2022-11-11T10:13:54-06:00 2021-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2021-01-01 941044474 Lodi Memorial Hospital Association Inc LODI 9164060000 975 S Fairmont Avenue Lodi CA 952405118 Katherine Delmore Treasurer 9164060000 2022-10-26 1 Katherine Delmore 999009999 Tracy S Paglia P00366884 2099556100 2022-10-26 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Adventist Health Lodi Memorial Brooke McCullough 975 S Fairmont Avenue Lodi CA 952405118 266545044 0 1071 X www.adventisthealth.org/lodi-memorial/ X 1945 CA Living God's love by inspiring health, wholeness and hope. 14 11 1393 16 141600 0 3269319 1554022 249590640 263179998 1678832 1793050 -28800 -22024 254509991 266505046 201593 368268 0 0 95682754 91317489 0 0 394865 156262298 170164640 252146645 261850397 2363346 4654649 263442209 253539238 189399077 201625136 74043132 51914102 X Living God's love by inspiring health, wholeness and hope. 0 0 211104275 368268 263179998 See Schedule O 211104275 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1393 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Reiner Scott Chair/CEO thru 12/21 0.00 50.00 X X 0 2940088 62418 Wing Bill Dir/Asst Secr/Vice Chair 0.00 50.00 X X 0 2459079 76222 Jahn Andrew Care Division President 2.00 48.00 X 0 1848683 72937 Beaman John Interim President as of 06/21 50.00 0.00 X 0 1366110 78586 Hofheins Todd CFO 0.00 50.00 X 0 1319147 59910 Nahapetian Arby Care Division Chief Medical Officer 2.00 48.00 X 0 1058113 78302 Wolcott Daniel Former President thru 12/20 0.00 50.00 X 0 932279 72937 Jobe Meredith Secretary 0.00 50.00 X 0 932705 59761 Larsen David - Former Finance Officer, CCR thru 04/19 0.00 50.00 X 0 876757 67250 Stevens Eric Care Division Operations Executive 2.00 48.00 X 0 884611 49992 Chen Steven - Former Finance Officer, CCR thru 02/20 0.00 50.00 X 0 779689 73789 Spenst Brett - Interim Pres thru 05/21/Care Div Fin Officer 2.00 48.00 X 0 786101 45300 Ferch Wayne Former President, CCR thru 02/20 0.00 0.00 X 0 586112 18351 McCollough Brooke Operations Executive 0.00 50.00 X 0 427890 82839 Cornwell Eric Medical Officer 50.00 0.00 X 0 432761 45404 Whitney Jason Treasurer/Asst Secr 50.00 0.00 X 0 399649 72669 Brown Mary RN 50.00 0.00 X 345895 0 105919 Grimm Mary Patient Care Executive thru 05/21 50.00 0.00 X 0 367788 32218 Pickering Christine - Former Communication Dir, CCR thru 02/20 0.00 50.00 X 0 313948 46375 Cook Becky Ambulatory & Physician Services Executive 8.33 41.67 X 0 305706 31399 Stewart Donovan Patient Care Executive as of 06/21 50.00 0.00 X 0 313640 43125 Beck Atwater Sandra Director Hospital Pharmacy 50.00 0.00 X 239383 0 65528 Pascua Helen RN, First Assistant 50.00 0.00 X 251858 0 39992 Heinrich Kerry Dir/CEO Elect as of 11/21 0.00 50.00 X 0 282697 2627 Reitz Matthew Director, Perioperative Services 50.00 0.00 X 221235 0 53431 Stump Valerie RN 50.00 0.00 X 220922 0 48776 Reppert Joseph Former CFO/Asst Secr thru 08/19 0.00 0.00 X 0 179119 11442 Freedman John Dir/Vice Chair/Chair as of 08/21 0.00 4.00 X X 0 26435 0 Banks David Director 0.00 4.00 X 0 26159 0 Cherry Robert Director 0.00 4.00 X 0 26159 0 Davis Andrew Director 0.00 4.00 X 0 26159 0 Innocent Larry Director 0.00 4.00 X 0 26159 0 Reiner Richard Director 0.00 4.00 X 0 26159 0 Graham Ricardo Dir/Chair thru 08/21 0.00 4.00 X X 0 19545 0 Woodson Marc Director 0.00 4.00 X 0 15909 0 Salazar Velino Director 0.00 4.00 X 0 6058 0 Ocampo Lucy Director 0.00 4.00 X 0 159 0 Fehr Joy Director 0.00 4.00 X 0 114 0 Newton Bradford Dir/Vice Chair as of 08/21 0.00 4.00 X X 0 0 0 1279293 19991687 1497499 305 1 1 0 Regents of the University of California PO Box 741816 Los Angeles CA 90074 Physician professional fees 8659460 CEP America - Anesthesia PC 2100 Powell St Suite 900 Emeryville CA 94608 Physician professional fees 3142499 Fastaff LLC PO Box 91142 Denver CO 80291 Contract labor 1964885 PT Solutions Holdings LLC PO Box 724557 Atlanta GA 31139 Outpatient PT,ST, and OT services 1647768 Maxim Healthcare Staffing Services Inc 13877 Collections Ctr Dr Chicago IL 60693 Contract labor 1380233 34 1045838 508184 1554022 Patient service revenue 621400 253802334 253802334 Revenue/subsidy from related orgs 900099 2098651 2098651 CARES Act revenue 621990 1682180 1682180 340B Pharmacy revenue 621400 1171020 1029420 141600 Incentive and quality revenue 621400 722464 722464 3703349 3703349 263179998 1793821 1793821 17203 39227 -22024 -22024 -22024 771 -771 -771 -771 266505046 263038398 141600 1771026 X 367268 367268 1000 1000 451934 451934 73502712 67180813 6010730 311169 3680790 3344563 321343 14884 8606334 8091242 472405 42687 5075719 4606848 446043 22828 29549142 29549142 272510 272510 22272 22272 12008 12008 47916717 44559394 3356939 384 18263 18263 1146736 831033 315703 8375535 2104426 6271109 4518911 4251763 267148 112640 91262 21378 12564 12564 4236931 4236931 10370695 10318904 51791 777017 776517 500 Patient care supplies 35002786 33380647 1619226 2913 Quality assurance fee 14808390 14808390 Leased equipment expens 400408 385535 14873 12611115 11291233 1319882 261850397 211104275 50351257 394865 54712239 48118262 12258 33319 34556137 40210645 4136078 3940476 964708 747938 280517010 164620642 123428193 115896368 7481924 6498524 38150672 38093706 263442209 253539238 22091369 29951046 19085 135064 426046 411725 166862577 171127301 189399077 201625136 X 70812858 48575995 3230274 3338107 74043132 51914102 263442209 253539238 X 4654649 -25800278 -983401 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12008 12008 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to NL Short Public Affairs were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 3230274 747274 1706 641147 3338107 3171700 2663248 2604674 3230274 541320 2659952 29572 3171700 602023 569686 630389 541320 562343 689003 3000 41917 602023 0.00000 0.00000 1.00000 0 0 9973938 9973938 196808041 104401014 92407027 3227133 2996273 230860 66853633 53543250 13310383 3654265 3680105 -25840 115896368 Receivables from third-party payors 28333174 Receivables from related organizations 9527010 Other assets 125957 State Board of Pharmacy receivable 107565 38093706 Payable to related organizations 153518090 Payables to third party payors 13454515 Other liabilities 4154696 171127301 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 583545 583545 0.00220 88356846 65615439 22741407 0.08680 88940391 65615439 23324952 0.08900 555434 100 555334 0.00210 382969 382969 0.00150 12334507 2492 12332015 0.04710 85177 85177 0.00030 13358087 2592 13355495 0.05100 102298478 65618031 36680447 0.14000 11328 11328 0.00000 11328 11328 0.00000 1 1285269 175346 54271273 56039466 -1768193 X 1 1 2 1 Lodi Memorial Hospital Association Inc dba AHLM 975 S Fairmont Ave Lodi CA 95240 www.adventisthealth.org/lodi-memorial/ 030000056 X X X A 2 Lodi Memorial Hospital - West dba AHLM 800 Lower Sacramento Road Acute Phys Lodi CA 95242 www.adventisthealth.org/lodi-memorial/ 030000056 X X Outpatient departments at this campus A Facility Reporting Group - A 0 0 1 X X X X X X X X X 19 1 1 1 1 X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X 1 19 1 See Sch H Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Lodi Memorial Hospital Association, Inc. dba A, - Facility 2: Lodi Memorial Hospital - West dba AHLM Facility Reporting Group - A Part V, Section B, line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering from community members. Community input was provided by a broad range of community members using key informant interviews, focus groups, and surveys. Individuals with the knowledge, information, and expertise relevant to the health needs of the community were consulted. These individuals included representatives from local governmental and public health agencies as well as leaders, representatives, or members of underserved, low-income, and minority populations. Additionally, where applicable, other individuals with expertise of local health needs were consulted. Thirteen key informant interviews individuals representing diverse sectors in San Joaquin County including: public health, health care, community-based organizations, social services, education and government. Thirty-one community resident focus groups were conducted in geographic areas within San Joaquin County, including Stockton, Lodi, Tracy and Manteca. Nineteen groups were conducted in English, ten were conducted in Spanish, one was conducted in Tagalog and one was conducted in Cambodian. Participants were teens, adults, and older adults, who represented underserved, low-income, and varied ethnic communities.Secondary data sources include collected data on key health indicators, morbidity, mortality, and various social determinants of health from the Kaiser Permanente CHNA Data Platform, Health Places Index, American Community Survey and various other state and federal databases. Facility Reporting Group - A Part V, Section B, line 6a: Hospitals that participated in the 2019 CHNA process included Dameron Hospital, Kaiser Permanente, Sutter Health and Dignity Health St. Joseph's Medical Center. Facility Reporting Group - A Part V, Section B, line 6b: Other non-hospital facilities that participated in the 2019 CHNA process included Community Medical Centers, First 5 San Joaquin, Health Net, Health Plan of San Joaquin, San Joaquin County Public Health Services. Facility Reporting Group - A 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. Our 2019 CHNA identified three areas of significant need: Mental Health, Economic Security, and Obesity/Healthy Eating Active Living (HEAL)/Diabetes. Priority Need 1 - Mental Health - The goal is to improve trauma informed care by creating awareness of trauma and providing or connecting our patients with the proper resources to address trauma. Strategy 1.1 - Hire a substance use navigator in our emergency department. Activity 1.1 - Substance Use Navigator (SUN). AHLM applied for funds under the Behavioral Health Pilot Program (BHPP) to support a substance use navigator (SUN) in our emergency department (ED). In 2021, the SUN provided services to 186 patients in ED inpatient care between April December. A total of 102 patients accepted referrals to Medicated Assisted Treatment (MAT) treatment, substance use treatment and behavioral health with scheduled appointments as the patients were discharged from the ER (Emergency Room) or inpatient hospital setting. Out of the 102 patients that accepted referral 65 patients were MAT referrals for opiates and alcohol. Out of 65 patients, 30 patients attended their MAT program schedule appointments. For the year of 2021, a total of 63 doses of buprenorphine was administered or written in the ER/inpatient setting. A total of 223 Patients were given an overdose diagnosis. Also, 339 patients were diagnosed with opiate use.Other work around mental health continuing as a funding partner of the "Unite Us" platform to participate in the San Joaquin County's Connected Community Network (CCN). Priority Need 2 - Economic Security - The goal is to improve economic security in our county by improving career opportunities for our residents, increasing the supply of qualified workers to meet the needs of the healthcare industry, and improve the overall health of our local businesses. Strategy 1.1 - AHLM has partnered with Health Force Partners to improve career pathway opportunities for community residents and to increase the supply of skilled workers to meet the needs of dynamic healthcare industry in the Northern San Joaquin Valley. Strategy 1.2 - AHLM is also collaborating with the American Heart Association and the Lodi Chamber of Commerce's Health Value Action Team to provide our local businesses with a nationally successful program, the Workplace Health Solutions. The program will offer local businesses a suite of science-based, evidence-informed tools and services to help build a workplace culture of health. Activity 1.1 - Participation in the HOPE pilot program & Activity 1.2 - Health Careers Academy - coincide. In 2021, the Board of Registered Nursing approved 40 fast track (18-month ADN) positions annually at San Joaquin Delta College (indefinitely). Half of the positions have been dedicated to the HOPE RN program. This enables partners to have a direct talent pool of nursing candidates to be employed at partnered employers. The current cohort (Cohort #2) has 22 incumbent workers. In 2021, Cohort #1 graduated with 24 out of 25 students passing their licensing and examination process. Activity 1.3 - Partnership with American Health Association - AHLM's successful collaboration with the Lodi Chamber of Commerce's Healthy Lodi initiative and the American Heart Association allows continued work to address economic security. Together we worked with local HR Directors, Workplace Wellness Champions and other organizational leaders to help their employees learn more about working towards cardiovascular health. The American Heart Association's Workplace Health Solutions is a "science-based, evidence-informed package of tools and services to help build and maximize an effective workplace culture of health." Building a healthy work environment and promoting a healthy workforce can lead to improved efficiency, reduced absenteeism, and cost savings for both workers and employers.In 2021, eight new organizations were recruited, for a total of 16 participating organizations. Over 12,850 employees were covered in the Workplace Wellness Program. Two quarterly learning cohorts for employer groups were facilitated for mutual sharing of workplace health practices and challenges they might have experienced. Priority Need 3 - Obesity/Healthy Eating Active Living (HEAL)/Diabetes - the goal is to increase physical activity for all ages and establish programs in high-risk neighborhoods. Strategy 1 - Engage businesses and community organizations to improve facilities and offer programs for physical activity. Activity 1.1 - Convene a Community Faith Summit in 2020 to encourage cross-sector collaboration and improve parks and neighborhoods, & Activity 1.2 - Diabetes Among Friends - Due to COVID-19 Adventist Health Lodi Memorial had lower participation but continued participating in community events, health fairs and sponsorships related to health priorities. The Diabetes Among Friends classes were halted due to COVID-19 restrictions and are expected to reactive in 2022. Part V, Section B, Line 11: Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health Lodi Memorial is committed to serving the community by adhering to its mission, and using its skills, expertise, and resources to provide a range of community benefit programs. 1. Violence/Injury Prevention: Need is being addressed by others. 2. Access to Care: Need is being addressed by others. 3. Substance Abuse/Tobacco: Need is currently being addressed by others, however, if we are awarded the Behavioral Health Pilot Project grant, we will be able to address this need through hiring a Substance Use Navigator. 4. Asthma: AHLM does not have the resources necessary at this time to address this need. 5. Oral Health: Need is being addressed by others. 6. Climate and Health: AHLM does not have the expertise to effectively address this need. 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 11 1 - Lodi Outpatient Surgical Center 521 S Ham Ln Suite F Lodi CA 95242 Ambulatory Surgical Center 2 - AHLM Wound & Hyperbaric Care 2415 W Vine St Suite 106 Lodi CA 95242 Outpatient Clinic - Hyperbaric & Wound Care 3 - Advanced Imaging Center at AHLM 1031 S Fairmont Ave Lodi CA 95240 Outpatient Diagnostic Imaging 4 - Urgent Care Clinic 1235 W Vine St Suite 20 Lodi CA 95240 Outpatient Clinic - Urgent Care Services 5 - Galt Family and Specialty Care 387 Civic Dr Galt CA 95632 Outpatient Clinic - Family Medicine 6 - AHLM West Pharmacy 2415 W Vine St Suite 104 B Lodi CA 95240 Retail Pharmacy 7 - Ham Lane Clinic - Fairmont Ave 845 S Fairmont Ave Suite 8 Lodi CA 95240 Outpatient Clinic - Cardiology & Pulmonology 8 - AHLM Occupational Medicine 800 S Lower Sacramento Road Lodi CA 95242 Outpatient Clinic - Occupational Medicine 9 - AHLM Prenatal Care 2415 W Vine Street Suite 103 Lodi CA 95242 Outpatient Clinic - Prenatal Care 10 - Ione Family Care Clinic 305 Preston Ave Ione CA 95640 Outpatient Clinic - Family Medicine 11 - AHLM Adult Day Services 125 Hutchins St Suite A Lodi CA 95240 Adult/Senior Care Day Services Part I, Line 7: Specific Ratios of Costs to charges are utilized for each department. Where applicable the source of these ratios are the Medicare Cost Report. Part II, Community Building Activities: The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020, Adventist Health acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be able to gain ground in shifting the balance from healthcare treating people once they are ill to transformative well-being changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint, 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 3: The Hospital provided care to all who presented themselves in our emergency room, without asking for proof of insurance. The Hospital's uninsured population continues to increase. Uninsured patients are screened for Medicaid linkage, given assistance in applying for Medicaid and if ineligible for Medicaid are given information regarding the Hospital's Charity Care Policy and encouraged to apply for charity care. Often the information gathered in the Medicaid application will make this determination "automatic". If additional information is required, the Hospital attempts to contact the patient. Those that do not respond will be sent to a collection agency after 120 days and four statements. The Hospital estimates 21% of bad debt expense (calculated at cost) should be considered charity care. The Hospital's bad debt accounts are analyzed by a third party to determine this amount. Part III, Line 4: Costing methodology:Utilizing the previous costing methodology as outlined in response to Part I, Line 7, all patients are assigned a payor class (i.e. charity, self pay, Medicare, Medi-Cal, managed care). The cost by payor is a summation of all patients in the assigned payor class. The amounts written off as bad debt (assigned to a collection agency) are net of any applicable payments or discounts. Any payments received after an account is assigned to a collection agency reduce the bad debt expense in the period received.Uncompensated care and community benefit costs:Our policy is to provide service to all who require it, regardless of their ability to pay. As such, the Hospital provides substantial amounts of uncompensated care. When this care is provided to patients who lack financial resources and therefore are deemed medically indigent, it is classified as charity care. When it is provided to patients who have the means to pay, but decline to do so, it is classified as provision for uncollectible accounts. Some undetermined portion of the provision for uncollectible accounts represents care to indigent patients who the Hospital has been unable to identity as charity. Charity care charges are not reflected in net patient service revenues. In addition, we provide services to poor and underserved persons who cannot afford health care because of inadequate resources and/or are uninsured or underinsured, including patients insured under certain government-reimbursed public aid programs. Such programs pay providers amounts that are less than established charges for the services provided to the recipients and frequently the payments are less than the costs of rendering the services.Patient accounts receivable:Patient accounts receivable for services provided to patients covered under the Medicare and Medicaid (Medi-cal in California) programs, privately sponsored managed care programs for which payment is made based on terms defined under formal contracts, and other payors (including self-pay) are recorded at their estimated realizable value based on contractual billing rates or our standard billing rates for our non-contracted payors. The Hospital regularly reviews accounts and contracts and provide appropriate estimates of contractual allowances that are then netted against patient accounts receivable. The Hospital also provides an estimated allowance for uncollectible accounts based on the Hospital's evaluation of the aging of our patient accounts receivable, the Hospital's historical collection experience for each type of payor and other relevant factors.The Hospital's primary concentration of credit risk is patient accounts receivable, which consists of amounts owed by various governmental agencies, insurance companies and private patients. The Hospital grants credit without collateral to the Hospital's patients and third party payors. 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 2019 CHNA, the 2021 Community Health Plan (CHP) Update for fiscal year 2021, and the 2020 Implementation Strategy adopted in 2020 are posted on the Hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/The most recent Community Health Needs Assessment, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the Community Health Plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, 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:https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-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: Adventist Health Lodi Memorial considers San Joaquin County its primary service area as well as the city of Galt. San Joaquin County contains both rural and urban areas. Communities and cities maintain their unique geographic identities, separated by agriculture and open space lands. The county includes seven incorporated cities: Stockton, Tracy, Manteca, Lodi, Lathrop, Ripon and Escalon as well as many small well-established rural communities in the unincorporated areas.The demographic profile of San Joaquin county indicates a total population of 745,424 with 17.8% living in poverty and 24.9% of children living in poverty. Unemployment is 11.7% and the uninsured population is 11.7% as well. Of the population, 41.6% identify as Hispanic/Latino, 31.8% identify as White, 16.7% identify as Asian, 8.2% identify as Black, 5.3% identify as multiple races and 2.0% identify as Native American/Alaska Native. 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 can 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 2021, Adventist Health Lodi Memorial (AHLM) continued the following actions in response to the needs created or exacerbated by COVID-19: Continued virtual healthcare visits to keep community members safe and healthy; continued their online symptom tracker; participated in a communitywide effort to vaccinate eligible community members. Additionally, AHLM made big strides in community outreach in 2021 by allocating resources to COVID-19 vaccination efforts to ensure the safety and wellness of the community. COVID-19 cases remained high during 2021 in San Joaquin County, and it was of utmost importance to AHLM that vaccines were made available and accessible to the community it is serving. Upon CDC's guidelines in late 2020 that healthcare workers be offered the vaccine, the AHLM team did not hesitate to offer the vaccines to the staff of surrounding skilled nursing facilities. The vaccination operation was soon moved to AHLM Urgent Care in January, 2021 and made the appointments available to other healthcare workers in the community. Over 9,700 vaccines were given at the AHLM Urgent Care from January, 2021 to April, 2021. In April, 2021, AHLM was part of two mass vaccination efforts in the San Joaquin County. Hutchins Street Square Vaccine Clinic was opened in collaboration with the City of Lodi, and the Stockton Arena Mass Vaccination Site was in partnership with Kaiser Permanente and Dignity Health. AHLM hired a bigger team utilizing contract nurses and pharmacists, retired nurses, and volunteers to provide the much-needed vaccination services. Both clinics had the capacity to provide over 7,000 vaccines per day. AHLM also conducted popup clinics at Heritage High School, and McNair High School in June/July, 2021 providing over 280 doses to students who were eligible to receive the vaccine. 1 CA Health Fund & Trust 1215 K St Suite 800 Sacramento CA 95814 941498697 501(c)(3) 163861 0 Hlth srvs un/underinsured pt Lodi Memorial Hospital Foundation 845 S Farimont Ave Suite 3 Lodi CA 95240 942719880 501(c)(3) 102187 0 General support to cover part of payroll American Heart Association 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 50000 0 Healthy for Good Sponsorship United Way of San Joaquin County 777 N Pershing Ave Suite B Stockton CA 95203 941279805 501(c)(3) 26677 0 Donation to HealthForce Partners Lodi District Chamber of Commerce 35 S School St Lodi CA 95240 940636200 501(c)(6) 8044 0 Grow in Lodi Sponsorship + 2 other minor voluntary donations 4 1 Part I, Line 2: Through the use of temporarily restricted accounts, we track and monitor the incoming receipts from grants and the utilization of grant funds. Each grant is tracked separately. Should the grantor agency require specific reports, we comply with their reporting requirements. The grants we monitor are specific to the grantor's needs and requests. X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Chair/CEO thru 12/21 0 1801000 0 1112062 0 27026 0 11644 0 50774 0 3002506 0 0 Wing Bill Dir/Asst Secr/Vice Chair 0 1440800 0 991833 0 26446 0 11644 0 64578 0 2535301 0 0 Jahn Andrew Care Division President 0 1044420 0 600285 0 203978 0 11644 0 61293 0 1921620 0 0 Beaman John Interim President as of 06/21 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 Nahapetian Arby Care Division Chief Medical Officer 0 700000 0 222478 0 135635 0 11644 0 66658 0 1136415 0 0 Wolcott Daniel Former President thru 12/20 0 601280 0 226669 0 104330 0 11644 0 61293 0 1005216 0 0 Jobe Meredith Secretary 0 616324 0 169142 0 147239 0 14609 0 45152 0 992466 0 0 Larsen David - Former Finance Officer, CCR thru 04/19 0 567118 0 201820 0 107819 0 11644 0 55606 0 944007 0 0 Stevens Eric Care Division Operations Executive 0 749000 0 76 0 135535 0 16336 0 33656 0 934603 0 0 Chen Steven - Former Finance Officer, CCR thru 02/20 0 515000 0 183275 0 81414 0 11644 0 62145 0 853478 0 0 Spenst Brett - Interim Pres thru 05/21/Care Div Fin Officer 0 734400 0 38124 0 13577 0 11644 0 33656 0 831401 0 0 Ferch Wayne Former President, CCR thru 02/20 0 0 0 585289 0 823 0 0 0 18351 0 604463 0 0 McCollough Brooke Operations Executive 0 310442 0 94668 0 22780 0 12499 0 70340 0 510729 0 0 Cornwell Eric Medical Officer 0 345385 0 34540 0 52836 0 11644 0 33760 0 478165 0 0 Whitney Jason Treasurer/Asst Secr 0 290481 0 80790 0 28378 0 11644 0 61025 0 472318 0 0 Brown Mary RN 343426 0 0 0 2469 0 12466 0 93453 0 451814 0 0 0 Grimm Mary Patient Care Executive thru 05/21 0 105973 0 94249 0 167566 0 1780 0 30438 0 400006 0 0 Pickering Christine - Former Communication Dir, CCR thru 02/20 0 247193 0 28551 0 38204 0 11227 0 35148 0 360323 0 0 Cook Becky Ambulatory & Physician Services Exec 0 165214 0 54585 0 85907 0 0 0 31399 0 337105 0 0 Stewart Donovan Patient Care Executive as of 06/21 0 238322 0 52622 0 22696 0 10691 0 32434 0 356765 0 0 Beck Atwater Sandra Director Hospital Pharmacy 219036 0 19539 0 808 0 9190 0 56338 0 304911 0 0 0 Pascua Helen RN, First Assistant 244630 0 1092 0 6136 0 11829 0 28163 0 291850 0 0 0 Heinrich Kerry Dir/CEO Elect as of 11/21 0 138538 0 123000 0 21159 0 0 0 2627 0 285324 0 0 Reitz Matthew Director, Perioperative Services 205959 0 15276 0 0 0 8282 0 45149 0 274666 0 0 0 Stump Valerie RN 195261 0 17418 0 8243 0 9062 0 39714 0 269698 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. Grimm, Mary - severance payment - $150,413 Reppert, Joseph - severance payment - $179,957 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. Larsen, David - contributed and distributed - $2,496 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 John Beaman, 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 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 P Gill Obstetrics and Gynecology >35% owned partnership by Parampal Gill, former board member 48884 Physician professional service-OB Clinic 0 P Gill Obstetrics and Gynecology >35% owned partnership by Parampal Gill, former board member 403050 Physician professional service-Emergency room call 0 Form 990, Part III, Line 4a: Lodi Memorial Hospital Association Inc., dba Adventist Health Lodi Memorial (AHLM), 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 AHLM, 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 AHLM 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. AHLM 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 2021 was $23,324,952. The following Inpatient services were provided to all our patients: - 888 babies delivered - 1,192 surgeries performed - 30,723 patient days The following Outpatient services were provided to all our patients: - 47,745 emergency department visits - 3,935 outpatient surgeries performed - 57,080 outpatient visits - 155,054 clinic visits AHLM 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 2021 was $13,355,496. 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 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, 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. Copies for the officers and key employees' COIs are kept in their personnel files. 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 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. A hospital president has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital (incentive potential is industry norm). Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. 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: Board compensation is for Adventist Health System/West Board of Directors only - not Hospital Board of Directors. Form 990, Part IX, line 11g Physician fees: Program service expenses 18,354,563. Management and general expenses 1,534,612. Fundraising expenses 0. Total expenses 19,889,175. Contract labor: Program service expenses 12,899,420. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,899,420. All other purchased services: Program service expenses 8,317,591. Management and general expenses 112,503. Fundraising expenses 384. Total expenses 8,430,478. Purchased medical services: Program service expenses 3,684,942. Management and general expenses 68,198. Fundraising expenses 0. Total expenses 3,753,140. Consulting fees: Program service expenses 879,849. Management and general expenses 1,580,605. Fundraising expenses 0. Total expenses 2,460,454. Repairs and maintenance: Program service expenses 423,029. Management and general expenses 48,100. Fundraising expenses 0. Total expenses 471,129. Other professional fees non-medical: Program service expenses 0. Management and general expenses 12,445. Fundraising expenses 0. Total expenses 12,445. Other medical professional fees: Program service expenses 0. Management and general expenses 476. Fundraising expenses 0. Total expenses 476. Form 990, Part XI, line 9: Change in investment in subsidiaries -983,401. 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. Artel LLC (dba Lodi Outpatient Surgery Center) 521 S Ham Lane Suite F Lodi CA 95242 263513966 Ambulatory surgical center CA 2687845 2512459 Lodi Memorial Hospital Association Inc Endoscopy Center of Lodi LLC 521 S Ham Lane Suite F Lodi CA 95242 261243362 Medical services CA 0 0 Artel LLC 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 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 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 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 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 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 Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC) 1001 S Fairmont Avenue Lodi CA 95240 943407786 Diagnostic imaging / MRI outpatient treatment center CA Lodi Memorial Hospital Association Inc Related -724057 3271014 0 0 1.00000 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 Delta Radiology Inc 975 S Fairmont Avenue Lodi CA 95240 941715690 Radiology services CA Lodi Regional Health Systems Inc C 3827384 1037487 1.00000 1 Lodi Regional Health Systems Inc 975 S Fairmont Avenue Lodi CA 95240 680398894 Physician management and medical office building development & management CA Lodi Memorial Hospital Association Inc C 4878449 11771967 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 1 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC) A 9059 FMV Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC) O 849521 FMV Lodi Regional Health Systems Inc O 212651 FMV Delta Radiology Inc P 1152528 FMV