2024-11-14T14:35:33-06:00 2023-12-31 910189318 MOSS ADAMS LLP 2882 PROSPECT PARK DR STE 300 RANCHO CORDOVA CA 95670 990 2023-01-01 320606993 ADVENTIST HEALTH AND RIDEOUT EMPLOYEE HEALTH PLAN TRUST ADVE 9164060000 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 PRINCIPAL BANK INSTITUTIONAL TRUSTEE 9164060000 2024-11-14 1 1 TRACY S PAGLIA P00366884 9165038100 2024-11-01 2023 2024-10-15 13:58:12Z CHRIS CHAMPLIN 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 32863071 0 X NONE X 2019 CA PROVIDE MEDICAL BENEFITS TO ELIGIBLE EMPLOYEES OF RIDEOUT AND MENDOCINO COAST & THEIR DEPENDENTS 1 1 0 0 0 0 0 0 30652777 32731253 75036 129521 2067 2297 30729880 32863071 0 0 28928220 33130149 2067 2297 0 0 0 1899654 1954639 30829941 35087085 -100061 -2224014 5965824 4489406 810546 1558142 5155278 2931264 NONE 0 0 RIDEOUT MEMORIAL HOSPITAL DBA ADVENTIST HEALTH AND RIDEOUT ("RIDEOUT"), WHICH IS A 501(C)(3) HOSPITAL ESTABLISHED THE ADVENTIST HEALTH AND RIDEOUT EMPLOYEE WELFARE PLAN (THE "PLAN"). THE PLAN PROVIDES MEDICAL BENEFITS TO ELIGIBLE EMPLOYEES OF RIDEOUT, ADVENTIST HEALTH MENDOCINO COAST, AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 X JOHN BEAMAN CFO 9164060000 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 PRINCIPAL BANK INSTITUTIONAL TRUSTEE 0.10 X 2297 0 0 2297 0 0 0 0 0 0 ADVENTIST HEALTH SYSTEMWEST 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 CLAIMS ADMINISTRATION FEES 1880088 0 EMPLOYER/EMPLOYEE CONTRIBUTIONS 900099 32731253 32731253 32731253 129521 129521 MUTUAL FUNDS REVENUE SHARING 900099 2297 2297 2297 32863071 32731253 0 131818 33130149 2297 41686 1880088 32865 35087085 574510 843199 5391314 3646207 5965824 4489406 810546 1558142 810546 1558142 X 0 0 0 0 5155278 2931264 5155278 2931264 5965824 4489406 -2224014 0 X 0 1 X 1 0 0 CLAIMS PAYMENTS ADMINISTRATOR PAYABLE 1354536 ADMINISTRATIVE EXPENSE PAYABLE 203606 1558142 X 32860774 0 32860774 2297 2297 32863071 35084788 0 35084788 2297 2297 35087085 PART X, LINE 2: THE VEBA TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS OBTAINED AN EXEMPTION LETTER EFFECTIVE FEBRUARY 1, 2019, IN WHICH THE INTERNAL REVENUE SERVICE STATED THAT THE TRUST, AS THEN DESIGNED, WAS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME, THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2023 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. ALTHOUGH THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER, THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. AND THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. IN ACCORDANCE WITH GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE PLAN ADMINISTRATOR EVALUATED THE PLAN'S TAX POSITIONS AND DOES NOT BELIEVE THE PLAN HAS ANY UNCERTAIN TAX POSITIONS THAT REQUIRE DISCLOSURE OR ADJUSTMENT TO THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PRINCIPAL CUSTODY SOLUTION FEE PART XII, LINE 4B - OTHER ADJUSTMENTS: PRINCIPAL CUSTODY SOLUTION FEE FORM 990, PART VI, SECTION A, LINE 8B THERE WERE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM WITH INFORMATION PROVIDED BY THE INSTITUTIONAL TRUSTEE. THE FORM 990 IS REVIEWED BY THE TREASURY MANAGER. THE RETURN WILL BE SENT OUT TO THE INSTITUTIONAL TRUSTEE TO REVIEW AND SIGN THE TAX RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE TRUST'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. THE TRUST'S SUMMARY ANNUAL REPORT IS PROVIDED TO PARTICIPANTS ON AN ANNUAL BASIS. RIDEOUT MEMORIAL HOSPITAL 989 PLUMAS STREET YUBA CITY CA 95991 941387866 HOSPITAL CA 501(C)(3) LINE 3 STONE POINT HEALTH 0 UNITED COM-SERVE 989 PLUMAS STREET YUBA CITY CA 95991 943015356 SKILLED NURSING/ASSISTED LIVING/HOME HEALTH CA 501(C)(3) LINE 12B, II STONE POINT HEALTH 0 ADVENTIST HEALTH MENDOCINO COAST 700 RIVER DRIVE FORT BRAGG CA 95437 845174585 HOSPITAL CA 501(C)(3) LINE 3 STONE POINT HEALTH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1