2012-11-15T17:03:27-08:00 2011-12-31 Clement & Associates CPA 2930 Honolulu Avenue Suite 200 La Crescenta CA 91214 990 2011-01-01 952282647 White Memorial Medical Center WHIT 3232685000 1720 Cesar E Chavez Ave Los Angeles CA 90033 John Raffoul 2012-11-15 true S Clement 8182491065 X 2011 2016-02-24 21:20:13Z Beth Zachary 1720 Cesar E Chavez Ave Los Angeles CA 900332443 315493669 false false 1071 X www.whitememorial.com X 1963 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 8 2094 206 -1689131 -1963178 7624851 4689466 321544234 294608484 11733971 10663698 -1113084 -204261 339789972 309757387 151760 191820 0 141034063 146755585 0 685322 165854963 153448422 307040786 300395827 32749186 9361560 571808172 582784398 145602182 146562954 426205990 436221444 As a Seventh-day Adventist medical center, we are a family of caring professionals serving our community with: 1) A passion for excellence, 2) A spirit of Christian service, 3) A commitment to medical education. false false 251817112 191820 294608484 As a Seventh-day Adventist medical center, we are a family of caring professionals serving our community with: 1. A spirit of Christian service 2. A passion for excellence and 3. A commitment to medical education.The White Memorial Medical Center 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 the White Memorial Medical Center, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:Providing free care and/or subsidized careProviding care to persons covered by governmental programs at below costProviding health/wellness activities and community education programsNot only does the White Memorial Medical Center 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. The White Memorial Medical Center 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 2011 was $93,055,483.Inpatient services in 2011 were provided to 23,524 patients. These services included: 4,116 Newborns 4,058 Babies delivered 6,930 Surgeries performed 2,292 Cardiac catherizations and other procedures 424 Skilled nursing patients 329 Rehabilitation patients 601 Neonatal Intensive Care Patients 280 Pediatric Intensive Care Patients 1,921 Psychiatric Care Patients 2,573 Medical Services Outpatient services in 2011 were provided to 114,734 patients. These services included: 44,773 Emergency room visits 4,807 Outpatient surgeries performed 91,266 Radiology procedures performed 5,464 Cardiac catherizations and other procedures960,075 Laboratory tests performed 2,756 Cleft Palate visits 5,834 Cancer Center proceduresThe White Memorial Medical Center recognizes it has an obligation to provide human services above and beyond its role as a healing facility. Thanks to support from our community partners, the organization is able to fulfill its mission through the following programs:Early Intervention ProgramHealthy Beginnings Program - 1,400 encounters for free classesHealthy Families Program Rainbow Center Child CarePartners for PreventionHealth Fairs - 1,826 Cancer Screenings & 100 Glucose Screenings for DiabetesPatient Healthcare Transportation - provided 2,195 encountersOne of the greatest assets an organization can possess is the trust of its community --both internal and external. WMMC devotes a significant amount of financial and human resources to carry on its legacy of close to 100 years of community-centered service to medically underserved communities in our area. Beyond our role as one of the leading providers of health care in our community, we are committed to operating as a socially responsible organization as we meet the needs of our different stakeholders--our patients, physicians, workforce, neighbors, partners and donors. Our goal is to enable people to achieve more than just good health; it is to create opportunities for growth and development that will make a real, lasting impact on the health of our community.WMMC serves a community whose residents are predominantly Latino and where 57% of the households have an annual income of less than $25,000 and 41% of families earn under $15,000, which is below the federal poverty level. WMMC is positioned to provide this historically medically underserved population with Latino-focused language programs and education, including Spanish bilingual doctors and nurses and is dedicated to providing all its patients with the same level of high quality health care. This care includes highly advanced specialty services including advanced certifications, specialty care services and state-of-the-art procedures. WMMC has adopted rigorous national quality standards and has won four Eureka Awards for Performance Excellence from the California Council on Excellence.WMMC mission anchors everything we do and extends out to the community in many ways. Collaborative efforts between WMMC, local organizations and donors has created critical programs needed to address the specific health care needs of the more than 2 million residents living throughout eastern Los Angeles. Together we can change the outcome of our community's health. For example, the Cecilia Gonzalez De La Hoya Cancer Center, named for the late mother of champion boxer and philanthropist, Oscar De La Hoya, helps address the area's high incidence of breast cancer. The Cancer Center features sophisticated diagnostic and treatment equipment, bilingual breast cancer support groups, a community resource center and free breast exams and mammograms to women who are uninsured or underinsured.The Diabetes Care Center at WMMC addresses the high prevalence of diabetes within the community and provides full-service diabetes testing, education, peer counseling and follow-up care and runs a successful Healthy Eating & Lifestyle Program (H.E.L.P.); a six-week program designed to teach children, at-risk of developing diabetes, the benefits of a well-balanced diet and regular exercise. No insurance is needed to access this bilingual program. A significant portion of the mission-driven benefits that WMMC provides to its community is intangible or otherwise difficult to quantify. The following brief story illustrates this reality:In November 2010 Philip Murray Simmons was getting ready to board a Greyhound bus to visit his sister in Texas when he suffered a devastating stroke. He awoke at White Memorial not knowing who he was or what had happened to him; with his wallet missing he had no I.D, and believed he'd been robbed.For a long time no one knew who Philip was, he was listed as John Doe. He had no insurance and was denied Medi-Cal. Yet for four months our physicians and medical staff went the extra mile to provide him with all the care he needed to slowly begin fighting his way back to recovery.Finally in March 2011 Philip was well enough to leave White Memorial--but he couldn't live on his own and he needed continued care for his recovery. His only relative was his sister in Texas. But neither Philip nor his sister had the funds to get him there.Seeing the need, a team of social workers, case managers and nurses swung into action. As a team they secured a flight and then obtained a donated walker and wheelchair from WMMC vendors. The hospital home health liaison identified a qualified home health volunteer to accompany Philip to Texas who then paid for her own trip. Social workers coordinated with Philip's sister. Nurses, therapists and physicians worked tirelessly to improve Philip's functionality to enable him to fly safely. Another employee secured a donated ambulance ride to get Philip to the airport and assisted in making final flight arrangements. A friend found Philip's wallet and I.D. in the luggage he'd left behind at the bus station all those months ago and brought both to him at the hospital.Despite the barriers, the team's persistence and tireless work paid off. When Philip left, the team had tears in their eyes, proud and happy of the vital part they had played in his care and in getting Philip to Texas and into his sister's arms. Today Philip's condition continues to improve under the safe and loving care of his sister. This is just one example on how our White Memorial employees, a family of caring individuals go above and beyond each day to meet the health care needs of our community.It takes special people to create change, people with a passion for making a difference in the lives of others. Not just because it is the right thing to do, but because their passion to help those less fortunate is in their heart. White Memorial invites you to partner with us in building on our legacy of primary care and our unwavering pursuit of excellence in quality, innovation and service. Visit us at www.whitememorial.com. 251817112 true true false true false false false false false true true false false false true false false true false false false true 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 false true 408 0 true 2094 false true true false false false false false false false false false 0 false false false false false false false false false false false X 13 8 false false false false true false true true true false false false true true true true true true true true false false X John Raffoul TreasurerVP Fin 3232685000 1720 Cesar E Chavez Ave Los Angeles CA 900332443 X Scott Reiner 50.00 X X 0 907841 160287 Larry Dodds 50.00 X X 0 685344 96060 Robert Carmen 50.00 X X 0 1749297 39804 Max Torkelsen 1.00 X 0 2381 0 Wes Rippey MD 1.00 X 0 98503 0 Al Reimche 1.00 X 0 1637 0 Helmuth Jones 1.00 X 0 350 0 Meredith Jobe Esq 1.00 X 12288 42329 0 Larry Innocent 1.00 X 0 350 0 Steven C Herber MD 1.00 X 0 219911 41678 Ricardo Graham 1.00 X 0 2652 0 Christine E Friestad Esq 1.00 X 0 2927 0 Ruthita Fike 1.00 X 0 635 0 Lynn Creitz 1.00 X 0 3123 0 Larry Caviness 1.00 X 0 2666 0 Robert Bradshaw DDS 1.00 X 0 4652 0 Albert Deininger 50.00 X 0 254111 53958 John Raffoul 50.00 X 0 389842 81005 Beth Zachary 50.00 X 0 751685 117923 Bill Wing 50.00 X 0 321588 89967 Rodney Wehtje 50.00 X 0 506336 95494 Douglas Rebok 50.00 X 0 857414 147299 David Wortham 50.00 X 0 143458 7156 Ray Morales 50.00 X 0 137386 10593 Roland Fargo 50.00 X 0 269660 36082 Mary Anne Chern 50.00 X 0 256644 56808 Mara Bryant 50.00 X 0 232887 35599 Lynne Whaley 50.00 X 0 284775 23886 Sharon McCoy 50.00 X 228940 0 10999 Thao Nguyen 50.00 X 216940 0 15546 Natasha Milatovich 50.00 X 202356 0 10795 Ampha Kamachi 60.00 X 199442 0 13799 Blin Richards 50.00 X 196896 0 14092 1056862 8130384 1158830 249 false true false White Memorial Pediatric Group 1701 Cesar Chavez Ave Ste 532 Los Angeles CA 90033 Medical Services 1060726 White Memorial Medical Group 1701 Cesar Chavez Ave Ste 510 Los Angeles CA 90033 Medical Services 1569638 Sodexo Dept 43283 Los Angeles CA 90088 Housekeeping Service 2832980 FCS Medical Corporation 5823 York Blvd Ste 1 Highland Park CA 90042 Teaching/Med Svcs 1674753 DVA Renal Healthcare Inc PO Box 403008 Atlanta GA 30384 Medical Services 2110374 72 347184 4114986 227296 4689466 Rental Income-Pgm Svc 531120 1803907 1803907 Patient Svc Revenue 621110 290520892 290520892 Parking 812930 737849 273465 464384 Other Prog Svc Rev 900099 100326 88914 11412 Dietary 722210 1405707 1405707 39803 39803 294608484 10650398 10650398 0 0 3773686 5736282 -1962596 -1962596 -1962596 13300 13300 13300 13300 0 0 0 Value Change-Net Asset 900099 272876 272876 Net Assets Rel from Rest 900099 1485459 1485459 Miscellaneous Revenue 900099 1758335 309757387 295617558 -1689131 11139494 180575 180575 0 11245 11245 0 7467 7467 0 114728713 105194890 9052142 481681 4024249 4024249 19568543 16668530 2811596 88417 8426613 7752856 640458 33299 0 2279595 2279595 1261892 1261892 0 0 0 19677257 16276827 3400430 1246932 725 1164390 81817 4577796 3597438 980358 9900416 9395232 505184 0 11412467 11411267 1200 271796 130366 141430 0 200766 118860 81906 16642 16642 0 15871566 15720836 150622 108 3705436 3705436 Rental/Lease Costs Equipment 3721193 3636601 84592 Purchased Services 21632392 13174696 8457696 Pt Care Supplies 39941732 39941732 Other Expenses 7328594 858109 6470485 Hospital CHFT Fees 10401950 10401950 0 300395827 251817112 47893393 685322 87144 356464 298312470 329822718 0 38857425 38316690 0 0 0 3674436 3941064 1396581 1163376 346121904 149197108 205650446 196924796 5372321 4274292 0 0 0 18457349 7984998 571808172 582784398 26891062 31058521 77069150 72714154 41641970 42790279 145602182 146562954 X 421854456 432224195 4351534 3997249 426205990 436221444 571808172 582784398 X 9361560 653894 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6414 true true 48530 54944 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Allocation of dues paid to industry and professional organizations. The industry and professional organizations conduct lobbying activity and a portion of the membership dues is allocated for this purpose.Executives met with state and federal legislators and attended industry organization meet and greet events for the purpose of educating legislators and advocating for the needs of the health care industry. 4351534 2139353 2493638 3997249 3749829 2721430 2119725 4351534 4944562 2259777 3454510 3749829 1.00000 false true true 34118 2263420 2297538 265964722 98509574 167455148 69100330 46876594 22223736 8759314 3810940 4948374 196924796 Workers Comp Payable 4897250 Settlements - Medicare, Pay to 3rd Party 37674183 Payables to Related Organizations 212460 Federal Taxes Payable 6386 42790279 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Gifts & Grants-Restricted-Rpt on VII line 1 $2139353 Net Assets Released from Restr-Cap Addtn $1008178 Restricted Assets Released from Restr $ -2493637 Transfers to Affiliates (Unrestr) $ -0 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. true East Asia Tsunami-Japa 11245 Check 1 false false false false false false Additional Supplemental Information Part IIDonation to Adventist Development and Relief Agency International (ADRA) for the Japan Tsunami relief. ADRA is a recognized US 501(c)(3) entity and the funds were used to further their assistance with the tsunami relief in Japan in early 2011. This was a matching contribution to donations from employees which totalled an additional $11,353. true true X true X true X true true false false true true 15988713 220839 15767874 0.05250 105217682 115514290 -10296608 1167172 630335 536837 0.00180 122373567 116365464 6008103 0.05430 1128845 133506 995339 0.00330 15565425 2655696 12909729 0.04300 168139 86724 81415 0.00030 424754 424754 0.00140 17287163 2875926 14411237 0.04800 139660730 119241390 20419340 0.10230 137662 137662 0.00050 1108257 1108257 0.00370 1245919 1245919 0.00420 true 2392078 1770136 71673878 68769275 2904603 X true true 1 0 White Memorial Medical Center

1720 Cesar E Chavez Ave Los Angeles CA 90033

X X X X Acute,Rehab,Skilled Nursing,Psychiatric White Memorial Medical Center 1 true true 200.0000 true 400.0000 true X X X X X X true true X X X X X X true false true X X false false Part VI - Additional Information Part V, Section BSchedule 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. Lacerte software has not provided a tool for an organization to indicate that it is opting not to complete Part V, Section B. In addition, the software has been programmed so that it populates responses when the organization chooses to provide no data inputs. Part V, Section B should be blank as the reporting organization opts to not complete it.Additional Information:White Memorial Medical Center (WMMC) is a full service 353-bed, non-profit, faith-based hospital that provides a full range of inpatient, outpatient, emergency and diagnostic services and is located just minutes from downtown Los Angeles. One of the greatest assets an organization can possess is the trust of its community --both internal and external. WMMC devotes a significant amount of financial and human resources to carry on its legacy of close to 100 years of community-centered service to medically underserved communities in our area. Beyond our role as one of the leading providers of health care in our community, we are committed to operating as a socially responsible organization as we meet the needs of our different stakeholders--our patients, physicians, workforce, neighbors, partners and donors. Our goal is to enable people to achieve more than just good health; it is to create opportunities for growth and development that will make a real, lasting impact on the health of our community.WMMC serves a community whose residents are predominantly Latino and where 57% of the households have an annual income of less than $25,000 and 41% of families earn under $15,000, which is below the federal poverty level. WMMC is positioned to provide this historically medically underserved population with Latino-focused language programs and education, including Spanish bilingual doctors and nurses and is dedicated to providing all its patients with the same level of high quality health care. This care includes highly advanced specialty services including advanced certifications, specialty care services and state-of-the-art procedures. WMMC has adopted rigorous national quality standards and has won four Eureka Awards for Performance Excellence from the California Council on Excellence.WMMC mission anchors everything we do and extends out to the community in many ways. Collaborative efforts between WMMC, local organizations and donors has created critical programs needed to address the specific health care needs of the more than 2 million residents living throughout eastern Los Angeles. Together we can change the outcome of our community's health. For example, the Cecilia Gonzalez De La Hoya Cancer Center, named for the late mother of champion boxer and philanthropist, Oscar De La Hoya, helps address the area's high incidence of breast cancer. The Cancer Center features sophisticated diagnostic and treatment equipment, bilingual breast cancer support groups, a community resource center and free breast exams and mammograms to women who are uninsured or underinsured.The Diabetes Care Center at WMMC addresses the high prevalence of diabetes within the community and provides full-service diabetes testing, education, peer counseling and follow-up care and runs a successful Healthy Eating & Lifestyle Program (H.E.L.P.); a six-week program designed to teach children, at-risk of developing diabetes, the benefits of a well-balanced diet and regular exercise. No insurance is needed to access this bilingual program. A significant portion of the mission-driven benefits that WMMC provides to its community is intangible or otherwise difficult to quantify. The following brief story illustrates this reality:In November 2010 Philip Murray Simmons was getting ready to board a Greyhound bus to visit his sister in Texas when he suffered a devastating stroke. He awoke at White Memorial not knowing who he was or what had happened to him; with his wallet missing he had no I.D, and believed he'd been robbed.For a long time no one knew who Philip was, he was listed as John Doe. He had no insurance and was denied Medi-Cal. Yet for four months our physicians and medical staff went the extra mile to provide him with all the care he needed to slowly begin fighting his way back to recovery.Finally in March 2011 Philip was well enough to leave White Memorial--but he couldn't live on his own and he needed continued care for his recovery. His only relative was his sister in Texas. But neither Philip nor his sister had the funds to get him there.Seeing the need, a team of social workers, case managers and nurses swung into action. As a team they secured a flight and then obtained a donated walker and wheelchair from WMMC vendors. The hospital home health liaison identified a qualified home health volunteer to accompany Philip to Texas who then paid for her own trip. Social workers coordinated with Philip's sister. Nurses, therapists and physicians worked tirelessly to improve Philip's functionality to enable him to fly safely. Another employee secured a donated ambulance ride to get Philip to the airport and assisted in making final flight arrangements. A friend found Philip's wallet and I.D. in the luggage he'd left behind at the bus station all those months ago and brought both to him at the hospital.Despite the barriers, the team's persistence and tireless work paid off. When Philip left, the team had tears in their eyes, proud and happy of the vital part they had played in his care and in getting Philip to Texas and into his sister's arms. Today Philip's condition continues to improve under the safe and loving care of his sister. This is just one example on how our White Memorial employees, a family of caring individuals go above and beyond each day to meet the health care needs of our community.It takes special people to create change, people with a passion for making a difference in the lives of others. Not just because it is the right thing to do, but because their passion to help those less fortunate is in their heart. White Memorial invites you to partner with us in building on our legacy of primary care and our unwavering pursuit of excellence in quality, innovation and service. Visit us at www.whitememorial.com. Part V - Explanation of Number of Facility Type The hospital provides outpatient services in multiple locations within its service area. 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 Part VI - Explanation Of How Organization Furthers Its Exempt Purpose The hospital has a governing board composed of community members who advise the president/CEO regarding the healthcare needs of the community. At the direction of the governing board, the hospital has developed outpatient and home care programs focused on rendering care in the most effective and efficient manner. The hospital's key medical services include Cardiac, Cancer, Women's Services, Ortho, Neuro, Behavioral Medicine, Rehabilitative Medicine, Emergency, and Home Care services, as well as a residency program. The hospital cooperates with area physicians to offer both family practice and obstetrics clinics. Part VI - Community Building Activities The hospital is involved in numerious community building activities which promote the health of the communities we serve. Numerous community concerns are addressed, including health and prevention 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. 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.The hospital serves a community where 28% of families fall below the federal poverty line and whose residents are predominantly Latino. WMMC is positioned to provide this historically medically underserved population with Latino-focused in-language programs and education, including Spanish bilingual doctors and nurses and is dedicated to providing all its patients with the same level of high quality health care. This care includes highly advanced specialty services including advanced certifications, specialty care services and state-of-the-art procedures. WMMC has adopted rigorous national quality standards and has won four Eureka Awards for Performance Excellence from the California Council on Excellence. WMMC mission anchors everything we do and extends out to the community in many ways. Collaborative efforts between WMMC, local organizations and donors has created critical programs needed to address the specific health care needs of the more than 2 million residents living throughout eastern Los Angeles. Together we can change the outcome of our community's health. Part VI - Community Information WMMC is located in the City of Los Angeles serving primarily the communities of East Los Angeles, Boyle Heights, Chinatown, Commerce, El Sereno, Glassel Park, Highland Park, Huntington Park, Lincoln Heights, Los Angeles, Maywood and Montebello. The largest ethnic group in our Primary Service Area is Hispanic, comprising 81% of the population of our service area and our second largest ethnic group is Asian at 7%. 57% of the households have an annual income of less than $25,000 of which 41% earn less than $15,000 annually translating to 87% of our patients being covered by Medical or Medicare. Based on the diversity of our service area we work to accomodate the diverse language and cultural needs. 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 hospital retains outside research firms every 3 years to assess changes in the market and community needs. 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 - 0 Part V, Line 19d - 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 Revenue Rec. *Medicare Cost Report Revenue $77,449,472 Prior Year Settlements - Cost Report Reimbursable Bad Debts 2,597,090 Estimates and Accrual Variances (7,238,740) Other (1,133,944) ___________ Subtotal - Amount reported in Pt III line 5 $71,673,878 Amount included in Part 1, lines g and f 1,923,082 ___________ Total Medicare Revenue $73,596,960*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 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.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.The system-wide combined audited financial statements do not contain a footnote describing bad debt expense. YMCA of Metropolitan LA 2900 Whittier Blvd Los Angeles CA 90023 951644052 501(c)(3) 10000 0 White Memorial Med Cntr Fdtn 1720 Cesar E Chavez Ave Los Angeles CA 90033 953760201 501(c)(3) 7317 0 Fundraising White Memorial Adv Schl Inc 1605 New Jersey Street Los Angeles CA 90033 954349770 501(c)(3) 31500 0 General Operations Telacu Education Foundation 5400 E Olympic Blvd Ste 120 Los Angeles CA 90022 954384333 501(c)(3) 15000 0 General Operations Mexican Amrcn Optnty Fdtn Inc 401 N Garfield Ave Montebello CA 90640 952594166 501(c)(3) 5500 0 General Operations Glendale Adv Mdcl Ctr Fdtn 1509 Wilson Terrace Glendale CA 91206 953899682 501(c)(3) 8000 0 Fundraising American Heart Association In PO Box 4002030 Des Moines IA 50340 135613797 501(c)(3) 16454 0 General Operations Altamed Health Services Inc 2040 Camfield Ave Los Angeles CA 90040 952810095 501(c)(3) 10833 0 General Operations Adventist Development and Rel 12501 Old Columbia Pike Silver Springs MD 20904 521314847 501(c)(3) 15011 0 Disaster Relief 41 2 X X X X X false true false false false false false false false false Thao Nguyen 193742 18796 4402 13219 2327 232486 Steven C Herber MD 212461 7450 27400 14278 261589 Sharon McCoy 194768 29356 4816 9133 1866 239939 Scott Reiner 577345 149092 181404 138780 21507 1068128 119583 Roland Fargo 219260 33557 16843 15014 21068 305742 Rodney Wehtje 340430 78784 87122 78557 16937 601830 52751 Robert Carmen 934340 267209 547748 18150 21654 1789101 424494 Natasha Milatovich 171999 26610 3747 8468 2327 213151 Mary Anne Chern 195900 29837 30907 39958 16850 313452 25719 Mara Bryant 187500 27626 17761 14217 21382 268486 Lynne Whaley 238750 36347 9678 15014 8872 308661 Larry Dodds 303557 171094 210693 79089 16971 781404 120139 John Raffoul 283067 42470 64305 59565 21440 470847 42515 Douglas Rebok 533280 149092 175042 128096 19203 1004713 123894 David Wortham 114461 20000 8997 7156 150614 Blin Richards 176443 16196 4257 11765 2327 210988 Bill Wing 305808 15780 74419 15548 411555 Beth Zachary 422760 96345 232580 98684 19239 869608 191120 Ampha Kamachi 199442 11964 1835 213241 Albert Deininger 182460 27822 43829 37116 16842 308069 21720 Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Part I, Line 1BAny items checked on this line are reported as taxable income to the employee, except first class or charter travel, which is only approved for business purposes on an exception basis. 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, but does file 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 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 reviews these questionnaires and disclosures each year during the audit process. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: 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 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 bylaws define its board of directors to be the same individuals who are members of Adventist Health System/West board of directors. Willits Hospital Inc 1 Madrone St Willits CA 95490 680108919 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false White Memorial Medical Center Fdtn 1720 Cesar E Chavez Ave Los Angeles CA 90033 952282647 Fundraising for Hospital CA 501(c)(3) 11, Type 1 Adventist Health SystemWest false Walla Walla General Hospital 1025 S Second Ave Walla Walla WA 99362 910617726 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 Sonora Community Hospital 1000 Greenley Rd Sonora CA 95370 941415069 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 Reedley Community Hospital 372 W Cypress Ave Reedley CA 93654 453220509 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 Facilit CA 501(c)(3) 1 Adventist Health SystemWest false Northwest Medical Fdtn 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 953899682 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 Physicians Network 2100 Douglas Blvd Roseville CA 95661 680357690 Hospital CA 501(c)(3) 11b, II Adventist Health SystemWest 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 Adventist Health SystemWest 2100 Douglas Blvd Roseville CA 95661 953484589 Support and Manage System-wide Activities CA 501(c)(3) 1 N/A false 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 true false false false false true true false false false true false false false