ADVENTIST HEALTH CLEARLAKE HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC (EIN 68-0395149)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201113199349308761
- Schema version
- 2010v3.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T14:17:05-08:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680395149 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Clearlake Hospital Inc | BusinessNameLine1 |
| Business Name Line2 | dba St Helena Hospital Clear Lake | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ADVE | NameControl |
| Phone | 7079955811 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 6710 | AddressLine1 |
| City | Clearlake | City |
| State | CA | State |
| ZIP Code | 95422 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Edward McDonald | Name |
| Title | Treas/Sr VP Finance | Title |
| Date Signed | 2011-11-15 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Terry Newmyer | NameOfPrincipalOfficerPerson |
| Gross Receipts | 64336524 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www.shhclearlake.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To share God's love by providing physical, mental, and spiritual healing. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 462 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 104577 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 902072 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 51638292 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 63182421 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 100034 | InvestmentIncomePriorYear |
| Investment Income Current Year | 184740 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 18332 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 51842903 | TotalRevenuePriorYear |
| Total Revenue Current Year | 64287565 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 25128322 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 26639875 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 171181 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 26496726 | OtherExpensePriorYear |
| Other Expenses Current Year | 30709908 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 51625048 | TotalExpensesPriorYear |
| Total Expenses Current Year | 57349783 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 217855 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 6937782 | RevenuesLessExpensesCY |
| Total Assets BOY | 29613272 | TotalAssetsBOY |
| Total Assets EOY | 36062491 | TotalAssetsEOY |
| Total Liabilities BOY | 59058758 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 58720045 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -29445486 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -22657554 | NetAssetsOrFundBalancesEOY |
| Mission Description | To share God's love by providing physical, mental, and spiritual healing. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 51207279 | Expense |
| Revenue | 63213989 | Revenue |
| Description | St. Helena Hospital Clearlake 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 St. Helena Hospital Clearlake, 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 a partnership for personal community health. In keeping with this committment 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 free care to persons covered by governmental programs at below costProviding health/wellness activities and community education programsNot only does St. Helena Hospital Clearlake 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. St. Helena Hospital Clearlake 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 2010 was $2,061,627.Inpatient services in 2010 were provided to 1,808 patients. These services included:176 Babies delivered260 Surgeries performed42,464 Laboratory tests performedOutpatient services in 2010 were provided to 178,347 patients. These services included:16,912 Emergency room visits1,395 Outpatient surgeries performed83,949 Medical clinic visits277,246 Laboratory testsSt. Helena Hospital Clearlake 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:Child Immunization ClinicsHealth FairsBlood Pressure ClinicsStudent Nursing ProgramOperation Christmas Joy | Description |
| Total Program Service Expense | 51207279 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 59 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 462 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Edward McDonald | NamePerson |
| Telephone Number | 7079633611 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Woodland Rd | AddressLine1 |
| City | St Helena | City |
| State | CA | State |
| ZIP Code | 94574 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | FormerFormer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Olson Joaline | |||||||||
| Former President | 0.00 | X | 0 | 452520 | 93744 | ||||
| Fike Ruthita | |||||||||
| Director | 50.00 | 0 | 405 | 74 | X | ||||
| Torkelson Max | |||||||||
| Director | 1.00 | 0 | 1854 | 74 | X | ||||
| Reiner Scott | |||||||||
| Asst Sec | 0.00 | 0 | 706956 | 142451 | |||||
| McDonald Edward | |||||||||
| Treas/Sr VPFin | 50.00 | 0 | 290460 | 57745 | X | ||||
| Newmyer Terrance | |||||||||
| President/CEO | 50.00 | 0 | 586518 | 99321 | X | ||||
| Graham Ricardo | |||||||||
| Director | 50.00 | 0 | 2309 | 74 | X | ||||
| Simons Marjorie | |||||||||
| Reg VP Pt Care | 50.00 | 0 | 217794 | 47802 | X | X | |||
| Wehtje Rodney | |||||||||
| Asst Treas | 1.00 | 0 | 484703 | 160891 | X | ||||
| Rebok Douglas | |||||||||
| Asst Sec | 0.00 | 0 | 701547 | 140807 | |||||
| Dodds Larry | |||||||||
| V Chair/Sec | 50.00 | 0 | 789424 | 159012 | X | ||||
| Rippey Wes | |||||||||
| Director | 0.00 | 0 | 144704 | 74 | |||||
| Swenson Jennifer | |||||||||
| Sr VP Ops | 1.00 | 0 | 210184 | 49069 | X | ||||
| Jobe Meredith | |||||||||
| Director | 1.00 | 0 | 16246 | 74 | X | ||||
| Friestad Christine | |||||||||
| Director | 1.00 | 0 | 1311 | 74 | X | ||||
| Creitz Lynn | |||||||||
| Director | 1.00 | 0 | 2123 | 74 | X | ||||
| Caviness Larry | |||||||||
| Director | 50.00 | 0 | 2505 | 74 | X | X | |||
| Carmen Robert | |||||||||
| Chairman | 1.00 | 0 | 1485849 | 256139 | X | ||||
| Herber Steven | |||||||||
| Director | 1.00 | 0 | 146754 | 74 | X | ||||
| Bradshaw Robert | |||||||||
| Director | 0.00 | 0 | 1321 | 74 | |||||
| Reimche Al | |||||||||
| Director | 1.00 | 0 | 1440 | 74 | X | ||||
| McCurry William | |||||||||
| RN IV | 0.00 | 166250 | 0 | 14115 | X | ||||
| Coppernoll Belinda | |||||||||
| Nurse Practitioner | 45.00 | 166377 | 0 | 14121 | X | ||||
| Myers Irvin | |||||||||
| Nuc Med Tech | 49.00 | 169323 | 0 | 14268 | X | ||||
| Gumpert Norman | |||||||||
| Pharmacist | 46.00 | 205024 | 0 | 16053 | X | ||||
| Robinson Ken | |||||||||
| Pharmacist in Chg | 55.00 | 223952 | 0 | 17000 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 930926 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6246927 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1283352 | TotalOtherCompensation |
| Number Individuals GT100 K | 48 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Adventist Health-California Medical Group | |||||
| PO Box 266 | Deer Park | CA | 94576 | Physician Services | 3393985 |
| Alliance Healthcare Services | |||||
| PO Box 6600 | Newport Beach | CA | 92658 | Medical Imaging Svcs | 492147 |
| NPH Medical Services Inc | |||||
| 2639 Forest Ave Ste 110 | Chico | CA | 95928 | Staffing Services | 510869 |
| Quantum Healthcare Medical | |||||
| 5000 Hopyard Rd Ste 100 | Pleasanton | CA | 94588 | Hospitalist Services | 755498 |
| Helmer & Sons Inc | |||||
| 910 Howell Mtn Rd N | Angwin | CA | 94508 | Construction Svcs | 1892636 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 34 | NumberOfContractorsGT100K |
| Government Grants | 835782 | GovernmentGrants |
| All Other Contributions | 66290 | AllOtherContributions |
| Total Contributions | 902072 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Other Revenue | 900099 | 31770 | 31770 |
| Rental Income | 531120 | 88716 | 88716 |
| Dietary | 722210 | 169456 | 169456 |
| Patient Service Revenue | 621990 | 62892479 | 62892479 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 63182421 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 184740 | TotalRevenueColumn |
| Exclusion | $184,740 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 67291 | GrossSalesOfInventory |
| Cost Of Goods Sold | 48959 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18332 | TotalRevenueColumn |
| Exclusion | $18,332 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64287565 | TotalRevenueColumn |
| Related Or Exempt Function Income | 63182421 | RelatedOrExemptFunctionIncome |
| Exclusion | $203,072 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20134078 | Total |
| Program Services | 18966897 | ProgramServices |
| Management And General | 1072757 | ManagementAndGeneral |
| Fundraising | 94424 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 430558 | Total |
| Program Services | 430558 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4609367 | Total |
| Program Services | 4287045 | ProgramServices |
| Management And General | 299622 | ManagementAndGeneral |
| Fundraising | 22700 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1465872 | Total |
| Program Services | 1380705 | ProgramServices |
| Management And General | 78869 | ManagementAndGeneral |
| Fundraising | 6298 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134325 | Total |
| Management And General | 134325 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169142 | Total |
| Management And General | 169142 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10528105 | Total |
| Program Services | 10370671 | ProgramServices |
| Management And General | 157434 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 132720 | Total |
| Program Services | 5632 | ProgramServices |
| Management And General | 120927 | ManagementAndGeneral |
| Fundraising | 6161 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1160600 | Total |
| Program Services | 851065 | ProgramServices |
| Management And General | 285577 | ManagementAndGeneral |
| Fundraising | 23958 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1516304 | Total |
| Program Services | 1498079 | ProgramServices |
| Management And General | 14959 | ManagementAndGeneral |
| Fundraising | 3266 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1645886 | Total |
| Program Services | 1498843 | ProgramServices |
| Management And General | 146143 | ManagementAndGeneral |
| Fundraising | 900 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100470 | Total |
| Program Services | 67748 | ProgramServices |
| Management And General | 29840 | ManagementAndGeneral |
| Fundraising | 2882 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44355 | Total |
| Program Services | 40701 | ProgramServices |
| Management And General | 3654 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1238746 | Total |
| Program Services | 1238746 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1874501 | Total |
| Program Services | 1793235 | ProgramServices |
| Management And General | 81266 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 485272 | Total |
| Program Services | 485272 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Rentals/Leases | 299332 | 264485 | 33510 | 1337 |
| All Other Expenses | 853345 | 49618 | 801694 | 2033 |
| Patient Care Supplies | 3939483 | 3939483 | ||
| Purchased Services | 6587322 | 4038496 | 2541604 | 7222 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57349783 | Total |
| Program Services | 51207279 | ProgramServices |
| Management And General | 5971323 | ManagementAndGeneral |
| Fundraising | 171181 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 929760 | BOY |
| EOY | 359071 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 622175 | BOY |
| EOY | 6662820 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 760782 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4710825 | BOY |
| EOY | 4969667 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 538054 | BOY |
| EOY | 501603 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 196882 | BOY |
| EOY | 317262 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 38653589 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 18390150 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17309874 | BOY |
| EOY | 20263439 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5305702 | BOY |
| EOY | 2227847 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29613272 | BOY |
| EOY | 36062491 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4011416 | BOY |
| EOY | 5034953 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15285287 | BOY |
| EOY | 16202951 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39762055 | BOY |
| EOY | 37482141 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59058758 | BOY |
| EOY | 58720045 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -29650653 | BOY |
| EOY | -23733225 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 205167 | BOY |
| EOY | 1075671 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -29445486 | BOY |
| EOY | -22657554 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29613272 | BOY |
| EOY | 36062491 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 6937782 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -149850 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $6,190 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6190 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i | Identifier |
| Return Reference | Part II-B, Line 1i - Other Activities Description | ReturnReference |
| Explanation | Portion of dues paid to membership organizations allocable to lobbying activities. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 205167 | BeginningOfYearBalance |
| Contributions | 902072 | Contributions |
| Other Expenditures | 31568 | OtherExpenditures |
| End Of Year Balance | 1075671 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 163745 | BeginningOfYearBalance |
| Contributions | 101725 | Contributions |
| Other Expenditures | 60303 | OtherExpenditures |
| End Of Year Balance | 205167 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 150123 | BeginningOfYearBalance |
| Contributions | 148157 | Contributions |
| Other Expenditures | 134535 | OtherExpenditures |
| End Of Year Balance | 163745 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1354985 | OtherCostOrOtherBasis |
| Book Value | 1354985 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 623863 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 16631434 | OtherCostOrOtherBasis |
| Depreciation | 10192330 | Depreciation |
| Book Value | 7062967 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9741026 | OtherCostOrOtherBasis |
| Depreciation | 7366928 | Depreciation |
| Book Value | 2374098 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10302281 | OtherCostOrOtherBasis |
| Depreciation | 830892 | Depreciation |
| Book Value | 9471389 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 20263439 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other Receivables | 372113 |
| Other Investments - Funds in Trust | 915189 |
| Receivables from Related Organizations | 940545 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2227847 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Payables to 3rd Party Payors | $5,783,679 |
| Payables to Related Organizations | $30,816,657 |
| Workers' Comp Payable | $881,805 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 37482141 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part V, Line 4 | Identifier |
| Return Reference | Part V, Line 4: Intended uses of the endowment fund. | ReturnReference |
| Explanation | Temporarily restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 559101 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | -3483 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 562584 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00980 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16863949 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 26349909 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -9485960 | NetCommunityBenefitExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3465765 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1966723 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1499042 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02610 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20888815 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 28313149 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -7424334 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03590 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3983 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3983 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2500 | NetCommunityBenefitExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6483 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 6483 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20895298 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 28313149 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -7417851 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03600 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 495 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 495 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 495 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 495 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,965,141 | BadDebtExpenseAmount |
| Amount Attributable To | 432331 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 21287916 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 20759029 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 528887 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 4 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (4 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | OtherOther | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|---|---|
| Family Health Ctr - Middletown | |||||||||
| 4 | 21337 Bush St | Middletown | CA | 95461 | Rural Health Clinic | ||||
| Family Health Ctr -Kelseyville | |||||||||
| 3 | 5290 State St | Kelseyville | CA | 95451 | Rural Health Clinic | ||||
| Family Health Ctr - Clearlake | |||||||||
| 2 | 15230 Lakeshore Drive | Clearlake | CA | 95422 | Rural Health Clinic | ||||
| St Helena Hospital Clearlake | |||||||||
| 1 | 15630 18th Ave | Clearlake | CA | 95422 | X | X | X | X | |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (4 entries)
| Hospital Facility NumberHospitalFacilityNumber | CHNA ConductedCHNAConducted | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | Uses FPG DiscountedUsesFPGDiscounted | Explains BasisExplainsBasis | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Family Health Ctr - Middletown | ||||||||||||
| 4 | false | false | false | false | false | false | false | false | false | true | false | false |
| Family Health Ctr -Kelseyville | ||||||||||||
| 3 | false | false | false | false | false | false | false | false | false | true | false | false |
| Family Health Ctr - Clearlake | ||||||||||||
| 2 | false | false | false | false | false | false | false | false | false | true | false | false |
| St Helena Hospital Clearlake | ||||||||||||
| 1 | false | false | false | false | false | false | false | false | false | true | false | false |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| St Helena General Surgery - Clearlake | ||||
| 15230 Lakeshore Dr Ste 102 | Clearlake | CA | 95422 | Outpatient Clinic |
| St Helena Cardiology - Lake Silverado | ||||
| 15250 Lakeshore Dr Ste C | Clearlake | CA | 95422 | Outpatient Clinic |
| St Helena Therapy Services - Clearlake | ||||
| 14880 Olympic Dr | Clearlake | CA | 95422 | Outpatient Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part VI - Additional Information | Part V, Section BSchedule H, Part V, Section B is optional for the reporting organization as the tax year began prior to March 23, 2010. Further, IRS Announcement 2011-37 states the entire Part V, Section B is optional for the 2010 Form 990. 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. |
| Part VI - States Where Community Benefit Report Filed | CA |
| Part VI - Affilated Health Care System Roles and Promotion | The hospital is a member of a larger health care system, which provides services in diversified areas of the Western United States. The hospital shares some services with other hospitals in its geographic area. Using today's technology, hospitals outside the geographic area are able to support the hospital by providing remote services such as telepharmacy and robotics surgery. The Corporate Office provides support for the rural health clinics, quality of care, and other clinical needs. |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | We do not wait until a community member needs our services through our clinics or our Emergency Department. We are active in the community we serve. By involving ourselves in various activities, groups, and outreaches, we communicate our willingness to serve our community and our commitment to our mission. Our community health needs assessment keeps us current with changes in the health of our community. By working with other groups and agencies we are better able to assess the needs of the community then if we relied only on our own resources. |
| 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 in a rural setting, predominately agricultural based. The average income is at or below the FPG. The population is predominately Caucasian, high-school educated, and geriatric in nature. |
| Part VI - Patient Education of Eligibility for Assistance | At the time of registration, patients who do not possess third party coverage are counseled on how to apply for assistance via government programs. In many Adventist Health facilities, outside vendors are hired to assist in the area. Patients also are informed of their right to request charity assistance at the time of registration and via signs and other communiques posted and displayed throughout the hospitals. System facilities also provide brochures at the time of registration that explain hospital billing and collection procedures, and how to request financial assistance. In additions, every billing statement sent to patients contains information on how to request financial assistance. |
| Part VI - Needs Assessment | The health system retains outside research firms 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. |
| 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 20,968,991Prior Year Settlements -Cost Report Reimbursable Bad Debts 2,221,079Estimates and Accrual Variances (1,179,909)Other (722,245)Subtotal - Amount reported in Pt III, line 5 21,287,916Amounts include in Part 1, lines g and f -Total Medicare Revenue 21,287,916*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 audited combined 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. 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, those accounts would have been reclassified from bad debt expense to charity care.The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | true | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | true | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||||
| McDonald Edward | ||||||||||||
| 167148 | 2540 | 48106 | 27799 | 20003 | 265596 | 16513 | ||||||
| Newmyer Terrance | ||||||||||||
| 324430 | 71576 | 88697 | 144827 | 16064 | 645594 | 54524 | ||||||
| Simons Marjorie | ||||||||||||
| 588930 | 152891 | 47603 | 142912 | 16100 | 948436 | |||||||
| Wehtje Rodney | ||||||||||||
| 57600 | 87104 | 74 | 144778 | |||||||||
| Rebok Douglas | ||||||||||||
| Dodds Larry | ||||||||||||
| 166400 | 31503 | 12281 | 29066 | 20003 | 259253 | |||||||
| Swenson Jennifer | ||||||||||||
| 16246 | 74 | 16320 | ||||||||||
| Carmen Robert | ||||||||||||
| 143001 | 3753 | 74 | 146828 | |||||||||
| McCurry William | ||||||||||||
| 158950 | 1038 | 6262 | 6177 | 7938 | 180365 | |||||||
| Coppernoll Belinda | ||||||||||||
| 165865 | 512 | 6183 | 7938 | 180498 | ||||||||
| Myers Irvin | ||||||||||||
| 168400 | 923 | 6330 | 7938 | 183591 | ||||||||
| Gumpert Norman | ||||||||||||
| 184592 | 1282 | 19150 | 8115 | 7938 | 221077 | |||||||
| Robinson Ken | ||||||||||||
| 219656 | 1371 | 2925 | 9062 | 7938 | 240952 | |||||||
| Olson Joaline | ||||||||||||
| 334380 | 78585 | 39555 | 74985 | 18759 | 546264 | |||||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch J, Part I, Line 6b | Identifier |
| Return Reference | Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or | ReturnReference |
| Explanation | An incentive plan is included as part of the board-approved compensation plan for hospital executives. The hospital has a similar plan for department directors. The purpose of these plans is to provide incentives to hospital management to accomplish the financial, operational, quality, and mission objectives of the hospital during each fiscal year. Each member of the management team is evaluated against pre-determined objectives to arrive at the incentive amount, if any, for the fiscal year. See Schedule O for additional detail. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VII, Line 1a - Board Comp | The directors serve on the Board without compensation. Amounts reported generally are for taxable benefits. Further explanation for those directors who receive compensation for services rendered in their professional capacity follows. Steven Herber, MD is the Chief Medical Officer (CMO) for St. Helena Hospital. The hospital paid Dr. Herber $144,001 for his services. The CMO services were provided under contract approved by the Board Compliance Committee.Jobe & Stoterau, a law practice with which Meredith Jobe is affiliated, provided legal services regarding real estate matters to White Memorial Medical Center in the amount of $13,791. Wesley Rippey, MD is the Chief Medical Officer for Portland Adventist Medical Center. The hospital paid Dr. Rippey $57,600 for his CMO services. Additionally, Dr. Rippey provides vascular study interpretations and on call coverage for patients of the hospital. The hospital paid $85,818 for these professional services. These services were provided under contract approved by the Board Compliance Committee. | |
| Form 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: 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 19 |
| 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 15b |
| 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 12c |
| 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 11 |
| 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 6 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 Ave | 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 |
| South Coast Medical Center | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 952037291 | Wind down after sale of hospital facilities | CA | 501(c)(3) | 3 | 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 |
| Selma Community Hospital Inc | ||||||||||
| 1141 Rose Ave | Selma | CA | 93662 | 770509133 | Supporting Hanford Community Hospital | CA | 501(c)(3) | 11c, III-FI | 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 Ter | 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 SystemWest | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 956619002 | 953484589 | Support and Manage System-wide Activities | CA | 501(c)(3) | 1 | NA | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |