2020-11-10T13:18:25-06:00 2019-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2019-01-01 770258013 Adventist Health Delano ADVE 9164060000 1401 Garces Hwy Delano CA 93215 Wally Hutcheson Treas/Asst Sec/Finance Officer 9164060000 2020-11-06 1 Tracy S Paglia P00366884 2099556100 2020-11-06 172.9.161.112 2020-11-06 17:31:59 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2019 2021-01-29 14:40:06Z Delano Regional Medical Center David Butler 1401 Garces Hwy Delano CA 93215 118805540 0 X www.adventisthealth.org/delano X 1990 CA Living God's love by inspiring health, wholeness, and hope. 16 14 890 16 -301090 0 810 0 89865958 98130610 1892268 1350600 530635 303353 92289671 99784563 0 0 0 0 41695886 41938585 0 0 0 46163292 39184219 87859178 81122804 4430493 18661759 158068691 174179222 43399426 38978207 114669265 135201015 X Living God's love by inspiring health, wholeness, and hope. 0 0 69060798 0 98130610 See Schedule O 69060798 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 124 0 1 890 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 CA X Jay Lipps VP System Controller 9164061092 PO Box 619135 Roseville CA 95661 X Reiner Scott Dir/Chair as of 12/19 0.00 50.00 X X 0 1995696 53734 Ghaffari Bahram President thru 12/19 40.00 0.00 X 1905931 0 25304 Wing Bill Dir/Asst Secr/CFO as of 12/19 0.00 50.00 X X 0 1572254 46583 Jobe Meredith Secretary as of 12/19 0.00 50.00 X 0 730385 45909 Noble William - Chairman Chief Executive thru 12/19 30.00 0.00 X X 612691 0 0 Butler David President as of 12/19 50.00 0.00 X 0 487381 58696 Datta Babita OB/GYN Physician 40.00 0.00 X 478299 0 6857 Monrian Terrance Pharmacy Director 40.00 0.00 X 305653 0 6104 Hutcheson Wally - TreasAsst Secr Finance Officer as of 12/19 50.00 0.00 X 0 192024 42068 Lee Mee Young Pharmacist 40.00 0.00 X 227156 0 6259 Meng Bryant Pharmacist 40.00 0.00 X 205617 0 5399 Bakich Sandra Compliance Officer/IS Director 40.00 0.00 X 197699 0 6666 Wade Evelyn Chief Nursing Officer 40.00 0.00 X 190603 0 7526 Khalil Samuel Pharmacist 40.00 0.00 X 183125 0 7442 Reiner Richard Director as of 12/19 0.00 4.00 X 0 28588 0 Davis Andrew Director as of 12/19 0.00 4.00 X 0 28246 0 Cherry Robert Director as of 12/19 0.00 4.00 X 0 26315 0 Wiggins Sheryl Corporate Secretary thru 12/19 3.00 0.00 X X 24000 0 0 Heinrich Kerry Director as of 12/19 0.00 4.00 X 0 20102 0 Innocent Larry Director as of 12/19 0.00 4.00 X 0 18852 0 Woodson Marc Director as of 12/19 0.00 4.00 X 0 15000 0 Graham Ricardo Director as of 12/19 0.00 4.00 X 0 8848 0 Banks David Director as of 12/19 0.00 4.00 X 0 6382 0 Ocampo Lucy Director as of 12/19 0.00 4.00 X 0 0 0 Philip Celeste Director as of 12/19 0.00 4.00 X 0 0 0 Freedman John Director as of 12/19 0.00 4.00 X 0 2367 0 Salazar Velino Director as of 12/19 0.00 4.00 X 0 553 0 Barba Irma Board member thru 12/19 1.00 0.00 X 0 0 0 EhteshamiMD Shahram Chief of Medical Staff 2.00 0.00 X 0 0 0 Gehlawat MD Dilbagh Board member 1.00 0.00 X 0 0 0 Hylton Linda Board member thru 12/19 1.00 0.00 X 0 0 0 Salmassi MD Sadegh Board member/COS thru 12/19 2.00 0.00 X 0 0 0 4330774 5132993 318547 85 0 1 0 Comfort Anesthesia Associates Inc 11704 Nantwick Ct Bakersfield CA 93311 Professional services anesthesia 1299738 Parikshat Sharma Inc DBA Golden State Ho 2403 Windermere St Bakersfield CA 93311 Professional services hospitalists 487000 Team Physicians of California Medical Gr PO Box 634850 Cinnanati OH 452634850 Professional services ER physicians 358333 Sheikh Latif DO 1320 Bailey Dr Ste 103 Hanford CA 93230 Professional services vascular surgeron 249531 Debbie Dennis-Johnson MD Inc 8766 Sunset Ave Fair Oaks CA 95628 Professional services OB/GYN physician 236652 14 Patient services 621400 98130610 98130610 98130610 1659884 1659884 313150 136737 176413 176413 176413 16615000 16615000 309284 0 -309284 -309284 -309284 1592960 1959956 -366996 -366996 Cafeteria sales 722100 298003 298003 Management fees 561000 65906 65906 130027 130027 493936 99784563 98130610 -301090 1955043 2522862 1807928 714934 28682860 27141700 1541160 8512152 7204724 1307428 2220711 2220711 537856 537856 699856 699856 8721 8721 7473221 6822985 650236 162012 162012 805260 337617 467643 1968863 1771977 196886 1432368 749073 683295 65627 56524 9103 56621 46416 10205 6105254 6105254 Medical/non-medical sup 6599660 6570791 28869 Quality Assurance Fees 5074290 5074290 Bad debts 2012631 2012631 Repairs and maintenance 1670539 1628027 42512 4511440 1522781 2988659 81122804 69060798 12062006 0 21746057 29798125 8613581 27159923 7747612 8415803 441983 0 1402509 1464823 934236 852863 129658766 92169336 41982584 37489430 57307350 42438879 122187 91151 17770592 26468225 158068691 174179222 21711076 11556013 1592931 4385901 19181487 19187500 913932 3848793 43399426 38978207 X 114669265 135201015 114669265 135201015 158068691 174179222 X 18661759 1901031 -31040 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8721 8721 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. 4179776 4179776 65439017 42787263 22651754 619702 483984 135718 59212514 48898089 10314425 207757 207757 37489430 Deposits 251578 Other receivables 2660022 Interest receivable 389063 Medi-Cal QAF fund 20646422 Bond issuance costs, net 2521140 26468225 Accrued bond interest 408500 Est. cost report settlement payable 2947647 Lease liability 492646 3848793 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 1 1 X 1 X 1 1 0 1 1 1338767 1338767 0.01690 47299211 30009866 17289345 0.21850 48637978 30009866 18628112 0.23540 2077545 2077545 0.02630 1148102 1148102 0.01450 18800 18800 0.00020 3244447 3244447 0.04100 51882425 30009866 21872559 0.27640 1 953158 653800 18154892 11274101 6880791 X 1 1 1 1 Adventist Health Delano 1401 Garces Hwy Delano CA 93215 https://www.adventisthealth.org/delano 120000180 X X X Adventist Health Delano 1 0 1 1 X X X X X X X X 19 1 1 0 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 19 1 See Sch H Part VI - Needs Assesment 0 1 X 200.000000000000 400.000000000000 X X 1 1 X 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 Delano Part V, Section B, Line 2: Adventist Health System/West entered into an affiliation agreement with Central California Foundation for Health dba: Delano Regional Medical Center, located in Delano, California, to become the sole member of Adventist Health Delano. This agreement was effective December 31, 2019. This acquisition allowed the System the ability to provide expanded healthcare services in the Delano, California, market. Adventist Health Delano Part V, Section B, Line 5: Secondary and primary data were collected to complete the CHNA. Primary data were obtained through community surveys and interviews with 41 key community stakeholders, public health, and service providers, members of medically underserved, low-income, and minority populations in the community, and individuals or organizations serving or representing the interests of such populations. The primary data collection process was designed to validate secondary data findings, identify additional community issues, solicit information on disparities among subpopulations, ascertain community assets potentially available to address needs and discover gaps in resources.Secondary data were collected from a variety of local, county and state sources to present a demographic profile, social determinants of health, health care access, birth indicators, leading causes of death, acute and chronic disease, health behaviors, mental health, substance use and misuse, and preventive practices. The analysis of secondary data yielded a preliminary list of significant health needs, which then informed primary data collection. Adventist Health Delano Part V, Section B, Line 6a: The Community Health Needs Assessment process was supported by the Kern County Community Benefit Collaborative. The Collaborative is comprised of Adventist Health Delano, Dignity Health (Mercy and Memorial Hospitals), Kern Medical, Adventist Health (Bakersfield and Tehachapi Valley), Valley Children's Healthcare and Kaiser Permanente. Adventist Health Delano Part V, Section B, Line 11: Adventist Health Delano examined the significant health needs and applied the following criteria to identify the health needs it will address: organizational capacity, established relationships, ongoing investment, and acknowledged competencies and expertise. As a result, Adventist Health Delano will address the following health needs through a commitment of community benefit programs and charitable resources.A. Access to care- provide financial assistance through both free and discounted care for health care services, consistent with the hospital's financial assistance policy.- connect the medically indigent to resources to access a medical home.- provide free preventive health screenings at community events.B. Food insecurity- promote screening for food insecurity at strategic intake points, including the ed and local health clinics and provide information on local food resources.- offer sign-up assistance for public programs that increase access to food.- participate in waste hunger not food kern county and C. Chronic diseases including overweight and obesity- provide diabetes education focused on prevention and disease self-management, healthy lifestyles, nutrition.D. Physical activity- distribute glucometers and glucose strips to individuals with diabetes who cannot afford or access these.E. Diabetes monitoring resources- provide public health education in the media and community health awareness events to encourage healthy behaviors and prevent chronic diseases.Taking existing hospital and community resources into consideration, Adventist Health Delano will not directly address the remaining health needs identified in the CHNA: housing and homelessness, mental health, economic insecurity, substance use and misuse, environmental pollution, sexually transmitted infections, violence and injury, dental care, birth indicators, Alzheimer's disease, unintentional injuries and preventive practices. Adventist Health Delano does not have the resources to address all health needs present in the community. Therefore, it will concentrate on those health needs that can most effectively be addressed given the organization's areas of focus and expertise. 4 1 - Delano Women's Medical Clinic 1201 Jefferson St Delano CA 93215 Outpatient Women's Clinic 2 - Wasco Medical Plaza 2300 7th Street Wasco CA 93280 Rural Health Clinic 3 - Delano Urgent Care 1201 Jefferson 12th Ave Entrance Delano CA 93215 Outpatient Urgent Care Clinic 4 - Delano Wound Care Clinic 1519 Garces Hwy Ste 103 Delano CA 93215 Outpatient Wound Care Clinic Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2,012,631. 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. 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. 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, those accounts would have been reclassified from bad debt expense to charity care. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8: Depending on Utilization and CMI average of the patients we may be either above or below cost.Costing methodology: Total cost as a percentage of total net revenue and apply total cost to the net revenue for Medicare.The Medicare cost report apportions the Hospital's costs based on 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 healthcare "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. Our mission is to promote health in the community regardless of a person's ability to pay. We provide care to those with Medicare coverage who present themselves to our facility without consideration that the costs may or may not be fully reimbursed. The Medicare shortfall is a community benefit because care is provided to Medicare beneficiaries who are primarily elderly and disabled individuals on fixed incomes and who usually have no other resources with which to obtain medical care. We are thus relieving a local and federal government burden by caring for these people. Part III, Line 9b: Once a patient is identified as a charity care patient all collection efforts cease.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: Adventist Health Delano is part of a core group of local healthcare and community agencies, that assesses the community needs we serve. Through the creation of a web based interactive needs assessment (www.healthykern.org) needs are assessed through a constantly updated needs assessment with reporting and tracking tools. This web based assessment provides a tool for community strategic planning, brings us together with other stakeholders in our community for partnership in determining the needs as well as defining best practices.Overall, Adventist Health Delano works collaboratively with these community organizations to address the identified health needs.- Delano Chamber of Commerce- Churches/faith communities- schools and school districts- prison system- local businesses- Delano and McFarland Police Departments- Delano Urgent Care ClinicsAdventist Health Delano continue to look for opportunities to engage additional community partners as a way to leverage resources and support increased participation in Adventist Health Delano decision making. The Hospital will address the identified health needs through a commitment of community benefit programs and charitable resources.The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) Update for fiscal year 2019, and 2020 Implementation Strategy, are posted on the hospital's website at:https://www.adventisthealth.org/delano/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: By letter and at admission, we inform patients about the availability to help apply for specific governmental program assistance and the patients' ability to apply for charity consideration. Also, posters in both English and Spanish are displayed in the ER, waiting area, clinics and hospital admission areas informing of the availability of the hospital's program to assist through the charity or sliding fee scale for their bill.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 Delano is located at 1401 Garces Highway, Delano, California 93215. The service area for the hospital includes six communities consisting of four ZIP Codes in Kern County and two ZIP Codes in Tulare County. Adventist Health Delano determines the community for the purposes of this CHNA by assigning ZIP Codes based on patient discharges. Over 70% of inpatient discharges constitute the hospital service area.The population of the Adventist Health Delano service area is 131,723.Of the area population, 55.6% are male and 44.4% are female. Children and youth, ages 0-17, make up 31.1% of the population, 62.4% are adults, ages 18-64, and 6.5% of the population are seniors, 65 and over. The service area has a higher percentage of young adults, ages 18-44, and a lower percentage of older adults, ages 45 and over, than the counties and state.In the Adventist Health Delano service area, 81.5% of the population is Hispanic/Latino, 8.0% are White, 5.6% are Asian, 3.6% are Black/African American, and the remaining 1.3% of the population is American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, other race/ethnicity, and multiple races. There is a higher percentage of Hispanics/Latinos, and a lower percentage of Whites in the service area than found in either county.72% of the service area population speaks Spanish in the home. English is spoken in the home by 22.5% of the population. 4.7% of the population speaks an Asian or Pacific Islander language, and less than 1% (0.5%) of the population speaks an Indo-European language at home.In the hospital service area, 2.5% of the civilian population, 18 years and older, were veterans, which was lower than county and state (5.9%) rates. In the hospital service area, 35.1% of the population is foreign-born. Among the foreign-born, 76.1% are not citizens. Part VI, Line 5: Adventist Health Delano's commitment to the communities extends to the employment of a Director of Marketing and Community Relations, as well as a Marketing & Community Relations Coordinator both of which provide outreach services within the communities Adventist Heatlh Delano serves. The Community Relations Coordinator serves as a liaison between Adventist Heatlh Delano's services and the community, in an effort to provide assistance to the medically underserved.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 are 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 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 X X X X 1 0 0 0 0 0 0 0 0 Reiner Scott Dir/Chair as of 12/19 0 1510024 0 420315 0 65357 0 16782 0 36952 0 2049430 0 0 Ghaffari Bahram President thru 12/19 1107993 0 321875 0 476063 0 0 0 25304 0 1931235 0 0 0 Wing Bill Dir/Asst Secr/CFO as of 12/19 0 1200390 0 318717 0 53147 0 16782 0 29801 0 1618837 0 0 Jobe Meredith Secretary as of 12/19 0 524870 0 65461 0 140054 0 16782 0 29127 0 776294 0 0 Noble William - Chairman Chief Executive thru 12/19 0 0 0 0 612691 0 0 0 0 0 612691 0 0 0 Butler David President as of 12/19 0 385387 0 25060 0 76934 0 16782 0 41914 0 546077 0 0 Datta Babita OB/GYN Physician 478299 0 0 0 0 0 0 0 6857 0 485156 0 0 0 Monrian Terrance Pharmacy Director 284217 0 21436 0 0 0 0 0 6104 0 311757 0 0 0 Hutcheson Wally - TreasAsst Secr Finance Officer as of 12/19 0 145801 0 17669 0 28554 0 7309 0 34759 0 234092 0 0 Lee Mee Young Pharmacist 227156 0 0 0 0 0 0 0 6259 0 233415 0 0 0 Meng Bryant Pharmacist 205617 0 0 0 0 0 0 0 5399 0 211016 0 0 0 Bakich Sandra Compliance Officer/IS Director 178916 0 16983 0 1800 0 0 0 6666 0 204365 0 0 0 Wade Evelyn Chief Nursing Officer 178916 0 11687 0 0 0 0 0 7526 0 198129 0 0 0 Khalil Samuel Pharmacist 183125 0 0 0 0 0 0 0 7442 0 190567 0 0 0 Part I, Line 4a 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. Ghaffari, Bahram - severance payment - $456,853 A City of Delano 956000702 245584BU0 2012-12-20 30542500 To refund and retire 1998 bonds at a lower rate of interest 0 0 0 A 11355000 30542500 3054250 610850 26877400 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 1 0 0 0 0 1 A 1 Form 990, Part III, Line 4a: Adventist Health Delano (AHDL) 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 Delano, 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 Delano 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. The following Inpatient services that were provided to all our patients. These services included: - 547 Babies delivered - 733 Surgeries performed - 7,903 Acute Patient days - 17,542 Special Care (sub-acute) Patient Days The following Outpatient services that were provided to all our patients. These services included: - 29,264 Emergency department visits - 1,173 Outpatient Surgeries performed - 27,185 Outpatient visits - 38,397 Clinic visits Form 990, Part VI, Section A, line 4 The Hospital adopted amendments to its Articles of Incorporation and Bylaws for its affiliation with Adventist Health System/West for the following: 1) Change the Hospital's name from Central Calif Foundation for Health to Adventist Health Delano. 2) The sole member of the Hospital was changed Adventist Health System/West. 3) The number, composition, qualifications, powers and election of the Hospital's Board of Directors were changed so that the Board of Directors of the sole member, Adventist Health System/West are the Hospital's Board of Directors. 4) The powers reserved and approval authority of the sole member were revised. 5) The duties of officers were revised. 6) Amendments to the governing documents require approval by the sole member. 7) The articles pertaining to the Audit Committee and Conflict of Interest procedures were removed from the Bylaws and replaced by separate provisions within the Affiliation Agreement or covered by corporate policy of the sole member. 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 Before filing, the Form 990 is reviewed by the Finance Officer. 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 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 15a The Hospital's 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 XI, line 9: Adjustment to eliminate DHA activity -31,040. 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 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 3 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 1 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 and 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 Delano Health Associates Inc 1401 Garces Hwy Delano CA 93215 770340007 To provide healthcare registry services to Delano Regional Medical Center. CA Adventist Health Delano C -36292 860161 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 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 Delano Health Associates L 65906 FMV Delano Health Associates M 184929 FMV Delano Health Associates Q 57490 FMV