2011-11-15T19:53:30-08:00 2010-12-31 990 2010-01-01 941415069 Sonora Community Hospital dba Sonora Regional Medical Center SONO 2095365000 1000 Greenley Rd Sonora CA 95370 Andrew Jahn 2011-11-15 2010 2016-02-24 21:20:13Z 178115651 false false 1071 X N/A X 1958 CA Following the example of Jesus, we alleviate human suffering by providing physical, mental and spiritual healing. 13 8 1382 116627 -261 345213 678344 155297255 176612107 393320 666452 268520 125427 156304308 178082330 78528 83632 0 71921702 81993826 0 258584 76695262 85661566 148695492 167739024 7608816 10343306 91714025 99152006 67605235 64654240 24108790 34497766 Following the example of Jesus, we alleviate human suffering by providing physical, mental and spiritual healing. false false 151564177 176520527 Sonora Community Hospital (SCH) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of SCH, the organization recognizes that not all individuals possess the ability to pay for essential medical services.SCH's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:- providing free care and/or subsidized care- providing care to persons covered by governmental programs at below cost- providing health/wellness activities and community education programsNot only does SCH provide low-cost care to individuals covered by government programs and those unable to afford health care, but it also helps patients find and access private and governmental resources for health care benefits. SCH recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. Inpatient services in 2010 were provided to approximately 4,953 patients. These services included:- Babies: 567 deliveries- Surgeries: 3,154 hours- Radiology: 10,068 procedures - Laboratory tests: 131,033 tests Outpatient services in 2010 were provided to about 260,000 patients. Including:- Emergency room: 26,174 visits- Outpatient surgeries: 4,589 hours- Radiology procedures: 50,906 performed- Laboratory tests: 267,656 performed- Medical clinics: 157,641 visitsSonora Community Hospital provides home care services in its surrounding communities. These services include, but are not limited to:- Respiratory Care- Elderly Care- Geriatric Case Management- Ostomy & Wound Care- Diabetes Care- IV Home TherapySCH recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission:Project HOPE, which stands for Health, Outreach, Prevention and Education- delivers dozens of free physicals and other services to indigent children and their parents at various locations throughout California's Tuolumne County with the help of volunteer nurses and physicians.Community Events - First aid stations at the local Mother Lode Fair, Home and Garden show and the Tuolumne Me-Wuk Health Fair. Exhibits at the Groveland Family Wellness Fair and the Tuolumne County Youth Health Fair. Close to 4,000 health screenings done at the annual Tuolumne County Health Fair.Health Education and Support ProgramsThe many support groups and health education classes conducted, including but not limited to:Cancer support group, Diabetes support group, Depression Recovery Program class, Spiritual Care training, CHIP Coronary Health Improvement Project, Epilepsy/Seizure Support Group, La Leche League, Childbirth Preparation Classes, Preparation for Cesarean Birth Classes, OakPlus Wellness Seminars, Quit for Life: Tobacco Cessation Classes, Lifeline Emergency Response ProgramMaintained and monitored up to 320 Lifeline Emergency Response Units. This 24-hour-a-day system offers immediate response to those whose physical condition could otherwise limit their ability to summon help.Spiritual SupportSCH's chaplains provided over 4,000 patient visits and over 1,500 hours of patient counseling, and provided over 300 hours of employee counseling, conducted memorial services and officiated at weddings.Community SupportSCH donated $26,450 to 33 community service organizations in 2010. 151564177 true true false true false false false false false true true false false false true true false true false false false false false false true false true true true true true false false false false false false true false false false false false false false false false true false true false false true 155 0 true 1382 true true true false false false false false false true true false 0 false false true true 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 Andrew Jahn 2095365000 1000 Greenley Rd Sonora CA 95370 Alan Rice 0.00 X 0 264502 30663 Rick Dodds 50.00 X 0 135150 23769 Pauline Campbell 50.00 X 0 197490 35700 Julie Kline 50.00 X 0 234450 53987 Alan J Rice 0.00 0 264502 30663 David Larsen 50.00 X 0 240152 68484 Douglas Duffield 50.00 X 0 14565 1696 Jeff Eller 50.00 X 0 388189 88750 Rodney Wehtje 50.00 X 0 484703 160891 Scott Reiner 50.00 X 0 706956 142451 Douglas Rebok 50.00 X 0 701547 140807 Larry Dodds 50.00 X X 0 789424 159012 Robert Carmen 50.00 X X 0 1485849 256139 Max Torkelsen 1.00 X 0 1854 74 WES RIPPEY 1.00 X 0 144704 74 Al Reimche 1.00 X 0 1440 74 Meredith Jobe 1.00 X 0 16246 74 Steven Herber 1.00 X 0 146754 74 Ricardo Graham 1.00 X 0 2309 74 Christine Friestad 1.00 X 0 1311 74 Ruthita Fike 1.00 X 0 405 74 Lynn Creitz 1.00 X 0 2123 74 LARRY CAVINESS 1.00 X 0 2505 74 Robert Bradshaw 1.00 X 0 1321 74 Deborah Goreham 0.00 X 205831 0 0 David Schwartz 40.00 X 258503 0 0 Shane Tipton 40.00 X 240728 0 0 Paul Bauman 45.00 X 244740 0 0 Susan Shinkai 40.00 X 178641 0 0 1128443 6228451 1193826 108 true true false Sierra Cardiology Med Assoc 900 Greenely Rd Ste 911 Sonora CA 95370 Medical Group 2787606 Sound Physicians 1123 Pacific Ave Tacoma WA 98402 Medical Group 1041607 Robert DAcquisto MD Inc 900 Greenley Rd Sonora CA 95370 Medical Group 976888 Sonora Anesthesia Services PO Box 845 Sonora CA 95370 Medical Group 875611 Sierra Emergency Medical Group PO Box 4685 Sonora CA 95370 Medical Group 2633493 46 95065 24002 559277 678344 Pharmacy 91580 91580 Other Revenue 900099 203819 203819 Rent - Medical Offices 531120 217365 217365 Dietary 900099 459555 459555 Patient Service Revenue 900099 175630478 175630478 9310 9310 176612107 666452 666452 0 0 0 0 42121 95065 33321 8800 8800 0 0 Company Store 621990 14037 14037 Sonora Oxygen Service 621610 40817 40817 Retail Pharmacy 446110 54760 54760 7013 7013 116627 178082330 176520527 116627 766832 26449 26449 57183 57183 0 0 0 0 60930444 57048555 3729238 152651 2383757 2204546 174270 4941 14240291 13196884 1015946 27461 4439334 4159923 268701 10710 0 271530 271530 342744 342744 0 0 0 18770141 16763006 2003875 3260 322596 322596 29846011 29165224 661586 19201 3696047 3696047 0 4392712 4128194 264518 533498 404836 127213 1449 0 198974 137704 59983 1287 2069789 2069789 0 4603785 4603785 1313055 1313055 Equipment rentals 1548928 1532683 16245 Miscellaneous 1582234 724859 857375 Purchased services 16169522 10331455 5800443 37624 0 167739024 151564177 15916263 258584 1073672 92183 12160366 21010900 0 20612385 19724199 0 0 0 3178202 3386731 1097247 1487266 96560189 45471932 51401421 51088257 0 0 0 53562 388589 2137170 1973881 91714025 99152006 9843362 9325129 489167 -122933 5088034 4579230 52184672 50872814 67605235 64654240 X 23400659 33592462 708131 905304 24108790 34497766 91714025 99152006 X 10343306 45670 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 10609 10609 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description A portion of industry association dues is allocated to lobbying activities. 708131 538837 341664 905304 572083 325741 189693 708131 427428 331644 186989 572083 false false false 2195922 2195922 55738342 18528594 37209748 6367742 1937321 4430421 31636345 25006017 6630328 621838 621838 51088257 Other liabilities -164542 Payables to third-party payers 1942475 Workers' comp liability 4742411 Payables to related orgs 44352470 50872814 Part X Part X : FIN48 Footnote The audited combined financial statement footnotes do not contain a FIN 48 disclosure. Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Donated property $45670 Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. X X X X false Gala 75396 48290 27106 2500 10269 400 5213 Golf Tournament 61790 46775 15015 500 3969 5192 3060 2218 137186 95065 42121 500 3969 7692 13329 400 7431 33321 8800 true true X true X true X true true true false false false 1137562 319647 817914 0.00490 25016256 31183074 -6166818 7590149 5391620 2198529 0.01310 33743967 36894341 -3150375 0.01800 165535 165535 0.00100 1484420 1484420 0.00880 28674 28674 0.00020 1678629 1678629 0.01000 35422596 36894341 -1471746 0.02800 true 1088648 206843 66374262 5074939 61299323 X true false 29 29 Sonora Regional Wound Care

12811 Covey Circle Sonora CA 95370

Wound Care clinic 28 Cedar Road Family Medical Cent

20044 Cedar Road Sonora CA 95370

Physician Office 27 Twain Harte Family Medical Cen

22629 Twain Harte Drive Twain Harte CA 95383

Physician Office 26 Sonora Oxygen and Medical Supp

358 W Stockton Street Sonora CA 95370

Home oxygen supplier 25 Sierra Vascular Clinic

690 Guzzi Lane Suite 104 Sonora CA 95370

Physician office 24 Hillside Internal Medicine

690 Guzzi Lane B Sonora CA 95370

Physician office 23 Groveland Family Medical Cente

18661 Highway 120 Groveland CA 95321

Physician office 22 Sonora Regional Surgery Center

905 Morning Star Drive Sonora CA 95370

OP Surgery Center 21 Foothill Primary Care

650 Pauline Court Sonora CA 95370

Physician Office 20 Community Pharmacy -Forest Rd

193 S Fairview Ln Suite A Sonora CA 95370

Pharmacy 19 Sonora Regional Home Health

467 South Main St Angels Camp CA 95222

Home Health agency 18 Radiation Oncology

900 Greenley Road Suite 901 Sonora CA 95370

Radiation Therapy treatment center 17 Sierra Internal Medicine Cente

900 Greenley Road Suite 922 Sonora CA 95370

Physician Office 16 Sierra Cardiology

900 Greenley Road Suite 911 Sonora CA 95370

Physician Office 15 Sierra Cancer Center

900 Greenley Road Suite 902 Sonora CA 95370

Physician office 14 Community Pharmacy

900 Greenley Road Suite 912 Sonora CA 95370

Outpatient Pharmacy 13 Cedarwood Internal Medicine Ce

690 Guzzi Lane Suite A Sonora CA 95370

Physician office 12 Arnold Family Medical Center

2037 Highway Four Arnold CA 95223

Physician Office 11 Angels Camp Family Medical Cen

445 S Main Street Angels Camp CA 95222

Physician office 10 Sonora Regional Home Health

20100 Cedar Road North Sonora CA 95370

Home Health agency 9 Cardiac and Pulmonary Rehab

19747 Greenley Rd Sonora CA 95370

Outpatient services 8 Anticoagulation Clinic

193 S Fairview Lane Suite L Sonora CA 95370

Outpatient clinic 7 Sonora Care Center

538 Ponderosa Dr Sonora CA 95370

Skilled Nursing Facility 6 Transitional Care Unit

179 S Fairview Ln Sonora CA 95370

Skilled Nursing Facility 5 Sonora Regional Imaging Center

12811 Covey Circle Sonora CA 95370

Imaging Center 4 Prompt Care Indian Rock

14540 Mono Way Sonora CA 95370

Urgent care clinic 3 Forest Rd Health and Wellness

193 Fairview Ln Sonora CA 95370

Physician offices and prompt care 2 Community Infusion Center

900 Greenley Rod Sonora CA 95370

OP Infusion center 1 Sonora Regional Medical Center

1000 Greenley Rd Sonora CA 95370

X X X Sonora Regional Wound Care 29 false false false false false false false false false true false false Cedar Road Family Medical Cent 28 false false false false false false false false false true false false Twain Harte Family Medical Cen 27 false false false false false false false false false true false false Sonora Oxygen and Medical Supp 26 false false false false false false false false false true false false Sierra Vascular Clinic 25 false false false false false false false false false true false false Hillside Internal Medicine 24 false false false false false false false false false true false false Groveland Family Medical Cente 23 false false false false false false false false false true false false Sonora Regional Surgery Center 22 false false false false false false false false false true false false Foothill Primary Care 21 false false false false false false false false false true false false Community Pharmacy -Forest Rd 20 false false false false false false false false false true false false Sonora Regional Home Health 19 false false false false false false false false false true false false Radiation Oncology 18 false false false false false false false false false true false false Sierra Internal Medicine Cente 17 false false false false false false false false false true false false Sierra Cardiology 16 false false false false false false false false false true false false Sierra Cancer Center 15 false false false false false false false false false true false false Community Pharmacy 14 false false false false false false false false false true false false Cedarwood Internal Medicine Ce 13 false false false false false false false false false true false false Arnold Family Medical Center 12 false false false false false false false false false true false false Angels Camp Family Medical Cen 11 false false false false false false false false false true false false Sonora Regional Home Health 10 false false false false false false false false false true false false Cardiac and Pulmonary Rehab 9 false false false false false false false false false true false false Anticoagulation Clinic 8 false false false false false false false false false true false false Sonora Care Center 7 false false false false false false false false false true false false Transitional Care Unit 6 false false false false false false false false false true false false Sonora Regional Imaging Center 5 false false false false false false false false false true false false Prompt Care Indian Rock 4 false false false false false false false false false true false false Forest Rd Health and Wellness 3 false false false false false false false false false true false false Community Infusion Center 2 false false false false false false false false false true false false Sonora Regional Medical Center 1 false false false false false false false false false true false false 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 The hospital continues to operate its 24-hour emergency department. The hospital has open medical staff to all qualified individuals. The hospital continues to expand its primary care outreach program through outpatient clinics, including a mobile clinic. The hospital operates skilled nursing facilities, which serve those who are unable to continue living without assistance due chronic medical conditions. Part VI - Community Building Activities Our hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. And, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part VI - Community Information The hospital is the only health care system in the area serving two counties and surrounding areas. In early 2009 the hospital was designated as a "sole community hospital" by Medicare. The area is rural. Agriculture, logging and tourism are the major employment opportunities. The population includes a large number of retired individuals. Part VI - Patient Education of Eligibility for Assistance At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients also are orally informed of their right to request charity assistance. Signs and other communiqus are posted and displayed throughout the hospital in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. Part VI - Needs Assessment The health system retains outside research firms every 3 years to assess changes in the market and community perception. Data is collected through a variety of vehicles, including phone surveys, paper surveys, and focus groups. Questions were added to the survey to help assess the impact of our community benefit activities and residents' barriers to access for health care services as well as unmet community needs. 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 - 57,732,860Prior year settlements - 269,819Cost Report remimbursable bad debts - 412,762Clinic 1206(D) revenue - 3,590,324Estimates and Accrual Variances - (285,927)Other - 4,654,424Total Medicare Revenue - 66,374,262*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 alraedy 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. true X 0 0 Utilities, food, other emergency assist 250 22107 Cash Transportation cancer pts to treatments 500 35076 Cash Grantmaker's Description of How Grants are Used Hospital does not monitor use of funds. X X X X true true false false false true true false false false Rick Dodds 128065 7085 7296 16473 158919 Pauline Campbell 160020 23908 13562 19735 15965 233190 Julie Kline 186020 30143 18287 38006 15981 288437 Alan J Rice 227615 36887 14367 16296 295165 32697 David Larsen 200240 33368 6544 46444 22040 308636 Jeff Eller 310080 65274 12835 68661 20089 476939 Rodney Wehtje 324430 71576 88697 144827 16064 645594 54524 Scott Reiner 510580 135332 61044 122323 20128 849407 Douglas Rebok 512780 137782 50985 122488 18319 842354 Larry Dodds 588930 152891 47603 142912 16100 948436 Robert Carmen 920840 235922 329087 235392 20747 1741988 211163 Deborah Goreham 205831 205831 David Schwartz 258503 258503 Shane Tipton 240728 240728 Paul Bauman 244740 244740 Susan Shinkai 178641 178641 Alan Rice 227615 36887 14367 16296 295165 32697 Sch J, Part I, Line 6b Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or An incentive plan is included as part of the board-approved compensation plan for hospital executives. [Use only if true statement - 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. Jeff Eller Housing X 150000 148500 false true true Rick Dodds Housing X 100000 99300 false true true 247800 Amanda Hardcastle Wehtje officer 77545 Employment false 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 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 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 review 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 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. WILLITS HOSPITAL INC 1 Madrone St Willits CA 95490 680108919 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false WHITE MEMORIAL MEDICAL CENTER 1720 Cesar E Chavez Ave Los Angeles CA 90033 952282647 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false WALLA WALLA GENERAL HOSPITAL 1025 S Second St Walla Walla WA 99362 910617726 Hospital WA 501(C)(3) 1 Adventist Health SystemWest false UKIAH ADVENTIST HOSPITAL 275 Hospital Dr Ukiah CA 95482 941639901 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false SOUTH COAST MEDICAL CENTER 2100 Douglas Blvd Roseville CA 95661 952037291 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false SIMI VALLEY HOSPITAL & HEALTH CARE SERVI 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) 11, type 3 functiona 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 PORT HUENEME ADVENTIST HOSPITAL 2100 Douglas Blvd Roseville CA 95661 952915819 Dissolution in process CA 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 NORTHWEST MEDICAL FOUNDATION OF TILLAMOO 1000 Third St Tillamook OR 97141 930622075 Hospital OR 501(C)(3) 1 Adventist Health SystemWest false HANFORD COMMUNITY HOSPITAL 450 Greenfield Ave Hanford CA 93230 940535360 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false GLENDALE ADVENTIST MEDICAL CENTER 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false Feather River Hospital 5974 Pentz Rd Paradise CA 95969 941101228 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false CENTRAL VALLEY GENERAL HOSPITAL 1025 N Douty St Hanford CA 93230 770324630 Hospital CA 501(C)(3) 1 Adventist Health SystemWest false CASTLE MEDICAL CENTER 640 Ulukahiki St Kailua HI 96734 990107330 Hospital HI 501(C)(3) 1 Adventist Health SystemWest false ADVENTIST HEALTH CLEARLAKE HOSPITAL 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 NA false false false false false true false false false false false false true false false false false false false ADVENTIST HEALTH SYSTEMWEST l 6041599 ADVENTIST HEALTH SYSTEMWEST e 44352470