2020-11-13T16:49:15-08:00 2019-12-31 800519547 THE ACCOUNTANCY LLP 500 N Brand Blvd Fl 20 Glendale CA 91203 990 2019-01-01 956064971 Simi Valley Hosp and Hlth Care Services dba Adventist Health Simi Valley SIMI 8059556000 2975 N Sycamore Dr Simi Valley CA 93065 Francis Owens Finance Officer 2020-11-13 true S Clement P01218012 8185475701 X 2019 2022-09-23 18:48:47Z Jennifer Swenson 163134361 false 1071 X www.adventisthealth.org/simi-valley X 1960 CA Living Gods love by inspiring health, wholeness and hope. 14 12 1060 162 401108 997784 12378687 120338 142184326 162441558 26724 520541 47395 51924 154637132 163134361 233298 131283 0 70442615 68586178 0 210725 82048500 91318408 152724413 160035869 1912719 3098492 177558588 193427233 135820651 147733714 41737937 45693519 Living Gods love by inspiring health, wholeness and hope. false false 128829013 131283 162068950 Simi Valley Hosp & Hlth Care Serv dba Adventist Health Simi Valley (AHSV) provides quality medical health care 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 Adventist Health Simi Valley, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths 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 will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Adventist Health Simi Valley 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.AHSV 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 2019 was $15,034758.The following Inpatient services that were provided to all our patients. These services included:472 Babies delivered1,151 Surgeries performed29,414 Patient days The following Outpatient services that were provided to all our patients. These services included:36,992 Emergency department visits2,156 Outpatient Surgeries performed51,925 Outpatient visits 43,870 Clinic visitsAHSV recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2019 was $7,112,071.Adventist Healths mission statement of Living Gods 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 Gods image has experienced the best health today, hope for tomorrow, and Gods love that endures forever.Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ 128829013 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 0 0 true 1060 true true true false false false false false false 0 false false false false false false false X 14 12 false false false false true true true true true false false true true true true true true true true true true CA X Jay Lipps 9164061092 PO Box 619135 Roseville CA 95661 X Raffoul John Finance Officer, SCR 10.00 40.00 0 2777239 48038 Reiner Scott Dir/Chair 0.00 50.00 X X 0 1995696 53734 Wing Bill Dir/A Sec/CFO 0.00 50.00 X X 0 1572254 46583 Jahn Andrew President, SCR 10.00 40.00 0 1254944 59912 Reppert Joseph A/Sec thru 8/19 0.00 50.00 X 0 1209069 57565 Nahapetian Arby Medical Officer, SCR 10.00 40.00 0 841794 58842 Zachary Beth President SCR thru 12/2019 10.00 40.00 0 840555 47667 Wagner Jack Former Asst Secr 0.00 50.00 0 778475 29189 Jobe Meredith Secretary 0.00 50.00 X 0 730385 45909 Swenson Jennifer President 50.00 0.00 X 0 577513 61892 Fargo Roland Former Physician Ops Officer 0.00 50.00 0 475946 39167 Milatovic Natasa Reg HR Dir, SCR 10.00 40.00 0 459205 49980 Dingilian John Medical Officer 50.00 0.00 0 381619 58586 Esparza Caroline COO/CNO 0.00 50.00 0 344846 48001 Burke James Medical Officer, SCR 10.00 40.00 0 336072 39227 Anderson Brian A Sec thru 5/19 50.00 0.00 X 0 316605 32046 Werner William VP Support Services 50.00 0.00 0 281493 55996 Owens Chip Treas/A Sec 50.00 0.00 X 0 267414 54649 Wehtje Ronald CFO SCR thru 03/2019 10.00 40.00 0 265160 8290 Mallari Christopher RN 50.00 0.00 203133 0 38494 Adamos Eugene Pharmacist 50.00 0.00 201180 0 34805 Carol Deamer Director, Pharmacy 50.00 0.00 214903 0 11988 Fernandes Shalini RN 50.00 0.00 188890 0 37439 Ferrier Cory Bus Dev Exec 50.00 0.00 0 200181 12126 Percival Kathleen Admin Dir, Org Per 50.00 0.00 187015 0 21038 DavisWhitney Comm Director, SCR 10.00 40.00 0 149648 28730 Reiner Richard Director 0.00 4.00 X 0 28588 0 Davis Andrew Director 0.00 4.00 X 0 28246 0 Cherry Robert Director 0.00 4.00 X 0 26315 0 Heinrich Kerry Director 0.00 4.00 X 0 20102 0 Innocent Larry Director 0.00 4.00 X 0 18852 0 Woodson Marc Director 0.00 4.00 X 0 15000 0 Graham Ricardo Director 0.00 4.00 X 0 8848 0 Banks David Director 0.00 4.00 X 0 6382 0 Freedman John Director 0.00 4.00 X 0 2367 0 Salazar Velino Director 0.00 4.00 X 0 553 0 Philip Celeste Director 0.00 4.00 X 0 0 0 Ocampo Lucy Director 0.00 4.00 X 0 0 0 995121 16211366 1079893 191 true true false Siemens Medical Solutions 6700 Koll Center Pkwy 220 Pleasanton CA 94566 Medical Services 1307108 Jr Abbott Construction Inc 25 E California Blvd Pasadena CA 91105 Construction Services 990459 Medical Solutions LLC 1010 N 102nd Street Suite 300 Omaha NE 68114 Medical Services 926048 Intensive Care Medical Specialists Inc 1177 Roadrunner Way Simi Valley CA 93065 Medical Services 744126 Sodexo Inc and Affiliates 9801 Washington Blvd Gathersburg MD 20878 Dietery Services 569754 37 120338 120338 Dietary 722514 209475 209475 Medical Office Rentals 531120 1189977 788869 401108 Other Revenue 900099 274456 274456 Patient Care Services 900099 160767650 160767650 162441558 468291 468291 23750 23750 0 0 28500 28500 28500 28500 0 0 51924 51924 51924 0 163134361 162068950 401108 543965 131283 131283 0 0 0 0 0 55539880 51996256 3384510 159114 2067777 2031830 29806 6141 7027702 6575103 431841 20758 3950819 3789668 150134 11017 312558 84371 228187 137097 17499 119598 462 462 0 0 0 6348584 5216135 1132449 52484 9841 42643 680916 354621 326295 2207948 2044789 159664 3495 0 5969555 4361249 1608306 107534 31170 76364 0 36730 17446 19284 3594195 3594082 113 0 8186472 8157950 28522 0 Purchased services 30303286 8855790 21447496 Patient Care Supplies 20695475 20660262 35213 Quality Assurance 9893630 9893630 Revenue Cycle Fees 1567164 1567164 1224318 1005576 208542 10200 160035869 128829013 30996131 210725 0 5530605 6913033 0 19113372 24514027 0 0 0 2693642 2922436 564677 644528 241884104 107872420 125449080 134011684 2019735 0 100121 100121 2227323 2227323 2210459 2210459 17649574 19883622 177558588 193427233 10451469 16352095 51927 1950000 123367255 131381619 135820651 147733714 X 40922512 44996201 815425 697318 41737937 45693519 177558588 193427233 X 3098492 1269837 -412747 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 24601 24601 false false Part II-B, Line 1i - Other Activities Description The organization 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. 815425 229369 35000 249339 760455 934825 216897 -6401 329896 815425 1796958 1327885 -1132209 1057809 -36359 3471458 2049302 -1648602 2075200 122466 3178248 54691 288054 49535 3471458 0.08300 0.91700 false true true 6378566 6378566 171356910 70717628 100639282 2052478 2000391 52087 51564874 31249530 20315344 10531276 3904871 6626405 134011684 Sycamore, Aspen, Oncure 2227324 C Investment in ASV 2149934 Investment in Fdtn 1570536 Other Assets Other Receivables 37336 Receivables from Related Organizations 11967712 Receivables from Third Parties 4158104 19883622 Other Liabilities 9994939 Payables to Related Organizations 121386680 131381619 X Part V, Line 4: Intended uses of the endowment fund. 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 : FIN48 Footnote 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, 2019 and 2018, 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 2015 in major tax jurisdictions. true true X true X true X true true true false true true 487868 487868 0.00300 39214087 24667197 14546890 0.09090 39701955 24667197 15034758 0.09390 1204817 8572 1196245 0.00750 202192 202192 0.00130 6332754 1062221 5270533 0.03290 443102 1 443101 0.00280 8182865 1070794 7112071 0.04450 47884820 25737991 22146829 0.13840 58022 58022 0.00040 23631 23631 0.00010 11254 11254 0.00010 10000 10000 0.00010 62441 62441 0.00040 6181 6181 4583 4583 176112 176112 0.00110 true 1361159 48208 39801925 44511047 -4709122 X true true Aspen Surgery Venture LLC Ambulatory surgery center 0.72500 0.27500 1 1 Simi Valley Hospital 2975 N Sycamore Dr Simi Valley CA 93065 See Form 990, Pg 1, Item J 050000216 X X X false false true X X X X X X X X X 19 true true true true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 19 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X X true X false X X X X true X false false Facility: - 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; 3. Data gathering from community members. The CHNA findings result from the extensive analysis of primary and secondary data sources; over 241 indicators from national and state data sources were included in the secondary analysis and primary data was collected from community leaders, non-health professionals, community-based organizations, community members and populations with unmet health needs and/or populations experiencing health disparities. The main source for the secondary data, or data that has been previously collected by the government and other health agencies to inform health planning, is the Health Matters in Ventura County platform, a publicly available data platform.Community Survey: The Community Health Assessment Survey (2019) was designed and disseminated by the Ventura County Community Health Needs Assessment Collaborative. A total of 2,722 responses were collected. The sample size met the conditions of 95% confidence interval and had a margin of error of 1.88%. This was a convenience sample, which means results may be vulnerable to selection bias. The results are generalizable to the population of Ventura County.Of the total survey participants, 84.6% (N = 2303) completed the survey in English and 15.4% (N=419) completed the survey in Spanish.Key Informant and Focus Group Discussion Findings: Key informant interviews and focus group discussions help to develop a deeper understanding for the reasons behind the health data seen in the previous sections. It also served to identify the high priorities among VCCHNAC members and stakeholders. In the case of the key informants, the interviews touched upon many issues that were specific to their area of work, especially with vulnerable populations, whereas the focus group discussions with community members focused on age, race and/or gender issues related to accessing healthcare and barriers to access. Facility: - Part V, Section B, Line 6a The Ventura County CHNA Collaborative (VCCHNAC) is a formal, charter-bound partnership of seven health agencies that came together in June 2018 to participate in the development of a joint CHNA exercise and report. The agencies that constitute the VCCHNAC are: Adventist Health Simi Valley, Camarillo Health Care District, Clinicas Del Camino Real, Inc., Community Memorial Hospital, Ojai Valley Community Hospital, St. Johns Regional Medical Center, Dignity Health, St. Johns Pleasant Valley Hospital and Dignity Health. Facility: - Part V, Section B, Line 11 Our 2016 CHNA identified four areas of significant needs: access to health care, cancer, diabetes, and mental health & substance abuse. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1-Access to Health Care The overall goal is to increase availability and access to healthcare.Focus: Workforce Development & Training Metric -Interventions: 1. COPE Health Scholars Program, Number of Community Members Served: 1,057 Students. 2. Moorpark College School of Nursing and Allied Health, Number of Community Members Served: 141 Students. 2. The College of The Canyons School of Nursing, Number of Community Members Served: 47 Students. 3. Ventura College Paramedic Training, Number of Community Members Served: 24 Students. 4. Simi Institute for Careers EMT, Radiology, Lab, CAN, Number of Community Members Served: 68 Students. Total students served: 1,337Focus: Clinical Services for the Underserved - Interventions: 1. The Free Clinic of Simi Valley1,242 Patients Served, 55 Mammograms, 90 Diagnostic Radiology Tests, 1097 Diagnostic Lab Tests, 4 Lung Cancer Screening Tests, Supplies, EMR, $250,000 in support, Sponsorship of Fundraiser Events for The Free Clinic.Focus: Sports Medicine for High School Athletes- Interventions:1. Personal Trainers and Primary Care for Athletic Programs at Simi Valley and Moorpark High Schools, over 260 athletes screened, valued at $32,263 in 2019.Priority Need 2-Cancer main goal to increase early identification of cancer and support treatment of cancer. Interventions:1. Cancer Care NavigationAHSV provides full time cancer navigators to provide step by step help in navigating a cancer diagnosis. We provide this to anyone in our community regardless of where they receive their treatments. Number of patients served: 300 +2. Breast and Female Cancers Support Groups and EventsAHSV provides support group locations, staff, food, marketing and education materials for various support group activities on a weekly, monthly and annual basis. Program offers: Monthly support group, weekly crochet group, free camisoles for breast cancer patients, free wigs and scarves, grant funding for cancer patients, and Pampered In Pink Annual Education Event. Number of people served: 500 +3. Preventative ScreeningsAHSV provides free lung cancer screenings for patients of the Free Clinic of Simi Valley. Number of people served: 44. Preventative ScreeningsAHSV provides free breast cancer screenings for patients of the Free Clinic of Simi Valley. Number of people served: 55Priority Need 3-Diabetes/Obesity main goal to reduce the impact of diabetes and increase the focus on disease prevention and treatment education. Interventions: Focus: Providing Education and Activities for Kids in Our Communities1. AHSV Provided 9 Free Healthy Kids Fun Zones at sports events and community events in Simi Valley and Moorpark. Paired with education about healthy lifestyle choices and materials for parents, the fun zones encouraged all children attending events to enjoy physical activities such as the rock climbing wall, bungee jumpers, bounce houses, petting zoos and much more. Events typically charge for these activities making them out of reach for some families. Our funding and participation helps the fun zone to have more impact and purpose. Number of Community Members Served: Approximately 15,0002. Healthy Food Program with Simi Valley and Moorpark Boys and Girls Clubs. Number of Community Members Served: Unknown.3. Enhancement Grants with Simi Valley Education Foundation. Number of Community Members Served: 117Focus: Education and Weight Loss1. AHSV helped fund two cohorts of Diabetes Undone and SiMi Fit classes with the Simi Valley Seventh-day Adventist Church. 48 people participated and achieved weight loss and reduction in blood pressure and blood sugar levels.Priority Need 4-Mental Health & Substance Abuse main goal to connect with 1,000 Simi Valley and/or Moorpark Youth with Health Education. Interventions:Focus Area: Prevention1. Sponsorship of empathy program for junior high students in Simi Valley Unified School District. Number of Community Members Served: 8202. Funding and Hosting of Every 15 Minutes DUI Awareness Experience. Number of Community Members Served: 1,4003. Sponsorship of Sports Programs. Number of Community Members Served: Unknown 4. Provided 2 Personal Trainers for Simi Valley High and Royal High. Number of Community Members Served: 200+5. Provided Primary Care for Moorpark College Health Clinic. Number of Community Members Served: 500+b. Based on your 2019 CHP Update, please describe any significant needs that the hospital has been unable to address, and explain why.Priority Areas Not Addressed:Taking existing hospital and community resources into consideration, Simi Valley Hospital will not directly address the remaining health needs identified in the CHNA including: cardiovascular disease, obesity, and preventive practices. Since the hospital cannot address all the health needs present in the community, it will concentrate on those health needs that can most effectively be addressed given the organizations areas of focus and expertise. Simi Valley Hospital will look for partnership opportunities that address needs not selected where it can appropriately contribute to addressing those needs, or where those needs align with current strategy and priorities. Aspen Outpatient Center 2750 N Sycamore Dr Simi Valley CA 93065 Outpatient Imaging & Surgery Child Development Center 1900 E Los Angeles Ave Simi Valley CA 93065 Outpatient Pediatric Therapy Nancy Reagan Breast Center 2750 N Sycamore Dr Simi Valley CA 93065 Outpatient Women's Imaging Part I, Line 7 - Explanation of Costing Methodology The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient charges Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio is multiplied times the hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. Part III, Line 4 - Bad Debt Expense The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals 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 evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments too 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.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue $39,801,925Prior Year Settlements 443,171Cost Report Reimbursable Bad Debts 660,731Estimates and Accrual Variances 211,236Other (1,959,776) __________Total Medicare Revenue $39,157,287*Note: The Medicare Cost Report Revenue includes the patient co-pay and deductible amounts, but not the bad-debt reimbursement. Adding the bad-debt reimbursement would have duplicated the revenue and deductible amounts. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients 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 - Needs Assessment The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) Update for fiscal year 2019, and the 2020 Implementation Strategy, are posted on the hospital's website at https://www.adventisthealth.org/simi-valley/about-us/community-benefit/The two most recent Community Health Needs Assessments, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website athttps://www.adventisthealth.org/about-us/community-benefit/In addition to the CHNA, our hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level? Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. Part VI, Line 3 - Patient Education of Eligibility for Assistance 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.pdf. These 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 - Community Information Located in southern California, Ventura County has a land area of 1,843.1 square miles, which encompasses 10 cities, 13 census-designated places, and 15 other unincorporated communities. According to 2019 Claritas Pop-Facts, Ventura County has a population of 859,967. The most populated zip codes are 93033 (Oxnard), 93065 (Simi Valley), 93030 (Oxnard), and 93063 (Simi Valley) with population totals of 83,972, 74,815, 62,482, and 56,653. The majority of the population is comprised of White (Non-Hispanic), with 41.4% of the population and Hispanics with 42.9% of the population. The Asian population accounts for 7.8% of the population, followed by two or more races with 3.5% of the population, Black or African American with 2.3% of the population, American Indian and Alaska Native with 1.9% of the population, and lastly Native Hawaiian and Other Pacific Islander with 0.3% of the population.In 2018, Ventura Countys population had a median age of 37.5 and a median household income of $81,972. In Ventura County, 50.5% of the population is female, 6.0% are below 5 years of age, 23.2% are below 18 years and 15.0% are 65 years and above. Among county residents, 42,012 have veteran status and 22.5% are foreign born. 38.6% of the people in Ventura County speak a non-English language, and 22.5% are foreign born. The median property value in Ventura County is $520,300 and the homeownership rate is 63.2%. The percent of households with a computer is 90.9% and with a broadband internet subscription is 85.1% (United States Census Bureau, 2018).Oxnard (93030, 93033 and 93036), Santa Paula (93060), Fillmore (93015), and Port Hueneme (93041) are the areas within the county that have the highest socioeconomic needs. In general, the areas of the county with higher socioeconomic needs (highlighted above) have a lower average life expectancy than the average of 82.0 years for Ventura County residents. Conversely, those areas with lower socioeconomic needs such as Oak Park (93777) and Thousand Oaks/Westlake (91361 and 91362) both have life expectancies of 85+ years. Barriers and disparities had the greatest impact among Black and African American populations, with disparities in 19 secondary data health indicators. The White population follows this with disparities in 16 indicators, and the Hispanic or Latino population, with disparities in 11 indicators. Part VI, Line 4 - Community Building Activities The hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. 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 VI, Line 5 - Promotion of Community Health Our hospitals mission is, Living Gods 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 todays 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 healthyeven 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 - Affilated Health Care System The hospital is a member of Adventist Health System/West, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as tele pharmacy 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 - States Filing of Community Benefit Report CA Part VI - Additional Information Part III Other community benefit 1. Breastfeeding and Early Infant Development: AHSV is a Baby-Friendly hospital, which means we have invested thousands of dollars each year for staff training, processes, community education and support for successful long-term breastfeeding.2. Human Trafficking Awareness and Education Initiative: Partnered with Soroptimist of Simi Valley, Simi Valley Police, Ventura County Sheriff and others to build a community outreach and education program to be launched in 2020. 3. AHSV Leaders participating on community-based organization boards: Boys & Girls Club of Simi Valley and Moorpark, Simi Valley Education Foundation, Simi Valley Chamber of Commerce, Moorpark Chamber of Commerce, Samaritan Center of Simi Valley, The Free Clinic of Simi Valley, Moorpark College, Ventura County Medical Resource Foundation, and The YMCA of Simi Valley.4. AHSV Leaders and Employees participating in CBO organizations: Every 15 Minutes, 2-Step CPR Training, First Five, Child Abuse Prevention Council, Rotary Club of Simi Valley, Kiwanis Club of Simi Valley, and Interfaith Council. true Free Clinic Of Simi Valley 2060 Tapo St Simi Valley CA 93063 237108154 501(c)(3) 7572 0 Funds Transfer Donation National Health Foundation 515 South Figueroa Street Los Angeles CA 90071 237314808 501(c)(3) 7000 0 Funds Transfer Donation Rotary Club Of Simi Sunrise 5005 E Los Angeles Ave Simi Valley CA 93063 770392570 501(c)(4) 10000 0 Funds Transfer Donation Simi Valley Seventh Day Adven 1636 Sinaloa Rd Simi Valley CA 93065 951816072 501(c)(3) 10000 0 Funds Transfer Donation Simi Valley Unified School Di 101 W Cochran St Simi Valley CA 93065 Government Agency 10000 0 Funds Transfer Donation 3 2 Additional Supplemental Information Grants are donations made to US tax exempt organizations, Government Entities and Civic organizations who are community partners, known to us, and present a valid purpose for their donation request. It is anticipated that no further monitoring is required. X X X X true true false false false false false false false Adamos Eugene Pharmacist 161550 39630 8118 26687 235985 Anderson Brian A Sec thru 5/19 97101 24502 195002 13864 18182 348651 Burke James Medical Officer, SCR 336072 11942 27285 375299 Carol Deamer Director, Pharmacy 207738 250 6915 11788 200 226891 DavisWhitney Comm Director, SCR 129567 16429 3652 7838 20892 178378 Dingilian John Medical Officer 291748 32509 57362 16782 41804 440205 Esparza Caroline COO/CNO 260896 25524 58426 16782 31219 392847 Fargo Roland Former Physician Ops Officer 58258 417688 39167 515113 Fernandes Shalini RN 186446 2444 10766 26673 226329 Ferrier Cory Bus Dev Exec 175000 2995 22186 12126 212307 Jahn Andrew President, SCR 811125 201952 241867 16782 43130 1314856 Jobe Meredith Secretary 524870 65461 140054 16782 29127 776294 Mallari Christopher RN 201333 1800 8115 30379 241627 Milatovic Natasa Reg HR Dir, SCR 314010 68963 76232 16782 33198 509185 Nahapetian Arby Medical Officer, SCR 556818 153586 131390 16782 42060 900636 Owens Chip Treas/A Sec 219292 41087 7035 15937 38712 322063 Percival Kathleen Admin Dir, Org Per 185558 250 1207 9858 11180 208053 Raffoul John Finance Officer, SCR 545731 198623 2032885 16782 31256 2825277 1893381 Reiner Scott Dir/Chair 1510024 420315 65357 16782 36952 2049430 Reppert Joseph A/Sec thru 8/19 581409 187572 440088 16782 40783 1266634 Swenson Jennifer President 401466 54532 121515 16782 45110 639405 Wagner Jack Former Asst Secr 778475 29189 807664 Wehtje Ronald CFO SCR thru 03/2019 209145 300 55715 8290 273450 Werner William VP Support Services 215710 21544 44239 14377 41619 337489 Wing Bill Dir/A Sec/CFO 1200390 318717 53147 16782 29801 1618837 Zachary Beth President SCR thru 12/2019 840555 11540 36127 888222 Denise Anderson Officer Spouse 20764 Employment false Henry Linda Key EE Sister 65157 Employment false Grant Swenson Officer Spouse 99331 Employment false Sandra Werner Key EE Spouse 320732 Employment false Joyce Newmyer Key EE-Sister IL 877534 Employment false Schedule L, Part V Supplemental Information Additional information regarding interested persons listed above:1. Denise Anderson is the wife of Brian Anderson, an officer of the board.2. Linda Henry is the sister of Former Adventist Health board member and current Key Employee, Wesley Rippey.3. Grant Swenson is the husband of Jennifer Swenson, President of AH Simi Valley.4. Sandra Werner is the wife of William Werner, a Key Employee.5. Joyce Newmeyer, a Key Employee of Adventist Health, is the sister of William Werner, a Key Employee of AH Simi Valley. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder 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 public benefit corporation that operates as a public charity. The Hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body 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, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 11b: Form 990 Review Process 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 corporation's Board of Directors prior to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital 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 CEO immediately.The Corporate General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees 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 Corporate General Counsel reviews all the disclosures on the board and Corporate employees' COIs. Corporate General Counsel retains the COIs for the board members. 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, Line 15a: Compensation Review & Approval Process - CEO, Top Management The hospital board of directors has established a Compensation Committee to overseethe executive compensation program. This committee is composed of independentdirectors with no conflicts of interest. The committee performs the followingfunctions: recommends a total compensation philosophy to the board; assurescompliance with the board-approved philosophy; meets annually to reviewcomparability data from outside consultants; recommends any adjustments to currentexecutive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annualgoals; recommends appropriate incentive awards to the board for approval; follows adiligent process that meets regulatory requirements for a rebuttable presumption ofreasonableness; records committee deliberations and decisions in timely minutes;selects, engages and supervises any consultant hired to advise and providecomparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs 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 CEO 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, Line 15b: Compensation Review and Approval Process for Officers and Key Employees See Line 15b explanation. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available 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. Other Changes In Net Assets Or Fund Balances - Other Decreases Change in minority interest - Aspen Surgery Cntr = -$24210 Other Changes In Net Assets Or Fund Balances - Other Decreases JV Distributions = -$100000 Other Changes In Net Assets Or Fund Balances - Other Decreases Loss from Non-Hospital investments = -$302112 Other Changes In Net Assets Or Fund Balances - Other Decreases Net Assets Released fr Restrictions = -$283285 Other Changes In Net Assets Or Fund Balances - Other Increases Net Assets Released From Restrictions Capital Addt'ns = $98599 Other Changes In Net Assets Or Fund Balances - Other Increases Other Adjustments = $33082 Other Changes In Net Assets Or Fund Balances - Other Increases Restricted Gifts & Grants = $165179 Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated Health System CA 501(c)(3) 10 NA false Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Medical Ctr Tehachapi 1100 Magellan Dr Tehachapi CA 93561 812240617 Hospoital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 12b2 Adventist Health SystemWest false Adventist Health So CA Medical Fdtn PO Box 619135 Roseville CA 95661 954424391 Discontinued Operations CA 501(c)(3) 12b2 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) 3 Adventist Health SystemWest false Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Fremont- Rideout Health Group 898 Plumas Street Yuba City CA 95991 942917251 Acute Care Hospital CA 501(C)(3) 12b2 Stone Point Health false Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Lodi Memorial Hospital Assn Inc 975 So Fairmont Ave Lodi CA 95240 941044474 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Northwest Medical Fdtn of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Reedley Community Hospital 372 Cypress Ave Reedley CA 95370 453220509 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Acute Care Hospital CA 501(c)(3) 3 Freemont Rideout Health Group false St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting Organization CA 501(C)(3) 12b2 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled Nursing/Assisted Living/Hm Care CA 501(c)(3) 12b2 Fremont Rideout Health Group false Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital WA 501(c)(3) 3 Advenstist Health System West false Western Health Resources PO Box 61935 Roseville CA 95661 953867863 Home Care CA 501(C)(3) 10 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Adventist Health Delano P O Box 460 Delano CA 93216 770258013 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 HOSPITAL CA 501(c)(3) 3 Adventist Health System West false Simi Valley Hospital Foundation 2975 N Sycamore Dr Simi Valley CA 93065 912135595 Fundraising for Hospital CA 501(c)(3) 3 Western Health Resources true ASPEN SURGERY VENTURE LLC 2975 SYCAMORE DRIVE SIMI VALLEY CA 93065 263913327 SURGERY CENTER CA SIMI VALLEY HOSPITAL false true 0.69000 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA AHSWest C-Corp false false false false false true false false false false false false true true true true true true true true Adventist Health SystemWest e 121386680 Notes Payable Adventist Health SystemWest o 1851655 Compensation Adventist Health SystemWest p 21868112 Operating Exp Adventist Health SystemWest r 96876 Cash Mgt Funds Simi Valley Hospital Foundation o 157987 Compensation Simi Valley Hospital Foundation s 137678 Fund Transfers