ADVENTIST HEALTH CLEARLAKE HOSPITAL INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC (EIN 68-0395149)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-06
- IRS object ID
- 202303109349302275
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-06T12:51:25-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | 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 | 2022-01-01 | 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 | 2023-11-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Jeffrey | PersonFirstNm |
| Person Last | Mock | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2023-10-27 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | 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 | $192,356,655 | 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 | 943 | TotalEmployeeCnt |
| Total Volunteers | 2 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,984,785 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,292,822 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $160,733,224 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $182,562,730 | CYProgramServiceRevenueAmt |
| PY Investment Income | $573,573 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,272,129 | CYInvestmentIncomeAmt |
| PY Other Revenue | $152,312 | PYOtherRevenueAmt |
| CY Other Revenue | $158,744 | CYOtherRevenueAmt |
| PY Total Revenue | $164,443,894 | PYTotalRevenueAmt |
| CY Total Revenue | $192,286,425 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $456,231 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $270,625 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $67,546,475 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $72,213,247 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $267,895 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $92,753,131 | PYOtherExpensesAmt |
| CY Other Expenses | $106,791,486 | CYOtherExpensesAmt |
| PY Total Expenses | $160,755,837 | PYTotalExpensesAmt |
| CY Total Expenses | $179,275,358 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,688,057 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $13,011,067 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $121,179,230 | TotalAssetsBOYAmt |
| Total Assets EOY | $139,959,853 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $113,851,859 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $112,497,711 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,327,371 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,462,142 | 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 | $110,310,034 | ExpenseAmt |
| Grant | $270,625 | GrantAmt |
| Revenue | $182,562,730 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $110,310,034 | 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 | 0 | 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 | 943 | 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 | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Wing Bill | ||||||||||
| Dir/Asst Secr/Vice Chair thru 01/22 | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $2,511,347 | $56,319 | |||
| Heinrich Kerry | ||||||||||
| Dir/Chair/CEO as of 01/22 | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $2,131,443 | $75,065 | |||
| Hofheins Todd | ||||||||||
| Dir/Vice Chair/COO as of 01/22 | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $1,971,652 | $72,279 | |||
| Jahn Andrew | ||||||||||
| Care Division President thru 02/22 | 0.00 | 50.00 | $0 | $1,409,539 | $74,100 | Yes (X) | ||||
| Beaman John | ||||||||||
| CFO/Asst Secretary as of 01/22 | 0.00 | 50.00 | Yes (X) | $0 | $1,361,096 | $58,476 | ||||
| Nahapetian Arby - Care | ||||||||||
| Division Medical Officer thru 02/22 | 0.00 | 50.00 | $0 | $1,334,111 | $68,537 | Yes (X) | ||||
| Stevens Eric - President | ||||||||||
| Northern CA/HI State Network | 5.00 | 45.00 | $0 | $1,315,314 | $62,845 | Yes (X) | ||||
| Spenst Brett - Care Division | ||||||||||
| Finance Officer thru 02/22 | 0.00 | 50.00 | $0 | $1,322,824 | $36,101 | Yes (X) | ||||
| Reiner Scott | ||||||||||
| Former Dir/Chair/CEO thru 12/21 | 0.00 | 0.00 | $0 | $1,222,073 | $36,652 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | Yes (X) | $0 | $930,036 | $39,184 | ||||
| Byrnes John - Former | ||||||||||
| Medical Officer, NCR thru 02/20 | 0.00 | 50.00 | $0 | $841,204 | $65,864 | Yes (X) | ||||
| Howe Judson | ||||||||||
| President, North Coast Network | 8.30 | 41.70 | $0 | $782,335 | $54,114 | Yes (X) | ||||
| Tetz Warren | ||||||||||
| Treasurer 07/22 - 12/22 | 12.50 | 37.50 | Yes (X) | $0 | $565,355 | $37,880 | ||||
| Cantrell Misty - Patient | ||||||||||
| Care Executive as of 09/22 | 50.00 | 0.00 | $0 | $507,425 | $64,679 | Yes (X) | ||||
| Cardenas Lucita | ||||||||||
| RN | 40.00 | 0.00 | $503,160 | $0 | $39,477 | Yes (X) | ||||
| Mock Jeffrey | ||||||||||
| Interim Treasurer as of 12/22 | 0.00 | 50.00 | Yes (X) | $0 | $422,487 | $97,833 | ||||
| Assavapisitkul Colleen - Pt | ||||||||||
| Cr Exec thru 05/22/Pres as of 05/22 | 50.00 | 0.00 | Yes (X) | $0 | $459,052 | $46,184 | ||||
| Cole Delores | ||||||||||
| RN | 40.00 | 0.00 | $421,517 | $0 | $27,052 | Yes (X) | ||||
| Jacobson Carlton - Former Treas | ||||||||||
| /Asst Secr thru 12/21/Fin Off AHCL | 50.00 | 0.00 | $0 | $383,633 | $42,724 | Yes (X) | ||||
| Eller Jeff | ||||||||||
| Former President, NCR | 0.50 | 8.50 | $0 | $352,684 | $52,686 | Yes (X) | ||||
| Anjejo Isaac | ||||||||||
| RN, First Assistant | 40.00 | 0.00 | $348,186 | $0 | $34,902 | Yes (X) | ||||
| McCance David | ||||||||||
| RN | 40.00 | 0.00 | $324,675 | $0 | $45,886 | Yes (X) | ||||
| Aleman Andrea | ||||||||||
| RN Supervisor | 40.00 | 0.00 | $319,624 | $0 | $35,240 | Yes (X) | ||||
| Lonto Robert | ||||||||||
| Former Reg HP Dir, NCR thru 02/20 | 0.00 | 50.00 | $0 | $270,421 | $82,148 | Yes (X) | ||||
| Santos David | ||||||||||
| President thru 05/22 | 50.00 | 0.00 | Yes (X) | $0 | $230,650 | $30,853 | ||||
| Shapiro Marc | ||||||||||
| Medical Officer | 50.00 | 0.00 | $0 | $158,109 | $0 | Yes (X) | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,858 | $0 | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,728 | $0 | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,478 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,478 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,478 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,478 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,478 | $0 | ||||
| Newton Bradford | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $25,180 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $21,478 | $0 | ||||
| Fehr Joy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $430 | $0 | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $430 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,917,162 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $20,716,284 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,337,080 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 170 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | 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 St | Rancho Cordova | CA | 95742 | Physician/medical provider | $3,066,814 |
| Rmg Medical Imaging Consultants | |||||
| 25360 Magic Mtn Pkwy Ste 270 | Valencia | CA | 91355 | Physician/medical provider | $1,536,241 |
| Lyons Huber Management A Medical Corp | |||||
| 512 Pine Hill Rd | Angwin | CA | 94508 | Physician/medical provider | $1,169,408 |
| Synchronous Health Inc | |||||
| 2021 21st Ave S Ste 400 | Nashville | TN | 37212 | Contract labor | $1,093,014 |
| Charles Barron | |||||
| PO Box 305 | Middletown | CA | 95461 | Construction | $1,004,785 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 53 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,704,576 | GovernmentGrantsAmt |
| All Other Contributions | $5,588,246 | AllOtherContributionsAmt |
| Total Contributions | $7,292,822 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621110 | $159,859,620 | $159,859,620 |
| CARES Act revenue | 621110 | $11,000,000 | $11,000,000 |
| Premium revenue | 621110 | $8,465,449 | $8,465,449 |
| Incentive/quality revenue | 531120 | $1,419,872 | $1,419,872 |
| 340B Pharmacy revenue | 621110 | $1,132,906 | $1,132,906 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $684,883 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $684,883 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $182,562,730 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,277,721 | TotalRevenueColumnAmt |
| Exclusion | $2,277,721 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $223,382 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $64,638 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $158,744 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $158,744 | TotalRevenueColumnAmt |
| Exclusion | $158,744 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,592 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$5,592 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,592 | TotalRevenueColumnAmt |
| Exclusion | -$5,592 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $192,286,425 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $182,562,730 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,430,873 | 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 | $270,625 | TotalAmt |
| Program Services | $270,625 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,281,948 | TotalAmt |
| Program Services | $41,492,269 | ProgramServicesAmt |
| Management And General | $14,598,390 | ManagementAndGeneralAmt |
| Fundraising | $191,289 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,983,268 | TotalAmt |
| Program Services | $1,473,895 | ProgramServicesAmt |
| Management And General | $501,664 | ManagementAndGeneralAmt |
| Fundraising | $7,709 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,105,346 | TotalAmt |
| Program Services | $7,194,750 | ProgramServicesAmt |
| Management And General | $2,884,022 | ManagementAndGeneralAmt |
| Fundraising | $26,574 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,842,685 | TotalAmt |
| Program Services | $2,901,589 | ProgramServicesAmt |
| Management And General | $924,053 | ManagementAndGeneralAmt |
| Fundraising | $17,043 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,210,504 | TotalAmt |
| Management And General | $18,210,504 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $558,371 | TotalAmt |
| Management And General | $558,371 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,035 | TotalAmt |
| Program Services | $22,035 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,191,781 | TotalAmt |
| Program Services | $31,342,954 | ProgramServicesAmt |
| Management And General | $10,847,576 | ManagementAndGeneralAmt |
| Fundraising | $1,251 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $317,750 | TotalAmt |
| Management And General | $317,750 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,359,967 | TotalAmt |
| Program Services | $768,266 | ProgramServicesAmt |
| Management And General | $585,026 | ManagementAndGeneralAmt |
| Fundraising | $6,675 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,929,316 | TotalAmt |
| Program Services | $434,119 | ProgramServicesAmt |
| Management And General | $4,494,603 | ManagementAndGeneralAmt |
| Fundraising | $594 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,674,808 | TotalAmt |
| Program Services | $3,959,102 | ProgramServicesAmt |
| Management And General | $712,875 | ManagementAndGeneralAmt |
| Fundraising | $2,831 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $418,006 | TotalAmt |
| Program Services | $231,491 | ProgramServicesAmt |
| Management And General | $177,693 | ManagementAndGeneralAmt |
| Fundraising | $8,822 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,492 | TotalAmt |
| Program Services | $13,544 | ProgramServicesAmt |
| Management And General | $32,933 | ManagementAndGeneralAmt |
| Fundraising | $1,015 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,059,507 | TotalAmt |
| Program Services | $2,059,507 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,834,564 | TotalAmt |
| Program Services | $4,559,931 | ProgramServicesAmt |
| Management And General | $270,541 | ManagementAndGeneralAmt |
| Fundraising | $4,092 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $999,992 | TotalAmt |
| Program Services | $994,110 | ProgramServicesAmt |
| Management And General | $5,882 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient care supplies | $10,870,471 | $10,092,073 | $778,398 |
| Rental/leases costs equ | $2,694,662 | $1,093,687 | $1,600,975 |
| Quality assurance fees | $85,698 | $85,698 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,516,562 | TotalAmt |
| Program Services | $1,320,389 | ProgramServicesAmt |
| Management And General | $11,196,173 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,275,358 | TotalAmt |
| Program Services | $110,310,034 | ProgramServicesAmt |
| Management And General | $68,697,429 | ManagementAndGeneralAmt |
| Fundraising | $267,895 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,379 | BOYAmt |
| EOY | $103,187 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,360,878 | BOYAmt |
| EOY | $46,019,310 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $337,360 | BOYAmt |
| EOY | $424,607 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,995,319 | BOYAmt |
| EOY | $29,994,709 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,208,210 | BOYAmt |
| EOY | $1,739,862 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $186,088 | BOYAmt |
| EOY | $49,674 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $90,590,379 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $54,221,421 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,813,266 | BOYAmt |
| EOY | $36,368,958 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,616 | BOYAmt |
| EOY | $177,626 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,016,114 | BOYAmt |
| EOY | $25,081,920 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,179,230 | BOYAmt |
| EOY | $139,959,853 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,580,595 | BOYAmt |
| EOY | $18,926,046 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,369,803 | BOYAmt |
| EOY | $181,680 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,901,461 | BOYAmt |
| EOY | $93,389,985 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,851,859 | BOYAmt |
| EOY | $112,497,711 | 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 | $6,657,871 | BOYAmt |
| EOY | $26,159,612 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $669,500 | BOYAmt |
| EOY | $1,302,530 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,327,371 | BOYAmt |
| EOY | $27,462,142 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,179,230 | BOYAmt |
| EOY | $139,959,853 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $13,011,067 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,061,337 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $11,185,041 | 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 | $22,035 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $22,035 | 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 | $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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $661,963 | BeginningYearBalanceAmt |
| Contributions | $236,726 | ContributionsAmt |
| Investment Earnings Or Losses | -$5,590 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $133,224 | GrantsOrScholarshipsAmt |
| Other Expenditures | $149,793 | OtherExpendituresAmt |
| End Year Balance | $610,082 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00762 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.99238 | 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 | $46,091,478 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,675,022 | DepreciationAmt |
| Book Value | $19,416,456 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,592,553 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,602,194 | DepreciationAmt |
| Book Value | $990,359 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,801,317 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,534,202 | DepreciationAmt |
| Book Value | $4,267,115 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,242,692 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,410,003 | DepreciationAmt |
| Book Value | $8,832,689 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $36,368,958 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from third-party payors | $17,599,433 |
| Right-of-use assets | $4,240,218 |
| Other receivables | $2,404,335 |
| Receivables from related organizations | $837,934 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $25,081,920 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $76,141,551 |
| Payables to third-party payors | $13,635,728 |
| Other liabilities | $3,612,706 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $93,389,985 | 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, 2022 and 2021, 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 (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2019 in major tax jurisdictions. |
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 | $1,182,539 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,182,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00660 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,160,526 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,810,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,349,893 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,343,065 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $44,810,633 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,532,432 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07550 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $826,725 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $826,725 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,960 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $74,960 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,559,373 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,217,641 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,341,732 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03540 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,520 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $74,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,535,578 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,217,641 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,317,937 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $87,878,643 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $67,028,274 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,850,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11630 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,266,342 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,266,342 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00710 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,738 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,738 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,851 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,851 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,281,931 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,281,931 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,820,274 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,570,557 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $60,818,899 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $57,827,945 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $2,990,954 | 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 and leadership, community-based healthcare workers focusing on behavioral health, education, health and 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 Hospital (AHCL) collaborated with Sutter Lakeside Hospital. |
| 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: The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible while ensuring the health and safety of those participating.Tax year 2022 was year three of the Implementation Strategy for the 2019 CHNA. All programs and activities provided to the community were in response to the priority health needs identified in the 2019 CHNA. Our 2019 CHNA identified four health priorities:1. Address drug abuse/substance use within the community.2. Increase housing stability and target homelessness.3. Community outreach & education for all high need and/or disenfranchised communities.4. Access to health services and increase opportunity for cancer prevention and screenings.Priority Need 1 - Address Drug Abuse/Substance Use Within the Community - the goal is to improve healthy behaviors by reducing drug dependency.Strategy 1 - Fill gaps in drug addiction recovery services continuum to improve recovery, access and outcomes.Activity 1.1 - ED Bridge and Substance Use Navigator (SUN) Program - AHCL applied for and received grant funding to provide the Medically Assisted Treatment (MAT) program to help address California's opioid epidemic in fiscal year 2020. Although most costs were covered by the grant, a small portion of community benefit expenses were associated with this program. During 2022 there were 1,534 encounters, 746 interventions, and 270 individuals who accepted treatment. 64% of patients were seen by a Substance Use Navigator and accepted treatment in 2022.Activity 1.2 - X-Wavier Training & Certification - Since starting the SUN program, lives have been impacted and 11 new providers in 2022 have received training specific for supporting patients who are ready for immediate medical assistance to begin navigating the road to recovery. Collaborative partners were Dr. Bradley - Mendocino Lakeview clinic, Sutter Lakeside Hospital, Lake County Behavioral Health, AA, NA, Celebrate Recovery, church groups throughout Lake County, and *CARE, Inc.Additional activities were placed on hold due to COVID-19.Priority Need 2 - Increase Housing Stability and Target Homelessness - The goal is to connect high utilizers of health care to housing.Strategy 1 - Grow capacity for existing programs and reduce time to secure supportive housing for program participants.Activity 1.1 - Restoration House - Project Restoration focuses on: high utilizer identification, readmission prevention, streamlined access to services for vulnerable populations, homelessness alternatives, intensive case management (through Live Well's Intensive Program), mental health options, and substance abuse support. In 2022, 16 clients were served. Additionally, under new administration in 2022, Restoration House transitioned from a medical respite care facility to recuperative care facility to better meet our goals and objectives.Activity 1.2 - Hope Center's mission is to provide individualized services for our neighbors experiencing homelessness. Through sponsorship by Adventist Health, 101 people were served and 51 people were housed in 2022.Activity 1.3 - Elijah House Collaboration - This program was closed in 2022 due to staffing shortages and COVID-19 impact.Activity 1.4 - Healthy Homes - Three individuals were housed in 2022. Priority Need 3 - Community outreach and engagement for all high need and/or disenfranchised communities, and access to health services - the goal is to increase healthy behaviors in the community.Strategy 1 - Providing services into the community and adding access points to health and social services.Activity 1.1 - Shower Trailer - The Shower Trailer serves the homeless, poorly sheltered, and others up to five days a week. In 2022, they increased their locations in Lake County to Clearlake Oaks, Big O Peer Center, Clearlake Shower Trailer site at the Senior Center, Lucerne, and Kelseyville. Two Health Outreach Events, offering COVID vaccines and testing, wound care, Narcan training and kit giveaway, dental screening, Social Services applications, haircuts, etc. were held in 2022. At each event we had nine community partners that also participated. With a local community grant, we have been able to provide clean clothes (socks, underwear, sweats, t-shirts) for our guests. In 2022, 2,388 individuals were provided showers.Activity 1.2 - Safe Sleeping for Baby & New Mothers (English & Spanish) - Baby Sleep Safe is part of the Comprehensive Perinatal Services Program (CPSP) that guides a mother through pregnancy and the postpartum journey. The program follows three assessments: health education, nutrition, and psychosocial. In 2022, there were 54 attendees with 29 English-speaking and 25 Spanish-speaking individuals. Priority Need 4 - Increase opportunity for cancer prevention and screenings - The goal is to reduce cancer mortality rates in Lake County.Strategy 1 - Increase screening opportunities by expanding early detection programming.Activity 1.1 - "AHEAD" Hereditary Cancer Screening - This program is currently on hold due to COVID-19 and staff shortagesActivity 1.2 - 3D Mammography - In 2022, a total of 2,202 screenings were provided.Activity 1.3 - Colorectal Screening (Scope) - In 2022, a total of 5,683 screenings were provided.Activity 1.4 - Prostate Cancer Screenings - This program is currently on hold due to COVID-19 and staff shortages.Additional activities - In 2022, AHCL continued to navigate the challenges of the pandemic. While there were increased numbers of 3D mammography and colorectal screenings, data for other types of cancer screenings was incomplete. The new goal of encouraging patients to schedule cancer screenings as we began to emerge from the pandemic became even more important. Due to patients' reluctance to visit medical facilities, AHCL's new expansive goal to encourage healthy lifestyle practices through the Blue Zone Project Lake County became a priority in light of these new challenges.Priority needs not addressed:For the 2020-2022 Community Health Plan (implementation strategy), AHCL elected to adopt a broad strategy that addressed all the priority needs identified. |
| 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 | 33 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (33 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AH Clearlake - RHC | ||||
| 15230 Lakeside Dr | Clearlake | CA | 95422 | Internal Medicine/Family Practice and Specialty Services |
| 2 - AH Paradise Skyway Primary Care - RHC | ||||
| 5125 Skyway Rd Ste G | Paradise | CA | 95969 | Primary Care |
| 3 - AH Clearlake Dental - RHC | ||||
| 15230 Lakeside Dr Ste 105 | Clearlake | CA | 95422 | Dental |
| 4 - AH Paradise Skyway Specialty - RHC | ||||
| 5125 Skyway Rd Ste D | Paradise | CA | 95969 | Medical Specialty |
| 5 - AH Hidden Valley Lake - RHC | ||||
| 18990 Coyote Valley Rd Ste 9 | Hidden Valley Lake | CA | 95467 | Internal Medicine |
| 6 - AH Clearlake Live Well - RHC | ||||
| 15230 Lakeside Dr Ste 104 | Clearlake | CA | 95422 | Live Well (psychiatry) |
| 7 - AH Paradise Skyway Dental - RHC | ||||
| 5125 Skyway Rd Ste I | Paradise | CA | 95969 | Primary Care |
| 8 - AH Clearlake Family Medicine 101- RHC | ||||
| 15230 Lakeside Dr Ste 101 | Clearlake | CA | 95422 | Family Practice |
| 9 - AH Corning Solano Primary Care - RHC | ||||
| 155 Solano St | Corning | CA | 96021 | Family Practice |
| 10 - AH Clearlake Hilltop Cardiology - RHC | ||||
| 15322 Lakeshore Dr Ste 201 | Clearlake | CA | 95422 | Medical Specialty |
| 11 - AH Paradise Skyway Psychiatry & BH - RHC | ||||
| 5125 Skyway Rd Ste B | Paradise | CA | 95969 | Primary Care |
| 12 - AH Paradise Skyway Immediate Care - RHC | ||||
| 5125 Skyway Rd Ste A | Paradise | CA | 95969 | Primary Care |
| 13 - AH Paradise Primary Care Lower Level - RHC | ||||
| 5125 Skyway Road | Paradise | CA | 95969 | Primary Care |
| 14 - AH Clearlake Synchronous BH - RHC | ||||
| 15230 Lakeshore Drive | Clearlake | CA | 95422 | Primary Care |
| 15 - AH Clearlake Hilltop Surgical Specialties | ||||
| 15322 Lakeshore Dr Ste 101 | Clearlake | CA | 95422 | Specialty Surgical |
| 16 - AH Lakeport 11th St - RHC | ||||
| 801 11th Street | Lakeport | CA | 954534100 | Primary Care |
| 17 - AH Middletown - RHC | ||||
| 21337 Bush St | Middletown | CA | 95461 | Family Practice w/OB |
| 18 - AH Kelseyville - RHC | ||||
| 5290 State St | Kelseyville | CA | 95451 | Internal Medicine |
| 19 - AH Lucerne - RHC | ||||
| 6300 E Hwy 20 | Lucerne | CA | 95458 | Family Practice |
| 20 - AH Paradise Skyway Pediatrics - RHC | ||||
| 5125 Skyway Rd Ste H | Paradise | CA | 95969 | Primary Care |
| 21 - AH Corning Solano Dental - RHC | ||||
| 155 Solano St | Corning | CA | 96021 | Dental |
| 22 - AH Lakeport Internal Medicine | ||||
| 487 South Main St Ste 122 | Lakeport | CA | 95453 | Primary Care |
| 23 - AH Clearlake Live Well BH - RHC | ||||
| 15230 Lakeshore Drive | Clearlake | CA | 95422 | Live Well (psychiatry) |
| 24 - AH Lakeport Pediatrics - RHC | ||||
| 487 South Main St Ste 122 | Lakeport | CA | 95453 | Primary Care |
| 25 - AH Lower Lake Konocti - RHC | ||||
| 9430 Lake St Ste C | Lower Lake | CA | 95457 | Family Practice, Pediatrics |
| 26 - AH Clearlake Hilltop - RHC | ||||
| 15322 Lakeshore Dr Ste 102 | Clearlake | CA | 95422 | Primary Care |
| 27 - AH Clearlake - Ophthalmology | ||||
| 15322 Lakeshore Dr | Clearlake | CA | 95422 | Ophthalmology |
| 28 - AH Paradise Skyway Live Well - RHC | ||||
| 5125 Skyway Road | Paradise | CA | 95969 | Live Well (psychiatry) |
| 29 - AH Laie - RHC | ||||
| 55-510 Kamehameha Hwy Ste 5 | Laie | HI | 96762 | Primary Care |
| 30 - AH Clearlake - Hilltop Cardiology | ||||
| 15322 Lakeshore Dr | Clearlake | CA | 95422 | Cardiology |
| 31 - AH Clearlake - Hilltop Surgical Specialtie | ||||
| 15322 Lakeshore Dr | Clearlake | CA | 95422 | Specialty |
| 32 - AH Paradise Skyway OBGYN - RHC | ||||
| 5125 Skyway Rd Ste C | Paradise | CA | 95969 | Medical Specialty |
| 33 - AH Clearlake - Hilltop Family Practice | ||||
| 15322 Lakeshore Dr | Clearlake | CA | 95422 | Family Practice |
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 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 completed the acquisition of Blue Zones as the first step toward reaching this goal. By partnering with Blue Zones, we are 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, and as we enter 2022 these projects are active. 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. These activities are not included elsewhere on Schedule H. |
| 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. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information, those accounts would have been reclassified from bad debt expense to charity care. |
| Part III, Line 4: | The system-wide 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: | The Hospital's 2022 Community Health Needs Assessment (CHNA), the 2023 Community Health Implementation Strategy (CHIS) approved in fiscal year 2023, and the 2022 Community Health Plan (CHP) updated for fiscal year 2022 are posted on the Hospital's website at: https://www.adventisthealth.org/clear-lake/about-us/community-benefit/The two most recent CHNAs, the two most recent CHIS reports and the 2020, 2021 and 2022 CHP Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The 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, our hospitals support 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 the regions we serve. 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. |
| 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: 1. https://www.adventisthealth.org/patient-resources/bill-pay/financial-assistance/ 2. https://www.adventisthealth.org/documents/financial-assistance/13863-Self-Pay-Billing-and-Collection-Policy.pdfThese documents are available in multiple languages.At 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 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, AHCL 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 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; and 3. 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, and 3. 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 telepharmacy 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, 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 2022, BZPLC launched the transformation phase of the Project, focusing on People, Places, and Policy. Below is a summary of Progress Outcomes for 2022.The local BZPLC Team coordinated a Kick-off Events in 2022 to spread awareness throughout the County. A total of 1,267 unique individuals 15 years or older participated in the following Blue Zones Project activities: Blue Zones Story Speech: 1,012, Walking Moais: 12, Purpose Workshops: 104, Cooking Demos/Classes: 102, Volunteers: 17, Sharecare Digital Platform: 23. Schools: Four of the six school districts in Lake County have registered all their school sites to become Blue Zones approved and are actively working through the pledge packet process with school board approval (equating to 15 of the 23 public schools in Lake County). In addition, BZPLC team members were invited to present at the ACSA (Association of California School Administrators) local chapter meeting, which has representation from all of Lake County's school districts.Restaurants: One restaurant achieved Blue Zones Approval status in year one. Two more are registered, actively engaged in the pledge process, and nearing approval. BZPLC was invited to make a presentation at Lake County's first annual Restaurant Expo and many restaurants offer healthy, organic, plant-based entres as part of their menu options, and BZPLC utilizes their catering services whenever possible in order to highlight them. Grocery Stores: Foods Etc. in Clearlake became Blue Zones Approved in November 2022, and the team is actively seeking engagement from a second grocery store.Worksites: AHCL, one of the top employers in Lake County is pursuing Blue Zones Certification and is actively engaged in Blue Zones Project activities, with representation on BZPLC Steering Committee, Leadership Team, and Sector Committees. Built Environment: BZPLC has been participating integrally with the Parks and Rec Master Planning Community Visioning process. Food: BZPLC is collaborating with the Mendocino-Lake Food Hub in support of a business plan for the organization.Tobacco: Adventist Health and BZPLC cohosted a vaping summit on November 16, 2022. It was a monumental community leader gathering where decision-makers from both Lake County and City of Clearlake agreed to promote the adoption of smoke-free and commercial tobacco retail policies in 2023. BZPLC championed the formation of a Commercial Tobacco Joint Policy Workgroup which is promoting policy options in Lakeport, Clearlake, and County Unincorporated. This group produced a Joint Policy Platform and its innovations and strategies have influenced coalitions in Mendocino County, Yuba, Sutter and beyond. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| California Health Fund & Trust | ||||||||
| 1215 K St Ste 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $26,548 | $0 | Hlth srvs un/underinsured pt |
| County Of Lake | ||||||||
| 922 Bevins Court | Lakeport | CA | 95453 | Gov't | $82,802 | $0 | CESH grant subcontractor | |
| Lake County Chamber Of Commerce | ||||||||
| PO Box 295 | Lakeport | CA | 95453 | 680159445 | 501(c)(6) | $17,000 | $0 | Meals on Wheels Program |
| Lake County Wine Alliance | ||||||||
| PO Box 530 | Kelseyville | CA | 95451 | 680447622 | 501(c)(3) | $10,000 | $0 | General support |
| North Coast Opportunities Inc | ||||||||
| 413 N State Street | Ukiah | CA | 95482 | 941671958 | 501(c)(3) | $55,000 | $0 | CESH grant subcontractor |
| Sunrise Special Services Foundation | ||||||||
| PO Box 479 | Upper Lake | CA | 95485 | 943096395 | 501(c)(3) | $55,000 | $0 | CESH grant subcontractor |
| Worldwide Healing Hands | ||||||||
| 8685 Main Street | Kelseyville | CA | 95451 | 900758374 | 501(c)(3) | $11,000 | $0 | General support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 6 | Total501c3OrgCnt |
| Total Other Org | 1 | 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 (26 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Wing Bill | ||||||||||||||
| Dir/Asst Secr/Vice Chair thru 01/22 | $0 | $263,334 | $0 | $662,638 | $0 | $1,585,375 | $0 | $12,220 | $0 | $44,099 | $0 | $2,567,666 | $0 | $0 |
| Heinrich Kerry | ||||||||||||||
| Dir/Chair/CEO as of 01/22 | $0 | $1,817,710 | $0 | $76 | $0 | $313,657 | $0 | $12,220 | $0 | $62,845 | $0 | $2,206,508 | $0 | $0 |
| Hofheins Todd | ||||||||||||||
| Dir/Vice Chair/COO as of 01/22 | $0 | $1,358,421 | $0 | $376,216 | $0 | $237,015 | $0 | $12,220 | $0 | $60,059 | $0 | $2,043,931 | $0 | $0 |
| Jahn Andrew | ||||||||||||||
| Care Division President thru 02/22 | $0 | $1,047,840 | $0 | $349,414 | $0 | $12,285 | $0 | $12,220 | $0 | $61,880 | $0 | $1,483,639 | $0 | $0 |
| Beaman John | ||||||||||||||
| CFO/Asst Secretary as of 01/22 | $0 | $1,047,636 | $0 | $298,600 | $0 | $14,860 | $0 | $12,220 | $0 | $46,256 | $0 | $1,419,572 | $0 | $0 |
| Nahapetian Arby - Care | ||||||||||||||
| Division Medical Officer thru 02/22 | $0 | $927,049 | $0 | $234,212 | $0 | $172,850 | $0 | $12,220 | $0 | $56,317 | $0 | $1,402,648 | $0 | $0 |
| Stevens Eric - President | ||||||||||||||
| Northern CA/HI State Network | $0 | $896,507 | $0 | $250,602 | $0 | $168,205 | $0 | $12,220 | $0 | $50,625 | $0 | $1,378,159 | $0 | $0 |
| Spenst Brett - Care Division | ||||||||||||||
| Finance Officer thru 02/22 | $0 | $817,612 | $0 | $416,845 | $0 | $88,367 | $0 | $12,220 | $0 | $23,881 | $0 | $1,358,925 | $0 | $0 |
| Reiner Scott | ||||||||||||||
| Former Dir/Chair/CEO thru 12/21 | $0 | $348,458 | $0 | $870,709 | $0 | $2,906 | $0 | $12,220 | $0 | $24,432 | $0 | $1,258,725 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $639,741 | $0 | $154,687 | $0 | $135,608 | $0 | $12,220 | $0 | $26,964 | $0 | $969,220 | $0 | $0 |
| Byrnes John - Former | ||||||||||||||
| Medical Officer, NCR thru 02/20 | $0 | $154,814 | $0 | $187,322 | $0 | $499,068 | $0 | $12,220 | $0 | $53,644 | $0 | $907,068 | $0 | $0 |
| Howe Judson | ||||||||||||||
| President, North Coast Network | $0 | $523,665 | $0 | $152,359 | $0 | $106,311 | $0 | $12,220 | $0 | $41,894 | $0 | $836,449 | $0 | $0 |
| Tetz Warren | ||||||||||||||
| Treasurer 07/22 - 12/22 | $0 | $435,029 | $0 | $63,870 | $0 | $66,456 | $0 | $12,220 | $0 | $25,660 | $0 | $603,235 | $0 | $0 |
| Cantrell Misty - Patient | ||||||||||||||
| Care Executive as of 09/22 | $0 | $270,061 | $0 | $61,401 | $0 | $175,963 | $0 | $12,220 | $0 | $52,459 | $0 | $572,104 | $0 | $0 |
| Cardenas Lucita | ||||||||||||||
| RN | $502,849 | $0 | $311 | $0 | $0 | $0 | $12,220 | $0 | $27,257 | $0 | $542,637 | $0 | $0 | $0 |
| Mock Jeffrey | ||||||||||||||
| Interim Treasurer as of 12/22 | $0 | $286,124 | $0 | $75,485 | $0 | $60,878 | $0 | $12,220 | $0 | $85,613 | $0 | $520,320 | $0 | $0 |
| Assavapisitkul Colleen - Pt | ||||||||||||||
| Cr Exec thru 05/22/Pres as of 05/22 | $0 | $359,184 | $0 | $61,531 | $0 | $38,337 | $0 | $12,220 | $0 | $33,964 | $0 | $505,236 | $0 | $0 |
| Cole Delores | ||||||||||||||
| RN | $421,441 | $0 | $76 | $0 | $0 | $0 | $12,220 | $0 | $14,832 | $0 | $448,569 | $0 | $0 | $0 |
| Jacobson Carlton - Former Treas | ||||||||||||||
| /Asst Secr thru 12/21/Fin Off AHCL | $0 | $286,289 | $0 | $65,488 | $0 | $31,856 | $0 | $11,509 | $0 | $31,215 | $0 | $426,357 | $0 | $0 |
| Eller Jeff | ||||||||||||||
| Former President, NCR | $0 | $0 | $0 | $177,886 | $0 | $174,798 | $0 | $5,337 | $0 | $47,349 | $0 | $405,370 | $0 | $0 |
| Anjejo Isaac | ||||||||||||||
| RN, First Assistant | $273,423 | $0 | $74,763 | $0 | $0 | $0 | $10,446 | $0 | $24,456 | $0 | $383,088 | $0 | $0 | $0 |
| McCance David | ||||||||||||||
| RN | $324,446 | $0 | $229 | $0 | $0 | $0 | $9,740 | $0 | $36,146 | $0 | $370,561 | $0 | $0 | $0 |
| Aleman Andrea | ||||||||||||||
| RN Supervisor | $316,970 | $0 | $2,654 | $0 | $0 | $0 | $9,589 | $0 | $25,651 | $0 | $354,864 | $0 | $0 | $0 |
| Lonto Robert | ||||||||||||||
| Former Reg HP Dir, NCR thru 02/20 | $0 | $175,680 | $0 | $73,176 | $0 | $21,565 | $0 | $8,113 | $0 | $74,035 | $0 | $352,569 | $0 | $0 |
| Santos David | ||||||||||||||
| President thru 05/22 | $0 | $198,774 | $0 | $0 | $0 | $31,876 | $0 | $6,919 | $0 | $23,934 | $0 | $261,503 | $0 | $0 |
| Shapiro Marc | ||||||||||||||
| Medical Officer | $0 | $0 | $0 | $0 | $0 | $158,109 | $0 | $0 | $0 | $0 | $0 | $158,109 | $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 - $465,750 Wing, Bill - severance payment - $1,584,880 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 2022 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, Jeff Eller, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Scott Reiner, Brett Spenst, 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 2022 Part II: Eller, Jeff, Former President, NCR was paid through an unrelated organization, Jeffrey D. Eller dba Mountaingate Coaching that was reported on Form 1099 and included in Schedule J, Part II. Marc Shapiro, Medical Officer was paid through an unrelated organization, Marc R. Shapiro Medical Corp that was reported on Form 1099 and included on Schedule J, Part II. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 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 2022 was $13,532,432. The following Inpatient services were provided to all our patients: - 126 babies delivered - 137 surgeries performed - 5,841 patient days The following Outpatient services were provided to all our patients: - 20,530 emergency department visits - 2,202 outpatient surgeries performed - 105,309 outpatient visits - 261,172 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 2022 was $7,317,937. 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 VI, Section A, line 6 | The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The Hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, 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 sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. |
| 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 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 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 50th 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 21,259,933. Management and general expenses 8,662,091. Fundraising expenses 0. Total expenses 29,922,024. All other purchased services: Program service expenses 3,860,625. Management and general expenses 1,186,659. Fundraising expenses 1,251. Total expenses 5,048,535. Contract labor: Program service expenses 3,796,059. Management and general expenses 136,148. Fundraising expenses 0. Total expenses 3,932,207. Purchased medical services: Program service expenses 1,689,951. Management and general expenses 28,241. Fundraising expenses 0. Total expenses 1,718,192. Consulting and other management fees: Program service expenses 360,060. Management and general expenses 212,021. Fundraising expenses 0. Total expenses 572,081. Repairs and maintenance: Program service expenses 366,294. Management and general expenses 307,286. Fundraising expenses 0. Total expenses 673,580. Other professional medical fee: Program service expenses 284. Management and general expenses 226,639. Fundraising expenses 0. Total expenses 226,923. Other non-medical professional fees: Program service expenses 9,748. Management and general expenses 88,491. Fundraising expenses 0. Total expenses 98,239. |
| 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 (27 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 Highway | Delano | CA | 93215 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | 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 | |
| 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 1 | 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 & 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 12b, II | 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 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 |
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