ADVENTIST HEALTH AND RIDEOUT EMPLOYEE: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
ADVENTIST HEALTH AND RIDEOUT EMPLOYEE (EIN 32-0606993)
Tax period
2019-02-01 to 2019-12-31
Filed
2020-10-30
IRS object ID
202043049349301969
Schema version
2019v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-10-30T16:12:49-05:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN910189318PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12882 PROSPECT PARK DR STE 300AddressLine1Txt
CityRANCHO CORDOVACityNm
State AbbreviationCAStateAbbreviationCd
ZIP95670ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-02-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN320606993EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ADVENTIST HEALTH AND RIDEOUT EMPLOYEEBusinessNameLine1Txt
Business Name Line2HEALTH PLAN TRUSTBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlADVEBusinessNameControlTxt
Phone9164060000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 619135AddressLine1Txt
CityROSEVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95661ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonWELLS FARGOPersonNm
Person TitleINSITUTIONAL TRUSTEEPersonTitleTxt
Phone9164060000PhoneNum
Signature2020-10-20SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTRACY S PAGLIAPreparerPersonNm
PTINP00366884PTIN
Phone9165038100PhoneNum
Preparation2020-09-20PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address172.9.161.112IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-10-20IPDt
IP Tm17:45:21IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3AtSubmissionCreationDeviceId
At Submission Filing Device Id2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-04-22 16:20:28ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Initial ReturnYes (X)InitialReturnInd
Principal OfficerRICHARD RAWSONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 619135AddressLine1Txt
CityROSEVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95661ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$41,944,096GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressNONEWebsiteAddressTxt
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation2019FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionTO PROVIDES MEDICAL, DENTAL, AND VISION BENEFITS TO ELIGIBLE EMPLOYEES OF RIDEOUT AND THEIR DEPENDENTS.ActivityOrMissionDesc
Voting Members Governing Body1VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
CY Contributions Grants$0CYContributionsGrantsAmt
CY Program Service Revenue$41,916,410CYProgramServiceRevenueAmt
CY Investment Income$27,686CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
CY Total Revenue$41,944,096CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$36,886,324CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$364CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
CY Other Expenses$1,975,422CYOtherExpensesAmt
CY Total Expenses$38,862,110CYTotalExpensesAmt
CY Revenues Less Expenses$3,081,986CYRevenuesLessExpensesAmt
Total Assets EOY$3,081,986TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances EOY$3,081,986NetAssetsOrFundBalancesEOYAmt
MissionNONEMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
DescRIDEOUT MEMORIAL HOSPITAL DBA ADVENTIST HEALTH AND RIDEOUT ("RIDEOUT"), WHICH IS A 501(C)(3) HOSPITAL, ESTABLISHED THE ADVENTIST HEALTH AND RIDEOUT EMPLOYEE WELFARE PLAN (THE "PLAN"). THE PLAN PROVIDES MEDICAL, DENTAL, AND VISION BENEFITS TO ELIGIBLE EMPLOYEES OF RIDEOUT AND THEIR DEPENDENTS.Desc
Described In Section501c30DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members1GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing Body0MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JAY LIPPS VP SYSTEM CONTROLLERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9164061092PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 619135AddressLine1Txt
CityROSEVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95661ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp

FieldValueIRS element (for citing)
PersonWELLS FARGOPersonNm
TitleTRUSTEETitleTxt
Average Hours Per Week1.00AverageHoursPerWeekRt
Individual Trustee Or DirectorYes (X)IndividualTrusteeOrDirectorInd
Reportable Comp From Org$364ReportableCompFromOrgAmt
Reportable Comp From Rltd Org$0ReportableCompFromRltdOrgAmt
Other Compensation$0OtherCompensationAmt
FieldValueIRS element (for citing)
Total Reportable Comp From Org$364TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ADVENTIST HEALTH SYSTEMWESTBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 619135AddressLine1Txt
CityROSEVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95661ZIPCd
FieldValueIRS element (for citing)
ServicesCLAIMS ADMINISTRATION FEESServicesDesc
Compensation$1,844,942CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescEMPLOYER AND EMPLOYEE CONTRIBUTIODesc
Business900099BusinessCd
Total Revenue Column$41,916,410TotalRevenueColumnAmt
Related Or Exempt Func Income$41,916,410RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$41,916,410TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$27,686TotalRevenueColumnAmt
Exclusion$27,686ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,944,096TotalRevenueColumnAmt
Related Or Exempt Func Income$41,916,410RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$27,686ExclusionAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$36,886,324TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$364TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,844,942TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$70,985TotalAmt

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$59,495TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$38,862,110TotalAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,081,986EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,081,986EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,081,986EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,081,986EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,081,986EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,081,986ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 8ANO MEETINGS WERE HELD DURING THE TAX YEAR.
FORM 990, PART VI, SECTION A, LINE 8BTHE TRUST HAS NO SEPARATE COMMITTEES.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM WITH INFORMATION PROVIDED BY THE INSTITUTIONAL TRUSTEE. THE FORM 990 IS REVIEWED BY THE TREASURY MANAGER AND THEN BY THE VP SYSTEM CONTROLLER. THE RETURN WILL BE SENT OUT TO WELLS FARGO, THE INSTITUTIONAL TRUSTEE TO REVIEW AND SIGN THE TAX RETURN.
FORM 990, PART VI, SECTION C, LINE 19THE TRUST'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. THE TRUST'S SUMMARY ANNUAL REPORT IS PROVIDED TO PARTICIPANTS ON AN ANNUAL BASIS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
FREMONT-RIDEOUT HEALTH GROUP
989 PLUMAS STREETYUBA CITYCA95991942917251ACUTE CARE HOSPITALCA501(C)(3)LINE 12B, IISTONE POINT HEALTH0
RIDEOUT MEMORIAL HOSPITAL
989 PLUMAS STREETYUBA CITYCA95991941387866HOSPITALCA501(C)(3)LINE 3FREMONT-RIDEOUT HEALTH GROUP0
UNITED COM-SERVE
989 PLUMAS STREETYUBA CITYCA95991943015356SKILLED NURSING/ASSISTED LIVING/HOME HEALTHCA501(C)(3)LINE 12B, IIFREMONT-RIDEOUT HEALTH GROUP0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

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