2022-11-11T09:49:41-06:00 2021-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2021-01-01 953867863 Western Health Resources WEST 9164060000 1 Adventist Health Way Roseville CA 956613266 Meredith Jobe Secretary 9164060000 2022-11-03 1 Meredith Jobe 999009999 Tracy S Paglia P00366884 2099556100 2022-11-03 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Adventist HealthHome Care Melissa Ward 1 Adventist Health Way Roseville CA 956613266 66062205 0 1071 X www.adventisthealth.org/ X 1983 CA Living God's love by inspiring health, wholeness and hope. 6 0 663 34 0 0 10339 31250 65839584 66030760 0 195 0 0 65849923 66062205 0 0 0 0 51091115 48697746 0 0 0 18056608 16512314 69147723 65210060 -3297800 852145 29445542 15390414 33078950 29710328 -3633408 -14319914 X Living God's love by inspiring health, wholeness and hope. 0 0 40021259 0 66030760 See Schedule O 40021259 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 663 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 Jahn Andrew Dir/Chair 0.50 50.00 X X 0 1848683 72937 Beaman John Director 0.50 50.00 X 0 1366110 78586 Hofheins Todd CFO 0.50 50.00 X 0 1319147 59910 El-Asmar Hoda - Former Dir Vice Chair/Pres thru 10/20 0.00 0.00 X 0 1264697 23191 Ashlock Mark Former Dir/Vice Chair thru 06/20 0.00 0.00 X 0 1180696 32717 Jobe Meredith Dir/Secretary 0.50 50.00 X X 0 932705 59761 Liebowitz Jacalyn Dir/Vice Chair 0.50 50.00 X X 0 750899 67250 Ward Melissa Director, President 0.50 50.00 X X 0 364576 45456 Mock Jeffrey Director 0.50 50.00 X 0 272391 62110 Mendoza Sherry Former CEO thru 01/20 0.00 0.00 X 0 245184 29917 Ainsworth Laura Administrative Director, Operations 50.00 0.00 X 181984 0 55297 Summers Jacob Administrative Director, Operations 50.00 0.00 X 179121 0 36970 Rengiil Evadne Administrative Director, Operations 50.00 0.00 X 174143 0 40832 Porter Dennis RN 50.00 0.00 X 160554 0 51045 Kasson Paul Administrative Director, Operations 50.00 0.00 X 177926 0 23716 Reppert Joseph Former CFO/Asst Secr thru 08/19 0.00 0.00 X 0 179119 11442 873728 9724207 751137 129 1 1 0 AHSA LLC PO Box 670529 Dallas TX 75267 Medical services 842442 Stateserv Network Services 1201 S Alma School Rd Mesa AZ 85210 Medical equipment service 427739 AMN Healthcare Inc 2735 Collections Center Dr Chicago IL 60693 Medical services 190524 Hospice Source LLC PO Box 219168 Kansas City MO 64121 Medical equipment service 116909 Edmund H Lew MD Inc 1505 Wilson Terr Suite 250 Glendale CA 91206 Medical services 115250 5 31250 31250 Patient service revenue 621110 65539700 65539700 CARES Act funding 900099 483998 483998 Incentive & quality revenue 621990 5652 5652 1410 1410 66030760 195 195 66062205 66030760 0 195 38798282 27460903 11337379 1362937 965476 397461 5748387 3733789 2014598 2788140 1985913 802227 2830348 7600 2822748 22632 22632 4509948 1804102 2705846 517 517 1272507 12003 1260504 603190 485 602705 1056312 1056312 1584374 1441811 142563 21604 3243 18361 744424 744424 526859 492937 33922 113708 36962 76746 Patient care supplies 2372184 2076035 296149 Rental/lease costs equi 540339 540339 313368 313368 65210060 40021259 25188801 0 25840876 9614626 221732 170655 4955316 3110796 2065321 1844520 850000 850000 467613 2910613 29445542 15390414 5992952 6477424 27085998 23232904 33078950 29710328 X -3821236 -14555781 187828 235867 -3633408 -14319914 29445542 15390414 X 852145 -11538651 0 X 0 1 X 1 1 1 X 65624 315174 127865 10339 31250 550252 57002656 59461015 56791474 65839584 66030760 305125489 57068280 59776189 56919339 65849923 66062010 305675741 0 0 0 305675741 16183 112817 90086 195 219281 16183 112817 90086 195 219281 57084463 59889006 57009425 65849923 66062205 305895022 0.99930 0.99920 0.00070 0.00080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 187828 48854 815 235867 199611 3830 15613 187828 137020 64903 2312 199611 137850 30000 30830 137020 146695 878 9723 137850 0.00000 0.00000 1.00000 0 0 1640458 1172852 467606 245099 241430 3669 2992092 1618847 1373245 77667 77667 0 1844520 Receivables from related organizations 2910393 Other receivables 220 2910613 Payables to related organizations 22484916 Other liabilities 747988 23232904 X Part V, Line 4: Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2021 and 2020, 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 2018 in major tax jurisdictions. X X X X 1 1 0 0 0 0 0 0 0 Jahn Andrew Dir/Chair 0 1044420 0 600285 0 203978 0 11644 0 61293 0 1921620 0 0 Beaman John Director 0 892500 0 455303 0 18307 0 11644 0 66942 0 1444696 0 0 Hofheins Todd CFO 0 999600 0 116549 0 202998 0 11644 0 48266 0 1379057 0 0 El-Asmar Hoda - Former Dir Vice Chair/Pres thru 10/20 0 0 0 407203 0 857494 0 0 0 23191 0 1287888 0 0 Ashlock Mark Former Dir/Vice Chair thru 06/20 0 0 0 426536 0 754160 0 0 0 32717 0 1213413 0 0 Jobe Meredith Dir/Secretary 0 616324 0 169142 0 147239 0 14609 0 45152 0 992466 0 0 Liebowitz Jacalyn Dir/Vice Chair 0 507000 0 165422 0 78477 0 11644 0 55606 0 818149 0 0 Ward Melissa Director, President 0 285600 0 38118 0 40858 0 13927 0 31529 0 410032 0 0 Mock Jeffrey Director 0 207060 0 55940 0 9391 0 11999 0 50111 0 334501 0 0 Mendoza Sherry Former CEO thru 01/20 0 0 0 0 0 245184 0 0 0 29917 0 275101 0 0 Ainsworth Laura Administrative Director, Operations 174000 0 0 0 7984 0 6179 0 49118 0 237281 0 0 0 Summers Jacob Administrative Director, Operations 163995 0 14500 0 626 0 5344 0 31626 0 216091 0 0 0 Rengiil Evadne Administrative Director, Operations 172500 0 0 0 1643 0 6967 0 33865 0 214975 0 0 0 Porter Dennis RN 160001 0 247 0 306 0 5356 0 45689 0 211599 0 0 0 Kasson Paul Administrative Director, Operations 175673 0 0 0 2253 0 5928 0 17788 0 201642 0 0 0 Reppert Joseph Former CFO/Asst Secr thru 08/19 0 0 0 0 0 179119 0 0 0 11442 0 190561 0 0 Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health System/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Ashlock, Mark - severance payment - $749,559 El-Asmar, Hoda - severance payment - $857,260 Mendoza, Sherry - severance payment - $246,475 Reppert, Joseph - severance payment - $179,957 Select executives agreed to participate in CAP-EX in place of a traditional insurance SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life participants are Mark Ashlock, John Beaman, Todd Hofheins, Andrew Jahn, Scott Reiner, 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 amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2021 Form 990, Part III, Line 4a: Adventist Health Home Care offers advanced, high quality health care in an at-home setting by operating 14 home health agencies and seven hospices. In 2021, care, compassion and high-quality services were provided with 210,225 home health visits and 74,069 hospice days. Many of the agencies provide specialized programs and treatment plans, such as, wound care, CHF and diabetes management. Our home health mission is to help patient's recover, regain independence and become as self-sufficient as possible in the comfort of their home. Our hospice mission is to provide whole-person care that envelopes the body, comforts the mind and nurtures the spirit. We are most proud of the following accomplishments in 2021: -Implemented telehealth/remote patient monitoring for CHF patients -Bakersfield Hospice cared for their first patient, earned their Medicare certification and CHAP accreditation -Mendocino Coast Home Health joined the AH family and became integrated into our EMR, operational processes and platforms -New devices were rolled out to all AH associates -Enhanced hospice ePrescribe platform was implemented to meet patient, MD and regulatory needs -Re-launched and expanded ExactCare pharmacy services to assist patients with medication management -Implemented a readmission task force to reduce hospital readmissions and improve hospital partnerships -Glendale Home Health and Hospice were accredited by CHAP -Received regulatory change of ownership approval for Rideout Home Health Form 990, Part VI, Section A, line 6 Individuals representing the Seventh-day Adventist Church and its health care operations serve as members of Western Health Resources. Annually, the members meet for the purpose of conducting the business of the membership. Actions are taken as required to enable Western Health Resources to continue operating in concert with its Articles of Incorporation and Bylaws. Form 990, Part VI, Section A, line 7a Annually, the members meet for the purpose of conducting the business of the membership. Actions are taken as required to enable Western Health Resources to continue operating in concert with its Articles of Incorporation and Bylaws. Board appointments are approved by the membership. Form 990, Part VI, Section A, line 7b The membership must approve all amendments to the Organization's 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 System Senior Finance Officer and Market Finance 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, hospital officers, key employees and department directors are asked to complete an online annual conflict of interest questionnaire. The questionnaire includes an explanation of what constitutes potential conflicts and reminds the recipient that if a perceived conflict should arise before the next annual questionnaire, that person is to notify the Office of General Counsel immediately. Disclosures are reviewed by General Counsel, and potential conflicts are taken to the Board of Directors for review. If present during a Board review, the individual with the potential conflict must recuse themselves during any vote on the transaction. All proceedings are documented in the meeting minutes of the Board of Directors. Form 990, Part VI, Section B, line 15 The Organization's Board of Directors has established a Human Performance 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 Organization does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Organization does not make its Conflict of Interest Policy publicly available. 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. Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Foundation fka Feather River Health Foundation 1 Adventist Health Way Roseville CA 95661 680002188 Fundraising for hospital CA 501(c)(3) Line 12a, I N/A 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 N/A 0 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 Central Valley Health Foundation 1021 N Douty Street Hanford CA 93232 770578450 Fundraising for hospital CA 501(c)(3) Line 12a, I N/A 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 Glendale Adventist Medical Center Foundation 1509 Wilson Terrace Glendale CA 91206 953899682 Fundraising for hospital CA 501(c)(3) Line 12a, I N/A 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 North America Community Benefit Corporation 1 Adventist Health Way Roseville CA 95661 113698591 Supporting charitable activities of WHR CA 501(c)(3) Line 12c, III-FI N/A 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 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital and Health Care Services 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital Foundation 2975 N Sycamore Drive Simi Valley CA 93065 912135595 Fundraising for hospital CA 501(c)(3) Line 12a, I N/A 0 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 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 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 White Memorial Medical Center Charitable Foundation 1720 Cesar E Chavez Avenue Los Angeles CA 90033 953760201 Fundraising for hospital CA 501(c)(3) Line 12a, I N/A 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Blue Legacy Ventures LLC 1010 NE 2nd Avenue Miami FL 33132 871254649 Real property rental FL N/A 0 0 Blue Zones LLC 200 Southdale Center Edina MN 55435 271603327 Education MN N/A 0 0 PAR LLC 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 931262371 Real property rental OR N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Real property rental OR N/A 0 0 PVHR2 LLC dba Parkview at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Real property rental OR N/A 0 0 WWGHR LLC 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Rental OR N/A 0 0 Western Physician Services Inc PO Box 619135 Roseville CA 95661 942536300 Inactive CA Western Health Resources C 1.00000 1 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center 1 Adventist Health Way Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 200 Southdale Center Edina MN 55435 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1