2020-11-10T15:13:25-06:00 2019-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2019-01-01 941639901 Ukiah Adventist Hospital UKIA 9164060000 275 Hospital Drive Ukiah CA 95482 Judson Howe Treasurer 9164060000 2020-10-29 1 Tracy S Paglia P00366884 2099556100 2020-10-29 172.9.161.112 2020-10-29 19:16:07 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2019 2021-01-29 14:40:06Z Adventist Health Ukiah Valley Jason Wells 275 Hospital Drive Ukiah CA 95482 200787260 0 1071 X www.adventisthealth.org/ukiah-valley/ X 1967 CA Living God's love by inspiring health, wholeness and hope. 14 12 925 38 0 0 637022 1194529 200406296 196090958 1674506 3477446 32232 10472 202750056 200773405 443311 126127 0 0 65742706 69981857 0 0 309223 116478675 125156711 182664692 195264695 20085364 5508710 207274569 220501180 78431384 86149285 128843185 134351895 X Living God's love by inspiring health, wholeness and hope. 0 0 158961275 126127 196090958 See Schedule O 158961275 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 925 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 12 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X Jay Lipps VP System Controller 9164061092 PO Box 619135 Roseville CA 95661 X Reiner Scott Dir/Chair 0.00 50.00 X X 0 1995696 53734 Wing Bill Dir/Asst Secretary/CFO 0.00 50.00 X X 0 1572254 46583 Reppert Joseph CFO/Asst Secr thru 08/2019 50.00 0.00 X 0 1209069 57565 Eller Jeff President, NCR 10.00 40.00 X 0 1172082 40197 McDonald Edward Former Treas/Asst Secr thru 07/2017 0.00 0.00 X 0 1034618 13010 Lang Kevin Finance Officer, NCR 10.00 40.00 X 0 1038744 0 Wagner Jack Former Asst Secr 0.00 0.00 X 0 778475 29189 Jobe Meredith Secretary 50.00 50.00 X 0 730385 45909 Byrnes John Medical Officer, NCR 10.00 40.00 X 0 718300 29813 Ocampo-Alva Gwen President thru 01/2019 50.00 0.00 X 0 555865 45225 Wells Jason President 50.00 0.00 X 0 534382 57479 Lonto Robert Reg HP Dir, NCR 0.00 50.00 X 0 388199 58409 Poole Aaron Former Treas/Asst Secr 0.00 0.00 X 0 367137 51507 Van Housen Heather Former PCE 0.00 50.00 X 0 369042 46449 Howe Judson Finance Officer 10.00 40.00 X 0 351467 54951 Quattlebaum Ryan Treasurer 50.00 0.00 X 0 317584 50435 Spencer Lindsey Patient Care Exec 0.00 50.00 X 0 286944 53821 Nunn James Admin Director thru 11/19 50.00 0.00 X 246220 0 40974 Petersen Lisa RN, Nurse Lead 50.00 0.00 X 253362 0 29543 Rehm Donna RN 50.00 0.00 X 241056 0 41683 Willsher Heidi Director, RN thru 08/19 50.00 0.00 X 203896 0 24304 Lagrace Jacky Reg Director thru 01/19 50.00 0.00 X 209171 0 2237 Kinney Jill Admin Dir Marketing & Comm, NCR 10.00 40.00 X 0 181700 21349 Reiner Richard Director 0.00 4.00 X 0 28588 0 Davis Andrew Director 0.00 4.00 X 0 28246 0 Cherry Robert Director 0.00 4.00 X 0 26315 0 Heinrich Kerry Director 0.00 4.00 X 0 20102 0 Innocent Larry Director 0.00 4.00 X 0 18852 0 Woodson Marc Director 0.00 4.00 X 0 15000 0 Graham Ricardo Director 0.00 4.00 X 0 8848 0 Banks David Director 0.00 4.00 X 0 6382 0 Freedman John Director 0.00 4.00 X 0 2367 0 Salazar Velino Director 0.00 4.00 X 0 553 0 Ocampo Lucy Director 0.00 4.00 X 0 0 0 Philip Celeste Director 0.00 4.00 X 0 0 0 1153705 13757196 894366 174 1 1 1 Pacific Redwood Medical Services Inc 242 Hospital Drive Suite B Ukiah CA 95482 Medical services 4541128 Herrero Builders Inc 2100 Oakdale Avenue San Francisco CA 94124 Construction 4463788 Bivens Medical Corporation 20105 Geisendorfer Applegate CA 95703 Medical services 1312621 Radiology Medical Group MAG VII PO Box 86348 Los Angeles CA 90086 Professional & medical services 1256045 Comphealth Inc 7259 S Bingham Junction Blvd Midvale UT 84047 Staffing and recruiting 900967 34 42750 67937 1083842 1194529 Patient service revenue 621110 195054354 195054354 Other program revenue 900099 755295 755295 Dietary 722210 224954 224954 Rent medical office bldg 531120 56355 56355 196090958 3464613 3464613 11200 1633 0 0 11200 1633 12833 12833 13090 42750 13094 -4 -4 2755 0 2755 2755 8482 761 7721 7721 200773405 196090958 0 3487918 X 126127 126127 53634296 49999870 3497675 136751 2071713 1946882 119839 4992 10473129 9794213 655927 22989 3802719 3603770 190076 8873 14174268 1417427 12756841 121281 87351 33930 1693 1693 18327 18327 63594295 52419798 11056051 118446 37209 29988 7221 1342701 1151351 185821 5529 7272167 1438324 5827218 6625 6922441 5645624 1276567 250 393075 274053 117209 1813 65915 63577 2338 1359098 1358228 870 5689358 5610202 79156 175051 175051 Patient care supplies 22601679 22552774 48879 26 Rental/lease costs equi 836129 828140 7989 Sales taxes 3128 3128 548896 420198 125769 2929 195264695 158961275 35994197 309223 117196 616718 71725081 82174707 16040043 14922011 3010203 3398676 267252 430898 136390644 49301666 79390947 87088978 3850194 28548 500000 500000 172586 172586 32201067 31168058 207274569 220501180 15119395 12123851 63311989 74025434 78431384 86149285 X 127072956 133040373 1770229 1311522 128843185 134351895 207274569 220501180 5508710 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18327 18327 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 1770229 1131568 5 861270 729080 1311452 5410928 567262 3220 13744 4197437 1770229 5268630 798626 193575 4820 845083 5410928 4179423 1348696 259489 5268630 3563283 663489 1870 49219 4179423 0.00000 0.00000 1.00000 0 0 1276873 1276873 93060178 23075229 69984949 1559167 1103805 455362 36777279 25122632 11654647 3717147 3717147 87088978 Receivables from third-party payors 27401363 Receivables from related organizations 3357451 Other receivables 409244 31168058 Payables to related organizations 55452239 Payables to third party payors 12367150 Lease liability 6195343 MOB deposits 10702 74025434 X Part V, Line 4: Board-designated and temporarily 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. Golf tournament 41055 32266 8789 280 5455 3054 Colors for cancer fun run 14785 10484 4301 4305 55840 42750 13090 280 5455 7359 13094 -4 1 1 X 1 X 1 X 1 1 0 1 1 2101265 2101265 0.01080 2101265 2101265 0.01080 616316 1500 614816 0.00310 259092 259092 0.00130 9859615 3601592 6258023 0.03200 60384 60384 0.00030 10795407 3603092 7192315 0.03670 12896672 3603092 9293580 0.04750 1786 1786 0.00000 1054 1054 0.00000 4037 4037 0.00000 465323 465323 0.00240 472200 472200 0.00240 944400 944400 0.00480 1 2256266 927233 49005806 56147261 -7141455 X 1 1 1 Hospital Dr Med Plaza Assn Property management 0.33000 0.00000 0.67000 1 1 Adventist Health Ukiah Valley 275 Hospital Drive Ukiah CA 95482 See Form 990, Pg 1, Item J 110000095 X X X Adventist Health Ukiah Valley 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X 1 19 1 See Sch H Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X Sch H, Part VI-Patient Educ X Sch H, Part VI-Patient Educ X Sch H, Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Adventist Health Ukiah Valley 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 accomplished by using a widely-distributed community health survey and conducting key informant interviews and written surveys. Community Health Survey: Community Health Survey was provided to Mendocino County residents online as well as in hardcopy format. A total of 1,324 residents completed the Community Health Survey; 1,276 were completed in English and 48 in Spanish; 94 were completed by Native Americans, mostly from the Round Valley area.Key Informant Interviews and written surveys: 34 key stakeholders in the community, including representatives of county and city government, private businesses, health and human services, hospitals and clinics, community-based organizations and nonprofits, law enforcement, children and youth services, education, media, geography, and racial/ethnic groups, among others. Interviews were conducted in person or by phone. Some questions were also provided in hardcopy format for written response. While an effort was made to have diverse representation, the opinions provided by the key informants are not necessarily representative of the county as a whole. Key Leader Survey of 56 formal and informal leaders in the community that was provided online. Together with the Key Informant Interviews, a total of 90 key informants/leaders in Mendocino County participated.These key stakeholders were selected by the workgroup because they would provide a unique perspective on the health of the community, health care delivery systems in place and overall conditions that influence health behaviors. Secondary data sources included publicly available state and nationally recognized data sources. Data on key health indicators, morbidity, mortality, and various social determinants of health were collected from the US Government Accountability office, California Department of Social Services, California Department of Public Health, US department of Health and Human Services, HealthyPeople2020, Centers for Disease Control and Prevention, and the American Heart Association. Adventist Health Ukiah Valley Part V, Section B, Line 6a: Adventist Health Ukiah Valley partnered with Adventist Health Howard Memorial Hospital to produce the 2019 CHNA. Adventist Health Ukiah Valley Part V, Section B, Line 6b: Ukiah Valley Medical Center collaborated with the Mendocino County Health and Human Services Agency Public Health Branch, Healthy Mendocino, Redwood Community Services, Mendocino Coast Clinics, Mendocino Community Health Clinics, Alliance for Rural Community Health and North Coast Opportunities to prepare the 2019 Community Health Needs Assessment. Adventist Health Ukiah Valley Part V, Section B, Line 11: Our 2016 CHNA identified three areas of significant needs: mental health, childhood obesity and family wellness, and childhood trauma. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1 - Mental health - County-wide mental health consciousness is reflected in a proactive, no-shame view of the issues. Communities, agencies, and schools take a comprehensive approach to care and case management. People with mental illnesses and their families and health practitioners have access to needed treatment and case management resources across the continuum of care. Our main goals are: (a) to educate the community about mental illness to reduce stigma and increase resilience; (b) to expand treatment and case management options and access; and (c) to improve prevention for all residents and all mental health conditions. Interventions:1. Homeless/Street Medicine Outreach: Addresses the complex care of patients with high impact social determinants of health. A team of staff and volunteers bring healthcare to homeless individuals and families in the Ukiah area. Scheduled clinic referrals from Mendocino County Health Clinic and Rural Health Clinics are made to homeless shelters, medical respite units, social services, Project Sanctuary, Manzanita and Mendocino County Aids and Viral Hepatitis Network (MCAVHN). Number of community members served by the Outreach Team: 300 (75 clinics).2. Live Well Programing - launched in 2017, the Live Well Program is focused on helping patients address their chronic disease using the tools of lifestyle change. A team including the patient works to determine specific health goals and map a plan including fitness training, nutrition counseling, behavioral health counseling, diabetes education, pain management and more. This program is open to all through self-referral or provider referral. A hallmark of the program are the complimentary group meetings which support patients during and after their Live Well programming. Group meetings are held on various frequencies and encompass topics such as sleep, healthy weight, community walks and more. Number of community members served in the Live Well Clinic: 234.3. QPR Workshops: Working with a contract facilitator, Adventist Health Ukiah Valley sponsored community and staff workshops to teach the principles of Question, Persuade, Refer (QPR). The QPR mission is to reduce suicidal behaviors and save lives by providing innovative, practical and proven suicide prevention training. Partnering with Mendocino County Public Health, AHUV also provided space for "Train the Trainer" sessions which allowed employees from Ukiah Unified School District, Health and Human Services, Redwood Community Services, Manzanita and more to continue to teach workshops to new employees and others interested in learning the principles of QPR. Number of community members served with QPR Workshops: 309.4. Emergency Room Dedicated Case Manager: Case Manager offers referral services to outpatient homeless and other community members for classes, mental health services, housing information on Medication Assisted Treatment (MAT) program referrals, rehab center coordination as well as AA/NA follow up. Case Manager helps coordinate pharmacy insurance for patients prescribed a new medication. Assistance includes whether the patient has coverage, if there's a copay or if there's another suitable substitute should the medication not be covered and/or be out of the patient's financial range. Data not collected on community members served.5. COMPASS Program/Vertical Change Platform: In 2019, COMPASS team has continued to be a major player in developing and implementing Vertical Change, an information sharing system that allows the various agencies and healthcare providers in Ukiah to share information about shared clients. What this means in practical terms is that clients receive care in a timelier manner, there is less duplication of services, and providers can obtain up to date and pertinent information about clients. In 2019, COMPASS team has held weekly outreach clinics in two community center locations: Center for Hope and Building Bridges. There, the team helps clients access the various community resources, including primary care providers, behavioral health agencies, mental health providers and social services. Data not collected on community members served.Priority Need 2 - Childhood obesity and family wellness - we strive for healthy, active children in healthy families and wide access to healthy food and safe recreational opportunities. Our main goals are: (a) to increase public awareness of relevant community programs and resources and (b) to change the health environment at workplace, recreation, and community meeting venues, offering access to healthy foods. Fifth grade students who are at a healthy weight or underweight showed a value of 58.2% in 2018-219 which represents an increase in value from prior years of 52.4%. Ninth grade students who are at a health weight or underweight showed a value of 58.5% in 2018-2019 which is a slight decrease from a prior value of 60.2%. Interventions: 1. Healthy Mendocino: Family Wellness & Childhood Obesity Team. AVUV is an active member of the Family Wellness & Childhood Obesity Action team with the goal to help improve the quality of life in Mendocino County for children and families. During 2019, the Team supported a program called Morning Mile at grammar schools in Ukiah and Willits. Number of community members served: 300.2. Ukiah on Ice: Partnership with the City of Ukiah to host an open-air ice-skating rink downtown Ukiah. The rink was used by individual citizens, ice hockey teams and area schools for field trips. In 2019, AHUV hosted a special "free skate" day for the community. Included in the day was face painting, arts & crafts, music and a hot cocoa station with delicious treats. Families were encouraged to enjoy time together under the big top tent were tables and chairs were set up. Number of community members served: skating season 8,000. Number of community members served: free skate day: 1,500.3. Children's Health Fair: A free children's health fair with the goal to connect local families with community resources that have a positive impact on the lives of their children and families. A bilingual event, this health fair includes screenings for diabetes, vision, hearing, and an emphasis on healthy eating with interactive community partner booths. The location of the event has been carefully selected to be within walking distance of neighborhoods with traditional underserved populations. Number of community members served: 300.4. Kids Triathlon: This annual event is a partnership between the City of Ukiah and AHUV. Youth ages 4 to 16 can participate in the event featuring swimming, biking and running. The focus is celebrating youth at all levels of fitness to help fight childhood obesity and encourage physical activity in Mendocino County. A healthy lunch is provided free of charge to all families who participate. Number of community members served: 50.5. Colors for Cancer Fun Run/Walk: This community centered event is an annual AHUV program which fosters family fun and the great outdoors. Running/walking along the Ukiah Redwood Trail, adjacent to AHUV, participants can run in memory of a loved one who has passed from cancer or in the spirit of someone who is currently battling cancer. A Wellness Fair is also held to educate participants on a variety of family friendly activities in the Mendocino County area. Proceeds from the event benefit the Focus on Healing program. Number of community members served: 240. Part V, Section B, Line 11: Priority Need 3 - Childhood trauma - All children need to grow up in stable and supportive families, and all families must have support in times of crisis. Our main goals are: (a) to educate community members and leaders about the impact of adverse childhood experiences; (b) to increase support for at-risk families, including parents struggling with substance abuse and (c) to develop and promote local policies that strive to prevent childhood trauma. Based on statistics from the University of California at Berkeley our total population of children in child welfare programs did not change although, as would be expected the age ratios changed. Most pronounced was the increase of under one-year old's from eleven to twenty. Interventions:1. Dream It Be It: This free program hosted by Soroptimist International of Ukiah in partnership with AHUV and other community partners provides a day-long workshop for at-risk teen girls focused on empowerment and career readiness. In 2019, the fourth Dream It Be It Conference was held for teen girls attending South Valley High School. The program prioritized working with girls who have obstacles such as poverty, unstable home lives, living in foster care, or teen motherhood. Highlights included engaging speakers and a curriculum that works to provide young women with the information and resources they need to be successful and realize their dreams. Number of community members served: 60.2. Health Careers Exploration Summer Institute: This program is designed to promote the advancement of health care workforce through quality education and service. AHUV partners with Ukiah Unified School District to introduce local high school students to a career in the health care field. Students participate in a three-week course to observe the roles and responsibilities, scope of practice and educational requirement of tten different hospital rotations. Number of community members served: 10. 32 1 - The Cancer Treatment & Infusion Center 260 Hospital Drive Suite 207 Ukiah CA 95482 Oncology 2 - Advanced Wound Center 415 Hospital Drive Ukiah CA 95482 Wound care center 3 - Ukiah Adventist Hospital - Outpatient Pa 245 Hospital Drive Ukiah CA 95482 Outpatient surgery 4 - Ukiah Valley Radiology 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology 5 - Ukiah Valley RadiologyMRI 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology/Mri 6 - Mendocino Radiology 1165 S Dora Street Suite D Ukiah CA 95482 Radiology 7 - Rehabilitation Clinic 271 Observatory Avenue Ukiah CA 95482 PT 8 - Ukiah Valley Clinic 415A Hospital Drive Ukiah CA 95482 Pre-Op Clinic 9 - Ukiah Adventist Health Pavilion Surgica 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology 10 - Ukiah Valley Cardiology Clinic 115 Hospital Drive Ukiah CA 95482 Cardiology 11 - Ukiah Valley General Surgery 246 Hospital Drive Ukiah CA 95482 General surgery 12 - Rapid Care at Ukiah Valley Rural Health 260 Hospital Drive Suite 204 Ukiah CA 95482 Pediatric care 13 - Rapid Care at Ukiah Rural Health Center 260 Hospital Drive Suite 209 Ukiah CA 95482 Family practice 14 - Outpatient Physician Services 246 Hospital Drive Suite 248-B Ukiah CA 95482 Ophthalmology 15 - Outpatient Physician Services-Dora-ENT 1165 S Dora Street Suite C-2 Ukiah CA 95482 Hospital-based outpatient clinic 16 - Ukiah Valley RadiologyMammography 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology/Mammography 17 - Ukiah Valley Pain Management Clinic 260 Hospital Drive Suite 102 Ukiah CA 95482 Pain management 18 - Ukiah Valley Urology Clinic 260 Hospital Drive Suite 201 Ukiah CA 95482 Rural health clinic 19 - Gastroenterology Clinic 234 Hospital Drive Suite A B Ukiah CA 95482 HBOIC-GI 20 - Ukiah Valley Rural Health 1050 N State Street Ukiah CA 95482 Rural health clinic 21 - Ukiah Valley Internal MedicineAllergy C 260 Hospital Drive Suite 103 Ukiah CA 95482 Internal Medicine 22 - Ukiah Valley Orthopedics 260 Hospital Drive Suite 107 Ukiah CA 95482 Orthopedics 23 - Lakeport Internal Medicine 487 S Main Street Suite 122 Lakeport CA 95453 Internal Med 24 - Lakeport Cardiology 475 N Forbes Street Lakeport CA 95453 Cardiology 25 - Fort Bragg Family Practice Center 850 Sequoia Circle Fort Bragg CA 95437 Family Medicine 26 - Physical Therapy at Redwood Health Club 3101 S State Street Ukiah CA 95453 Physical therapy 27 - Ukiah Valley Clinic Billing 238 Hospital Drive Suite A Ukiah CA 95482 Billing - Clinics 28 - Ukiah Valley Rural Health Center Lakepor 487 S Main Street Lakeport CA 95453 Pediatricians 29 - Ukiah Valley OBGYN 1050 North State Street Ukiah CA 95482 OB/GYN 30 - Rehabilitation Clinic 271 Observatory Avenue Ukiah CA 95482 Speech Therapy 31 - Ukiah Valley Behavioral Health Clinic 260 Hospital Drive Suite 101 Ukiah CA 95482 Behavioral Health 32 - Ukiah Valley Neurology 260 Hospital Drive Suite 103 Ukiah CA 95482 Neurology Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesUkiah Valley Medical Center is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. 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 2: Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3: The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. 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 evolving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments 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 49,005,806Prior Year Settlements 795,810Cost Report Reimbursable Bad Debts 948,395Estimates and Accrual Variances 308,459Other 2,731,486 Total Medicare Revenue 53,789,956*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. 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 III - Other Community Benefit: Adventist Health recognized the health needs of our community that may not be part of the CHNA. Interventions to address those needs include:1. Focus on Healing programing is a community service provided to any community member going through the cancer experience by bringing healing arts and support for healing through animal assisted therapy available to patients, staff, visitors and the public with stress reduction, Caring/Ceres Kitchen provides nutritious meals to cancer patients and families by providing food prepared by students and volunteers and Pet Therapy is available at no cost to assist patients, staff, visitors and public with stress reduction and healing. Total number of community members served: 1,073.2. Diabetes Education. Monthly classes in English and Spanish are open to anyone in the community that has been diagnosed with diabetes. Family members and support members are welcome to join and learn how to manage their diabetes and stay healthy. Education and free screenings are a major component of the interventions. Number of community members served: 509.3. Smoking Cessation Classes are no cost for community members based on the American Lung Association guidelines. This six-week program is held at the hospital and is a confidential space for people to come and create their own plan for stopping smoking. Number of community members served: 37. 4. Food with Friends: Free community facing plant-based cooking demonstrations focused on nutritionally dense ingredients. Partnering with the Ukiah Natural Foods Co-op, AHUV Outpatient Nutrition and Wellness Departments host 10-hour long workshops with demonstrate the preparation of three or more recipe samples and take-home recipes are included. Number of community members served: 200.5. Complete Health Improvement Program (CHIP): Based on principle of the Lifestyle Medicine Institute, CHIP is a nine-week program which uses videos and live sessions to help participants create goals and achieve better health and wellness. Offered free to the community and staff, the program is aimed at helping participants lose weight, lower their A1C, lower blood pressure and find more enjoyment in life. Number of community members served: 8.6. Parkinson's Support Group: A direct request from the community, the Parkinson's Support Group was formed to give community members living with Parkinson's and their care partners a place to share knowledge, gain information and make friends. The monthly meetings focus on a variety of topics including medications, exercise, sleep and nutrition. Number of community members served: 15.7. Community Health Fairs: Members of the AHUV Wellness Team travel to various local businesses and community events to share information about diabetes education, test blood pressures and perform body composition testing. Many participants have not visited a doctor recently and the staff are able to create connections and help visitors find a medical professional. Number of community members served: 500. 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/ukiah-valley/about-us/community-benefit/The two most recent Community Health Needs Assessments, two most recent Implementation Strategy reports and the and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/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.pdfThese documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. Part VI, Line 4: Adventist Health Ukiah Valley is a 78-bed acute care hospital with 21 outpatient clinics that provide primary and specialty care. The hospital is situated in the city of Ukiah, the county seat and largest city of Mendocino County, with a population of approximately 16,000. The hospital's primary service area, however, consists of nearly the entire rural county, which spans over 3,500 square miles. Small, geographically isolated communities make up a large part of the county's nearly 88,000 residents. According to 2018 data from the U.S. Census Bureau, Mendocino County has an estimated population of 87,580, slightly lower than the 87,869 reported in the 2014 U.S. Census data. More than one-half (55%) of the population live in urban areas, while 45% live in rural communities, on farms or ranches. The proportion of residents who are ages 65 years and over make up 21.7% of the county population, higher than the proportion in the state with 14.5%.In 2018, the county's population was 76% White, 22% Hispanic, 4% Native American, 1% Asian, .7% African American, .6% Pacific Islander, and 15.4% Two or More Races. Between 2010 and 2060, the Hispanic/Latino population is expected to increase from 19,802 to 37,293 or to 37% of the county population, while Whites will decrease from 60,449 to 48,450 (to 48% of the county population). In the most recent data, nearly one-quarter of adults in Mendocino County ages 25 and older (22%) had a bachelor's degree or higher, and 7% had less than a high school diploma (compared to 31% and 10%, respectively, for California as a whole). Also in 2017, the median household income in Mendocino County, at $47,656, was 36% lower than that of the state ($74,605), compared to 2014 when the median household income in Mendocino County was 29% lower than the state.The 2019 County Health Rankings estimate that about 27% of the county population lives in substandard housing, i.e., without a kitchen or adequate plumbing, or lives in crowded conditions. In addition to substandard or crowded housing, over one-half of Mendocino County residents who rent (52%) pay more than a third (35%) of their total income for rent. Part VI, Line 5: Our hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to 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 1 CA Health Fund & Trust 1215 K Street Ste 800 Sacramento CA 95814 941498697 501(c)(3) 60877 Hlth srvs un/underinsured pt Ukiah Junior Academy 180 Stipp Lane Ukiah CA 95482 542188297 501(c)(3) 6000 Glenn Miller Memorial Golf Tournament Mendocino College Foundation 1000 Hensley Creek Road Ukiah CA 95482 680040876 501(c)(3) 51750 Nursing Program Cancer Resource Centers of Mendocino County 510 Cypress Street B-200 Fort Bragg CA 95437 680357416 501(c)(3) 5000 Pure Mendocino Fundraiser for Cancer Resources 4 0 Part I, Line 2: Charitable support and assistance is provided with no reporting required by recipient. X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Dir/Chair 0 1510024 0 420315 0 65357 0 16782 0 36952 0 2049430 0 0 Wing Bill Dir/Asst Secretary/CFO 0 1200390 0 318717 0 53147 0 16782 0 29801 0 1618837 0 0 Reppert Joseph CFO/Asst Secr thru 08/2019 0 581409 0 187572 0 440088 0 16782 0 40783 0 1266634 0 0 Eller Jeff President, NCR 0 868316 0 193574 0 110192 0 16782 0 23415 0 1212279 0 0 McDonald Edward Former Treas/Asst Secr thru 07/2017 0 0 0 0 0 1034618 0 0 0 13010 0 1047628 0 861740 Lang Kevin Finance Officer, NCR 0 0 0 0 0 1038744 0 0 0 0 0 1038744 0 0 Wagner Jack Former Asst Secr 0 0 0 0 0 778475 0 0 0 29189 0 807664 0 0 Jobe Meredith Secretary 0 524870 0 65461 0 140054 0 16782 0 29127 0 776294 0 0 Byrnes John Medical Officer, NCR 0 493269 0 77663 0 147368 0 1523 0 28290 0 748113 0 0 Ocampo-Alva Gwen President thru 01/2019 0 79878 0 78888 0 397099 0 14573 0 30652 0 601090 0 0 Wells Jason President 0 398135 0 69586 0 66661 0 16782 0 40697 0 591861 0 0 Lonto Robert Reg HP Dir, NCR 0 273824 0 52858 0 61517 0 16764 0 41645 0 446608 0 0 Poole Aaron Former Treas/Asst Secr 0 172396 0 18598 0 176143 0 15662 0 35845 0 418644 0 0 Van Housen Heather Former PCE 0 269712 0 38105 0 61225 0 16284 0 30165 0 415491 0 0 Howe Judson Finance Officer 0 266973 0 31461 0 53033 0 13329 0 41622 0 406418 0 0 Quattlebaum Ryan Treasurer 0 257729 0 27287 0 32568 0 13828 0 36607 0 368019 0 0 Spencer Lindsey Patient Care Exec 0 213750 0 27459 0 45735 0 12466 0 41355 0 340765 0 0 Nunn James Admin Director thru 11/19 143163 0 11399 0 91658 0 4288 0 36686 0 287194 0 0 0 Petersen Lisa RN, Nurse Lead 243816 0 6677 0 2869 0 14684 0 14859 0 282905 0 0 0 Rehm Donna RN 234609 0 6447 0 0 0 12596 0 29087 0 282739 0 0 0 Willsher Heidi Director, RN thru 08/19 121577 0 6416 0 75903 0 8856 0 15448 0 228200 0 0 0 Lagrace Jacky Reg Director thru 01/19 17300 0 0 0 191871 0 0 0 2237 0 211408 0 0 0 Kinney Jill Admin Dir Marketing & Comm, NCR 0 161220 0 12898 0 7582 0 8890 0 12459 0 203049 0 0 Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Lagrace, Jacky - severance payment - $171,736 McDonald, Edward - severance payment - $125,962 Nunn, James - severance payment - $78,418 Ocampo-Alva, Gwen - severance payment - $304,720 Poole, Aaron - severance payment - $108,130 Reppert, Joseph - severance payment - $194,953 Wagner, Jack - severance payment - $778,453 Willsher, Heidi - severance payment - $60,737 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. McDonald, Edward - $861,740 A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. McDonald, Edward - $47,940 Part II: Kevin Lang, Finance Officer, NCR was paid through an unrelated organization KJL, Inc. that was reported on Form 1099. Compensation paid is reported in Form 990, Part VII, Section A and Schedule J, Part II. Form 990, Part III, Line 4a: Ukiah Adventist Hospital (AHUV) 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 to Ukiah Adventist Hospital, 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 Ukiah Adventist Hospital 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. AHUV 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 $2,101,265. The following Inpatient services that were provided to all our patients. These services included: - 759 Babies delivered - 626 Surgeries performed - 12,534 Patient days The following Outpatient services that were provided to all our patients. These services included: - 31,961 Emergency department visits - 3,428 Outpatient Surgeries performed - 102,198 Outpatient visits - 134,520 Clinic visits AHUV recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2019 was $7,192,315. 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 their Article 8.1, Execution of Legal Documents, to include more 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 professional fees: Program service expenses 29,481,600. Management and general expenses 0. Fundraising expenses 0. Total expenses 29,481,600. Consulting and other management fees: Program service expenses 0. Management and general expenses 508,395. Fundraising expenses 0. Total expenses 508,395. Other professional fees non-medical: Program service expenses 70,089. Management and general expenses 30,038. Fundraising expenses 0. Total expenses 100,127. Purchased medical services: Program service expenses 21,918,713. Management and general expenses 0. Fundraising expenses 0. Total expenses 21,918,713. Repairs and maintenance: Program service expenses 824,722. Management and general expenses 85,068. Fundraising expenses 0. Total expenses 909,790. All other purchased services: Program service expenses 124,674. Management and general expenses 1,420,823. Fundraising expenses 118,446. Total expenses 1,663,943. Revenue cycle fees: Program service expenses 0. Management and general expenses 9,011,727. Fundraising expenses 0. Total expenses 9,011,727. 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 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital 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 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 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 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 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 Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II 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 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0