2021-11-15T20:35:16-06:00 2020-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2020-01-01 953484589 Adventist Health SystemWest ADVE 9164060000 1 Adventist Health Way Roseville CA 95661 Todd Hofheins Chief Financial Officer 9164060000 2021-11-15 1 Todd Hofheins 999009999 Tracy S Paglia P00366884 2099556100 2021-11-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X Adventist Health Scott Reiner 1 Adventist Health Way Roseville CA 95661 768259201 0 1071 X www.adventisthealth.org/ X 1980 CA Living God's love by inspiring health, wholeness and hope. 14 12 4715 0 113566 2325317 795492 656685 344940537 594258703 13808361 5929276 15364321 57591236 374908711 658435900 4770896 3181946 0 0 260843076 389662256 0 0 1444704 258399416 347228956 524013388 740073158 -149104677 -81637258 2329560827 3118796040 2597540161 3317448358 -267979334 -198652318 X Living God's love by inspiring health, wholeness and hope. 0 0 228881608 3181946 594258703 See Schedule O 228881608 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 2923 0 1 4715 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X Todd Hofheins CFO 9164060000 PO Box 619135 Roseville CA 95661 X Larsen David Senior Finance Officer 50.00 0.00 X 3202560 0 614651 Reiner Scott CEO 50.00 0.00 X X 2358378 0 54819 Wing Bill - DirAsst SecCFO to 08/20/President as of 08/20 50.00 0.00 X X 1760327 0 59054 Jahn Andrew President, Care Division 50.00 0.00 X 1365841 0 59307 Ferch Wayne President, CCR 50.00 0.00 X 1298607 0 49186 El-Asmar Hoda Chief Clinical Officer thru 10/20 50.00 0.00 X 1247499 0 39498 Eller Jeff President, NCR thru 06/20 50.00 0.00 X 1154747 0 49411 Olson JoAline - Former Chief Human Perf Officer, AHRS thru 08/19 0.00 0.00 X 1051211 0 30421 Beaman John Chief Business Officer 50.00 0.00 X 963104 0 45033 Ashlock Mark - Ambulatory Post-Acute President thru 06/20 50.00 0.00 X 963056 0 44174 Newmyer Joyce President, PNR 50.00 0.00 X 933247 0 62067 Nahapetian Arby Care Division Chief Medical Officer 50.00 0.00 X 868206 0 54711 Kofl Andrea President, AHHF 50.00 0.00 X 842089 0 49411 Raffoul John FO, SCR/President 50.00 0.00 X 817586 0 49411 Reppert Joseph Former CFO/Asst Secr thru 08/19 0.00 0.00 X 813425 0 41111 Issai Alice President, AHGL 50.00 0.00 X 814454 0 29312 Rawson Richard President, AHRO 50.00 0.00 X 798315 0 29537 Briggs Sharlet President, AHBD thru 08/20 50.00 0.00 X 775419 0 46197 Jobe Meredith Secretary 50.00 0.00 X 769985 0 43868 Byrnes John Medical Officer, NCR 50.00 0.00 X 766859 0 46424 Long Collier Business Development Executive 50.00 0.00 X 769706 0 41198 Brass Steven Medical Officer 50.00 0.00 X 762403 0 35825 Chen Steven Finance Officer, CCR 50.00 0.00 X 719712 0 59174 Wells Jason Chief Consumer & Innovation Officer 50.00 0.00 X 712445 0 59307 Wolcott Daniel President, AHLM 50.00 0.00 X 695987 0 59307 Beehler Robert Mkt Dev, M&A Exec 50.00 0.00 X 702064 0 46579 Bancarz Gloria System Chief Quality Officer 50.00 0.00 X 702620 0 32013 Fink Matthew Chief Information Officer 50.00 0.00 X 671197 0 59152 Liebowitz Jacalyn System Chief Nursing Officer 50.00 0.00 X 679163 0 44488 Raethel Kathryn President, AHCS 50.00 0.00 X 678307 0 44499 Conklin Jeffrey - Former Payer Strategy Exec thru 07/19 0.00 0.00 X 551575 0 41343 Hofheins Todd CFO as of 08/20 50.00 0.00 X 469107 0 13281 Church Lowell Former VP Material Mgmt thru 03/19 0.00 0.00 X 350078 0 31378 Wagner Jack Former CFO/Asst Secr thru 03/18 0.00 0.00 X 269387 0 13558 Knittel Monty Former President, AHFR thru 09/18 0.00 0.00 X 123451 0 8068 Zachary Beth Former President, SCR thru 01/18 0.00 0.00 X 110666 0 11291 Freedman John Director/Vice Chair 4.00 0.00 X X 27216 0 0 Davis Andrew Director 4.00 0.00 X 26971 0 0 Reiner Richard Director 4.00 0.00 X 26764 0 0 Cherry Robert Director 4.00 0.00 X 26160 0 0 Innocent Larry Director 4.00 0.00 X 25608 0 0 Graham Ricardo Director/Chair 4.00 0.00 X X 23359 0 0 Heinrich Kerry Director 4.00 0.00 X 20608 0 0 Woodson Marc Director 4.00 0.00 X 20608 0 0 Ocampo Lucy Director 4.00 0.00 X 20358 0 0 Banks David Director 4.00 0.00 X 15441 0 0 Salazar Velino Director 4.00 0.00 X 6651 0 0 Fehr Joy Director 4.00 0.00 X 108 0 0 Philip Celeste Director thru 04/20 4.00 0.00 X 0 0 0 32772635 0 2098064 749 1 1 0 Cerner Corporation 2800 Rockcreek Parkway Kansas City MO 64117 IT Solutions Management 6484100 Huron Consulting Services LLC 3005 Momentum Place Chicago IL 60689 Operations Managment 4828061 Swinerton Builders 15 Business Park Way Suite 101 Sacramento CA 95828 Construction 3987964 Latham and Watkins LLP PO Box 894256 Los Angeles CA 90189 Legal Services 2360625 Robert Half International Inc PO Box 743295 Los Angeles CA 90074 Contract Labor 2250120 159 656685 656685 Management fees 900099 573266585 569128300 4138285 Other program service rev 900099 20992118 20992118 594258703 4321057 4321057 26664 0 26664 26664 26664 111357583 8000 109757364 0 1600219 8000 1608219 1608219 76593 65937 10656 10656 Vendor rebates 900099 34865675 34865675 Health plan liability adj 900099 19823387 19823387 Partnership income 523900 -4024719 -4024719 6889573 6889573 57553916 658435900 590120418 113566 67545231 X 3181946 3181946 27357782 27357782 3697040 1331709 2365331 290524249 78903319 211548405 72525 9190099 5266654 3921425 2020 39863931 9128764 30723437 11730 19029155 5253553 13769590 6012 104093 5813 98280 9980390 9980390 4304571 4304571 625075 625075 206923507 56743054 149179192 1001261 14502838 14502838 9299059 1454471 7759464 85124 34808002 23288493 11253477 266032 7181000 4527170 2653830 2295751 918983 1376768 118019 43273 74746 24355173 24355173 11989851 5913732 6076119 345410 334241 11169 Patient care supplies 3233771 3233771 Income taxes 1670452 1669866 586 Rental/lease costs equi 403277 197231 206046 15088717 2505317 12583400 740073158 228881608 509746846 1444704 284018550 109284618 27871 97245 17058 726 54227593 54208997 6812192 5870461 42824285 47575339 531877096 222879921 330467992 308997175 1532854443 2199558333 11609673 143935557 66701170 249267589 2329560827 3118796040 219704780 261367830 2141149922 2043611693 0 59997108 236685459 952471727 2597540161 3317448358 X -270248542 -199886561 2269208 1234243 -267979334 -198652318 2329560827 3118796040 X -81637258 147374807 3589467 X 0 1 X 1 0 X 50000 96561 7311552 795492 656685 8910290 289039507 263827180 241640379 339571640 590120418 1724199124 289089507 263923741 248951931 340367132 590777103 1733109414 6349290 4259278 6178041 8120494 14691141 39598244 0 6349290 4259278 6178041 8120494 14691141 39598244 1693511170 57028162 8329768 2629457 5992756 4347721 78327864 57028162 8329768 2629457 5992756 4347721 78327864 272887 517858 573287 1364032 1997795 660599 15292368 61655228 79605990 348388351 272771367 252815274 361652256 656780052 1892407300 0.89490 0.89210 0.04140 0.07860 X Schedule A, Part III, Line 12, Explanation of Other Income: Gain on debt refinancing Miscellaneous revenue Settlement proceeds RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 625075 625075 0 Part II-B, Line 1: Adventist Health engages lobbyists and belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 3418916 656685 1691650 2383951 3006309 795400 3399636 3782429 3418916 1146338 7277972 -3327136 2090865 3006309 1131235 96561 18082 94541 4999 1146338 1114944 50000 21830 55539 1131235 0.48230 0.00000 0.51770 0 0 43387821 43387821 117404821 5429050 111975771 3482330 609276 2873054 367602124 216841595 150760529 308997175 Receivables from related organizations 229016819 Other receivables 15135291 Other assets 5115479 249267589 Payables to related organizations 738931624 Malpractice liability 99710473 Workers' compensation liability 66393345 Other liabilities 42333941 Payables to third party 5049567 Income tax payable 52777 952471727 X Part V, Line 4: A $1M board-designated fund was established to honor a former AH president. The earnings are used to provide funding for paying college student interns and graduate student residents as they participate in tracks such as accounting/finance, human resources, communications and management with the goal of introducing the participants to career options in the integrated health care field. Individuals who participate in the program frequently become employed within the AH system upon completion of their academic studies. 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, 2020 and 2019, 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 2016 in major tax jurisdictions. Central America and the Caribbean 0 0 Program services Administration, legal and accounting fees 57500 Central America and the Caribbean 0 0 Program services Reinsurance fees 1273750 Central America and the Caribbean 0 0 Investments in region N/A 97000962 0 0 0 0 0 0 98332212 0 98332212 1 0 1 1 1 0 Part I, line 3: Accrual method Part III Accounting Method: 1 Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 501(c)(3) 10000 General support Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 501(c)(3) 10000 Employee Emergency Fund Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 501(c)(3) 10000 Imaging Pavilion American Red Cross 1565 Exposition Blvd Sacramento CA 95815 530196605 501(c)(3) 10000 Community Integration Blanche Memillan 41-902 Oluolu Street Waimanalo HI 96795 822039190 501(c)(3) 10000 Rapid Response - COVID-19 California Farmworker Foundation 800 10th Avenue Delano CA 93215 813960575 501(c)(3) 10000 Rapid Response - COVID-19 Carmichael SDA Church 4600 Winding Way Sacramento CA 95841 941576849 501(c)(3) 15000 Community Integration Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 501(c)(3) 10000 ER equipment update CityServe Network 7001 Auburn Street Bakersfield CA 93306 824490879 501(c)(3) 10000 Rapid Response - COVID-19 Community Action Resource Enterprises (CARE) Inc 2310 1st St Suite 2 Tillamook OR 97141 931062448 501(c)(3) 10000 Rapid Response - COVID-19 Conejo Valley Senior Concerns 401 Hodencamp Road Thousand Oaks CA 91360 952992927 501(c)(3) 10000 Rapid Response - COVID-19 Cornerstone Community Alcohol & Drug Recovery Systems Inc PO Box 1124 Hanford CA 92322 770259210 501(c)(3) 10000 Rapid Response - COVID-19 Delano Community Alliance 1842 Norwalk Street Delano CA 93215 821310319 501(c)(3) 10000 Rapid Response - COVID-19 End Homelessness California 463 Hartford Ave 308 Los Angeles CA 90017 814962168 501(c)(3) 10000 Rapid Response - COVID-19 Food Roots PO Box 1275 Tillamook CA 97141 205371832 501(c)(3) 20000 Rapid Response - COVID-19 Ford Street Project 139 Ford Street Ukiah CA 95482 942767559 501(c)(3) 10000 Rapid Response - COVID-19 Fremont Rideout Foundation 414 G Street Marysville CA 95901 237366330 501(c)(3) 20000 Annual Sponsorship Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 501(c)(3) 10000 NICU Cooling blanket Habilitat Inc PO Box 801 Kaneohi HI 96744 990146306 501(c)(3) 10000 Rapid Response - COVID-19 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 501(c)(3) 10000 Employee Emergency Fund Highlands Senior Service Center PO Box 180 Clearlake CA 95422 680010987 501(c)(3) 10000 Rapid Response - COVID-19 Interfaith Community Social Services 18500 Striker Ct Sonora CA 95370 770207244 501(c)(3) 10000 Rapid Response - COVID-19 Kings Gospel Mission 126 W 7th St Hanford CA 92320 770259210 501(c)(3) 10000 Annual Sponsorship LCF - Lodi Parks and Recreation Fund 955 University Ave Suite A Sacramento CA 95825 942891517 501(c)(3) 10000 Rapid Response - COVID-19 Lighthouse Rescue Mission PO Box 1453 Tulare CA 93275 030551530 501(c)(3) 10000 Rapid Response - COVID-19 Lodi Memorial Hospital Foundation 845 S Fairmont Ave Ste 3 Lodi CA 95240 942719880 501(c)(3) 10000 Annual Sponsorship 400.99 Mentis 709 Franklin Street Napa CA 94559 941236934 501(c)(3) 10000 Rapid Response - COVID-19 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 501(c)(3) 10000 Childrens Health, ambulance, Faith in Action Paradise Adventist Church 2500 Floral Ave Ste 30 Chico CA 95973 941702441 501(c)(3) 50000 Fire Fund Paradise Seventh Day Adventist Church PO Box 1266 Paradise CA 95967 941702441 501(c)(3) 20000 Rapid Response - COVID-19 Paradise Stronger PO Box 3991 Chico CA 95927 844195690 501(c)(3) 8220 Fire Fund Portland Adventist Community Services 11020 NE Halsey St Portland CA 97220 352468744 501(c)(3) 10000 Rapid Response - COVID-19 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 501(c)(3) 10000 Cancer care services RaisingHOPE Inc 1107 Whitecliff Rd Thousand Oaks CA 91360 471788053 501(c)(3) 16000 Rapid Response - COVID-19 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 501(c)(3) 10000 Employee Emergency Fund Resiliency Village PO Box 523 Soulsbyville CA 95372 611946540 501(c)(3) 10000 Rapid Response - COVID-19 Roseville Area Chamber Of Commerce 650 Douglas Blvd Roseville CA 95678 941079379 501(c)(6) 7900 Annual Sponsorship Sacramento Region Community Foundation 955 University Ave Suite A Sacramento CA 95825 942891517 501(c)(3) 10000 Annual Sponsorship San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 501(c)(3) 10000 Event underwriting, breast cancer center Simi Valley Hospital Foundation 2975 N Sycamore Drive Simi Valley CA 93065 912135595 501(c)(3) 10000 Advance Care Expansion, Cath Lab Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 501(c)(3) 10000 Hospice, Cancer, Birth Center St Helena Hospital Foundation 10 Woodland Road St Helena CA 94574 201384250 501(c)(3) 80000 Rapid Response - Wildfire Tamara Tadman 3461 Walnut Ave No 13 Carmichael CA 95608 501(c)(3) 6000 Annual Sponsorship The Weingart East Los Angeles YMCA 625 S New Hampshire Ave Los Angeles CA 90005 951644052 501(c)(3) 20000 Rapid Response - COVID-19 Tillamook County Community Action Resource Enterprises Inc 2310 1st St Suite 2 Tillamook OR 97141 931062448 501(c)(3) 10000 Annual Sponsorship Tulare Hospital Foundation 906 N Cherry St Tulare CA 93274 770166566 501(c)(3) 10000 Annual Sponsorship 400.99 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 501(c)(3) 10000 New MRI UpValley Family Centers of Napa County 1440 Spring Street St Helena CA 94574 800023012 501(c)(3) 10000 Rapid Response - COVID-19 Weingart East Los Angeles YMCA 2900 Whittier Blvd Los Angeles CA 90023 951644052 501(c)(3) 20000 Annual Sponsorship White Memorial Medical Center Charitable Foundation 1720 Cesar E Chavez Avenue Los Angeles CA 90033 953760201 501(c)(3) 10000 Healthcare Workforce Development Willits Daily Bread Inc PO Box 1826 Willits CA 95490 680411538 501(c)(3) 10000 Rapid Response - COVID-19 Yuba Sutter Food Bank 760 Stafford Way Yuba City CA 95991 942909773 501(c)(3) 10000 Rapid Response - COVID-19 51 1 Part I, Line 2: Funding provided to other organizations is provided to recipients with the understanding that the funds are being used only for the designated purposes. No monitoring is conducted by AH. X 1 1 X X X X 1 1 0 0 0 0 0 0 0 Larsen David Senior Finance Officer 595439 0 106067 0 2501054 0 576851 0 37800 0 3817211 0 2400418 0 Reiner Scott CEO 1631895 0 352059 0 374424 0 17042 0 37777 0 2413197 0 349200 0 Wing Bill - DirAsst SecCFO to 08/20/President as of 08/20 1458328 0 279883 0 22116 0 17042 0 42012 0 1819381 0 0 0 Jahn Andrew President, Care Division 992796 0 210574 0 162471 0 17042 0 42265 0 1425148 0 0 0 Ferch Wayne President, CCR 1018284 0 250697 0 29626 0 17042 0 32144 0 1347793 0 0 0 El-Asmar Hoda Chief Clinical Officer thru 10/20 719268 0 163690 0 364541 0 17042 0 22456 0 1286997 0 0 0 Eller Jeff President, NCR thru 06/20 926131 0 197976 0 30640 0 17042 0 32369 0 1204158 0 0 0 Olson JoAline - Former Chief Human Perf Officer, AHRS thru 08/19 4836 0 102043 0 944332 0 0 0 30421 0 1081632 0 212518 0 Beaman John Chief Business Officer 815598 0 130585 0 16921 0 0 0 45033 0 1008137 0 0 0 Ashlock Mark - Ambulatory Post-Acute President thru 06/20 720972 0 153655 0 88429 0 14637 0 29537 0 1007230 0 0 0 Newmyer Joyce President, PNR 757634 0 155648 0 19965 0 17042 0 45025 0 995314 0 0 0 Nahapetian Arby Care Division Chief Medical Officer 648088 0 107260 0 112858 0 12449 0 42262 0 922917 0 0 0 Kofl Andrea President, AHHF 587803 0 128954 0 125332 0 17042 0 32369 0 891500 0 0 0 Raffoul John FO, SCR/President 606284 0 81799 0 129503 0 17042 0 32369 0 866997 0 0 0 Reppert Joseph Former CFO/Asst Secr thru 08/19 2779 0 0 0 810646 0 0 0 41111 0 854536 0 0 0 Issai Alice President, AHGL 616370 0 91597 0 106487 0 0 0 29312 0 843766 0 0 0 Rawson Richard President, AHRO 585738 0 115611 0 96966 0 0 0 29537 0 827852 0 0 0 Briggs Sharlet President, AHBD thru 08/20 395851 0 98542 0 281026 0 17042 0 29155 0 821616 0 0 0 Jobe Meredith Secretary 575127 0 81637 0 113221 0 13010 0 30858 0 813853 0 0 0 Byrnes John Medical Officer, NCR 578510 0 98480 0 89869 0 17042 0 29382 0 813283 0 0 0 Long Collier Business Development Executive 587019 0 80611 0 102076 0 15674 0 25524 0 810904 0 0 0 Brass Steven Medical Officer 600167 0 53904 0 108332 0 14533 0 21292 0 798228 0 0 0 Chen Steven Finance Officer, CCR 533654 0 104566 0 81492 0 17042 0 42132 0 778886 0 0 0 Wells Jason Chief Consumer & Innovation Officer 524002 0 80171 0 108272 0 17042 0 42265 0 771752 0 0 0 Wolcott Daniel President, AHLM 510921 0 98950 0 86116 0 17042 0 42265 0 755294 0 0 0 Beehler Robert Mkt Dev, M&A Exec 510207 0 76256 0 115601 0 17042 0 29537 0 748643 0 0 0 Bancarz Gloria System Chief Quality Officer 509793 0 86481 0 106346 0 17042 0 14971 0 734633 0 0 0 Fink Matthew Chief Information Officer 507077 0 84499 0 79621 0 17042 0 42110 0 730349 0 0 0 Liebowitz Jacalyn System Chief Nursing Officer 467077 0 55070 0 157016 0 5700 0 38788 0 723651 0 0 0 Raethel Kathryn President, AHCS 492087 0 66191 0 120029 0 17042 0 27457 0 722806 0 0 0 Conklin Jeffrey - Former Payer Strategy Exec thru 07/19 0 0 0 0 551575 0 0 0 41343 0 592918 0 0 0 Hofheins Todd CFO as of 08/20 297756 0 66 0 171285 0 0 0 13281 0 482388 0 0 0 Church Lowell Former VP Material Mgmt thru 03/19 0 0 0 0 350078 0 0 0 31378 0 381456 0 0 0 Wagner Jack Former CFO/Asst Secr thru 03/18 0 0 0 0 269387 0 0 0 13558 0 282945 0 0 0 Knittel Monty Former President, AHFR thru 09/18 0 0 0 0 123451 0 0 0 8068 0 131519 0 0 0 Zachary Beth Former President, SCR thru 01/18 0 0 0 0 110666 0 0 0 11291 0 121957 0 4831 0 Part I, Line 1a Tax indemnification and gross-up payments - received by 11 directors All items checked on this line are reported as taxable income to the employee or director receiving the benefit. Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Ashlock, Mark - severance payment - $ 57,658 Briggs, Sharlet - severance payment - $189,316 Church, Lowell - severance payment - $349,054 Conklin, Jeffrey - severance payment - $551,575 El-Asmar, Hoda - severance payment - $197,829 Knittel, Monty - severance payment - $123,451 Olson, Joaline - severance payment - $722,636 Reppert, Joseph - severance payment - $809,806 Wagner, Jack - severance payment - $269,387 Zachary, Beth - severance payment - $110,666 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 - funding - $559,809 Larsen, David - distribution - $2,400,418 Olson, JoAline - distribution - $212,518 Select executives agreed to participate in CAP-EX in place of a traditional SERP. See Schedule L, Part V, for a broader description. Split-Dollar life insurance participants are Mark Ashlock, John Beaman, Jeffrey Eller, Alan Ferch, Joyce Newmyer, JoAline Olson, Scott Reiner, Jack Wagner, Bill Wing, and Beth Zachary. 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. Reiner, Scott - $349,200 Zachary, Beth - $4,831 A CSCDA Series A 2007 680164610 1307957C5 2007-05-08 57500000 See Part VI 0 0 0 B CHFFA Series B 2009 521643828 13033LBC0 2009-05-20 30000000 See Part VI 0 0 0 C CHFFA Series C 2011 521643828 000000000 2011-06-09 130000000 See Part VI 0 0 0 D CHFFA Series A 2013 521643828 13033LS65 2013-02-14 208420907 See Part VI 0 0 0 A 21440000 57500000 643910 1409177 4480297 50966616 2010 0 0 1 1 B 30000000 216916 29783084 2009 0 0 1 1 C 45540000 130000000 478200 129521800 2015 0 0 1 1 D 43510000 208420907 979977 207440930 2016 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 0 0 0.00000 0.00020 0.00020 0 0 1 A 1 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: CHFFA Series B 2009 Date the Rebate Computation was Performed: 06/17/2019 Issuer Name: CHFFA Series C 2011 Date the Rebate Computation was Performed: 07/25/2016 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Part I, Columns (A-D) Issuer's Name: CSCDA - California Statewide Communities Development Authority CHFFA - California Health Facilities Financing Authority HFA - The Hospital Facilities Authority of Multnomah County, Oregon Part I, Entity 1, Column (f), Line A: Construct, equip and remodel the following health care facilities: Feather River Hospital, Paradise, CA Hanford Community Hospital, Hanford, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Part I, Entity 1, Column (f), Line B: Acquire, construct and equip the following health care facilities: Adventist Health Clearlake Hospital Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Part I, Entity 1, Column (f), Line C: Refinance a bank loan used to construct, equip the following health care facilities: Adventist Health Clearlake Hospital, Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA Part I, Entity 1, Column (f), Line D: Refund outstanding balance of the following bond issues: 1991 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 23, 1991 1991 California Health Facilities Financing Authority (AHS/West Series B) bonds issued September 25, 1991 1991 City of Glendale (AHS/West Series A) bonds issued July 23, 1991 Part I, Entity 2, Column (f), Line A: Acquire, construct, and equip the following health care facilities: Central Valley General Hospital, Hanford, CA Feather River Hospital Paradise, CA Willits Hospital, Inc, Willits, CA Hanford Community Hospital, Hanford, CA San Joaquin Community Hospital, Bakersfield, CA Ukiah Valley Hospital, Ukiah, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA Part I, Entity 2, Column (f), Line B: Refund outstanding balance of the following bond issue: 2005 California Statewide Communities Development Authority (AHS/West Series A) bonds issued on October 18, 2005 Part I, Entity 2, Column (f), Line C: Acquire, construct, and equip the following health care facilities: Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Part I, Entity 2, Column (f), Line D: Refund outstanding balance of the following bond issues: 2002 California Health Facilities Financing Authority (AHS/West Series A) bonds issued March 20, 2002 2002 California Health Facilities Financing Authority (AHS/West Series B) bonds issued March 2002 2003 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 1, 2003 Part I, Entity 3, Column (f), Line A: Finance the new headquarters facility for the Corporation located in Roseville, CA and refinance the following bond issues: City of Marysville, CA Rideout Series 2011 Bonds acquired in the affiliation with The Fremont-Rideout Health Group and Rideout Memorial Hospital effective April 1, 2018 Part I, Entity 3, Column (f), Line B: Refund the outstanding balance of the following bond issue: 2009 HFA - The Hospital Facilities Authority of Multnomah County, Oregon (AHS/West Series A) issued September 30, 2009 Part II, Entity 1, Line 11, Column D: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow. Part II, Entity 2, Line 11, Columns B & D: The other spent proceeds are the refunding proceeds no longer in escrow. Part II, Entity 3, Line 11, Column A: The other spent proceeds are the proceeds used to pay off the taxable line of credit which was used to finance initial costs of the project. Part II, Entity 3, Line 11, Column B: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow. A CHFFA Series A 2013 521643828 13033LS57 2013-02-14 100741934 See Part VI 0 0 0 B CSCDA Series A 2015 680164610 13080SJL9 2015-06-30 157990834 See Part VI 0 0 0 C CSCDA Series A 2015 680164610 13080SJM7 2015-06-30 42422999 See Part VI 0 0 0 D CHFFA Series A 2016 521643828 13032UGL6 2016-09-08 309720490 See Part VI 0 0 0 A 5935000 100741934 741934 100000000 2016 0 0 1 1 B 14118000 157990834 1493445 9150 156488239 2015 1 0 1 1 C 3982000 42422999 420423 2576 42000000 2019 0 0 1 1 D 51020000 309720490 2280369 307440121 2016 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 0 0 0.00000 0.00020 0.00020 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A CSCDA Series A 2018 680164610 13080SWK6 2018-09-27 272074615 See Part VI 0 0 0 B HFA Multnomah 2019 931266280 62551PCX3 2019-11-13 60886489 See Part VI 0 0 0 A 115000 272074615 2098459 242976156 27000000 2019 0 1 1 1 B 60886489 493229 60393260 2019 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 Ashlock M Key employee Supplemental retirement CASD X 3724014 3742915 0 1 1 El-Asmar H Key employee Relocation X 150000 143850 0 1 1 Beaman J Key employee Relocation X 125000 298150 0 1 1 Beaman J Key employee Supplemental retirement CASD X 2358349 2370319 0 1 1 Beehler R Key employee Relocation X 100000 78100 0 1 1 Byrnes J Key employee Relocation X 200000 196200 0 1 1 Chen S Highest compensated employee Relocation X 100000 148650 0 1 1 Eller J Key employee Supplemental retirement CASD X 7956827 7997210 0 1 1 Ferch W Key employee Supplemental retirement CASD X 6584597 6618016 0 1 1 Fink M Highest compensated employee Relocation X 100000 94350 0 1 1 Jahn A Key employee Relocation X 400000 395600 0 1 1 Jobe M Officer Relocation X 100000 82000 0 1 1 Larsen D Key employee Relocation X 150000 148050 0 1 1 Liebowitz J Key employee Relocation X 150000 149000 0 1 1 Newmyer J Key employee Relocation X 150000 135600 0 1 1 Newmyer J Key employee Supplemental retirement CASD X 4475347 4498061 0 1 1 Olson J Highest compensated employee Relocation X 200000 52500 0 1 1 Olson J Highest compensated employee Supplemental retirement CASD X 1862254 1871706 0 1 1 Raethel K Key employee Relocation X 61050 6050 0 1 1 Rawson R Key employee Relocation X 100000 96000 0 1 1 Reiner S Officer Supplemental retirement CASD X 8683504 8727576 0 1 1 Wagner J Former officer Supplemental retirement CASD X 6671634 6705495 0 1 1 Wing B Officer Relocation X 200000 189200 0 1 1 Wing B Officer Supplemental retirement CASD X 7191107 7227604 0 1 1 Wolcott D Key employee Relocation X 200000 200000 0 1 1 Zachary B Former key employee Supplemental retirement CASD X 2026510 2036795 0 1 1 54208997 Beehler Matthew Family member of Key EE, B. Beehler 312565 Employment 0 Bancarz Michelle Family member of Key EE, G. Bancarz 133738 Employment 0 Bancarz Theodore Family member of Key EE, G. Bancarz 110481 Employment 0 Eller Eric Family member of Key EE, J. Eller 67487 Employment 0 Ferch Josiah Family member of Key EE, W. Ferch 73707 Employment 0 PVHR LLC Greater than 35% owned by former Director, M. Gabriel and family members Interest 0 Part II, Supplemental Retirement Benefits: The organization provides supplemental retirement benefits through an alternative funding arrangement the IRS calls "collateral assignment split dollar" (CASD). Although the IRS requires reporting in the loan section of Schedule L, CASD is not an actual loan - no funds are transferred to the executive. Rather, the "loan" treatment applies because after the executive has received retirement benefits, the organization recovers all outlays plus interest.The recovery right is a key advantage of CASD for the organization. Rather than paying retirement benefits to the executive that would never be recovered, under CASD the organization recovers not only its outlays, but also consideration for the time value of money.CASD works as follows. The organization deposits funds into a cash value life insurance policy on the executive's life. During life, to the extent the executive fulfills service and vesting requirements, the executive can borrow against values in the policy to supplement retirement income. Policy performance is closely monitored. If policy performance lags, the executive's borrowing rights are reduced to protect the organization's recovery rights.At the executive's death, the policy death proceeds are first used to repay the organization its deposits plus compounded interest (at the IRS long-term applicable federal rate). The executive's beneficiary then receives any projected retirement borrowing the executive did not access during life. Any remaining death proceeds were available to be paid to the executive's beneficiary. However, the executives made a gift of the excess proceeds, estimated to total $98 million, to the organization to provide additional funding for the organization's charitable activities.Gift of excess proceeds (estimated):Mark Ashlock: $7,108,295: John Beaman: $7,387,524; Jeffrey Eller: $15,637,403; Alan Ferch: $9,908,434; Joyce Newmyer: $6,815,816; JoAline Olson: $2,507,864; Scott Reiner: $17,423,228; Jack Wagner: $14,494,934; Bill Wing: $14,236,602; Beth Zachary: $3,197,524. Part IV, Page 1, Line 1: Melody Gabriel, an AH director, and her husband are owners and officers of businesses that engage in joint ventures with AH and member hospitals. Other family members with ownership and officer positions in these businesses include her parents, her brother and his wife, and trusts established on behalf of her children. The ventures are organized as LLCs. At the end of 2020, PVHR, LLC had an outstanding balance of $1,673,320 secured and unsecured market rate interest bearing loans. This LLC is 50% controlled by another LLC of which Ms. Gabriel and her family have a controlling interest. Interest is accrued on these loans, principal and interest at the end of 2020 was $237,991. Principal and interest payments are being made monthly. Total interest paid during 2020 was $44,039. Form 990, Part III, Line 4a: Adventist Health is a faith-based, nonprofit integrated health system serving more than 80 communities on the West Coast and Hawaii. Founded on Seventh-day Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care agencies, hospice agencies and joint-venture retirement centers in both rural and urban communities. Our compassionate and talented team of 35,000 includes associates, medical staff physicians, allied health professionals and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope. Together, we are transforming the American healthcare experience with an innovative, yet timeless, whole-person focus on physical, mental, spiritual and social healing. Mission-driven The healthcare industry continues to experience significant changes. From high and rising costs to regulatory initiatives, these issues are causing hospitals and health systems to re-think who they are and how they want to deliver care. At Adventist Health, we are thriving and growing in the face of this transition by building on our legacy and reestablishing ourselves as the leader in physical, mental, spiritual and social health. We remain committed to "living God's love by inspiring health, wholeness and hope." Our mission represents the heart of our people. It expresses that we know the love of God and consistently reflect that love in our actions, relationships and work. Mission is the reason our organization exists. Community Health Development Adventist Health's commitment to improve well-being not only grew out of our mission to live God's love, but also from the needs we see in communities across our system of 23 hospitals. While diseases of despair continue to escalate along with healthcare costs, we are presented with the opportunity to bring whole person care, philanthropy, public heath, human services, government, community members, and business owners together to change the well-being of people, places, and policies. A key step towards well-being transformation is the formation of the Well-Being Division, an entity within Adventist Health established in 2020 after its acquisition of Blue Zones, a pioneer in taking a systemic and environmental approach to improving the health of entire cities and communities. Moving toward our vision to see a time when well-being is accessible to everyone, the Well-Being Division works with Blue Zones to design, leverage and demonstrate evidence-informed solutions that measurably and sustainably improve individual, organizational and community well-being. This work starts with our 35,000 associates, who have access to a wide variety of well-being resources from a Blue Zones at Adventist Health well-being app to free online counseling and chaplaincy services. Adventist Health locations also have access to Blue Zones Campus Certification, which invests in creating safe environments that foster well-being and longevity. In early 2021, the Well-Being Division launched four Blue Zones Campus Certifications and four Blue Zones Projects with a goal to roll-out both initiatives across Adventist Health's entire footprint. Over the next three years, every community with an Adventist Health hospital will begin working towards a Blue Zones Project, an achievement that transforms health and well-being everywhere people live, work and play. Outside of Blue Zones specific initiatives, the Well-Being Division has delivered the following to our community members and partner organizations: - 7,976,162 pounds of food to our California communities, - 10,863 showers to our homeless populations - 2.68 million personal protected equipment - $470,000 of household goods and furnishings to fire victims These intentionally targeted and strategically aligned initiatives not only alleviate a significant equity gap in our communities but have also proven to produce lasting, transformative change. Adventist Health has developed a substantiated capacity for vulnerable population community well-being solutions designed for replication further establishing our commitment to ensuring an equity lens through access to well-being for all. Population Health Population health is a whole-person, outcomes-based approach that works to improve the health of entire communities. It requires collaboration among researchers, providers, public health entities and policy makers. Population health aligns with Adventist Health's philosophy of care and, as overall health declines in North America, provides unprecedented opportunities. Adventist Health believes that improving the health status of entire populations begins at home In 2020, Adventist Health moved to one plans but still offered wellness-focused programs and tools, including a wellness website, fitness activities, nutrition guidance, smoking cessation workshops and more. As a safety transition due to the pandemic, members able to complete a free at-home biometric screening and those with high-risk conditions were able to take part in a free care management program that provides support and education. In 2020, 155 members completed a biometric screening. Whole-person health involves mind, body and spirit. The health plans empowers employees, their families and, by extension, the larger community to take an active role in managing their health so they may live vibrant and productive lives. Care Transformation Care Transformation in Adventist Health reflects our promise to deliver top decile safety and quality performance and top quartile in clinical operations. The transformation focuses on initiatives such as Clinical Leadership Development, High Reliability Organization, Patient Experience, Care Redesign, Population Health and Clinical Workforce. All these efforts focus on effectively blending people, processes and technology, and include consistent design, delivery and evaluation of care performance. Our caregivers are working hard every day to achieve the clinical goals and continue to spread our mission. Patient Safety & Quality Adventist Health focuses not only on patient safety and quality patient care, but also provides a quality work environment for its associates. Maintaining a culture of teamwork and safety among clinicians and staff is foundational to Care Transformation. For the past nine years, Adventist Health has participated in the Culture of Safety survey, which provides insight into focused areas where actions can be taken to improve the safety and teamwork climate in clinical departments. Adventist Health hospitals received quality and safety awards from The Joint Commission, The LeapFrog Group, Healthgrades, CMS and Malcolm Baldrige. Physician Alignment Adventist Health operates 379 medical offices across the West Coast and Hawaii. These ambulatory care centers include Rural Health Clinics (RHC), hospital-based outpatient clinics (HBOC), employed physician models in Oregon and Hawaii, medical foundation in California and community health clinics. These medical offices offer primary care and more than 50 different specialties in medical offices large and small. We have more than 500 primary care providers and about 700 specialists providing services ranging from Addiction Medicine to Wound Care, Audiology to Vascular Surgery. Adventist Health also provides much-needed dental care in 10 of our rural communities. The providers in these medical offices are committed to providing best practice, quality-driven care with excellent health outcomes and exceptional patient experience. In each of the past four years we have provided more than 2 million patient visits in 2020 many of those visits shifted to virtual care to safely continue delivering care in the midst of the COVID-19 pandemic. Patient satisfaction scores skyrocketed as the communities we serve recognized how our physicians and associates were working diligently to get them the medical care they needed. The excellent experience our physicians and Advanced Practice Providers offer patients results in a patient satisfaction Star Rating of 4.7 out of 5 stars. Form 990, Part III, Line 4a (continued): Rural Health Clinic (RHC) As an extension of our mission, high quality services are provided to rural communities where access to care is often significantly more challenging than urban areas. We have 70 rural health clinics (RHCs) providing healthcare to underserved populations throughout Northern and Central California, Hawaii and Oregon. Our system of rural health continues to be the largest network of clinics in the state of California (more than 10 percent of the RHCs in the state are part of Adventist Health). Our RHC network also is one of the largest in the country, representing almost one percent of the nation's RHCs. Adventist Health provides oversight services for all our RHCs to include financial monitoring, program audits, operational support, professional development, advocacy and education regarding new regulations. Thanks to the RHCs, many of these rural communities' most disenfranchised have access to primary care, dentistry, women's and children's services and health education. Specialty care services are also available at many RHC locations, including 24 behavioral health programs. Home Care Services Adventist Health /Home Care offers advanced, high quality health care in an at-home setting by operating 14 home health agencies and nine hospices. In 2020, care, compassion and high-quality services were provided with 204,587 home health visits and 78,641 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 2020: 1. Implemented Cardinal Health at-Home to provide patient direct supplies 2. Implemented Forcura to create efficiencies for physician orders and intake 3. Received regulatory change of ownership approval for Lodi Home Health to move under Western Health Resources 4. Expanded the Yuba City, CA service area to include the Feather River population 5. Migrated all contracts to Conga to create system standardization 6. Prepared for mandatory Electronic Visit Verification in Hawaii for an anticipated go-live of 8/1/2021 7. Started HCHB optimization Developing a Virtual Care Network The Adventist Health Virtual Care Network allows health care professionals to evaluate, diagnose and treat patients using telecommunications technology. Virtual Care is the umbrella term for the group of services and functions that include telemedicine, telepharmacy, teleICU, teleradiology, and telepathology, but which also includes and can support regional health information sharing, patient education and provider networking. Virtual Care provides patients with access to high-quality, affordable specialty care when and where they need it, aiding in rapid diagnosis, treatment and improved patient outcomes. This collaboration supports Adventist Health's mission of bringing high-quality health and healing to the communities it serves, and is consistent with the organization's focus on innovation, strategic growth and population health. Virtual Care services continued to grow in 2019 and took a huge leap in 2020 with the onset of the COVID-19 pandemic. Our clinics implemented virtual visits using Microsoft Teams as a means to safely continue caring for patients with primary care or chronic health needs. Our traditional telehealth visits combined with Teams visits totaled 45,791 in April and 36,295 in May. Inpatient virtual care continues to serve hundreds of patients. Thirteen hospitals use telehealth stroke services, seven hospitals use pediatric services, five sites use infectious disease services and ten sites use emergency psychiatry assessment services. Under an initiative with Blue Shield of California, funds from a USDA grant and hospital investment, telehealth equipment was provided for medical specialty outpatient care and deployed to 28 sites in California and Oregon including three non-Adventist Health sites. We are also positioned to grow in 2020 with six more sites being added, including in Hawaii. We continue to offer store and forward services for dermatology and diabetic retinopathy screenings, as well as peer-to-peer e-consults. A direct-to-Consumer service we offer to Adventist Health employees, Adventist Health OnDemand, was expanded to consumers as well and communicated to our markets as an additional health care resource available amidst the pandemic. Adventist Health is a preferred provider for Virtual Care with the California Department of Corrections and Rehabilitation, serving multiple prison locations through the Virtual Care Care Coordination Center. Strategic Planning Our ten-year strategy represents a bold vision that is fully aligned with the calling of our mission. This diversified, growth-oriented 2030 strategy is based on building an organization that will bring "affordable consumer health and well-being within reach" for everyone we serve. Within 10 years, we will grow to reach more than 10 million individuals each year within our own footprint and another 50 million across the nation with health and well-being solutions. To support this work and bring our 2030 strategy to life, we have organized into three divisions: Care Division, Health Division and Well-being Division. These divisions will work together to meet the needs of our consumers and exceed expectations physically, virtually or digitally. We will provide better care at a lower cost by focusing on efficiencies in delivery operations and creating value-based care models accountable for the health of defined populations. And we will develop new businesses that bring health and well-being solutions within reach in the communities we serve. Form 990, Part VI, Section A, line 6 Individuals who represent the Seventh-day Adventist Church and lay people who are in good standing with the Seventh-day Adventist Church serve as members of Adventist Health System/West (the Organization") including the following: (a) the president, treasurer, and one other representative from both the offices of the Pacific Union and the North Pacific Union; (b) one representative from each of the local conferences of the Church in which affiliated health care facilities are located; (c) two representatives selected from among the colleges and universities affiliated with the Church and located in the Pacific Union or North Pacific Union; (d) the CEO of the Organization, plus three additional representatives of the management of the Organization; (e) three representatives selected from the presidents of the hospitals affiliated with the Organization; (f) three healthcare leaders; (g) up to 16 lay representatives who do not belong to any of the other categories set forth but who otherwise meet the qualifications for membership. Annually, the members meet for the purpose of conducting the business of the membership. Actions are taken as required to enable Adventist Health System/West to continue operating in concert with its Articles and Bylaws. Form 990, Part VI, Section A, line 7a The Organization's Board of Directors consists of the following: (a) The president of the Pacific Union and North Pacific Union of the Seventh-day Adventist Church; (b) two presidents selected from among the local conferences of the Church in which are located affiliated health care institutions; (c) The CEO of the Organization; (d) the president of the Organization, if there is no president, such other persons as the membership shall appoint; (e) two professional health care providers who are practicing or serving in healthcare leadership; and (f) seven lay representatives as elected by the membership. Form 990, Part VI, Section A, line 7b Amendments to the Organization's Bylaws require approval by the membership. 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 Controller and Market Finance Officer, and shared by electronic communication with the Organization'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, 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 remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The statements for the AHSW Board of Directors are reviewed by the EY auditor as part of the annual financial statement audit. All conflicts are reviewed by the System General Counsel. For potential conflicts, the System General Counsel will determine and present all relevant facts to the governing body for decision. After addressing any questions asked by the governing body, the person with a declared conflict must leave the meeting during the discussion of the matter that involves a conflict and during any vote on the matter. Form 990, Part VI, Section B, line 15 The Organization's Board of Directors has established a Compensation 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 Presidents and 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 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 available to the public. Form 990, Part VII: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 82,600. Management and general expenses 1,088,182. Fundraising expenses 0. Total expenses 1,170,782. Other medical professional fees: Program service expenses 0. Management and general expenses 545,415. Fundraising expenses 0. Total expenses 545,415. Consulting and other management fees: Program service expenses 3,701,023. Management and general expenses 29,123,364. Fundraising expenses 957,378. Total expenses 33,781,765. Other professional fees non-medical: Program service expenses 550. Management and general expenses 5,654,694. Fundraising expenses 0. Total expenses 5,655,244. Contract labor: Program service expenses 1,180,818. Management and general expenses 8,798,021. Fundraising expenses 0. Total expenses 9,978,839. Repairs & Maintenance: Program service expenses 34,745,988. Management and general expenses 134,912. Fundraising expenses 0. Total expenses 34,880,900. Purchased medical services: Program service expenses 448,841. Management and general expenses 721,401. Fundraising expenses 0. Total expenses 1,170,242. Other purchased services: Program service expenses 16,583,234. Management and general expenses 103,113,203. Fundraising expenses 43,883. Total expenses 119,740,320. Form 990, Part XI, line 9: BlueZones acquisition adjustment -435,252. Partnership loss reported on Sch K-1 4,024,719. Incentive Acute Care Network LLC PO Box 619135 Roseville CA 95661 Acute care network CA 0 0 Adventist Health SystemWest Incentive Health LLC PO Box 619135 Roseville CA 95661 MSO CA 471080 4360717 Adventist Health SystemWest Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 845174585 Hospital CA 501(c)(3) Line 3 Stone Point Health 1 Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 1 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 1 Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health 1 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 1 Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest 1 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 1 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 1 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 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 1 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest 1 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health 1 Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 1 Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 1 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 1 Blue Zones LLC 323 N Washington Avenue 2nd Floor Minneapolis MN 55401 271603327 Education MN Adventist Health SystemWest Unrelated 1776845 7727528 0 -5555454 1 1.00000 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Real property rental OR Adventist Health SystemWest Unrelated 151388 17366645 0 151356 1 0.50000 PVHR2 LLC dba Parkview at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Real property rental OR Adventist Health SystemWest Unrelated -121349 3690666 0 -121349 1 0.50000 WWGHR LLC 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Rental OR Adventist Health SystemWest Unrelated -497278 4325030 0 -497558 1 0.50000 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD Adventist Health SystemWest C 526319 1705393 0.50000 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA Adventist Health SystemWest C 33254537 6995662 1.00000 1 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA Adventist Health SystemWest C 1.00000 1 Thrive Productions Inc 323 N Washington Avenue Minneapolis MN 55401 453369049 Production company MN Adventist Health SystemWest C 273567 12137 1.00000 1 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 Adventist Health Clearlake Hospital Inc L 17537429 FMV Adventist Health Medical Center Tehachapi L 5241349 FMV Adventist Health Physicians Network L 14552939 FMV Castle Medical Center L 20722656 FMV Glendale Adventist Medical Center L 57478182 FMV Hanford Community Hospital L 42765902 FMV Lodi Memorial Hospital Association Inc L 30126621 FMV Northwest Medical Foundation of Tillamook L 11515897 FMV Portland Adventist Medical Center L 35230876 FMV Reedley Community Hospital L 23899035 FMV Rideout Memorial Hospital L 54794348 FMV San Joaquin Community Hospital L 54183805 FMV Simi Valley Hospital and Health Care Services L 20460874 FMV Sonora Community Hospital L 32559671 FMV St Helena Hospital L 25094376 FMV Ukiah Adventist Hospital L 24997598 FMV Western Health Resources L 2541289 FMV White Memorial Medical Center L 54846796 FMV Willits Hospital Inc L 9846208 FMV Adventist Health Clearlake Hospital Inc O 773828 FMV Adventist Health Delano O 763057 FMV Adventist Health Medical Center Tehachapi O 590517 FMV Adventist Health Mendocino Coast O 325860 FMV Adventist Health Tulare O 177870 FMV Castle Medical Center O 1291529 FMV Feather River Hospital O 61764 FMV Glendale Adventist Medical Center O 2667966 FMV Hanford Community Hospital O 1897365 FMV Lodi Memorial Hospital Association Inc O 1861248 FMV Northwest Medical Foundation of Tillamook O 617690 FMV Portland Adventist Medical Center O 1373320 FMV Rideout Memorial Hospital O 2331023 FMV San Joaquin Community Hospital O 2315319 FMV Simi Valley Hospital and Health Care Services O 1731039 FMV Sonora Community Hospital O 1399501 FMV St Helena Hospital O 1457140 FMV Ukiah Adventist Hospital O 802743 FMV White Memorial Medical Center O 2960826 FMV Willits Hospital Inc O 763199 FMV Adventist Health Delano Q 243073 FMV Adventist Health Mendocino Coast Q 176107 FMV Adventist Health Ukiah Valley Q 85883 FMV Castle Medical Center Q 51476 FMV Glendale Adventist Medical Center Q 81350 FMV Hanford Community Hospital Q 87702 FMV Lodi Memorial Hospital Association Inc Q 57311 FMV San Joaquin Community Hospital Q 55851 FMV Simi Valley Hospital and Health Care Services Q 54427 FMV Sonora Community Hospital Q 130455 FMV Adhealth Limited R 1273750 Cash transfer amount Adventist Health Medical Center Tehachapi R 16920105 Cash transfer amount Adventist Health Physicians Network R 11420845 Cash transfer amount Castle Medical Center R 16087689 Cash transfer amount Hanford Community Hospital R 47714622 Cash transfer amount Northwest Medical Foundation of Tillamook R 10675399 Cash transfer amount Portland Adventist Medical Center R 12984570 Cash transfer amount Reedley Community Hospital R 23516677 Cash transfer amount San Joaquin Community Hospital R 13393216 Cash transfer amount Simi Valley Hospital and Health Care Services R 1305132 Cash transfer amount Sonora Community Hospital R 25107956 Cash transfer amount Ukiah Adventist Hospital R 10052018 Cash transfer amount Walla Walla General Hospital R 301770 Cash transfer amount White Memorial Medical Center R 155647057 Cash transfer amount Willits Hospital Inc R 3377609 Cash transfer amount Adventist Health Clearlake Hospital Inc S 2831038 Cash transfer amount Adventist Health Tulare S 32717189 Cash transfer amount Feather River Hospital S 18880382 Cash transfer amount Fremont-Rideout Health Group S 11670649 Cash transfer amount Glendale Adventist Medical Center S 10780495 Cash transfer amount Lodi Memorial Hospital Association Inc S 50043904 Cash transfer amount Rideout Memorial Hospital S 45133709 Cash transfer amount South Coast Medical Center S 601992 Cash transfer amount St Helena Hospital S 6214337 Cash transfer amount United Com-Serve S 55771404 Cash transfer amount Western Health Resources S 11429423 Cash transfer amount