ADVENTIST HEALTH CLEARLAKE HOSPITAL INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC (EIN 68-0395149)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-05
- IRS object ID
- 202443109349302629
- Schema version
- 2023v5.1
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-05T14:13:51-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680395149 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Clearlake Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ADVE | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15630 18th Avenue | AddressLine1Txt |
| City | Clearlake | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95422 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jeffrey Mock | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2024-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2024-11-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Clear Lake | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Colleen Assavapisitkul | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15630 18th Avenue | AddressLine1Txt |
| City | Clearlake | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95422 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $191,928,621 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/clear-lake/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 996 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,292,822 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,344,105 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $182,562,730 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $189,317,343 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,272,129 | PYInvestmentIncomeAmt |
| CY Investment Income | $945,015 | CYInvestmentIncomeAmt |
| PY Other Revenue | $158,744 | PYOtherRevenueAmt |
| CY Other Revenue | $195,763 | CYOtherRevenueAmt |
| PY Total Revenue | $192,286,425 | PYTotalRevenueAmt |
| CY Total Revenue | $191,802,226 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $270,625 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $51,352 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $72,213,247 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $79,481,728 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $208,015 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $106,791,486 | PYOtherExpensesAmt |
| CY Other Expenses | $100,142,802 | CYOtherExpensesAmt |
| PY Total Expenses | $179,275,358 | PYTotalExpensesAmt |
| CY Total Expenses | $179,675,882 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $13,011,067 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $12,126,344 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $139,959,853 | TotalAssetsBOYAmt |
| Total Assets EOY | $152,811,093 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $112,497,711 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $110,744,048 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $27,462,142 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $42,067,045 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $143,071,369 | ExpenseAmt |
| Grant | $51,352 | GrantAmt |
| Revenue | $189,317,343 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $143,071,369 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 996 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | John Beaman CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Adventist Health Way | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (37 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Heinrich Kerry | ||||||||||
| Dir/Chair/CEO | 0.00 | 50.50 | Yes (X) | Yes (X) | $0 | $3,302,428 | $57,395 | |||
| Hofheins Todd | ||||||||||
| Dir/Vice Chair/COO | 0.00 | 50.50 | Yes (X) | Yes (X) | $0 | $2,272,592 | $76,141 | |||
| Beaman John | ||||||||||
| CFO/Assistant Secretary | 0.00 | 50.50 | Yes (X) | $0 | $1,680,553 | $73,355 | ||||
| Stevens Eric - President | ||||||||||
| Northern CA/HI State Network | 5.00 | 45.50 | $0 | $1,526,293 | $59,552 | Yes (X) | ||||
| Jahn Andrew - Former | ||||||||||
| Care Division President thru 02/22 | 0.00 | 50.00 | $0 | $1,465,906 | $103,785 | Yes (X) | ||||
| Nahapetian Arby - Former Care | ||||||||||
| Division Medical Officer thru 02/22 | 0.00 | 50.00 | $0 | $1,482,294 | $69,613 | Yes (X) | ||||
| Wing Bill - Former | ||||||||||
| Dir/Asst Secr/Vice Chair thru 01/22 | 0.00 | 0.00 | $0 | $1,438,460 | $40,073 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.50 | Yes (X) | $0 | $959,488 | $59,410 | ||||
| Howe Judson - President | ||||||||||
| North Coast Network thru 03/23 | 8.30 | 41.70 | $0 | $808,895 | $28,997 | Yes (X) | ||||
| Cantrell Misty | ||||||||||
| Patient Care Executive | 50.00 | 0.00 | $0 | $661,754 | $74,551 | Yes (X) | ||||
| Assavapisitkul Colleen | ||||||||||
| President | 50.00 | 0.00 | Yes (X) | $0 | $601,799 | $26,786 | ||||
| Tetz Warren | ||||||||||
| Former Treasurer thru 12/22 | 0.00 | 0.00 | $0 | $560,025 | $58,835 | Yes (X) | ||||
| Eberhart Gregory | ||||||||||
| Area Medical Officer | 12.50 | 37.50 | $0 | $582,946 | $27,959 | Yes (X) | ||||
| Spenst Brett - Former Care | ||||||||||
| Division Finance Officer thru 02/22 | 0.00 | 50.00 | $0 | $520,625 | $45,847 | Yes (X) | ||||
| Mock Jeffrey | ||||||||||
| Treasurer/Asst Secr as of 09/23 | 10.00 | 40.50 | Yes (X) | $0 | $470,391 | $67,797 | ||||
| Shepardson Dean - Treasurer | ||||||||||
| Asst Secr from 03/23 thru 09/23 | 12.50 | 37.50 | Yes (X) | $0 | $461,843 | $55,761 | ||||
| Assadian Hoda | ||||||||||
| Operations Executive | 16.70 | 33.30 | $0 | $460,925 | $52,377 | Yes (X) | ||||
| Jacobson Carlton - Former Treas | ||||||||||
| /Asst Secr thru 12/21/Fin Off AHCL | 50.00 | 0.00 | $0 | $407,917 | $44,184 | Yes (X) | ||||
| Anjejo Isaac | ||||||||||
| RN | 40.00 | 0.00 | $404,234 | $0 | $26,773 | Yes (X) | ||||
| Bloom Evan | ||||||||||
| Medical Officer | 50.00 | 0.00 | $0 | $367,771 | $45,783 | Yes (X) | ||||
| Cardenas Lucita | ||||||||||
| RN | 40.00 | 0.00 | $316,965 | $0 | $57,269 | Yes (X) | ||||
| Kruger Thomas | ||||||||||
| RN | 40.00 | 0.00 | $319,338 | $0 | $30,762 | Yes (X) | ||||
| Shelton Jacarre | ||||||||||
| Director, Pharmacy | 40.00 | 0.00 | $285,726 | $0 | $63,558 | Yes (X) | ||||
| Flynn Laura | ||||||||||
| Director, RN | 40.00 | 0.00 | $270,383 | $0 | $71,941 | Yes (X) | ||||
| Byrnes John - Former | ||||||||||
| Medical Officer, NCR thru 02/20 | 0.00 | 0.00 | $0 | $263,659 | $34,955 | Yes (X) | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,770 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Newton Bradford | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,611 | $0 | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,181 | $0 | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $21,611 | $0 | ||||
| Wagner Jack | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $16,180 | $0 | ||||
| Fehr Joy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $430 | $0 | ||||
| Ocampo Lucy | ||||||||||
| Director thru 08/23 | 0.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,596,646 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $20,547,402 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,353,459 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 160 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Acqhire Inc | |||||
| 2941 Sunset Boulevard Street | Rancho Cordova | CA | 95742 | Physician/medical provider | $2,500,149 |
| RMG Medical Imaging Consultants | |||||
| 25360 Magic Mtn Pkwy Ste 270 | Valencia | CA | 91355 | Physician/medical provider | $1,649,036 |
| Galen Inpatient Physicians Inc | |||||
| 2100 Powell St Suite 400 | Emeryville | CA | 94608 | Physician/medical provider | $1,628,047 |
| Pacific Redwood Medical Group Inc | |||||
| 242 Hospital Drive | Ukiah | CA | 95482 | Physician/medical provider | $1,394,040 |
| Lyons Huber Management A Medical Corp | |||||
| 512 Pine Hill Road | Angwin | CA | 94508 | Physician/medical provider | $1,070,845 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 46 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $396,224 | GovernmentGrantsAmt |
| All Other Contributions | $947,881 | AllOtherContributionsAmt |
| Total Contributions | $1,344,105 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621110 | $170,711,526 | $170,711,526 |
| CARES Act revenue | 621110 | $8,094,928 | $8,094,928 |
| Premium revenue | 621110 | $6,429,723 | $6,429,723 |
| Incentive/quality revenue | 531120 | $2,309,484 | $2,309,484 |
| 340B pharmacy revenue | 621110 | $1,170,772 | $1,170,772 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $600,910 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $600,910 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $189,317,343 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $950,339 | TotalRevenueColumnAmt |
| Exclusion | $950,339 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $182,279 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $72,912 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $109,367 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $109,367 | TotalRevenueColumnAmt |
| Exclusion | $109,367 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,324 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$5,324 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,324 | TotalRevenueColumnAmt |
| Exclusion | -$5,324 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $134,555 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $48,159 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $86,396 | TotalRevenueColumnAmt |
| Exclusion | $86,396 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $191,802,226 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $189,317,343 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,140,778 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,352 | TotalAmt |
| Program Services | $51,352 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,215,782 | TotalAmt |
| Program Services | $53,065,690 | ProgramServicesAmt |
| Management And General | $9,020,111 | ManagementAndGeneralAmt |
| Fundraising | $129,981 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,240,271 | TotalAmt |
| Program Services | $1,916,461 | ProgramServicesAmt |
| Management And General | $318,932 | ManagementAndGeneralAmt |
| Fundraising | $4,878 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,877,964 | TotalAmt |
| Program Services | $9,486,289 | ProgramServicesAmt |
| Management And General | $1,371,403 | ManagementAndGeneralAmt |
| Fundraising | $20,272 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,147,711 | TotalAmt |
| Program Services | $3,633,409 | ProgramServicesAmt |
| Management And General | $504,651 | ManagementAndGeneralAmt |
| Fundraising | $9,651 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,611,015 | TotalAmt |
| Management And General | $16,611,015 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $362,221 | TotalAmt |
| Management And General | $362,221 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,898 | TotalAmt |
| Program Services | $11,898 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,708,174 | TotalAmt |
| Program Services | $46,352,681 | ProgramServicesAmt |
| Management And General | $1,354,243 | ManagementAndGeneralAmt |
| Fundraising | $1,250 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,592 | TotalAmt |
| Management And General | $330,592 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,377,174 | TotalAmt |
| Program Services | $1,034,465 | ProgramServicesAmt |
| Management And General | $328,908 | ManagementAndGeneralAmt |
| Fundraising | $13,801 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,659,620 | TotalAmt |
| Program Services | $481,235 | ProgramServicesAmt |
| Management And General | $4,178,385 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,416,224 | TotalAmt |
| Program Services | $3,927,930 | ProgramServicesAmt |
| Management And General | $484,329 | ManagementAndGeneralAmt |
| Fundraising | $3,965 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $544,077 | TotalAmt |
| Program Services | $453,853 | ProgramServicesAmt |
| Management And General | $85,946 | ManagementAndGeneralAmt |
| Fundraising | $4,278 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,900 | TotalAmt |
| Program Services | $31,984 | ProgramServicesAmt |
| Management And General | $20,621 | ManagementAndGeneralAmt |
| Fundraising | $2,295 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,334,145 | TotalAmt |
| Program Services | $2,334,145 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,579,073 | TotalAmt |
| Program Services | $4,352,534 | ProgramServicesAmt |
| Management And General | $210,173 | ManagementAndGeneralAmt |
| Fundraising | $16,366 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $994,897 | TotalAmt |
| Program Services | $994,897 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient care supplies | $12,740,097 | $12,696,294 | $43,803 |
| Rental/leases costs equ | $1,914,679 | $1,847,178 | $67,501 |
| Quality assurance fees | $102,063 | $102,063 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,401,953 | TotalAmt |
| Program Services | $297,011 | ProgramServicesAmt |
| Management And General | $1,103,664 | ManagementAndGeneralAmt |
| Fundraising | $1,278 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,675,882 | TotalAmt |
| Program Services | $143,071,369 | ProgramServicesAmt |
| Management And General | $36,396,498 | ManagementAndGeneralAmt |
| Fundraising | $208,015 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,187 | BOYAmt |
| EOY | $3,555 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,019,310 | BOYAmt |
| EOY | $42,205,706 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $424,607 | BOYAmt |
| EOY | $197,048 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,994,709 | BOYAmt |
| EOY | $19,581,659 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,739,862 | BOYAmt |
| EOY | $1,625,416 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,674 | BOYAmt |
| EOY | $214,953 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $95,519,160 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $57,238,040 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,368,958 | BOYAmt |
| EOY | $38,281,120 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,626 | BOYAmt |
| EOY | $123,827 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,081,920 | BOYAmt |
| EOY | $50,577,809 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,959,853 | BOYAmt |
| EOY | $152,811,093 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,926,046 | BOYAmt |
| EOY | $13,685,480 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,680 | BOYAmt |
| EOY | $501,891 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,389,985 | BOYAmt |
| EOY | $96,556,677 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,497,711 | BOYAmt |
| EOY | $110,744,048 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,159,612 | BOYAmt |
| EOY | $41,132,625 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,302,530 | BOYAmt |
| EOY | $934,420 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,462,142 | BOYAmt |
| EOY | $42,067,045 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,959,853 | BOYAmt |
| EOY | $152,811,093 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $12,126,344 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,769,559 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$291,000 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $11,898 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $11,898 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to NL Short Public Affairs were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,312,530 | BeginningYearBalanceAmt |
| Contributions | $2,157,928 | ContributionsAmt |
| Other Expenditures | $2,526,796 | OtherExpendituresAmt |
| End Year Balance | $943,662 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $680,895 | BeginningYearBalanceAmt |
| Contributions | $7,048,370 | ContributionsAmt |
| Investment Earnings Or Losses | -$17,964 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,398,771 | OtherExpendituresAmt |
| End Year Balance | $1,312,530 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,278,092 | BeginningYearBalanceAmt |
| Contributions | $3,372,492 | ContributionsAmt |
| Investment Earnings Or Losses | $15,218 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,984,907 | OtherExpendituresAmt |
| End Year Balance | $680,895 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $601,407 | BeginningYearBalanceAmt |
| Contributions | $4,754,613 | ContributionsAmt |
| Investment Earnings Or Losses | -$2,147 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,075,781 | OtherExpendituresAmt |
| End Year Balance | $1,278,092 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $610,082 | BeginningYearBalanceAmt |
| Contributions | $1,733,152 | ContributionsAmt |
| Investment Earnings Or Losses | $28,727 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $1,380,823 | GrantsOrScholarshipsAmt |
| Other Expenditures | $389,731 | OtherExpendituresAmt |
| End Year Balance | $601,407 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00979 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.99021 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,862,339 | OtherCostOrOtherBasisAmt |
| Book Value | $2,862,339 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,885,446 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,418,093 | DepreciationAmt |
| Book Value | $18,467,353 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,592,553 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,698,831 | DepreciationAmt |
| Book Value | $893,722 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,007,364 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,312,850 | DepreciationAmt |
| Book Value | $4,694,514 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,171,458 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,808,266 | DepreciationAmt |
| Book Value | $11,363,192 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $38,281,120 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from third-party payors | $36,870,949 |
| Right-of-use assets | $9,305,187 |
| Receivables from related organizations | $2,491,042 |
| Other receivables | $1,910,631 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $50,577,809 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $77,441,691 |
| Payables to third-party payors | $10,493,511 |
| Other liabilities | $8,621,475 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $96,556,677 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| Part X, Line 2: | The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2023 and 2022, no such assets or liabilities were recorded. The System currently files Form 990 (Informational Return of Organizations Exempt From Income Taxes) and Form 990-T (Exempt Organization Business Income Tax Return) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2020 in major tax jurisdictions. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Gala | Event1Nm |
| Gross Receipts Event1 | $77,520 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $77,520 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $13,537 | NonCashPrizesEvent1Amt |
| Other Direct Expenses Event1 | $5,061 | OtherDirectExpensesEvent1Amt |
| Event2 | Golf Event | Event2Nm |
| Gross Receipts Event2 | $57,035 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $57,035 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $750 | RentFacilityCostsEvent2Amt |
| Other Direct Expenses Event2 | $28,811 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $134,555 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $134,555 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $13,537 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $750 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $33,872 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $48,159 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $86,396 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $705,091 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $705,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,335,964 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $59,592,630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,041,055 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $59,592,630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $705,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,566,547 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $50,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,516,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,962,390 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,280,546 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,681,844 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $110,847 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $800 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $110,047 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,639,784 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,331,346 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,308,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07960 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $91,680,839 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $84,923,976 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,013,529 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08350 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $964,235 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $964,235 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,900 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $25,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,576 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,576 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,068,811 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,900 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,066,911 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,868,995 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $726,831 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $44,156,536 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $41,060,852 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $3,095,684 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Clearlake Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15630 18th Avenue | AddressLine1Txt |
| City | Clearlake | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95422 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | adventisthealth.org\clear-lake | WebsiteAddressTxt |
| State License | 110000174 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Clearlake Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assessment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assessment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Adventist Health Clearlake Hospital | Part V, Section B, Line 5: The 2022 Community Health Needs Assessment was developed using four separate sources of primary and secondary data. This mixed methods approach is considered a preferred practice for needs assessments because it allows for the greatest understanding of community needs from the broadest range of perspectives. Primary data refers to data collected and analyzed specifically for this project, while secondary data refers to data compiled and analyzed by external groups and utilized here. Qualitative primary data collection involved focus group interviews with local service providers and service recipients and individual key informant interviews with local leaders. These were conducted in person and virtually. Direct quotes were taken from a transcription of key informant interviews and are intended to be 100% accurate but could not be verified in all situations. This information was collected by the Adventist Health Community Well Being team and evaluation consultants from the Center for Behavioral Health Integration. Secondary data was amassed and analyzed across 45 different data sets by the University of Missouri Extension Center for Applied Research and Engagement Systems (CARES). Finally, survey data sets of registered voters in the community were collected and analyzed by UC Berkeley Institute of Governmental Studies (IGS). In total, seven focus groups were conducted with 41 participants, and 19 key informant interviews were held. Survey data was gathered from the North Coast region (region name defined by survey administrator, UC Berkeley IGS).Represented populations included Agricultural workers (Spanish-speaking), civic government & leadership, community-based healthcare workers focusing on behavioral health, education, health & human services, higher education, providers, families, food insecure, law enforcement, low-income, medically underserved, men, older adults, public health, students, tribal health services, unhoused and women populations. |
| Adventist Health Clearlake Hospital | Part V, Section B, Line 6a: Adventist Health Clearlake and Sutter Lakeside Hospital worked together to produce the 2022 CHNA. |
| Adventist Health Clearlake Hospital | Part V, Section B, Line 6b: Participating organizations include City of Clearlake, City of Lakeport, County of Lake, Employment Development Department, Hope Rising, Lake County Aging Services, Lake County Behavioral Health, Lake County Chamber of Commerce, Lake County Health & Human Services, Lake County Sheriff's Department, Lake County Department of Public Health, Lake County Office of Education, Lake County Transit Authority, Lake County Tribal Health, Lake Family Resource Center, and Woodland Community College. |
| Adventist Health Clearlake Hospital | Part V, Section B, Line 11: Tax year 2023 was Year One of the Implementation Strategy for the 2022 Community Health Needs Assessment (CHNA). All programs and activities provided to the community were in response to the priority health needs identified in the 2022 CHNA. Our 2022 CHNA identified three health priorities: Access to Care, Health Risk Behaviors, Mental Health.Priority Need One: Access to Care The goal is to expand services to meet the needs of the community's health through the opening of a Rapid Care Clinic in Clearlake and Lakeport and launching services with partner community organizations in bringing the mobile shower trailer to community locations for showers and street medicine. In 2023, Adventist Health Clearlake, Inc. (AHCL) opened its Rapid Care clinic providing walk in care for minor illness and injuries. "Adventist Health is excited and proud to be the first to establish Rapid Care services for our community," said Colleen Assavapisitkul, President of AHCL. "We heard the voices of our neighbors asking for timely access to care when needed most." The Rapid Care clinic addresses a gap in services that was identified in the 2022 Community Health needs Assessment. Community members requiring immediate medical care can visit the rapid care clinic without an appointment. Over 9,000 patients were seen at the Clearlake clinic and almost two thousand patients seen in Lakeport. The mobile shower trailer has been providing those community members who have experienced housing instability or those living in poverty without running water, essential services with dignity and respect since 2022. Additionally, on-site staffing of a registered nurse and community health workers provide medical assessments and referrals. The mobile van is used to provide triage, medical case management, first aid, HEP-C and COVID testing, and resource referrals. The van is utilized in community outreach events such as the health fairs, Recovery Happens, Point in Time Count and Mental Health Matters. In 2023, the mobile shower trailer provided services to five thousand community members and the mobile medical van provided medical care to 371 vulnerable persons. AHCL primary and secondary service areas show a severe shortage of primary care providers including practicing physicians specializing in general practice medicine, family medicine, internal medicine, and pediatrics. Within the service area, there are 40,419 people living in a Health Professional Shortage Area of primary care, dental or mental health professionals. This represents 93.78% of the total population. In 2023, AHCL was able to recruit twenty-one permanent provider positions to Clearlake and surrounding areas including two pediatricians, one pain management physician, one cardiologist, one chiropractic doctor and one osteopathic doctor. Three dentists, six nurse practitioners, four physician assistants, and two licensed clinical social workers began in 2023 as a means to address access to care. Over 9% of Lake County residents suffer from coronary artery disease. AHCL through its philanthropy department helped to raise money to purchase new cardiac diagnostic ultrasounds. The Vivid S70N, powered by artificial intelligence, provides 3D imaging of the heart to support earlier diagnosis and medical treatment of heart conditions. This ultrasound is ultra-fast, ultra-precise and ultra-efficient providing quicker exams and scan results. Lake County residents previously had to travel out of the county for these services. Having them available locally improves access to care and treatment of cardiac health conditions.Priority Need Two: Health Risk BehaviorsAHCL's goal is to advocate for smoking and vaping policies and provide cessation support and education for youth and increase healthy food access for underserved community members. This was accomplished in 2023 through the implementation of food security screenings through staff training to identify possible food security risks during intake and discharge. Resource information is provided and documented. Mountain View Cafe became a Blues Zone approved restaurant in November of 2023 and a ribbon cutting ceremony will be happening March of 2024. A Blue Zones restaurant is approved by demonstrating a commitment to offering smart, healthy choices to their customers.In February 2023, Blue Zones Project Lake County (BZPLC) powered and partnered by Adventist Health, participated in a presentation to the Lake County Board of Supervisors promoting a Tobacco Retail License Ordinance and Smoke-free Parks Ordinance. BZPLC continues to champion, advocate for, and provide technical assistance to County Public Health staff to see these ordinances through to adoption. BZPLC and BZPMC cohosted a secondhand smoke summit on November 9, 2023. Policy influencers and decision-makers from both Lake and Mendocino Counties participated in action planning to support smoke-free initiatives in both counties. Priority Need Three: Mental HealthAHCL's goal is to elevate existing programs and organizations to have a positive impact on student and staff and train faith leaders s certified mental health coaches. In 2023, this was accomplished by having three faith leaders complete the Light University Mental Health Coaches 1st Responder Training through AHCL provided scholarships. These coaches help clients develop a healthy balance in life, give guidance in decision making, offer support in navigating mental health difficulties, and assistance in establishing a recovery plan. Coaches help clients find ways to obtain and maintain stability, manage difficult symptoms, rebuild relationships, and find a purpose for living. Coaches also help clients find resources for professional care and treatment, family support, and education. AHCL continued to engage and partner with Hope Rising's Smart Start Bright Future initiative in 2023. Other community benefit programs that directly impact the community relating to other health priority needs are the partnership between World Vision and AHCL. This collaboration addresses community social determinants of health through the Inspire Hope Program. This program receives truckloads of furniture, household goods, building supplies, camping items and small appliances which are then shared with local organizations to distribute to families in need. In 2023, AHCL received six trucks of household goods and products which were shared with twelve community-based agencies and impacted 78 families.AHCL also began a partnership with COPE Health Scholars in 2023 to provide workforce development for local students to gain firsthand experience in clinical and administrative health care settings and become an integral part of the care delivery team. These students assist with basic care for patients alongside nurses, physicians and other members of the care delivery team and have the opportunity to earn volunteer hours for medical school, nursing school and other graduate programs and are well positioned for entry-level positions in healthcare.Significant needs not met:No hospital can address all the health needs identified in its community. AHCL is committed to serving the community by adhering to its mission, and using its skills, expertise and resources to provide a range of community benefit programs. Significant health needs that will not be addressed directly included the following: housing, financial stability, health conditions, food security, environment & infrastructure, inclusion & equity, COVID, education, community vitality and community safety. |
| Adventist Health Clearlake Hospital | Part V, Section B, Line 13h: Patients who do not meet the income criteria, may be eligible for financial assistance based on essential living expenses and resources. The following two (2) qualifications must both apply:1. Essential living expenses: Exceed fifty percent (50%) of the household income; and2. Resources: The patient's excess medical expenses (the amount that allowable medical expenses are greater than 50% of annual household income) must be greater than available qualifying assets. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 38 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (38 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AH Clearlake - RHC | ||||
| 15230 Lakeside Drive | Clearlake | CA | 95422 | Internal medicine/family practice and specialty services |
| 2 - AH Paradise Skyway Primary Care - RHC (AHC | ||||
| 5125 Skyway Road Suite G | Paradise | CA | 95969 | Primary care |
| 3 - AH Paradise Skyway Specialty - RHC (AHCL) | ||||
| 5125 Skyway Road Suite D | Paradise | CA | 95969 | Medical specialty |
| 4 - AH Clearlake Dental - RHC (AHCL) | ||||
| 15230 Lakeside Drive Suite 105 | Clearlake | CA | 95422 | Dental |
| 5 - AH Paradise Skyway Dental - RHC (AHCL) | ||||
| 5125 Skyway Road Suite I | Paradise | CA | 95969 | Primary care |
| 6 - AH Clearlake Live Well - RHC | ||||
| 15230 Lakeside Drive Suite 104 | Clearlake | CA | 95422 | Live Well (psychiatry) |
| 7 - AH Hidden Valley Lake - RHC (AHCL) | ||||
| 18990 Coyote Valley Road Suite 9 | Hidden Valley Lake | CA | 95467 | Internal medicine |
| 8 - AH Clearlake Hilltop Cardiology - RHC (AHC | ||||
| 15322 Lakeshore Drive Suite 201 | Clearlake | CA | 95422 | Medical specialty |
| 9 - AH Paradise Skyway Psychiatry & BH - RHC ( | ||||
| 5125 Skyway Road Suite B | Paradise | CA | 95969 | Primary care |
| 10 - AH Corning Solano Primary Care - RHC | ||||
| 155 Solano Street | Corning | CA | 96021 | Family practice |
| 11 - AH Paradise Skyway Immediate Care - RHC (A | ||||
| 5125 Skyway Road Suite A | Paradise | CA | 95969 | Primary care |
| 12 - AH Clearlake Synchronous BH - RHC | ||||
| 15230 Lakeshore Drive | Clearlake | CA | 95422 | Primary care |
| 13 - AH Paradise Skyway Pediatrics - RHC (AHCL) | ||||
| 5125 Skyway Road Suite H | Paradise | CA | 95969 | Primary care |
| 14 - AH Kelseyville - RHC | ||||
| 5290 State Street | Kelseyville | CA | 95451 | Internal medicine |
| 15 - AH Middletown - RHC | ||||
| 21337 Bush Street | Middletown | CA | 95461 | Family practice w/OB |
| 16 - AH Clearlake Family Medicine 101- RHC (AHC | ||||
| 15230 Lakeside Drive 101 | Clearlake | CA | 95422 | Family practice |
| 17 - AH Clearlake Rapid Care - RHC | ||||
| 15230 Lakeshore Drive 101 | Clearlake | CA | 95422 | Urgent care |
| 18 - AH Lakeport 11th St - RHC | ||||
| 801 11th Street | Lakeport | CA | 954534100 | Primary care |
| 19 - AH Clearlake Hilltop Surgical Specialties | ||||
| 15322 Lakeshore Drive Suite 101 | Clearlake | CA | 95422 | Specialty surgical |
| 20 - AH Lucerne - RHC | ||||
| 6300 E Highway 20 | Lucerne | CA | 95458 | Family practice |
| 21 - AH Clearlake Live Well BH - RHC | ||||
| 15230 Lakeshore Drive | Clearlake | CA | 95422 | Live Well (psychiatry) |
| 22 - AH Paradise Primary Care Lower Level - RHC | ||||
| 5125 Skyway Road | Paradise | CA | 95969 | Primary care |
| 23 - AH Hidden Valley Lake Specialty - RHC | ||||
| 18990 Coyote Valley Road | Hidden Valley Lake | CA | 95467 | Specialty care |
| 24 - AH Lakeport Heart Institute - RHC | ||||
| 487 South Main Street | Lakeport | CA | 95453 | Heart institute |
| 25 - AH Lower Lake Konocti - RHC | ||||
| 9430 Lake Street Suite C | Lower Lake | CA | 95457 | Family practice, pediatrics |
| 26 - AH Clearlake Hilltop - RHC (AHCL) | ||||
| 15322 Lakeshore Drive Suite 102 | Clearlake | CA | 95422 | Primary care |
| 27 - AH Paradise Skyway Synchronous BH - RHC | ||||
| 5125 Skyway Road | Paradise | CA | 95969 | Primary care |
| 28 - AH Lakeport Pediatrics - RHC (AHCL) | ||||
| 487 South Main Street Suite 122 | Lakeport | CA | 95453 | Primary care |
| 29 - AH Lakeport Main St Rapid Care - RHC | ||||
| 487 South Main Street | Lakeport | CA | 95453 | Urgent care |
| 30 - AH Lucerne BH - RHC | ||||
| 6300 E Highway 20 | Lucerne | CA | 95458 | Primary care |
| 31 - AH Lakeport Internal Medicine (AHCL) | ||||
| 487 South Main Street Suite 122 | Lakeport | CA | 95453 | Primary care |
| 32 - AH Hidden Valley Lake BH - RHC | ||||
| 18990 Coyote Valley Road | Hidden Valley Lake | CA | 95467 | Specialty care |
| 33 - AH Corning Solano Dental - RHC | ||||
| 155 Solano Street | Corning | CA | 96021 | Dental |
| 34 - AH Lakeport Main St BH - RHC | ||||
| 487 South Main Street | Lakeport | CA | 95453 | Specialty care |
| 35 - AH Lakeport 11th St BH - RHC | ||||
| 801 11th Street | Lakeport | CA | 95453 | Specialty care |
| 36 - AH Clearlake - Ophthalmology | ||||
| 15322 Lakeshore Drive | Clearlake | CA | 95422 | Ophthalmology |
| 37 - AH Kelseyville - BH - RHC | ||||
| 260 Hospital Drive 101 | Ukiah | CA | 95482 | Specialty care |
| 38 - AH Clearlake - Clinic Non Office Profee Ca | ||||
| 15630 18th Avenue | Clearlake | CA | 95422 | Non-office profee capture |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (provision for bad debts + other revenue + interest income)/gross patient chargesThe Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. |
| Part II, Community Building Activities: | The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020, Adventist Health acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be able to gain ground in shifting the balance from healthcare treating people once they are ill to transformative well-being changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint. In 2022, these projects were active and growing. In 2023, we saw tremendous growth in several of our markets promoting walking moais, worksite wellness, Blue Zones Project school pledges to create an environment that instills healthy lifestyle choices for our children and Blue Zones Project restaurant pledges to provide healthy options. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. 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. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. |
| Part III, Line 2: | 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. The resulting figure has been reported as bad debts at cost on Part III, Line 2. |
| Part III, Line 3: | The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. |
| Part III, Line 4: | The Adventist Health audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8: | The Medicare Cost Report apportions the Hospital's 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 involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.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. For further information, please refer to Schedule H, Part III, Section B. |
| Part III, Line 9b: | 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 VI, Line 2: | Adventist Health Clearlake, Inc. promotes access to their 2022 Community Health Needs Assessment (CHNA), the 2023 Community Health Implementation Strategy (CHIS) approved in fiscal year 2023, and the Year One Update, FY2023 for the Community Health Implementation Strategy by posting their reports on the Hospital's website at:https://www.adventisthealth.org/clear-lake/about-us/community-benefit/The two most recent Community Health Needs Assessments, the two most recent Community Health Implementation Strategy reports and the 2021, 2022 and 2023 Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/ The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, the Hospital supports local partners to augment our own efforts, and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of our region. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community. In addition to the CHNA, our Hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level. Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. |
| Part VI, Line 3: | The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at: https://www.adventisthealth.org/patient-resources/bill-pay/financial-assistance/ The documents are available in multiple languages. The link to the Hospital's Self-Pay Billing and Collection Policy is posted at: https://www.adventisthealth.org/documents/system/13863-self-pay-billing-and-collection-policy.pdfAt the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The Hospital also provides a brochure during the registration process that explains the Hospital's 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, Line 4: | Near America's oldest lake and the recreational and outdoor activities it supports, the Hospital serves a scenic, rural community with a total population of 69,918. Surrounded by mountainous terrain, Lake County is divided into two main cities, with Clearlake on the south shore and Lakeport on the north shore. Lake County is home to the following Native American Tribes: Big Valley Rancheria, Elem Indian Colony, Middletown Rancheria, Robinson Rancheria, Scotts Valley Band of Pomo Indians and Upper Lake Habematoel, whose rich cultures bring vibrance to Lake County. The community is vibrant with art galleries, festivals, local events and small businesses. Of the total population, 21.09% are Hispanic. The median household income for the community we serve is $50,811, and 68.05% of income is spent on housing and transportation. In this community, 23.94% of children live in poverty, compared to 16.80% in California and 17.48% in the country. Additionally, 7.83% of students are unhoused, compared to 4.25% in the state and 2.77% in the country.The following zip codes represent Sutter Health Lakeside and AHCL's primary service area (PSA), accounting for 75% of hospital discharges. Additionally, we took a collaborative approach and expanded our PSA by inviting Steering Committee members to include the zip codes of those they serve. The County of Lake Community Health Needs Assessment market has a total population of 69,918 (based on the 2020 Decennial Census). The largest city in the service area is Clearlake, with a population of 15,250. The service area is comprised of the following zip codes: 95451, 95443, 95435, 95464, 95493, 95426, 95423, 95485, 95457, 95461, 95469, 95458, 95453, 95422, 95467.The following zip codes represent Sutter Health Lakeside and AHCL's primary service area (PSA), accounting for 75% of hospital discharges. Additionally, we took a collaborative approach and expanded our PSA by inviting Steering Committee members to include the zip codes of those they serve. The County of Lake CHNA market has a total population of 69,918 (based on the 2020 Decennial Census). The largest city in the service area is Clearlake, with a population of 15,250. The service area is comprised of the following zip codes: 95451, 95443, 95435, 95464, 95493, 95426, 95423, 95485, 95457, 95461, 95469, 95458, 95453, 95422, 95467. |
| Part VI, Line 5: | Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "Triple Aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low-income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy.Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy - even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population,2. Factors that cause the present outcomes distribution, and3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to:1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors,2. Improve care quality and patient safety, and3. Advance care coordination across the health care continuum.We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. |
| Part VI, Line 6: | The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as tele-pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7, Reports Filed With States | CA |
| Part VI, Other Information: | In September of 2021, Adventist Health Clearlake, Inc. (AHCL) proudly launched Blue Zones Project Lake County (BZPLC). The BZPLC team focuses on partnering and collaborating with community leaders and organizations active in the sectors of built environment, education, economic and workforce development, mental and physical well-being, policy, and public health. Together the BZPLC team and sector leaders develop a community Blueprint that strategically aligns and leverages the actions and resources of the sectors where we live, learn, work, and play to help advance the efforts around the community's biggest social determinant of health challenges while connecting them to health-related social needs organizations. Equity is a strategic priority woven throughout the Blueprint and programs. Policies and initiatives are developed in a way that honors the local culture that is focused on reaching out to all populations. Each year, BZPLC sector leads come together to evaluate and update the Blueprint to ensure community alignment.In April 2023, BZPLC launched Year Two of the transformation phase of BZPLC. Below is a summary of progress measure highlights for 2023 relating to three pillars: People, Places and Policy.The local BZPLC team collaborates with multiple Lake County community leaders, stakeholders, businesses, and resource agencies to create awareness around the Blue Zones Project (BZP) vision as well as a variety of free-to-the-public classes, demonstrations, workshops, and more. In 2023, almost two thousand community members engaged with one or more BZP activities with 1,465 individuals completing the Real Age test; 292 individuals attending a Blue Zones purpose workshop; 210 individuals attending a Blue Zones cooking demonstration and 6,456 interacting with Blue Zones team members at community events. Additionally, numerous transformation stories have been collected since the inception of the project, including one story from an individual who stated that their involvement/understanding of Blue Zones has affected them greatly after taking the RealAge Test and implementing the recommended changes to help transform their health. This person said: "I lost about 20 lbs., discovered that my joints were not as sore, and now have a lot more energy. My blood pressure is now at a normal level, and I just feel like a different person." Another individual said she has lost 200+ lbs. in two years by implementing "Hara Hachi Bu" portion control as well as adopting a #MoveNaturally walking regimen. She decided to take a non-surgical route for weight loss, eliminating larger plates in the house to restrict larger portion opportunities, and attributes her improved health to her exposure to the Blue Zones Power 9. In addition to the above engagement numbers, BZPLC educates and informs a large portion of Lake County's population through social media and the local newsletter. In 2023, these engagement numbers were: Instagram - 897 followers; Facebook - 1,519 followers; project newsletter - 1,811 subscribers. BZPLC currently has two schools approved as BZPs and thirteen that are registered or working through the approval process. Konocti Unified School District (KUSD) is the first school district in the nation working towards a Blue Zones National Worksite Certification. In July 2023, KUSD hosted a Blue Zones themed management retreat for their team members. And in January 2024, KUSD held a Blue Zones Power 9 Professional Development Day, which included a walking moai demonstration hosted at multiple schools, a cooking demonstration at the District Office, and interactive Power 9 activities throughout the day.Three restaurants in Lake County are currently approved under the BZP with another six registered or working through the approval process. BZBLC played an integral role in the Lake County Annual Restaurant Expo, highlighting the benefits of being BZPLC approved. Foods Etc. is a local grocery store that is an active BZPLC partner and is under new ownership with a revision of their sustainability.Five worksites are approved with another twelve in the registration and working through the approval process to become Blue Zones certified. North Coast Opportunities (NCO) became BZP Approved in October 2023. In November 2023, they hosted their All-Staff Day in coordination with cross-county BZPLC/BZP and Mendocino County Approval Ceremonies. In December 2023, BZPLC hosted a cooking demonstration for NCO's BUILD project team. AHCL became BZPLC approved in November 2023. AHCL is also working towards Blue Zones National Worksite Certification. The City of Clearlake is actively working on their pledge packet and close to approval submission. Lake County Office of Education became BZPLC Approved in October 2023.Lakeport Unified School District (LUSD) made the decision to engage their leadership as a worksite prior to seeking school approvals. BZPLC has partnered closely with LUSD on their Wellness Wednesdays (which is one Wednesday a month) that focuses on staff well-being. BZPLC supports a number of civic, faith, and other community organizations through the approval process. This partnership includes the creation of goal-oriented sustainability plans, which have strong influence on our community's well-being in the current year and beyond. BZPLC partnered with the following organizations in 2023: Kelseyville Presbyterian Church; Clearlake Rotary; Konocti Functional Fitness; Clearlake Lioness Club; Jitter Bean Coffee House; Clearlake Senior Center; Muscle Matrix Gym; Lakeport Rotary and Lake County Chamber of Commerce. Policy work included work around built environment: BZPLC helped coordinate the largest Walking School Bus demonstration in Blue Zones history with Konocti Unified School District and City of Clearlake to highlight urgent safe routes to schools priorities for Pomo and Burns Valley Elementary Schools in June 2023 and has been integrally supporting the Lake County Parks and Recreation Master Plan community visioning process. Work on food policy included support for the launch of the Lake County Food Policy Council in September 2023. Tobacco policy work began in February 2023, BZPLC participating in a presentation to the Lake County Board of Supervisors promoting a Tobacco Retail License Ordinance and Smoke-free Parks Ordinance. BZPLC continues to champion, advocate for, and provide technical assistance to County Public Health staff to see these ordinances through to adoption. BZPLC and Blue Zones Project Mendocino County cohosted a secondhand smoke summit on November 9, 2023. Policy influencers and decision-makers from both Lake and Mendocino Counties participated in action planning to support smoke-free initiatives in both counties. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | California Health Fund & Trust | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 K Street Suite 800 | AddressLine1Txt |
| City | Sacramento | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95814 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 941498697 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $0 | CashGrantAmt |
| Non Cash Assistance | $51,352 | NonCashAssistanceAmt |
| Purpose Of Grant | Hlth srvs un/underinsured pt | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Grantees are provided support based on the program for which they are soliciting funds. Our expectation is that the monies will be used accordingly, and reporting from the recipient is not required. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Heinrich Kerry | ||||||||||||||
| Dir/Chair/CEO | $0 | $2,017,000 | $0 | $1,208,880 | $0 | $76,548 | $0 | $13,296 | $0 | $44,099 | $0 | $3,359,823 | $0 | $0 |
| Hofheins Todd | ||||||||||||||
| Dir/Vice Chair/COO | $0 | $1,389,462 | $0 | $735,265 | $0 | $147,865 | $0 | $13,296 | $0 | $62,845 | $0 | $2,348,733 | $0 | $0 |
| Beaman John | ||||||||||||||
| CFO/Assistant Secretary | $0 | $1,091,769 | $0 | $569,149 | $0 | $19,635 | $0 | $13,296 | $0 | $60,059 | $0 | $1,753,908 | $0 | $0 |
| Stevens Eric - President | ||||||||||||||
| Northern CA/HI State Network | $0 | $1,045,616 | $0 | $319,995 | $0 | $160,682 | $0 | $13,296 | $0 | $46,256 | $0 | $1,585,845 | $0 | $0 |
| Jahn Andrew - Former | ||||||||||||||
| Care Division President thru 02/22 | $0 | $1,044,420 | $0 | $406,990 | $0 | $14,496 | $0 | $53,160 | $0 | $50,625 | $0 | $1,569,691 | $0 | $0 |
| Nahapetian Arby - Former Care | ||||||||||||||
| Division Medical Officer thru 02/22 | $0 | $967,385 | $0 | $329,621 | $0 | $185,288 | $0 | $13,296 | $0 | $56,317 | $0 | $1,551,907 | $0 | $0 |
| Wing Bill - Former | ||||||||||||||
| Dir/Asst Secr/Vice Chair thru 01/22 | $0 | $0 | $0 | $0 | $0 | $1,438,460 | $0 | $13,296 | $0 | $26,777 | $0 | $1,478,533 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $660,525 | $0 | $168,715 | $0 | $130,248 | $0 | $13,296 | $0 | $46,114 | $0 | $1,018,898 | $0 | $0 |
| Howe Judson - President | ||||||||||||||
| North Coast Network thru 03/23 | $0 | $538,154 | $0 | $186,337 | $0 | $84,404 | $0 | $13,296 | $0 | $15,701 | $0 | $837,892 | $0 | $0 |
| Cantrell Misty | ||||||||||||||
| Patient Care Executive | $0 | $277,192 | $0 | $124,207 | $0 | $260,355 | $0 | $13,296 | $0 | $61,255 | $0 | $736,305 | $0 | $0 |
| Assavapisitkul Colleen | ||||||||||||||
| President | $0 | $436,394 | $0 | $104,043 | $0 | $61,362 | $0 | $13,296 | $0 | $13,490 | $0 | $628,585 | $0 | $0 |
| Tetz Warren | ||||||||||||||
| Former Treasurer thru 12/22 | $0 | $17,731 | $0 | $125,629 | $0 | $416,665 | $0 | $13,296 | $0 | $45,539 | $0 | $618,860 | $0 | $0 |
| Eberhart Gregory | ||||||||||||||
| Area Medical Officer | $0 | $516,674 | $0 | $19,931 | $0 | $46,341 | $0 | $13,296 | $0 | $14,663 | $0 | $610,905 | $0 | $0 |
| Spenst Brett - Former Care | ||||||||||||||
| Division Finance Officer thru 02/22 | $0 | $259,692 | $0 | $250,809 | $0 | $10,124 | $0 | $13,296 | $0 | $32,551 | $0 | $566,472 | $0 | $0 |
| Mock Jeffrey | ||||||||||||||
| Treasurer/Asst Secr as of 09/23 | $0 | $344,451 | $0 | $53,131 | $0 | $72,809 | $0 | $13,296 | $0 | $54,501 | $0 | $538,188 | $0 | $0 |
| Shepardson Dean - Treasurer | ||||||||||||||
| Asst Secr from 03/23 thru 09/23 | $0 | $307,500 | $0 | $25,000 | $0 | $129,343 | $0 | $13,296 | $0 | $42,465 | $0 | $517,604 | $0 | $0 |
| Assadian Hoda | ||||||||||||||
| Operations Executive | $0 | $329,595 | $0 | $101,331 | $0 | $29,999 | $0 | $13,296 | $0 | $39,081 | $0 | $513,302 | $0 | $0 |
| Jacobson Carlton - Former Treas | ||||||||||||||
| /Asst Secr thru 12/21/Fin Off AHCL | $0 | $305,167 | $0 | $62,824 | $0 | $39,926 | $0 | $13,296 | $0 | $30,888 | $0 | $452,101 | $0 | $0 |
| Anjejo Isaac | ||||||||||||||
| RN | $290,491 | $0 | $113,743 | $0 | $0 | $0 | $1,780 | $0 | $24,993 | $0 | $431,007 | $0 | $0 | $0 |
| Bloom Evan | ||||||||||||||
| Medical Officer | $0 | $278,922 | $0 | $64,696 | $0 | $24,153 | $0 | $13,296 | $0 | $32,487 | $0 | $413,554 | $0 | $0 |
| Cardenas Lucita | ||||||||||||||
| RN | $312,014 | $0 | $1,650 | $0 | $3,301 | $0 | $10,673 | $0 | $46,596 | $0 | $374,234 | $0 | $0 | $0 |
| Kruger Thomas | ||||||||||||||
| RN | $311,346 | $0 | $1,650 | $0 | $6,342 | $0 | $16,947 | $0 | $13,815 | $0 | $350,100 | $0 | $0 | $0 |
| Shelton Jacarre | ||||||||||||||
| Director, Pharmacy | $226,133 | $0 | $22,267 | $0 | $37,326 | $0 | $12,858 | $0 | $50,700 | $0 | $349,284 | $0 | $0 | $0 |
| Flynn Laura | ||||||||||||||
| Director, RN | $225,827 | $0 | $22,252 | $0 | $22,304 | $0 | $9,157 | $0 | $62,784 | $0 | $342,324 | $0 | $0 | $0 |
| Byrnes John - Former | ||||||||||||||
| Medical Officer, NCR thru 02/20 | $0 | $0 | $0 | $0 | $0 | $263,659 | $0 | $13,183 | $0 | $21,772 | $0 | $298,614 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | Severance payments are made based upon agreements between certain qualifying employees and Adventist Health System/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Byrnes, John - severance payment - $262,731 Cantrell, Misty - severance payment - $199,615 Tetz, Warren - severance payment - $416,673 Wing, Bill - severance payment - $1,440,800 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Jacobson, Carlton - participant, no activity in 2023 Select executives agreed to participate in CAP-EX in place of a traditional SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life insurance participants are John Beaman, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Brett Spenst, Jack Wagner, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an of their corporate provided benefits. The balance is set aside for forfeiture and is at risk to the creditors of Adventist Health. Payouts substantial risks of forfeiture have lapsed. The plan was frozen for new amount equivalent to 41 percent of their base compensation, less the value nonvested deferred compensation that is subject to substantial risk of occur according to the participants' payment elections after all non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2023 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | Adventist Health Clearlake Hospital, Inc., DBA Adventist Health Clear Lake (AHCL), provides quality medical healthcare 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 AHCL, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following coverage will be considered when individuals who need health care cannot afford to pay: - Free care and/or subsidized care - Care to persons covered by governmental programs at/or below cost - Health/wellness activities and community education programs Not only does AHCL provide low-cost care to individuals covered by government programs, and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHCL recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2023 was $705,091. The following Inpatient services were provided to all our patients: - 94 babies delivered - 156 surgeries performed - 5,463 patient days The following Outpatient services were provided to all our patients: - 19,990 emergency department visits - 2,177 outpatient surgeries performed - 119,999 outpatient visits - 246,537 clinic visits AHCL recognizes it has an obligation to provide human services above and beyond its role as a healing facility. Schedule H provides more details on the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2023 was $14,308,437. Adventist Health's mission statement of living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry, as represented by the life of Jesus Christ, and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs, and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ |
| Form 990, Part III, Line 4a (continued): | Adventist Health Clearlake Hospital (AHCL) announced the opening of its new Rapid Care clinic this month, providing walk-in care for minor illnesses and injuries, treating patients 60 days and older. "Adventist Health is excited and proud to be the first to establish Rapid Care services for our community," said Colleen Assavapisitkul, president of AHCL. "We heard the voices of our neighbors asking for timely access to care when needed most." Services include treatment for: - Allergic reactions; - Animal and bug bites; - Body and muscle aches; - Bronchitis, sore throat, respiratory infections; - Cold and flu symptoms; - Coughing and wheezing; - Cuts and lacerations; - Diarrhea; - Ear/Eye infections; - Fever; - Falls and sprains; - Headaches; - Minor cuts and burns; - Minor trauma; - Pain and swelling in extremities; - Rashes and itching; - Sinus infections; - Urinary tract infections; - Onsite testing for strep, pregnancy, blood sugar, urinalysis. Patients requiring immediate medical care can visit the Rapid Care clinic without an appointment. Staffed with quality healthcare providers with extensive experience, the AHCL Rapid Care team can assess and treat minor illnesses, injuries, and emergencies. With the addition of Rapid Care services in Lake County, immediate medical care has never been more convenient. Whatever the medical need, patients have direct access to exceptional care through AHCL's emergency department, clinics, and rapid care services. Located at 15230 Lakeshore Drive, Suite 101 in Clearlake, hours of operation are 7:30 a.m. to 6:30 p.m. on weekdays. For more information about AHCL's Rapid Care, visit www.AdventistHealthClearLake.org/ClearLakeRapidCare. |
| Form 990, Part VI, Section A, line 4 | The Hospital's Articles of Incorporation were amended for the following: 1. Article 3 was updated to allow for the Board of Directors of the Hospital to have sole authority to amend or repeal the Articles of Incorporation, subject to the additional approval of the Board of Directors of Adventist Health System/West. The Hospital has no members within the meaning of Section 5056 of the California Corporations Code. The Hospital's Bylaws were amended for the following: 1. Article 2 was removed and the Hospital has no members. All sections relating to the membership were removed. 2. Article 5 was revised to indicate that only directors may serve as the chair of the Board and that the vice chair of the Board is designated by the Chief Executive Officer of Adventist Health System/West. |
| Form 990, Part VI, Section A, 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. |
| Form 990, Part VI, Section A, line 7b | The Board of Directors of the Hospital shall have sole authority to amend or repeal the Articles of Incorporation, subject to the additional approval of the Board of Directors of Adventist Health System/West. The Hospital does not have any Members. |
| Form 990, Part VI, Section B, line 11b | This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the Corporate Finance Officer and Market Financial Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. |
| Form 990, Part VI, Section B, line 12c | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital corporate 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 market president or the System General Counsel immediately. The System General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The System General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System General Counsel retains the COIs for all individuals. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. |
| Form 990, Part VI, Section B, line 15 | The Hospital's Board of Directors has established a Human Resources 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 at least annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital presidents and finance officers 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 executives, with midpoints aligned with the 60th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. |
| Form 990, Part VI, Section C, line 19 | 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 VII, Section A: | Board compensation is for Adventist Health System/West Board of Directors only - not hospital Board of Directors. |
| Form 990, Part IX, line 11g | Physician professional fees: Program service expenses 33,869,209. Management and general expenses 63,497. Fundraising expenses 0. Total expenses 33,932,706. All other purchased services: Program service expenses 4,068,017. Management and general expenses 833,614. Fundraising expenses 1,250. Total expenses 4,902,881. Contract labor: Program service expenses 5,010,488. Management and general expenses 90,205. Fundraising expenses 0. Total expenses 5,100,693. Purchased medical services: Program service expenses 1,347,333. Management and general expenses 55,285. Fundraising expenses 0. Total expenses 1,402,618. Consulting and other management fees: Program service expenses 380,705. Management and general expenses 190,522. Fundraising expenses 0. Total expenses 571,227. Repairs and maintenance: Program service expenses 1,580,900. Management and general expenses 27,695. Fundraising expenses 0. Total expenses 1,608,595. Other non-medical professional fees: Program service expenses 7,556. Management and general expenses 93,425. Fundraising expenses 0. Total expenses 100,981. Other medical professional fees: Program service expenses 88,473. Management and general expenses 0. Fundraising expenses 0. Total expenses 88,473. |
| Form 990, Part XI, Line 8: | Prior period adjustments were a result of cash balance correction and clean up books due to prior period activities including debt service, capital expenditures, and other items. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (29 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Delano | |||||||||||
| 1401 Garces Hwy | Delano | CA | 93215 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Foundation | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 680002188 | Charitable foundation | CA | 501(c)(3) | Line 7 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Mendocino Coast | |||||||||||
| 700 River Drive | Fort Bragg | CA | 95437 | 845174585 | Hospital | CA | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| Adventist Health Physicians Network | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| Adventist Health Tulare | |||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Glendale Adventist Medical Center | |||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Hanford Community Hospital | |||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Lodi Memorial Hospital Association Inc | |||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 941044474 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Mid-Columbia Medical Center | |||||||||||
| 1700 E 19th Street | The Dalles | OR | 97058 | 930386936 | Hospital | OR | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| Northwest Medical Foundation of Tillamook | |||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Paradise Valley Hospital | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 951816034 | Discontinued Operations | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Portland Adventist Medical Center | |||||||||||
| 10123 SE Market Street | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Reedley Community Hospital | |||||||||||
| 372 Cypress Avenue | Reedley | CA | 93654 | 453220509 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Rideout Memorial Hospital | |||||||||||
| 726 Fourth Street | Marysville | CA | 95901 | 941387866 | Acute care hospital | CA | 501(c)(3) | Line 3 | Stone Point Health | 0 | |
| St Helena Hospital | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| San Joaquin Community Hospital | |||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Simi Valley Hospital and Health Care Services | |||||||||||
| 2975 N Sycamore Drive | Simi Valley | CA | 93065 | 956064971 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Sonora Community Hospital | |||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Stone Point Health | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 823763347 | Supporting organization | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Ukiah Adventist Hospital | |||||||||||
| 275 Hospital Drive | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| United Com-Serve | |||||||||||
| 726 Fourth Street | Marysville | CA | 95901 | 943015356 | Skilled nursing/assisted living/home health | CA | 501(c)(3) | Line 10 | Stone Point Health | 0 | |
| Walla Walla General Hospital | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 910617726 | Hospital - closed July 2017 | WA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Western Health Resources | |||||||||||
| 1 Adventist Health Way | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | Line 10 | Adventist Health SystemWest | 0 | |
| White Memorial Medical Center | |||||||||||
| 1720 E Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Willits Hospital Inc | |||||||||||
| 1 Marcela Drive | Willits | CA | 95490 | 680108919 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| Blue Legacy Ventures LLC | |||||||||
| 1010 NE 2nd Avenue | Miami | FL | 33132 | 871254649 | Real property rental | FL | N/A | 0 | 0 |
| Blue Zones LLC | |||||||||
| 200 Southdale Center | Edina | MN | 55435 | 271603327 | Education | MN | N/A | 0 | 0 |
| PAR LLC DBA CherryWood Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 931262371 | Senior housing | OR | N/A | 0 | 0 |
| PVHR LLC DBA Paradise Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 260622555 | Senior housing | OR | N/A | 0 | 0 |
| PVHR2 LLC DBA Parkview Memory Care at Paradise Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 473300170 | Senior housing | OR | N/A | 0 | 0 |
| WWGHR LLC DBA Wheatland Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 810591221 | Senior housing | OR | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AdHealth Limited | ||||||||||||||
| PO Box HM 2062 | Hamilton | BD | HM HX | Pure captive insurance | BD | N/A | C | 0 | ||||||
| Adventist Health Plan Inc | ||||||||||||||
| Health insurance | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 463833261 | CA | |||||
| South Coast Medical Center | ||||||||||||||
| Wind down after sale of hospital | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 952037291 | CA | |||||
| Thrive Productions Inc | ||||||||||||||
| Production company | N/A | C | 0 | 200 Southdale Center | Edina | MN | 55435 | 453369049 | MN | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Comments