382 EMR Incentives 900099 2258003 2258003 Patient Service Revenue 900099 195072362 195072362 134031 134031 198435421 1389797 1389797 0 0 0 765241 868157 -102916 -102916 -102916 129005 27200 33030 95975 95975 0 0 Company Store 621990 7645 7645 Sonora Oxygen Service 621610 35396 35396 Retail Pharmacy 446110 58175 58175 851 851 102067 200607653 198198474 102067 1619803 X 15260 15260 98743 98743 0 0 0 0 66754335 60507681 6092319 154335 2542449 2542449 18175095 16024427 2112378 38290 4775307 4357581 406751 10975 0 354067 354067 346612 346612 0 0 0 20445318 19817135 628183 484298 484298 4964120 4251403 693328 19389 5300974 5300974 0 4996973 4683842 311669 1462 535082 404020 129244 1818 0 156902 123595 32329 978 1951501 1951501 0 5346410 5279780 66630 865206 865206 Equipment rentals 951252 938405 12847 Miscellaneous 1355995 325619 1030376 Purchased services 15857478 9632619 6149903 74956 Pt Care Supplies 24767013 24767013 0 181040390 161887253 18850934 302203 961034 2133763 29610488 49223988 0 22310697 19547286 0 0 0 3008037 2917808 1535079 1965331 106926503 55165385 49656225 51761118 1608598 1510593 0 0 374617 11644 1100821 2839595 110165596 131911126 10852156 11825209 38530 615585 4070426 3561622 50588855 51725818 65549967 67728234 X 43727814 63188936 887815 993956 44615629 64182892 110165596 131911126 19567263 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 11755 11755 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description A portion of industry association dues is allocated to lobbying activities. 887815 497849 98743 292965 993956 905304 378471 50891 345069 887815 708131 538837 341664 905304 572083 325741 189693 708131 427428 331644 186989 572083 1.00000 false false false 4644321 4644321 55507870 21610540 33897330 2957059 1768972 1188087 35950473 29459980 6490493 7866780 2325893 5540887 51761118 Other liabilities 184670 Payables to third-party payers 3565378 Workers' comp liability 6224522 Payables to related orgs 41751248 51725818 Part V, Line 4 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. X X X X X X X false Gala 86570 20400 66170 2850 4608 200 6920 Golf Tournament 69635 6800 62835 500 4134 6768 4749 2301 156205 27200 129005 500 4134 9618 9357 200 9221 33030 95975 true true X true X 300.000000000 true X true true true false true true 1684415 -137465 1821880 0.01040 6708047 3624376 3083671 0.01760 8392462 3486911 4905551 0.02800 173059 173059 0.00100 1098690 1098690 0.00630 23039 23039 0.00010 1294788 1294788 0.00740 9687250 3486911 6200339 0.03540 true 1556632 373592 70096213 74440265 -4344052 X true true 1 1 Sonora Regional Medical Center

1000 Greenley Rd Sonora CA 95370

X X X Sonora Regional Medical Center 1 true true 300.0000 true 400.0000 true X X X X X X X true true X X X X X X true false true X X false false 38 Foothill Specialty Group

680 Guzzi Ln Ste 206 Sonora CA 95370

Specialty Care Clinic Angels Camp Physicial Therapy

467 S Main St Angels Camp CA 95222

Outpatient Physical Therapy Services Foothill Primary Care

650 Pauline Ct Sonora CA 95370

Primary Care Clinic Mountain Medical Family Practice

680 Guzzi Ln Ste 101 Sonora CA 95370

Primary Care Clinic Hillside Internal Medicine

690 Guzzi Ln Ste B Sonora CA 95370

Primary Care Clinic Sierra Vascular Surgery

690 Guzzi Ln Ste 104 Sonora CA 95370

Specialty Care Clinic Cedarwood Internal Medicine Center

690 Guzzi Ln Ste A Sonora CA 95370

Primary Care Clinic Arnold Family Medical Center

2037 Hwy 4 Arnold CA 95223

Primary Care Clinic Groveland Family Medical Center

18661 Hwy 120 Groveland CA 95321

Primary Care Clinic Cardiac and Pulmonary Rehab

19747 Greenley Rd Sonora CA 95370

Outpatient Services Greenley Primary Care

19747 Greenley Rd Ste S2 Sonora CA 95370

Primary Care Clinic Angels Camp Family Medical Center

445 S Main St Angels Camp CA 95222

Primary Care Clinic Job Care Occupational Health Clinic

19747 Greenley Rd Ste S2 Sonora CA 95370

Occupational Health Clinic Sierra Cancer Center

900 Greenley Rd Ste 902 Sonora CA 95370

Specialty Care Clinic Greenley Oaks Physical Therapy

940 Sylva Ln Ste D1 Sonora CA 95370

Outpatient Physical Therapy Services Anticoagulation Clinic

193 S Fairview Ln Ste L Sonora CA 95370

Outpatient Services Indian Rock Physicial Therapy

14540 Mono Wy Ste 130 Sonora CA 95370

Outpatient Physical Therapy Services Community Pharmacy Forest Road

193 S Fairview Ln Ste A Sonora CA 95370

Outpatient Pharmacy Yosemite Joint Replacement

680 Guzzi Ln Ste 102 Sonora CA 95370

Specialty Care Clinic Angels Camp Prompt Care

23 N Main St Angels Camp CA 95222

Urgent Care Clinic Sonora Oxygen and Medical Supply

358 W Stockton St Sonora CA 95370

Oxygen and Durable Medical Equipment Supplier Sierra Surgical Associates

680 Guzzi Ln Ste 204 Sonora CA 95370

Specialty Care Clinic Sierra Internal Medicine Center

900 Greenley Rd Ste 922 Sonora CA 95370

Primary Care Clinic Sierra OBGYN

680 Guzzi Ln Ste 106 Sonora CA 95370

Specialty Care Clinic Greenley Oaks Ear Nose and Throat

795 Morningstar Dr Sonora CA 95370

Specialty Care Clinic Center for Wound Care

12811 Covey Cir Sonora CA 95370

Wound Care Clinic Community Pharmacy Greenley Road

900 Greenley Rd Ste 912 Sonora CA 95370

Outpatient Pharmacy Indian Rock Prompt Care

14540 Mono Wy Sonora CA 95370

Urgent Care Clinic Sierra Cardiology

900 Greenley Rd Ste 911 Sonora CA 95370

Specialty Care Clinic Sonora Care Center

538 Ponderosa Dr Sonora CA 95370

Skilled Nursing Facility Transitional Care Unit

179 S Fairview Ln Sonora CA 95370

Skilled Nursing Facility Community Infusion Center

900 Greenley Rd Sonora CA 95370

Outpatient Services Radiation Oncology

900 Greenley Rd Ste 901 Sonora CA 95370

Radiation Therapy Center Forest Rd Health and Wellness

193 Fairview Ln Sonora CA 95370

Primary, Specialty, Dental and Urgent Care Clinic Sonora Regional Home Health Angels Camp

467 S Main St Angels Camp CA 95222

Home Health Agency Sonora Regional Home Health

20100 Cedar Rd N Sonora CA 95370

Home Health Agency Sonora Regional Surgery Center

905 Morning Star Dr Sonora CA 95370

Outpatient Surgery Center Sonora Regional Imaging Center

12811 Covey Cir Sonora CA 95370

Diagnostic Imaging Center Part VI - Additional Information Part V, Section B, Lines 1 through 7Schedule H, Part V, Section B, Lines 1 through 7 is optional for the reporting organization as the tax year began prior to March 23, 2012, according to the instructions for Schedule H. Part V, Section B should be blank as the reporting organization opts to not complete it. Part VI - States Where Community Benefit Report Filed CA Part VI - Affilated Health Care System Roles and Promotion 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 communites served by all member hospitals. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose The hospital continues to operate its 24-hour emergency department. The hospital has open medical staff to all qualified individuals. The hospital continues to expand its primary care outreach program through outpatient clinics, including a mobile clinic. The hospital operates skilled nursing facilities, which serve those who are unable to continue living without assistance due chronic medical conditions. Part VI - Community Building Activities Our 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. And, 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 - Community Information The hospital is the only health care system in the area serving two counties and surrounding areas. In early 2009 the hospital was designated as a "sole community hospital" by Medicare. The area is rural. Agriculture, logging and tourism are the major employment opportunities. The population includes a large number of retired individuals. Part VI - Patient Education of Eligibility for Assistance At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients also are 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. The hospital charity assistance policy is posted on the hospital website. Part VI - Needs Assessment The health system retains outside research firms every 3 years to assess changes in the market and community perception. Data is collected through a variety of vehicles, including phone surveys, paper surveys, and focus groups. Questions were added to the survey to help assess the impact of our community benefit activities and residents' barriers to access for health care services as well as unmet community needs. Number of Hospital Faciltiy - 1 Part V, Line 20d - Other Billing Determination of Individuals Without Insurance The hospital's financial assistance policy has three income ranges for patients who received emergency medical care, which provides a discount based on Medicare rates. There are also three income ranges for patients who received non-emergency medical care; the two lower income ranges provide a discount based on Medicare rates. The higher income range provides a discount from the balance due after the uninsured discount, that is available to all uninsured patients without regard to income. Only five of the six income ranges are discounted based on Medicare rates. 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 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 to 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 69,760,801Prior Year Settlements 0Cost Report Reimbursable Bad Debts 428,141Clinic 1206(D) Revenue 0Estimates and Accrual Variances (92,729)Other 0Subtotal - Amount reported in Pt III, line 5 70,096,213Amounts include in Part 1, lines g and f 0Total Medicare Revenue 70,096,213*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 4 - Bad Debt Expense The system-wide combined audited financial statements do not contain a footnote describing bad debt expense. 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 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 combined audited financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2. 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 true 0 0 Utilities, food, other emergency assist 250 22565 Cash Transportation cancer pts to treatments 500 76178 Cash Grantmaker's Description of How Grants are Used Prior to issuing grants, hospital evaluates organization requesting grant and ensures alignment with hospital's exempt purpose and mission. After disbursing grant funds, hospital does not monitor use of funds. X X X X true true false false false true false false false false Rick Dodds 155250 18029 8626 10621 22881 215407 Pauline Campbell 134754 20267 19724 25732 15594 216071 9272 Julie Kline 211270 24200 47465 44059 18737 345731 32657 Bill Wing 554320 77197 33678 131876 22737 819808 Andrew Jahn 202240 9308 28800 13678 24998 279024 Jeff Eller 366000 70498 98697 83555 23007 641757 60220 Rodney Wehtje 362899 71582 100009 191288 18827 744605 63809 Scott Reiner 654000 149534 111866 160719 23025 1099144 42890 Douglas Rebok 561780 137623 172912 138641 21090 1032046 116805 Robert Carmen 982571 240680 591191 15298 23566 1853306 472760 Meredith Jobe 262685 55336 56358 17397 391776 Susan Shinkai 162970 4913 8129 10119 8863 194994 John Frank 164152 12005 10268 14536 200961 David Schwartz 182570 4982 9451 283 197286 Jacquie Cituk 184752 8743 1107 11485 20715 226802 Jeph Solo 196610 3011 907 7837 8854 217219 Larry Dodds 78280 562 3564 14928 97334 990, Part VI, Line 7a The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital Form 990, Part VI, Line 19 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. The hospital files monthly/quarterly summary financial reports with the state health-planning agency. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The hospital board of directors has established a Compensation Committee to 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 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary. Form 990, Part VI, Line 15a 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 12c 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 11b Form 990, Part VI, Line 11b: Form 990 Review Process The completed Form 990 is shared with members of the hospital'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 after their review but prior to filing. Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 6 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 2 Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Key Employee Rick Dodds is the child of Larry Dodds, a former officer listed on Schedule J. Reedley Community Hospital 372 W Cypress Ave Reedley CA 93654 453220509 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 Willits Hospital Inc 1 Madrone St Willits CA 95490 680108919 Hospital CA 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 Walla Walla General Hospital 1025 S Second St Walla Walla WA 99362 910617726 Hospital WA 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 Simi Valley Hospital & Health Care Svcs 2975 N Sycamore Dr Simi Valley CA 93065 956064971 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 St Helena Hospital 10 Woodland Rd St Helena CA 94574 941279779 Hospital 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 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 NW Medical Foundation of Tillamook 1000 Third St Tillamook OR 97141 930622075 Hospital OR 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 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 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 Central Valley General Hospital 1025 N Douty St Hanford CA 93230 770324630 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki St Kailua HI 96734 990107330 Hospital HI 501(c)(3) 1 Adventist Health SystemWest false Adventist Health Clearlake Hospital Ave 18 at Hwy 53 Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health SystemWest 2100 Douglas Blvd Roseville CA 95661 953484589 Support / manage system-wide activities CA 501(c)(3) 1 NA false South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false true false false true true false false false false true false true true false true true true false false