2024-11-05T14:13:51-06:00 2023-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2023-01-01 680395149 Adventist Health Clearlake Hospital Inc ADVE 9164060000 15630 18th Avenue Clearlake CA 95422 Jeffrey Mock Treasurer 9164060000 2024-11-01 1 0 Tracy S Paglia P00366884 2099556100 2024-11-01 2023 2024-10-15 13:58:12Z Adventist Health Clear Lake Colleen Assavapisitkul 15630 18th Avenue Clearlake CA 95422 191928621 0 1071 X www.adventisthealth.org/clear-lake/ X 1996 CA Living God's love by inspiring health, wholeness and hope. 13 11 996 7 0 0 7292822 1344105 182562730 189317343 2272129 945015 158744 195763 192286425 191802226 270625 51352 0 0 72213247 79481728 0 0 208015 106791486 100142802 179275358 179675882 13011067 12126344 139959853 152811093 112497711 110744048 27462142 42067045 X Living God's love by inspiring health, wholeness and hope. 0 0 143071369 51352 189317343 See Schedule O 143071369 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 996 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Heinrich Kerry Dir/Chair/CEO 0.00 50.50 X X 0 3302428 57395 Hofheins Todd Dir/Vice Chair/COO 0.00 50.50 X X 0 2272592 76141 Beaman John CFO/Assistant Secretary 0.00 50.50 X 0 1680553 73355 Stevens Eric - President Northern CA/HI State Network 5.00 45.50 X 0 1526293 59552 Jahn Andrew - Former Care Division President thru 02/22 0.00 50.00 X 0 1465906 103785 Nahapetian Arby - Former Care Division Medical Officer thru 02/22 0.00 50.00 X 0 1482294 69613 Wing Bill - Former Dir/Asst Secr/Vice Chair thru 01/22 0.00 0.00 X 0 1438460 40073 Jobe Meredith Secretary 0.00 50.50 X 0 959488 59410 Howe Judson - President North Coast Network thru 03/23 8.30 41.70 X 0 808895 28997 Cantrell Misty Patient Care Executive 50.00 0.00 X 0 661754 74551 Assavapisitkul Colleen President 50.00 0.00 X 0 601799 26786 Tetz Warren Former Treasurer thru 12/22 0.00 0.00 X 0 560025 58835 Eberhart Gregory Area Medical Officer 12.50 37.50 X 0 582946 27959 Spenst Brett - Former Care Division Finance Officer thru 02/22 0.00 50.00 X 0 520625 45847 Mock Jeffrey Treasurer/Asst Secr as of 09/23 10.00 40.50 X 0 470391 67797 Shepardson Dean - Treasurer Asst Secr from 03/23 thru 09/23 12.50 37.50 X 0 461843 55761 Assadian Hoda Operations Executive 16.70 33.30 X 0 460925 52377 Jacobson Carlton - Former Treas /Asst Secr thru 12/21/Fin Off AHCL 50.00 0.00 X 0 407917 44184 Anjejo Isaac RN 40.00 0.00 X 404234 0 26773 Bloom Evan Medical Officer 50.00 0.00 X 0 367771 45783 Cardenas Lucita RN 40.00 0.00 X 316965 0 57269 Kruger Thomas RN 40.00 0.00 X 319338 0 30762 Shelton Jacarre Director, Pharmacy 40.00 0.00 X 285726 0 63558 Flynn Laura Director, RN 40.00 0.00 X 270383 0 71941 Byrnes John - Former Medical Officer, NCR thru 02/20 0.00 0.00 X 0 263659 34955 Freedman John Director 0.00 4.00 X 0 26770 0 Cherry Robert Director 0.00 4.00 X 0 26611 0 Davis Andrew Director 0.00 4.00 X 0 26611 0 Innocent Larry Director 0.00 4.00 X 0 26611 0 Newton Bradford Director 0.00 4.00 X 0 26611 0 Reiner Richard Director 0.00 4.00 X 0 26611 0 Salazar Velino Director 0.00 4.00 X 0 26611 0 Banks David Director 0.00 4.00 X 0 26181 0 Woodson Marc Director 0.00 4.00 X 0 21611 0 Wagner Jack Director 0.00 4.00 X 0 16180 0 Fehr Joy Director 0.00 4.00 X 0 430 0 Ocampo Lucy Director thru 08/23 0.00 4.00 X 0 0 0 1596646 20547402 1353459 160 1 1 0 Acqhire Inc 2941 Sunset Boulevard Street Rancho Cordova CA 95742 Physician/medical provider 2500149 RMG Medical Imaging Consultants 25360 Magic Mtn Pkwy Ste 270 Valencia CA 91355 Physician/medical provider 1649036 Galen Inpatient Physicians Inc 2100 Powell St Suite 400 Emeryville CA 94608 Physician/medical provider 1628047 Pacific Redwood Medical Group Inc 242 Hospital Drive Ukiah CA 95482 Physician/medical provider 1394040 Lyons Huber Management A Medical Corp 512 Pine Hill Road Angwin CA 94508 Physician/medical provider 1070845 46 396224 947881 1344105 Patient service revenue 621110 170711526 170711526 CARES Act revenue 621110 8094928 8094928 Premium revenue 621110 6429723 6429723 Incentive/quality revenue 531120 2309484 2309484 340B pharmacy revenue 621110 1170772 1170772 600910 600910 189317343 950339 950339 182279 72912 109367 109367 109367 5324 -5324 -5324 -5324 134555 48159 86396 86396 191802226 189317343 0 1140778 X 51352 51352 62215782 53065690 9020111 129981 2240271 1916461 318932 4878 10877964 9486289 1371403 20272 4147711 3633409 504651 9651 16611015 16611015 362221 362221 11898 11898 47708174 46352681 1354243 1250 330592 330592 1377174 1034465 328908 13801 4659620 481235 4178385 4416224 3927930 484329 3965 544077 453853 85946 4278 54900 31984 20621 2295 2334145 2334145 4579073 4352534 210173 16366 994897 994897 Patient care supplies 12740097 12696294 43803 Rental/leases costs equ 1914679 1847178 67501 Quality assurance fees 102063 102063 1401953 297011 1103664 1278 179675882 143071369 36396498 208015 103187 3555 46019310 42205706 424607 197048 29994709 19581659 1739862 1625416 49674 214953 95519160 57238040 36368958 38281120 177626 123827 25081920 50577809 139959853 152811093 18926046 13685480 181680 501891 93389985 96556677 112497711 110744048 X 26159612 41132625 1302530 934420 27462142 42067045 139959853 152811093 X 12126344 2769559 -291000 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11898 11898 0 Part II-B, Line 1: 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. 1312530 2157928 2526796 943662 680895 7048370 -17964 6398771 1312530 1278092 3372492 15218 3984907 680895 601407 4754613 -2147 4075781 1278092 610082 1733152 28727 1380823 389731 601407 0.00979 0.00000 0.99021 0 0 2862339 2862339 46885446 28418093 18467353 2592553 1698831 893722 25007364 20312850 4694514 18171458 6808266 11363192 38281120 Receivables from third-party payors 36870949 Right-of-use assets 9305187 Receivables from related organizations 2491042 Other receivables 1910631 50577809 Payables to related organizations 77441691 Payables to third-party payors 10493511 Other liabilities 8621475 96556677 X 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. Gala 77520 77520 13537 5061 Golf Event 57035 57035 750 28811 134555 134555 13537 750 33872 48159 86396 1 1 X 1 X 1 X 1 1 1 0 1 1 705091 705091 0.00390 51335964 59592630 0 0.00000 52041055 59592630 705091 0.00390 1566547 50000 1516547 0.00840 37962390 25280546 12681844 0.07060 110847 800 110047 0.00060 39639784 25331346 14308438 0.07960 91680839 84923976 15013529 0.08350 964235 964235 0.00540 27000 1900 25100 0.00010 30000 30000 0.00020 47576 47576 0.00030 1068811 1900 1066911 0.00600 1 1868995 726831 44156536 41060852 3095684 X 1 1 1 1 Adventist Health Clearlake Hospital 15630 18th Avenue Clearlake CA 95422 adventisthealth.org\clear-lake 110000174 X X X X Adventist Health Clearlake Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X 1 22 1 See Sch H Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 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. 38 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 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. 1 California Health Fund & Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 0 51352 Hlth srvs un/underinsured pt 1 0 Part I, Line 2: 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. X X X X 1 1 0 0 0 0 0 0 0 Heinrich Kerry Dir/Chair/CEO 0 2017000 0 1208880 0 76548 0 13296 0 44099 0 3359823 0 0 Hofheins Todd Dir/Vice Chair/COO 0 1389462 0 735265 0 147865 0 13296 0 62845 0 2348733 0 0 Beaman John CFO/Assistant Secretary 0 1091769 0 569149 0 19635 0 13296 0 60059 0 1753908 0 0 Stevens Eric - President Northern CA/HI State Network 0 1045616 0 319995 0 160682 0 13296 0 46256 0 1585845 0 0 Jahn Andrew - Former Care Division President thru 02/22 0 1044420 0 406990 0 14496 0 53160 0 50625 0 1569691 0 0 Nahapetian Arby - Former Care Division Medical Officer thru 02/22 0 967385 0 329621 0 185288 0 13296 0 56317 0 1551907 0 0 Wing Bill - Former Dir/Asst Secr/Vice Chair thru 01/22 0 0 0 0 0 1438460 0 13296 0 26777 0 1478533 0 0 Jobe Meredith Secretary 0 660525 0 168715 0 130248 0 13296 0 46114 0 1018898 0 0 Howe Judson - President North Coast Network thru 03/23 0 538154 0 186337 0 84404 0 13296 0 15701 0 837892 0 0 Cantrell Misty Patient Care Executive 0 277192 0 124207 0 260355 0 13296 0 61255 0 736305 0 0 Assavapisitkul Colleen President 0 436394 0 104043 0 61362 0 13296 0 13490 0 628585 0 0 Tetz Warren Former Treasurer thru 12/22 0 17731 0 125629 0 416665 0 13296 0 45539 0 618860 0 0 Eberhart Gregory Area Medical Officer 0 516674 0 19931 0 46341 0 13296 0 14663 0 610905 0 0 Spenst Brett - Former Care Division Finance Officer thru 02/22 0 259692 0 250809 0 10124 0 13296 0 32551 0 566472 0 0 Mock Jeffrey Treasurer/Asst Secr as of 09/23 0 344451 0 53131 0 72809 0 13296 0 54501 0 538188 0 0 Shepardson Dean - Treasurer Asst Secr from 03/23 thru 09/23 0 307500 0 25000 0 129343 0 13296 0 42465 0 517604 0 0 Assadian Hoda Operations Executive 0 329595 0 101331 0 29999 0 13296 0 39081 0 513302 0 0 Jacobson Carlton - Former Treas /Asst Secr thru 12/21/Fin Off AHCL 0 305167 0 62824 0 39926 0 13296 0 30888 0 452101 0 0 Anjejo Isaac RN 290491 0 113743 0 0 0 1780 0 24993 0 431007 0 0 0 Bloom Evan Medical Officer 0 278922 0 64696 0 24153 0 13296 0 32487 0 413554 0 0 Cardenas Lucita RN 312014 0 1650 0 3301 0 10673 0 46596 0 374234 0 0 0 Kruger Thomas RN 311346 0 1650 0 6342 0 16947 0 13815 0 350100 0 0 0 Shelton Jacarre Director, Pharmacy 226133 0 22267 0 37326 0 12858 0 50700 0 349284 0 0 0 Flynn Laura Director, RN 225827 0 22252 0 22304 0 9157 0 62784 0 342324 0 0 0 Byrnes John - Former Medical Officer, NCR thru 02/20 0 0 0 0 0 263659 0 13183 0 21772 0 298614 0 0 Part I, Lines 4a-b 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 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. 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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 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 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center 1 Adventist Health Way Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 200 Southdale Center Edina MN 55435 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1