LODI MEMORIAL HOSPITAL ASSOCIATION INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- LODI MEMORIAL HOSPITAL ASSOCIATION INC (EIN 94-1044474)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-10
- IRS object ID
- 202003159349303225
- Schema version
- 2019v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-10T13:20:41-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941044474 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lodi Memorial Hospital Association Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LODI | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S Fairmont Avenue | AddressLine1Txt |
| City | Lodi | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952405118 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jason Whitney | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2020-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2020-10-29 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 172.9.161.112 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-29 | IPDt |
| IP Tm | 20:23:40 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Lodi Memorial | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Daniel Wolcott | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S Fairmont Avenue | AddressLine1Txt |
| City | Lodi | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952405118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $246,312,858 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/lodi-memorial/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1536 | TotalEmployeeCnt |
| Total Volunteers | 81 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $778,608 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,735,423 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $241,771,008 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $241,327,051 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,253,387 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,960,474 | CYInvestmentIncomeAmt |
| PY Other Revenue | $406,019 | PYOtherRevenueAmt |
| CY Other Revenue | $83,563 | CYOtherRevenueAmt |
| PY Total Revenue | $244,209,022 | PYTotalRevenueAmt |
| CY Total Revenue | $246,106,511 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $285,718 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $100,085 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $107,063,428 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $102,001,240 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $390,753 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $130,569,171 | PYOtherExpensesAmt |
| CY Other Expenses | $143,924,606 | CYOtherExpensesAmt |
| PY Total Expenses | $237,918,317 | PYTotalExpensesAmt |
| CY Total Expenses | $246,025,931 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,290,705 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $80,580 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $303,047,094 | TotalAssetsBOYAmt |
| Total Assets EOY | $239,446,881 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $229,243,113 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $166,271,894 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $73,803,981 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $73,174,987 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $198,682,967 | ExpenseAmt |
| Grant | $100,085 | GrantAmt |
| Revenue | $241,327,051 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $198,682,967 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1536 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jay Lipps VP System Controller | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9164061092 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Ferch Wayne | ||||||||||
| President, CCR | 8.33 | 41.67 | Yes (X) | $0 | $4,448,122 | $47,838 | ||||
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | $0 | $1,995,696 | $53,734 | Yes (X) | Yes (X) | |||
| Wing Bill | ||||||||||
| Dir/Vice Chair/Asst Secr | 0.00 | 50.00 | $0 | $1,572,254 | $46,583 | Yes (X) | Yes (X) | |||
| Reppert Joseph | ||||||||||
| CFO/Asst Secr thru 08/2019 | 0.00 | 50.00 | $0 | $1,209,069 | $57,565 | Yes (X) | ||||
| Larsen David | ||||||||||
| Finance Officer, CCR thru 04/19 | 8.33 | 41.67 | Yes (X) | $0 | $777,379 | $316,645 | ||||
| Wagner Jack | ||||||||||
| Former Asst Secr thru 03/18 | 0.00 | 0.00 | $0 | $778,475 | $29,189 | Yes (X) | ||||
| Wolcott Daniel | ||||||||||
| President | 50.00 | 0.00 | $0 | $722,077 | $59,517 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | $0 | $730,385 | $45,909 | Yes (X) | ||||
| Chen Steven | ||||||||||
| Finance Officer, CCR | 8.33 | 41.67 | Yes (X) | $0 | $671,517 | $59,363 | ||||
| Iris Patricia | ||||||||||
| Medical Officer | 8.33 | 41.67 | Yes (X) | $0 | $406,188 | $28,331 | ||||
| Moreno Debbe | ||||||||||
| CNO thru 09/19 | 0.00 | 50.00 | Yes (X) | $0 | $377,063 | $45,351 | ||||
| Whitney Jason | ||||||||||
| Treasurer | 50.00 | 0.00 | $0 | $357,622 | $56,322 | Yes (X) | ||||
| McCollough Brooke | ||||||||||
| Operations Executive | 0.00 | 50.00 | Yes (X) | $0 | $335,104 | $54,777 | ||||
| Gruzensky Denton | ||||||||||
| Reg HP Dir, CCR | 8.33 | 41.67 | Yes (X) | $0 | $321,342 | $45,976 | ||||
| Beck-Atwater Sandra | ||||||||||
| Director Hospital Pharmacy | 50.00 | 0.00 | $223,072 | $0 | $39,463 | Yes (X) | ||||
| Carmody Thomas | ||||||||||
| Physician Assistant | 50.00 | 0.00 | $228,102 | $0 | $26,749 | Yes (X) | ||||
| Brown Mary | ||||||||||
| RN, House Supervisor | 50.00 | 0.00 | $216,357 | $0 | $26,677 | Yes (X) | ||||
| Markovich Jennifer | ||||||||||
| Director, RN | 50.00 | 0.00 | $199,081 | $0 | $27,445 | Yes (X) | ||||
| Stump Valerie | ||||||||||
| Director, RN | 50.00 | 0.00 | $205,738 | $0 | $20,070 | Yes (X) | ||||
| PickeringChristine | ||||||||||
| Communication Dir, CCR | 8.33 | 41.67 | Yes (X) | $0 | $163,858 | $30,977 | ||||
| Ziegele Paul | ||||||||||
| Former Treas thru 05/2018 | 0.00 | 0.00 | $0 | $150,324 | $33,920 | Yes (X) | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | $0 | $28,588 | $0 | Yes (X) | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | $0 | $28,246 | $0 | Yes (X) | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | $0 | $26,315 | $0 | Yes (X) | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | $0 | $20,102 | $0 | Yes (X) | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | $0 | $18,852 | $0 | Yes (X) | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | $0 | $15,000 | $0 | Yes (X) | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | $0 | $8,848 | $0 | Yes (X) | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | $0 | $6,382 | $0 | Yes (X) | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | $0 | $2,367 | $0 | Yes (X) | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | $0 | $553 | $0 | Yes (X) | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | $0 | $0 | $0 | Yes (X) | ||||
| Philip Celeste | ||||||||||
| Director | 0.00 | 4.00 | $0 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,072,350 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $15,171,728 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,152,401 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 298 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Regents of the University of California | |||||
| 1111 Franklin Street 12th floor | Oakland | CA | 94607 | Physician Professional Fees | $8,192,891 |
| CEP America - Anesthesia PC | |||||
| 2100 Powell Street Suite 900 | Emeryville | CA | 94608 | Physician Professional Fees | $3,082,069 |
| Satellite Healthcare Inc | |||||
| PO Box 45545 | San Francisco | CA | 94145 | Dialysis Coverage | $757,211 |
| PT Solutions Holdings LLC | |||||
| PO Box 724557 | Atlanta | GA | 31139 | Physical, Speech, and Occupational Thera | $661,819 |
| Restorix Health | |||||
| 445 Hamilton Avenue Suite 800 | White Plains | NY | 10601 | Physician Professional Fees | $599,093 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 35 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $75,466 | GovernmentGrantsAmt |
| All Other Contributions | $2,659,957 | AllOtherContributionsAmt |
| Total Contributions | $2,735,423 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621400 | $237,998,487 | $237,998,487 |
| Prop 56/Tobacco Tax | 900099 | $1,758,705 | $1,758,705 |
| Other program revenue | 621990 | $875,601 | $875,601 |
| Dietary service revenue | 621400 | $694,258 | $694,258 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $241,327,051 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,957,850 | TotalRevenueColumnAmt |
| Exclusion | $1,957,850 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $245,603 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $171,432 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $74,171 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,171 | TotalRevenueColumnAmt |
| Exclusion | $74,171 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,624 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,624 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,624 | TotalRevenueColumnAmt |
| Exclusion | $2,624 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $44,307 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $34,915 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,392 | TotalRevenueColumnAmt |
| Exclusion | $9,392 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $246,106,511 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $241,327,051 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,044,037 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,085 | TotalAmt |
| Program Services | $100,085 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $421,629 | TotalAmt |
| Program Services | $421,629 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,276,648 | TotalAmt |
| Program Services | $74,574,385 | ProgramServicesAmt |
| Management And General | $5,392,946 | ManagementAndGeneralAmt |
| Fundraising | $309,317 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,788,427 | TotalAmt |
| Program Services | $3,630,633 | ProgramServicesAmt |
| Management And General | $142,456 | ManagementAndGeneralAmt |
| Fundraising | $15,338 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,699,480 | TotalAmt |
| Program Services | $11,027,643 | ProgramServicesAmt |
| Management And General | $635,945 | ManagementAndGeneralAmt |
| Fundraising | $35,892 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,815,056 | TotalAmt |
| Program Services | $5,496,945 | ProgramServicesAmt |
| Management And General | $294,595 | ManagementAndGeneralAmt |
| Fundraising | $23,516 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,640,618 | TotalAmt |
| Management And General | $18,640,618 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,827 | TotalAmt |
| Program Services | $112,446 | ProgramServicesAmt |
| Management And General | $96,381 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,799 | TotalAmt |
| Management And General | $21,799 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,960 | TotalAmt |
| Program Services | $20,960 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,175,904 | TotalAmt |
| Program Services | $34,033,530 | ProgramServicesAmt |
| Management And General | $14,142,374 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,615 | TotalAmt |
| Program Services | $3,529 | ProgramServicesAmt |
| Management And General | $1,086 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $887,709 | TotalAmt |
| Program Services | $741,392 | ProgramServicesAmt |
| Management And General | $140,287 | ManagementAndGeneralAmt |
| Fundraising | $6,030 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,476,415 | TotalAmt |
| Program Services | $1,651,416 | ProgramServicesAmt |
| Management And General | $5,824,999 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,411,260 | TotalAmt |
| Program Services | $5,474,516 | ProgramServicesAmt |
| Management And General | $936,744 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,360 | TotalAmt |
| Program Services | $128,776 | ProgramServicesAmt |
| Management And General | $91,584 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,380 | TotalAmt |
| Program Services | $89,228 | ProgramServicesAmt |
| Management And General | $62,152 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,482,397 | TotalAmt |
| Program Services | $4,478,024 | ProgramServicesAmt |
| Management And General | $4,373 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,909,977 | TotalAmt |
| Program Services | $10,880,560 | ProgramServicesAmt |
| Management And General | $29,417 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,664 | TotalAmt |
| Program Services | $369,664 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Patient care supplies | $30,475,598 | $30,335,727 | $139,211 | $660 |
| Hospital Medi-Cal Quali | $14,431,881 | $14,431,881 | ||
| Leased equipment expens | $603,215 | $602,123 | $1,092 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $432,027 | TotalAmt |
| Program Services | $77,875 | ProgramServicesAmt |
| Management And General | $354,152 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,025,931 | TotalAmt |
| Program Services | $198,682,967 | ProgramServicesAmt |
| Management And General | $46,952,211 | ManagementAndGeneralAmt |
| Fundraising | $390,753 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,693 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,961,565 | BOYAmt |
| EOY | $38,010,058 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,949 | BOYAmt |
| EOY | $20,750 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,008,053 | BOYAmt |
| EOY | $31,272,151 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,772,055 | BOYAmt |
| EOY | $3,299,452 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $468,288 | BOYAmt |
| EOY | $1,008,686 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $264,650,484 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $142,769,954 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,227,456 | BOYAmt |
| EOY | $121,880,530 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,976,079 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,686,702 | BOYAmt |
| EOY | $8,977,126 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,825,254 | BOYAmt |
| EOY | $34,978,128 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $303,047,094 | BOYAmt |
| EOY | $239,446,881 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,029,968 | BOYAmt |
| EOY | $20,120,044 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $210,213,145 | BOYAmt |
| EOY | $146,151,850 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,243,113 | BOYAmt |
| EOY | $166,271,894 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,262,660 | BOYAmt |
| EOY | $70,003,285 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $541,321 | BOYAmt |
| EOY | $3,171,702 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,803,981 | BOYAmt |
| EOY | $73,174,987 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $303,047,094 | BOYAmt |
| EOY | $239,446,881 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $80,580 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$709,574 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $20,960 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $20,960 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $541,320 | BeginningYearBalanceAmt |
| Contributions | $2,659,952 | ContributionsAmt |
| Other Expenditures | $29,572 | OtherExpendituresAmt |
| End Year Balance | $3,171,700 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $602,023 | BeginningYearBalanceAmt |
| Contributions | $569,686 | ContributionsAmt |
| Other Expenditures | $630,389 | OtherExpendituresAmt |
| End Year Balance | $541,320 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $562,343 | BeginningYearBalanceAmt |
| Contributions | $689,003 | ContributionsAmt |
| Grants Or Scholarships | $3,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $41,917 | OtherExpendituresAmt |
| End Year Balance | $602,023 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $547,340 | BeginningYearBalanceAmt |
| Contributions | $148,830 | ContributionsAmt |
| Other Expenditures | $133,827 | OtherExpendituresAmt |
| End Year Balance | $562,343 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $599,512 | BeginningYearBalanceAmt |
| Contributions | $2,186,902 | ContributionsAmt |
| Other Expenditures | $2,239,075 | OtherExpendituresAmt |
| End Year Balance | $547,339 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,811,038 | OtherCostOrOtherBasisAmt |
| Book Value | $9,811,038 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $187,005,423 | OtherCostOrOtherBasisAmt |
| Depreciation | $91,844,796 | DepreciationAmt |
| Book Value | $95,160,627 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,225,181 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,012,936 | DepreciationAmt |
| Book Value | $212,245 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $56,882,510 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,733,558 | DepreciationAmt |
| Book Value | $12,148,952 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,726,332 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,178,664 | DepreciationAmt |
| Book Value | $4,547,668 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $121,880,530 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from related organizations | $17,913,122 |
| Receivables from third-party payors | $16,586,819 |
| State Board of Pharmacy receivable | $345,251 |
| Other assets | $132,936 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $34,978,128 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Payable to related organizations | $140,985,413 |
| Other liabilities | $4,726,136 |
| Conditional asset retirement | $440,301 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $146,151,850 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| Part X, Line 2: | The principal operations of the System is 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, 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $419,866 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $419,866 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $85,494,723 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $66,403,494 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,091,229 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07760 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $85,914,589 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $66,403,494 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,511,095 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07930 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,101,795 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $607,700 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $494,095 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $385,004 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $385,004 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,276,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $124,863 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,151,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03720 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,259 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $900 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $37,359 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,801,882 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $733,463 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,068,419 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04100 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $96,716,471 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $67,136,957 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,579,514 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12030 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,491 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,491 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,647 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,647 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,775 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,775 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,913 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,902,169 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $196,100 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $60,688,759 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $63,180,458 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,491,699 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct | Ofcr Etc Profit Or OwnershipOfcrEtcProfitOrOwnershipPct | Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct |
|---|---|---|---|
| 2 Endoscopy Center of Lodi LLC | |||
| Ambulatory Surgery Center | 0.78000 | 0.00000 | 0.22000 |
| 3 Lodi Outpatient Surgery Center | |||
| Ambulatory Surgery Center | 0.78000 | 0.00000 | 0.22000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | State LicenseStateLicenseNum | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Facility Reporting GroupFacilityReportingGroupCd | Address Line2USAddress/AddressLine2Txt | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lodi Memorial Hospital Association Inc dba AHLM | ||||||||||||
| 1 | 975 S Fairmont Ave | Lodi | CA | 95240 | www.adventisthealth.org/lodi-memorial/ | 030000056 | Yes (X) | Yes (X) | Yes (X) | A | ||
| Lodi Memorial Hospital - West dba AHLM | ||||||||||||
| 2 | 800 Lower Sacramento Road Acute | Lodi | CA | 95242 | www.adventisthealth.org/lodi-memorial/ | 030000056 | Yes (X) | Yes (X) | A | Phys | Outpatient departments at this campus | |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Facility Reporting Group - A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assessment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assessment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Section B | Facility Reporting Group A |
| Facility Reporting Group A consists of: | - Facility 1: Lodi Memorial Hospital Association, Inc. dba A, - Facility 2: Lodi Memorial Hospital - West dba AHLM |
| Facility Reporting Group - A Part V, Section B, line 5: | The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering from community members. Community input was provided by a broad range of community members using key informant interviews, focus groups, and surveys. Individuals with the knowledge, information, and expertise relevant to the health needs of the community were consulted. These individuals included representatives from local governmental and public health agencies as well as leaders, representatives, or members of underserved, low-income, and minority populations. Additionally, where applicable, other individuals with expertise of local health needs were consulted. Thirteen key informant interviews individuals representing diverse sectors in San Joaquin County including: public health, health care, community-based organizations, social services, education and government. Thirty-one community resident focus groups were conducted in geographic areas within San Joaquin County, including Stockton, Lodi, Tracy and Manteca. Nineteen groups were conducted in English, ten were conducted in Spanish, one was conducted in Tagalog and one was conducted in Cambodian. Participants were teens, adults, and older adults, who represented underserved, low-income, and varied ethnic communities.Secondary data sources include collected data on key health indicators, morbidity, mortality, and various social determinants of health from the Kaiser Permanente CHNA Data Platform, Health Places Index, American Community Survey and various other state and federal databases. |
| Facility Reporting Group - A Part V, Section B, line 6a: | Hospitals that participated in the 2019 CHNA process included Dameron Hospital, Kaiser Permanente, Sutter Health and Dignity Health St. Joseph's Medical Center. |
| Facility Reporting Group - A Part V, Section B, line 6b: | Other non-hospital facilities that participated in the 2019 CHNA process included Community Medical Centers, First 5 San Joaquin, Health Net, Health Plan of San Joaquin, San Joaquin County Public Health Services. |
| Facility Reporting Group - A Part V, Section B, line 11: | Our 2016 CHNA identified three priority areas for our community health investments from 2017-2019 which are Wellness (diabetes and obesity prevention), Access to Care (including mental health) and Youth Development. The results from the CHNA have guided the following interventions on how we could best provide for our community and the most vulnerable among us. Priority Need 1 - Wellness (Diabetes and Obesity Prevention): Our Goal is to increase community knowledge of healthy nutrition through educational programming, the partnership with community organizations and faith congregations to conduct children focused nutritional education and the collaboration with area organizations and churches to conduct health eating lecture events. We also want to offer support services to enhance physical activity, partner with area organizations to increase opportunity for activity within our community and collaborate with area organizations to promote a broader awareness about the importance of activity. Interventions: 1. Diabetes Among Friends is a five-week series of diabetes education to prevent prediabetes progression to type 2 and to improve management in those with type 1 and type 2 diabetes. The program is designed to take important nutrition and activity education out to the most critical areas in the community. The lessons include "Getting to know Diabetes," "Healthy Eating," "Healthy Coping & Physical Activity," "Diabetes Medications, and Staying Healthy with Diabetes." Number of community members served: 66.2. Healthy Choices is another class offered free of charge to community members. The class is held once a month. Each class is designed to educate and provide the skills to support sustainable, health-improving behavior change. Our team of physicians, nurses, dietitians and health coaches will offer lectures, interactive workshops and health coaching. Some of the topics will include: Tips to improve weight control, disease prevention and management including: high blood pressure, high cholesterol, diabetes, heart disease, healthy cooking 101: cooking demonstrations, healthy meals, sweets and holiday recipes, nutrition education, label reading and tips for eating out and stress management. Number of community members served: 151.3. Dancing for Health Nutrition Education & Zumba Class: AHLM partnered with San Joaquin County Public Health Services and the First Baptist Church to run a program that included Zumba, a nutritional health lesson, and a nutrition demo with healthy foods. The event was free to community members, with a specific focus on our Latino population, as Latinos face higher rates of obesity and diabetes in our county. Pre and post surveys administered in the Dancing for Health Nutrition Education & Zumba Class, demonstrated that participants' awareness of healthy food options increased. Some of the participants shared changes they were making in their food choices and lifestyles based on what they learned in the class. Number of community members served: 23.4. Adventist Health Lodi Memorial offered ongoing and consistent opportunities for the community to increase nutritional knowledge. Those programs included a range of learning environments, from small groups to community health expos and fairs. Staff time and organizational financial resources were utilized to accomplish this objective. The list of those outreach initiatives includes: diabetes preventions talk, health fairs were held in various locations and times, including the Sikh Temple, Walk for the Health of It and Love Lodi. Cooking classes for youth were held at Lodi Middle School and Millswood Middle School. Nutrition and diabetes prevention talk was also done for community members at a monthly support group with healthy cooking demos and physician and dietician lectures were held at our West Campus. Number of community members served: 251.Priority Need 2 - Access to Care (Including Mental Health): Our goal is to increase access to primary care, provide education on care access points for at risk populations and promote enrollment of uninsured into appropriate government programs. Interventions: 1. Enrollment Assistance/Public Medical Programs - Enrollment Assistance/Public Medical Programs - The admissions office at Adventist Health Lodi Memorial screens for insurance coverage and refers uninsured patients to a service call Parallone. Parallone assists with setting these patients up with Medi-Cal. Adventist Health Lodi Memorial uses a service called Cryacomm (Language Access Network), which offers over-the-phone interpreter services. This service has over 250 available languages. This service can be used to assist patients who do not speak English. Number of community members served: 420.2. Enrollment Assistance/Public Medical Programs - Provided free services through the WEROC Clinic for those that did not qualify for insurance. Number of community members served: 692.3. Recruited primary care providers to meet access to demand: five providers were recruited in 2019. These include gastroenterologists, orthopedic doctors, an anesthesiologist, a primary care provider, and family practice provider. 4. AHLM continues to provide mental health resources online under the patient resources tab. Priority Need 3 - Youth Development: We envision a community where the youth will thrive through early youth development with an emphasis on literacy, education, mentorship, and the support of organizations dedicated to helping youth in the community. Interventions:1. Camp Hutchins - Camp Hutchins is a professional child care and preschool for children three to five years of age. The program is designed specifically for children in preparation for kindergarten with creative and cultural experiences in music, art, literature, group and hands-on learning activities. Camp Hutchins has a year-round swimming pool, provides opportunity for outdoor play, and transportation from local schools to the program. Camp Hutchins also provides students lunch and snacks. Number of community members served: 95 children had 15,882 visits. 2. School Based Health Education Programs - Adventist Health Lodi Memorial's exercise physiologist attended Westwood Nutrition, Health, & Safety Fair. He provided interactive presentation questioning and guiding topics related to physical activity and health, i.e. asking recommended exercise minutes for children, why should we exercise, what is exercise, what exercises do you enjoy. Students then performed a team relay applying cardio, strength, and mobility. Adventist Health also hosted a health and nutrition booth. Another school-based program was led by our community outreach nurse who provides the students with healthy foods cooking demos and recipes. Lastly, Heritage Elementary School hosted a community event which included gardening activities, medical screenings, a farmer's market, summer meal access to children, and more. Adventist Health Lodi Memorial had two booths - one provided physical activity and the other was a nutritional "rethink your drink" type of booth. The physical activity booth provided education, and a tug of war event for the children. Community members served: 735. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 18 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (18 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Lodi Outpatient Surgical Center | ||||
| 521 S Ham Lane Suite F | Lodi | CA | 95242 | Ambulatory Surgical Center |
| 2 - AHLM Wound & Hyperbaric Care | ||||
| 2415 W Vine Street Suite 106 | Lodi | CA | 95242 | Outpatient Clinic - Hyperbaric & Wound Care |
| 3 - Endoscopy Center of Lodi LLC | ||||
| 840 S Fairmont Avenue Suite 1 | Lodi | CA | 95240 | Ambulatory Endoscopy/Surgical Center |
| 4 - AHLM Millsbridge Family Medicine | ||||
| 1901 W Kettleman Lane Suite 200 | Lodi | CA | 95242 | Community Clinic - Family Medicine |
| 5 - Galt Family and Specialty Care | ||||
| 387 Civic Drive | Galt | CA | 95632 | Outpatient Clinic - Family Medicine |
| 6 - Advanced Imaging Center at AHLM | ||||
| 1031 S Fairmont Avenue | Lodi | CA | 95240 | Outpatient Diagnostic Imaging |
| 7 - AHLM Pediatric Care | ||||
| 2415 W Vine Street Suite 100 | Lodi | CA | 95242 | Outpatient Clinic - Pediatric care |
| 8 - Urgent Care Clinic | ||||
| 1235 W Vine Street Suite 20 | Lodi | CA | 95240 | Outpatient Clinic - Urgent Care Services |
| 9 - Ham Lane Clinic - Fairmont Ave | ||||
| 845 S Fairmont Avenue Suite 8 | Lodi | CA | 95240 | Outpatient Clinic - Cardiology & Pulmonology |
| 10 - AHLM Family Medicine | ||||
| 2415 W Vine Street Suite 105 | Lodi | CA | 95242 | Outpatient Clinic - Family Medicine |
| 11 - AHLM OrthopedicsSports Medicine | ||||
| 1235 W Vine Street Suite 22 | Lodi | CA | 95240 | Community Clinic - Orthopedics & Sports Medicine |
| 12 - Adventist Health Home Health | ||||
| 800 S Lower Sacramento Road | Lodi | CA | 95242 | Home Care Services |
| 13 - AHLM West Pharmacy | ||||
| 2415 W Vine Street Suite 104 B | Lodi | CA | 95240 | Retail Pharmacy |
| 14 - AHLM Trinity Multi-Specialty Care | ||||
| 10200 Trinity Parkway Suite 102 | Stockton | CA | 95219 | Community Clinic - Multi-specialty Care |
| 15 - Ione Family Care Clinic | ||||
| 305 Preston Avenue | Ione | CA | 95640 | Outpatient Clinic - Family Medicine |
| 16 - AHLM Prenatal Care | ||||
| 2415 W Vine Street Suite 103 | Lodi | CA | 95242 | Outpatient Clinic - Prenatal Care |
| 17 - AHLM Occupational Medicine | ||||
| 800 S Lower Sacramento Road | Lodi | CA | 95242 | Outpatient Clinic - Occupational Medicine |
| 18 - AHLM Walter E Reiss Outreach Clinic | ||||
| 300 W Oak Street | Lodi | CA | 95240 | Free Clinic |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Specific Ratios of Costs to charges are utilized for each department. Where applicable the source of these ratios are the Medicare Cost Report. |
| Part II, Community Building Activities: | The hospital is involved in numerous community building activities which promote the health of the 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 III, Line 3: | The Hospital provided care to all who presented themselves in our emergency room, without asking for proof of insurance. The Hospital's uninsured population continues to increase. Uninsured patients are screened for Medicaid linkage, given assistance in applying for Medicaid and if ineligible for Medicaid are given information regarding the Hospital's Charity Care Policy and encouraged to apply for charity care. Often the information gathered in the Medicaid application will make this determination "automatic". If additional information is required, the Hospital attempts to contact the patient. Those that do not respond will be sent to a collection agency after 120 days and four statements. The Hospital estimates 21% of bad debt expense (calculated at cost) should be considered charity care. The Hospital's bad debt accounts are analyzed by a third party to determine this amount. |
| Part III, Line 4: | Costing methodology:Utilizing the previous costing methodology as outlined in response to Part I, Line 7, all patients are assigned a payor class (i.e. charity, self pay, Medicare, Medi-Cal, managed care). The cost by payor is a summation of all patients in the assigned payor class. The amounts written off as bad debt (assigned to a collection agency) are net of any applicable payments or discounts. Any payments received after an account is assigned to a collection agency reduce the bad debt expense in the period received.Uncompensated care and community benefit costs:Our policy is to provide service to all who require it, regardless of their ability to pay. As such, the Hospital provides substantial amounts of uncompensated care. When this care is provided to patients who lack financial resources and therefore are deemed medically indigent, it is classified as charity care. When it is provided to patients who have the means to pay, but decline to do so, it is classified as provision for uncollectible accounts. Some undetermined portion of the provision for uncollectible accounts represents care to indigent patients who the Hospital has been unable to identity as charity. Charity care charges are not reflected in net patient service revenues. In addition, we provide services to poor and underserved persons who cannot afford health care because of inadequate resources and/or are uninsured or underinsured, including patients insured under certain government-reimbursed public aid programs. Such programs pay providers amounts that are less than established charges for the services provided to the recipients and frequently the payments are less than the costs of rendering the services.Patient accounts receivable:Patient accounts receivable for services provided to patients covered under the Medicare and Medicaid (Medi-cal in California) programs, privately sponsored managed care programs for which payment is made based on terms defined under formal contracts, and other payors (including self-pay) are recorded at their estimated realizable value based on contractual billing rates or our standard billing rates for our non-contracted payors. The Hospital regularly reviews accounts and contracts and provide appropriate estimates of contractual allowances that are then netted against patient accounts receivable. The Hospital also provides an estimated allowance for uncollectible accounts based on the Hospital's evaluation of the aging of our patient accounts receivable, the Hospital's historical collection experience for each type of payor and other relevant factors.The Hospital's primary concentration of credit risk is patient accounts receivable, which consists of amounts owed by various governmental agencies, insurance companies and private patients. The Hospital grants credit without collateral to the Hospital's patients and third party payors. |
| Part III, Line 8: | The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the united states. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer. Since the 1997 balanced budget act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others.Without Medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare revenue from the Hospital's Medicare Cost Report to GL: Revenue Rec. *Medicare Cost Report revenue 60,688,759 Prior year settlements 4,800,695 Cost report reimbursable bad debts 1,045,492 Non-Cost Report Revenue 14,509,031 Estimates and accrual variances 688,922 Other 1,844,425 Total Medicare revenue 83,577,323*Note: the Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Allowable costs are calculated from information in the Medicare Cost Report and paid claim summaries obtained from the Medicare program. |
| Part III, Line 9b: | When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part VI, Line 2: | The hospital's 2019 CHNA, the 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/lodi-memorial/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 Update are also available on the Adventist Health Corporate website at:https://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: | 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: | Adventist Health Lodi Memorial considers San Joaquin County its primary service area as well as the city of Galt. San Joaquin County contains both rural and urban areas. Communities and cities maintain their unique geographic identities, separated by agriculture and open space lands. The county includes seven incorporated cities: Stockton, Tracy, Manteca, Lodi, Lathrop, Ripon and Escalon as well as many small well-established rural communities in the unincorporated areas.The demographic profile of San Joaquin county indicates a total population of 745,424 with 17.8% living in poverty and 24.9% of children living in poverty. Unemployment is 11.7% and the uninsured population is 11.7% as well. Of the population, 41.6% identify as Hispanic/Latino, 31.8% identify as White, 16.7% identify as Asian, 8.2% identify as Black, 5.3% identify as multiple races and 2.0% identify as Native American/Alaska Native. |
| Part VI, Line 5: | Our hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively 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: | The hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area can provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7, Reports Filed With States | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CA Health Fund & Trust | |||||||
| 1215 K Street Ste 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $65,385 | Hlth srvs un/underinsured pt |
| Lodi District Chamber Of Commerce | |||||||
| 35 S School Street | Lodi | CA | 95240 | 940636200 | 501(c)(6) | $12,200 | Sponsorships: Job Attraction & Marketing Campaign |
| United Way of San Joaquin County | |||||||
| 777 N Pershing Avenue Suite B | Stockton | CA | 95203 | 941279805 | 501(c)(3) | $22,500 | Donation to HealthForce Partners |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Through the use of temporarily restricted accounts, we track and monitor the incoming receipts from grants and the utilization of grant funds. Each grant is tracked separately. Should the grantor agency require specific reports, we comply with their reporting requirements. The grants we monitor are specific to the grantor's needs and requests. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (21 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ferch Wayne | ||||||||||||||
| President, CCR | $0 | $932,651 | $0 | $191,401 | $0 | $3,324,070 | $0 | $16,782 | $0 | $31,056 | $0 | $4,495,960 | $0 | $3,180,848 |
| Reiner Scott | ||||||||||||||
| Dir/Chair | $0 | $1,510,024 | $0 | $420,315 | $0 | $65,357 | $0 | $16,782 | $0 | $36,952 | $0 | $2,049,430 | $0 | $0 |
| Wing Bill | ||||||||||||||
| Dir/Vice Chair/Asst Secr | $0 | $1,200,390 | $0 | $318,717 | $0 | $53,147 | $0 | $16,782 | $0 | $29,801 | $0 | $1,618,837 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| CFO/Asst Secr thru 08/2019 | $0 | $581,409 | $0 | $187,572 | $0 | $440,088 | $0 | $16,782 | $0 | $40,783 | $0 | $1,266,634 | $0 | $0 |
| Larsen David | ||||||||||||||
| Finance Officer, CCR thru 04/19 | $0 | $536,325 | $0 | $110,451 | $0 | $130,603 | $0 | $276,207 | $0 | $40,438 | $0 | $1,094,024 | $0 | $0 |
| Wagner Jack | ||||||||||||||
| Former Asst Secr thru 03/18 | $0 | $0 | $0 | $0 | $0 | $778,475 | $0 | $0 | $0 | $29,189 | $0 | $807,664 | $0 | $0 |
| Wolcott Daniel | ||||||||||||||
| President | $0 | $469,178 | $0 | $109,652 | $0 | $143,247 | $0 | $16,782 | $0 | $42,735 | $0 | $781,594 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $524,870 | $0 | $65,461 | $0 | $140,054 | $0 | $16,782 | $0 | $29,127 | $0 | $776,294 | $0 | $0 |
| Chen Steven | ||||||||||||||
| Finance Officer, CCR | $0 | $472,282 | $0 | $90,908 | $0 | $108,327 | $0 | $16,782 | $0 | $42,581 | $0 | $730,880 | $0 | $0 |
| Iris Patricia | ||||||||||||||
| Medical Officer | $0 | $343,750 | $0 | $12,156 | $0 | $50,282 | $0 | $1,855 | $0 | $26,476 | $0 | $434,519 | $0 | $0 |
| Moreno Debbe | ||||||||||||||
| CNO thru 09/19 | $0 | $255,951 | $0 | $44,076 | $0 | $77,036 | $0 | $16,645 | $0 | $28,706 | $0 | $422,414 | $0 | $0 |
| Whitney Jason | ||||||||||||||
| Treasurer | $0 | $261,779 | $0 | $41,595 | $0 | $54,248 | $0 | $15,808 | $0 | $40,514 | $0 | $413,944 | $0 | $0 |
| McCollough Brooke | ||||||||||||||
| Operations Executive | $0 | $250,289 | $0 | $27,511 | $0 | $57,304 | $0 | $11,985 | $0 | $42,792 | $0 | $389,881 | $0 | $0 |
| Gruzensky Denton | ||||||||||||||
| Reg HP Dir, CCR | $0 | $232,276 | $0 | $41,926 | $0 | $47,140 | $0 | $15,932 | $0 | $30,044 | $0 | $367,318 | $0 | $0 |
| Beck-Atwater Sandra | ||||||||||||||
| Director Hospital Pharmacy | $204,005 | $0 | $19,067 | $0 | $0 | $0 | $11,753 | $0 | $27,710 | $0 | $262,535 | $0 | $0 | $0 |
| Carmody Thomas | ||||||||||||||
| Physician Assistant | $223,562 | $0 | $4,540 | $0 | $0 | $0 | $13,063 | $0 | $13,686 | $0 | $254,851 | $0 | $0 | $0 |
| Brown Mary | ||||||||||||||
| RN, House Supervisor | $215,126 | $0 | $0 | $0 | $1,231 | $0 | $6,324 | $0 | $20,353 | $0 | $243,034 | $0 | $0 | $0 |
| Markovich Jennifer | ||||||||||||||
| Director, RN | $165,089 | $0 | $30,503 | $0 | $3,489 | $0 | $6,629 | $0 | $20,816 | $0 | $226,526 | $0 | $0 | $0 |
| Stump Valerie | ||||||||||||||
| Director, RN | $181,501 | $0 | $16,073 | $0 | $8,164 | $0 | $6,324 | $0 | $13,746 | $0 | $225,808 | $0 | $0 | $0 |
| PickeringChristine | ||||||||||||||
| Communication Dir, CCR | $0 | $146,846 | $0 | $11,637 | $0 | $5,375 | $0 | $8,397 | $0 | $22,580 | $0 | $194,835 | $0 | $0 |
| Ziegele Paul | ||||||||||||||
| Former Treas thru 05/2018 | $0 | $0 | $0 | $0 | $0 | $150,324 | $0 | $9,077 | $0 | $24,843 | $0 | $184,244 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | 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. Moreno, Debbe - severance payment - $10,295 Reppert, Joseph - severance payment - $194,953 Wagner, Jack - severance payment - $778,453 Ziegele, Paul - severance payment - $123,600 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 - $259,425 Ferch, Wayne - vested distribution - $3,180,848 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| P Gill Obstetrics and Gynecology | |||
| >35% owned partnership by Parampal Gill, former board member | $120,024 | Physician professional service-OB Clinic | 0 |
| P Gill Obstetrics and Gynecology | |||
| >35% owned partnership by Parampal Gill, former board member | $301,125 | Physician professional service-Emergency room call | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | Adventist Health Lodi Memorial (AHLM) 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 Lodi Memorial, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does Adventist Health Lodi Memorial provide low cost care to individuals covered by government-programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHLM recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2019 was $19,511,095. The following Inpatient services that were provided to all our patients. These services included: - 1,051 Babies delivered - 1,388 Surgeries performed - 30,204 Patient days The following Outpatient services that were provided to all our patients. These services included: - 53,107 Emergency department visits - 3,213 Outpatient Surgeries performed - 75,264 Outpatient visits - 156,071 Clinic visits AHLM 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 $10,368,419. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ |
| Form 990, Part VI, Section A, line 4 | The Hospital made changes to Article 8.1, Execution of Legal Documents, which consolidated signature authority. |
| Form 990, Part VI, Section A, line 6 | The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation that operates as a public charity. The Hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, Section A, line 7a | The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. |
| Form 990, Part VI, Section A, line 7b | The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. |
| Form 990, Part VI, Section B, line 11b | This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Hospital's Board of Directors prior to filing. |
| Form 990, Part VI, Section B, line 12c | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital 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, Section B, line 15 | The Hospital Board of Directors has established a Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital presidents and finance officers that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital 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, Section C, line 19 | The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. |
| Form 990, Part VII: | In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors receive compensation when their employment agreements with their employers allow such payments. For those whose employers do not allow accepting compensation for board service, the funds are directly distributed to charitable organizations as mandated by their employment agreements. In addition, amounts paid for taxable benefits are also reported. |
| Form 990, Part IX, line 11g | Physician fees: Program service expenses 29,187,797. Management and general expenses 0. Fundraising expenses 0. Total expenses 29,187,797. Other medical professional fees: Program service expenses 3,155,625. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,155,625. Consulting fees: Program service expenses 0. Management and general expenses 974,466. Fundraising expenses 0. Total expenses 974,466. Contract labor: Program service expenses 0. Management and general expenses 975,739. Fundraising expenses 0. Total expenses 975,739. Repairs and maintenance: Program service expenses 1,690,108. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,690,108. Revenue cycle fees: Program service expenses 0. Management and general expenses 12,192,169. Fundraising expenses 0. Total expenses 12,192,169. |
| Form 990, Part XI, line 9: | Change in investments of subsidiaries -709,574. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (27 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Delano | |||||||||||
| PO Box 460 | Delano | CA | 93216 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Physicians Network | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| Adventist Health Tulare | |||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| 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 | |
| Glendale Adventist Medical Center | |||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Hanford Community Hospital | |||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Northwest Medical Foundation of Tillamook | |||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Paradise Valley Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 951816034 | Discontinued operations | CA | 501(c)(3) | Line 1 | Adventist Health SystemWest | 0 | |
| Portland Adventist Medical Center | |||||||||||
| 10123 SE Market Street | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Reedley Community Hospital | |||||||||||
| 372 Cypress Avenue | Reedley | CA | 93654 | 453220509 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Rideout Memorial Hospital | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 941387866 | Acute care hospital | CA | 501(c)(3) | Line 3 | Fremont-Rideout Health Group | 0 | |
| San Joaquin Community Hospital | |||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Simi Valley Hospital & Health Care Services | |||||||||||
| 2975 N Sycamore Drive | Simi Valley | CA | 93065 | 956064971 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Sonora Community Hospital | |||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| St Helena Hospital | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Stone Point Health | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 823763347 | Supporting organization | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Ukiah Adventist Hospital | |||||||||||
| 275 Hospital Drive | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| United Com-Serve | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled nursing/assisted living/home health | CA | 501(c)(3) | Line 12b, II | Fremont-Rideout Health Group | 0 | |
| Walla Walla General Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital - closed July 2017 | WA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Western Health Resources | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | Line 10 | Adventist Health SystemWest | 0 | |
| White Memorial Medical Center | |||||||||||
| 1720 Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Willits Hospital Inc | |||||||||||
| 1 Marcela Drive | Willits | CA | 95490 | 680108919 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC) | |||||||||||||
| 1001 S Fairmont Avenue | Lodi | CA | 95240 | 943407786 | Diagnostic imaging / MRI outpatient treatment center | CA | Lodi Memorial Hospital Association Inc | Related | $308,577 | $382,458 | 0 | 0 | 0.51000 |
| Artel LLC (dba Lodi Outpatient Surgery Center) | |||||||||||||
| 521 S Ham Lane Suite F | Lodi | CA | 95240 | 263513966 | Ambulatory surgical centers | CA | Lodi Memorial Hospital Association Inc | Related | -$291,424 | $1,069,380 | 0 | 0 | 0.78150 |
| Endoscopy Center of Lodi LLC | |||||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 261243662 | Endoscopy services | CA | Artel LLC | Related | 0 | 0 | 0.78150 | ||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lodi Regional Health Systems Inc | |||||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 680398894 | Physician management and medical office building development & management | CA | Lodi Memorial Hospital Association Inc | C | $5,473,926 | $15,853,421 | 1.00000 | Yes (1) | |
| Delta Radiology Inc | |||||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 941715690 | Radiology services | CA | Lodi Regional Health Systems Inc | C | $3,986,052 | $6,374,436 | 1.00000 | Yes (1) | |
| South Coast Medical Center | |||||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 952037291 | Wind down after sale of hospital | CA | C | 0 | N/A | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Advanced Imaging Center at Lodi | ||
| O | $673,450 | FMV |
| Artel LLC | ||
| O | $82,137 | FMV |
| Delta Radiology Inc | ||
| P | $735,908 | FMV |
| Lodi Regional Health Systems Inc | ||
| D | $869,231 | FMV |
| Lodi Regional Health Systems Inc | ||
| K | $121,238 | FMV |
| Lodi Regional Health Systems Inc | ||
| O | $220,209 | FMV |
Comments