2021-10-21T13:34:06-05:00 2020-12-31 910189318 MOSS ADAMS LLP 2882 PROSPECT PARK DR STE 300 RANCHO CORDOVA CA 95670 990 2020-01-01 320606993 ADVENTIST HEALTH AND RIDEOUT EMPLOYEE HEALTH PLAN TRUST ADVE 9164060000 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 WELLS FARGO INSTITUTIONAL TRUSTEE 9164060000 2021-10-20 1 WELLS FARGO 999009999 TRACY S PAGLIA P00366884 9165038100 2021-10-20 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X RICHARD RAWSON 1 ADVENTIST HEALTH WAY ROSEVILLE CA 95661 33352998 0 X NONE X 2019 CA PROVIDE MEDICAL BENEFITS TO ELIGIBLE EMPLOYEES OF RIDEOUT AND MENDOCINO COAST & THEIR DEPENDENTS 1 0 0 0 0 0 0 0 41916410 33331976 27686 21022 0 0 41944096 33352998 0 0 36886324 22938786 364 1140 0 0 0 1975422 2296526 38862110 25236452 3081986 8116546 3081986 12311994 0 825355 3081986 11486639 NONE 0 0 RIDEOUT MEMORIAL HOSPITAL DBA ADVENTIST HEALTH AND RIDEOUT ("RIDEOUT"), WHICH IS A 501(C)(3) HOSPITAL ESTABLISHED THE ADVENTIST HEALTH AND RIDEOUT EMPLOYEE WELFARE PLAN (THE "PLAN"). THE PLAN PROVIDES MEDICAL BENEFITS TO ELIGIBLE EMPLOYEES OF RIDEOUT, ADVENTIST HEALTH MENDOCINO COAST, AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X TODD HOFHEINS CFO 9164060000 PO BOX 619135 ROSEVILLE CA 95661 WELLS FARGO TRUSTEE 1.00 X 1140 0 0 1140 0 0 0 0 0 0 ADVENTIST HEALTH SYSTEMWEST PO BOX 619135 ROSEVILLE CA 95661 CLAIMS ADMINISTRATION FEES 2197891 0 EMPLOYER AND EMPLOYEE CONTRIBUTIO 900099 33331976 33331976 33331976 21022 21022 33352998 33331976 0 21022 22938786 1140 2197891 96335 2300 25236452 3081986 10455564 0 1856430 3081986 12311994 0 825355 0 825355 X 0 0 0 0 3081986 11486639 3081986 11486639 3081986 12311994 8116546 288107 0 X 0 1 X 1 0 0 CLAIMS PAYMENTS ADMININSTRATOR PAYABLE 636412 ADMINISTRATIVE EXPENSE PAYABLE 188943 825355 X 33352998 0 33352998 0 33352998 25236452 0 25236452 0 25236452 PART X, LINE 2: THE VEBA TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS OBTAINED AN EXEMPTION LETTER EFFECTIVE FEBRUARY 1, 2019, IN WHICH THE INTERNAL REVENUE SERVICE STATED THAT THE TRUST, AS THEN DESIGNED, WAS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME, THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2020 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. ALTHOUGH THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER, THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. AND THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. IN ACCORDANCE WITH GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE PLAN ADMINISTRATOR EVALUATED THE PLAN'S TAX POSITIONS AND DOES NOT BELIEVE THE PLAN HAS ANY UNCERTAIN TAX POSITIONS THAT REQUIRE DISCLOSURE OR ADJUSTMENT TO THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 8A NO MEETINGS WERE HELD DURING THE TAX YEAR. FORM 990, PART VI, SECTION A, LINE 8B THE TRUST HAS NO SEPARATE COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM WITH INFORMATION PROVIDED BY THE INSTITUTIONAL TRUSTEE. THE FORM 990 IS REVIEWED BY THE TREASURY MANAGER. THE RETURN WILL BE SENT OUT TO WELLS FARGO, THE INSTITUTIONAL TRUSTEE TO REVIEW AND SIGN THE TAX RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE TRUST'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. THE TRUST'S SUMMARY ANNUAL REPORT IS PROVIDED TO PARTICIPANTS ON AN ANNUAL BASIS. 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 0 RIDEOUT MEMORIAL HOSPITAL 989 PLUMAS STREET YUBA CITY CA 95991 941387866 HOSPITAL CA 501(C)(3) LINE 3 STONE POINT HEALTH 0 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 0 ADVENTIST HEALTH MENDOCINO COAST 700 RIVER DRIVE FORT BRAGG CA 95437 845174585 HOSPITAL CA 501(C)(3) LINE 3 STONE POINT HEALTH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1