2020-11-11T16:04:44-06:00 2019-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2019-01-01 942917251 Fremont-Rideout Health Group FREM 9164060000 989 Plumas Street Yuba City CA 95991 Eduardo Gonzalez Treasurer 9164060000 2020-10-29 1 Tracy S Paglia P00366884 2099556100 2020-10-29 172.9.161.112 2020-10-29 02:31:08 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2019 2021-01-29 14:40:06Z Rideout Health Richard Rawson 989 Plumas Street Yuba City CA 95991 27265035 0 X www.adventisthealth.org/rideout/ X 1983 CA Living God's love by inspiring health, wholeness, and hope. 3 2 112 0 0 0 0 62503 15285661 26610374 121215 592158 51 0 15406927 27265035 0 75700 0 0 5549048 4262179 0 0 0 4149695 10971451 9698743 15309330 5708184 11955705 40810635 57699198 15352710 20285914 25457925 37413284 Living God's love by inspiring health, wholeness, and hope. 0 0 7778475 75700 26610374 Providing shared management services for related tax exempt entities - Rideout Memorial Hospital and United Com-Serve. 7778475 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 112 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 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 Wing Bill Chair 0.00 50.00 X X 0 1572254 46583 Eller Jeff President, NCR 3.00 47.00 X 0 1172082 40197 Lang Kevin Finance Officer, NCR 3.00 47.00 X 0 1038744 0 Jobe Meredith Secretary 0.00 50.00 X 0 730385 45909 Rawson Richard President 12.00 38.00 X 0 740386 28958 Byrnes John Medical Officer, NCR 3.00 47.00 X 0 718300 29813 Sheikh Azad Medical Officer 40.00 0.00 X 0 593549 52213 Gordon Cyndy Patient Care Executive 0.00 40.00 X 0 461688 35752 Lonto Robert Reg HP Dir, NCR 3.00 47.00 X 0 388199 58409 Chibaya Daniel Operations Manager 40.00 0.00 X 0 380827 54263 Arrowsmith Monica Bus Dev Leader 40.00 0.00 X 0 365299 39248 Gonzalez Eduardo Treasurer 12.00 38.00 X 0 344409 55272 Toglia Anthony Director, IT 40.00 0.00 X 205410 0 7128 Mills Michael Director, Finance 40.00 0.00 X 201341 0 6248 Munguia-Pittman Sylvia Director, Human Performance 40.00 0.00 X 192268 0 14451 Swanson Jeffery President, Philanthropy 40.00 0.00 X 187179 0 14444 Ramirez Carol Admin Dir, Comm Res & Mission Dev 40.00 0.00 X 167565 0 9116 Reiner Richard Director 0.00 4.00 X 0 28588 0 Innocent Larry Director 0.00 4.00 X 0 18852 0 953763 8553562 538004 26 0 1 1 Change Healthcare Technologies LLC PO Box 98347 Chicago IL 60693 Subscription services 498766 Healthcare Transformation Inc 875 N Michigan Avenue Suite 3100 Chicago IL 60611 Temporary staffing 196217 Moss Adams LLP PO Box 101822 Pasadena CA 91189 Consulting services 124442 3 62503 62503 Management fees 541610 24595431 24595431 Inc/(loss from FRD Mgmt 541610 2014943 2014943 26610374 592158 592158 27265035 26610374 0 592158 75700 75700 3526061 759157 2766904 234578 215730 18848 338325 338325 163215 50540 112675 1681590 181242 1500348 62711 62711 1305121 59274 1245847 7246 7246 298183 20164 278019 5933152 5932652 500 710622 54610 656012 63088 8521 54567 15249 739 14510 875 875 71430 71430 Rental/lease costs equi 302366 287440 14926 519818 53155 466663 15309330 7778475 7530855 0 12995942 21869670 1031279 0 1448638 667704 15332449 17223862 10002327 17937962 40810635 57699198 12390725 9589084 2961985 10696830 15352710 20285914 X 25457925 37413284 25457925 37413284 40810635 57699198 11955705 -346 0 X 0 1 X 1 0 X X 1 Rideout Memorial Hospital 941387866 3 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Part IV, Section A, Line 1: Fremont-Rideout Health Group (FRHG) supports the functions of hospitals and health facilities of which FRHG is a member in the state of California and such other subordinate units of FRHG that qualify as exempt organizations under section 501(c)(3) of the code and are described in either section 509(a)(1) or section 509(a)(2) of the Code. FRHG has a historic and continuing relationship with Rideout Memorial Hospital, a section 509(a)(1) organization. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Investment in FRD Management Company LLC 17223862 F 17223862 Receivables from related organizations 13071360 AHRO Employee Benefit Trust - assets held by trustees 3087431 Other assets 1779171 17937962 Payables to related organizations 3211952 Workers' compensation liability 5789857 Other liabilities 1695021 10696830 X 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. 1 Punjabi American Heritage Society 820 Plaza Way Yuba City CA 95991 680449082 20000 Punjabi American Festival Lodi Pink October 871 E Onstott Road Yuba City CA 95991 201530007 501(c)(3) 6500 Misc 1 1 Part I, Line 2: Grantees are provided support based on the program for which they are soliciting funds. Our expectation is that the monies will be used accordingly, and reporting from the recipient is not required. X X X X 0 0 0 0 0 0 0 0 0 Wing Bill Chair 0 1200390 0 318717 0 53147 0 16782 0 29801 0 1618837 0 0 Eller Jeff President, NCR 0 868316 0 193574 0 110192 0 16782 0 23415 0 1212279 0 0 Lang Kevin Finance Officer, NCR 0 0 0 0 0 1038744 0 0 0 0 0 1038744 0 0 Jobe Meredith Secretary 0 524870 0 65461 0 140054 0 16782 0 29127 0 776294 0 0 Rawson Richard President 0 546538 0 90538 0 103310 0 0 0 28958 0 769344 0 0 Byrnes John Medical Officer, NCR 0 493269 0 77663 0 147368 0 1523 0 28290 0 748113 0 0 Sheikh Azad Medical Officer 0 423077 0 81450 0 89022 0 16109 0 36104 0 645762 0 0 Gordon Cyndy Patient Care Executive 0 333173 0 64142 0 64373 0 13330 0 22422 0 497440 0 0 Lonto Robert Reg HP Dir, NCR 0 273824 0 52858 0 61517 0 16764 0 41645 0 446608 0 0 Chibaya Daniel Operations Manager 0 285577 0 54979 0 40271 0 11389 0 42874 0 435090 0 0 Arrowsmith Monica Bus Dev Leader 0 269712 0 51924 0 43663 0 11369 0 27879 0 404547 0 0 Gonzalez Eduardo Treasurer 0 264423 0 45250 0 34736 0 10728 0 44544 0 399681 0 0 Toglia Anthony Director, IT 193358 0 9464 0 2588 0 3897 0 3231 0 212538 0 0 0 Mills Michael Director, Finance 139474 0 60224 0 1643 0 3017 0 3231 0 207589 0 0 0 Munguia-Pittman Sylvia Director, Human Performance 178317 0 5399 0 8552 0 3581 0 10870 0 206719 0 0 0 Swanson Jeffery President, Philanthropy 176272 0 7876 0 3031 0 3574 0 10870 0 201623 0 0 0 Ramirez Carol Admin Dir, Comm Res & Mission Dev 156933 0 7698 0 2934 0 3153 0 5963 0 176681 0 0 0 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 VI, Section A, line 6 The sole member of the organization is Stone Point Health, a California nonprofit public benefit corporation. Form 990, Part VI, Section A, line 7a Each individual who is a director of the board of Stone Point Health shall automatically be a director of Fremont-Rideout Health Group, and shall serve as a director of Fremont-Rideout Health Group until such time as that person is no longer a director of Stone Point Health. Form 990, Part VI, Section A, line 7b Stone Point Health shall exercise its membership rights through its board of directors, which may, by, resolution, authorize one or more of its officers to exercise its vote on any matter to come before the membership of FRHG. Request for action by Stone Point Health may be made by the Chair of Stone Point Health's Board or any other person designated in writing by Stone Point Health. Amendments to the organization's governing documents require approval from the sole member, Stone Point Health. 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 corporation's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, corporate officers, key employees, and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The statements are reviewed by the internatl audit staff as part of the annual financial statement audit. For potential conflicts, the CEO or a designee will determine and present all relevant facts to the governing body prior to the decision. After addressing any questions asked by the governing body, the responsible person must leave the meeting during the discussion of the matter that involves a conflict and during any vote on the matter. Form 990, Part VI, Section B, line 15 The governance committee develops the executive compensation policy and strategy to be followed in establishing the CEO's compensation and for the CEO to follow in establishing compensation for other key employees. The primary strategy is to utilize an outside firm to provide executive salary market data within the Health Care industry for comparability when setting executive compensation levels. The CEO then reports salary decisions for key employees utilizing this data to the governance committee. Annually the governance committee reports a summary of its actions and established compensation philosophy to the board. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, or financial statements available to the public. 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 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 1 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 1 Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 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 FRD Management Company LLC PO Box 2128 Marysville CA 95901 943335136 Operation of cancer center CA Fremont-Rideout Health Group related 2446946 17958148 0 1 0.51000 Fremont-Rideout Management Services Organization Inc 989 Plumas Street Yuba City CA 95991 271350379 DME Sales CA Fremont-Rideout Health Group C 1.00000 1 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 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 FRD Management Company LLC S 244611 FMV Rideout Memorial Hospital S 62307757 FMV United Com-Serve S 5020644 FMV Rideout Memorial Hospital D 7464482 FMV United Com-Serve D 374470