ST HELENA HOSPITAL: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ST HELENA HOSPITAL (EIN 94-1279779)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-10
- IRS object ID
- 202043159349303484
- Schema version
- 2019v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-10T13:50:58-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941279779 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Helena Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STHE | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Woodland Road | AddressLine1Txt |
| City | St Helena | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94574 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Elisa Blethen | PersonNm |
| Person Title | Treasurer/Asst Secretary | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2020-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2020-10-29 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 172.9.161.112 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-29 | IPDt |
| IP Tm | 19:13:08 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health St Helena | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steven Herber | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Woodland Road | AddressLine1Txt |
| City | St Helena | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94574 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $239,511,048 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/st-helena/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1898 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1384 | TotalEmployeeCnt |
| Total Volunteers | 78 | TotalVolunteersCnt |
| Total Gross UBI | $1,444,759 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,821,270 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,930,353 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $242,718,082 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $234,262,512 | CYProgramServiceRevenueAmt |
| PY Investment Income | $654,474 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,318,183 | CYInvestmentIncomeAmt |
| PY Other Revenue | $74,114 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $249,267,940 | PYTotalRevenueAmt |
| CY Total Revenue | $239,511,048 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $141,337 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,316,458 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $92,476,556 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $90,992,485 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,095,033 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $163,788,332 | PYOtherExpensesAmt |
| CY Other Expenses | $170,347,469 | CYOtherExpensesAmt |
| PY Total Expenses | $256,406,225 | PYTotalExpensesAmt |
| CY Total Expenses | $267,656,412 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$7,138,285 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$28,145,364 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $207,231,740 | TotalAssetsBOYAmt |
| Total Assets EOY | $195,818,524 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $94,388,581 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $110,887,504 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $112,843,159 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $84,931,020 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $214,623,430 | ExpenseAmt |
| Grant | $6,316,458 | GrantAmt |
| Revenue | $234,262,512 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $214,623,430 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1384 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jay Lipps VP System Controller | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9164061092 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $1,995,696 | $53,734 | |||
| Wing Bill | ||||||||||
| Dir/Asst Secretary/CFO | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $1,572,254 | $46,583 | |||
| Reppert Joseph | ||||||||||
| CFO/Asst Secr thru 08/2019 | 0.00 | 50.00 | Yes (X) | $0 | $1,209,069 | $57,565 | ||||
| Eller Jeff | ||||||||||
| President, NCR | 10.00 | 40.00 | $0 | $1,172,082 | $40,197 | Yes (X) | ||||
| McDonald Edward | ||||||||||
| Former Treas/Asst Secr thru 07/2017 | 0.00 | 0.00 | $0 | $1,034,618 | $13,010 | Yes (X) | ||||
| Lang Kevin | ||||||||||
| Finance Officer, NCR | 10.00 | 40.00 | $0 | $1,038,744 | $0 | Yes (X) | ||||
| Wagner Jack | ||||||||||
| Former Asst Secr | 0.00 | 0.00 | $0 | $778,475 | $29,189 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | Yes (X) | $0 | $730,385 | $45,909 | ||||
| Byrnes John | ||||||||||
| Medical Officer, NCR | 10.00 | 40.00 | $0 | $718,300 | $29,813 | Yes (X) | ||||
| Herber Steven | ||||||||||
| President | 50.00 | 0.00 | Yes (X) | $0 | $615,116 | $53,734 | ||||
| Lonto Robert | ||||||||||
| Reg HP Dir, NCR | 10.00 | 40.00 | $0 | $388,199 | $58,409 | Yes (X) | ||||
| Lendaris Antonia | ||||||||||
| Patient Care Executive thru 05/2019 | 0.00 | 50.00 | $0 | $336,159 | $31,622 | Yes (X) | ||||
| Kares Tim | ||||||||||
| Finance Officer thru 08/2019 | 50.00 | 0.00 | $0 | $354,494 | $745 | Yes (X) | ||||
| Hasso Ruth | ||||||||||
| RN | 50.00 | 0.00 | $255,538 | $0 | $30,984 | Yes (X) | ||||
| Olaiz Amphone | ||||||||||
| RN | 50.00 | 0.00 | $253,999 | $0 | $28,970 | Yes (X) | ||||
| Barnes Geoffrey | ||||||||||
| Manager, Cardiovascular | 50.00 | 0.00 | $246,642 | $0 | $35,027 | Yes (X) | ||||
| Madrid Daniel | ||||||||||
| Dir, Acctg & Fin thru 09/19 | 25.00 | 25.00 | $242,614 | $0 | $28,499 | Yes (X) | ||||
| Dickinson Elizabeth | ||||||||||
| Patient Care Executive as of 06/2019 | 50.00 | 0.00 | $0 | $242,292 | $23,604 | Yes (X) | ||||
| Butcher Sara | ||||||||||
| RN | 50.00 | 0.00 | $239,418 | $0 | $13,103 | Yes (X) | ||||
| Blethen Elisa - Interim | ||||||||||
| Finance Officer as of 08/2019 | 10.00 | 40.00 | $0 | $191,538 | $34,717 | Yes (X) | ||||
| Chilton Harold | ||||||||||
| Former COO thru 09/2017 | 0.00 | 50.00 | $0 | $201,212 | $16,002 | Yes (X) | ||||
| Lyons Timothy | ||||||||||
| Medical Officer | 10.00 | 40.00 | $0 | $208,230 | $0 | Yes (X) | ||||
| Kinney Jill | ||||||||||
| Admin Dir Marketing & Comm, NCR | 10.00 | 40.00 | $0 | $181,700 | $21,349 | Yes (X) | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $28,588 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $28,246 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,315 | $0 | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,102 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $18,852 | $0 | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $15,000 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $8,848 | $0 | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $6,382 | $0 | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $2,367 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $553 | $0 | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Philip Celeste | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,238,211 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $13,123,816 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $692,765 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 276 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Adventist Health CMG Inc | |||||
| 821 South St Helena Hwy Suite 208 | St Helena | CA | 94574 | Physician services | $6,092,684 |
| Acute Medical Providers Inc | |||||
| PO Box 94760 | Oklahoma City | OK | 73143 | Physician services | $3,520,328 |
| Healthcare Design and Construction LLC | |||||
| 200 Montgomery Dr | Santa Rosa | CA | 95404 | Design and construction | $3,095,466 |
| Sound Inpatient Physicians Inc | |||||
| PO Box 74936 | Los Angeles | CA | 90074 | Physician services | $1,543,654 |
| Patient Access Medical Group | |||||
| 10 Woodland Rd | St Helena | CA | 94574 | Physician services | $1,091,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 54 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $3,881,387 | RelatedOrganizationsAmt |
| All Other Contributions | $48,966 | AllOtherContributionsAmt |
| Total Contributions | $3,930,353 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Patient service revenue | 621110 | $231,321,485 | $229,876,726 | $1,444,759 |
| Rental income | 531120 | $1,404,837 | $1,404,837 | |
| Dietary | 722210 | $931,178 | $931,178 | |
| Other revenue | 900099 | $605,012 | $605,012 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $234,262,512 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,199,930 | TotalRevenueColumnAmt |
| Exclusion | $1,199,930 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $118,253 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $118,253 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $118,253 | TotalRevenueColumnAmt |
| Exclusion | $118,253 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $239,511,048 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $232,817,753 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,444,759 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,318,183 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,316,458 | TotalAmt |
| Program Services | $6,316,458 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,903,495 | TotalAmt |
| Program Services | $64,296,478 | ProgramServicesAmt |
| Management And General | $7,915,970 | ManagementAndGeneralAmt |
| Fundraising | $691,047 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,611,948 | TotalAmt |
| Program Services | $2,365,451 | ProgramServicesAmt |
| Management And General | $212,192 | ManagementAndGeneralAmt |
| Fundraising | $34,305 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,293,236 | TotalAmt |
| Program Services | $8,984,486 | ProgramServicesAmt |
| Management And General | $1,213,141 | ManagementAndGeneralAmt |
| Fundraising | $95,609 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,183,806 | TotalAmt |
| Program Services | $4,652,238 | ProgramServicesAmt |
| Management And General | $476,322 | ManagementAndGeneralAmt |
| Fundraising | $55,246 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,663,454 | TotalAmt |
| Program Services | $2,166,345 | ProgramServicesAmt |
| Management And General | $19,480,148 | ManagementAndGeneralAmt |
| Fundraising | $16,961 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $685,263 | TotalAmt |
| Program Services | $71,242 | ProgramServicesAmt |
| Management And General | $614,021 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,121 | TotalAmt |
| Management And General | $86,230 | ManagementAndGeneralAmt |
| Fundraising | $11,891 | FundraisingAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,715 | TotalAmt |
| Program Services | $28,715 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,925,357 | TotalAmt |
| Program Services | $49,564,991 | ProgramServicesAmt |
| Management And General | $11,284,927 | ManagementAndGeneralAmt |
| Fundraising | $75,439 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,086 | TotalAmt |
| Management And General | $87,368 | ManagementAndGeneralAmt |
| Fundraising | $25,718 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $960,269 | TotalAmt |
| Program Services | $599,642 | ProgramServicesAmt |
| Management And General | $338,895 | ManagementAndGeneralAmt |
| Fundraising | $21,732 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,369,548 | TotalAmt |
| Program Services | $2,451,716 | ProgramServicesAmt |
| Management And General | $7,892,375 | ManagementAndGeneralAmt |
| Fundraising | $25,457 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,799,194 | TotalAmt |
| Program Services | $7,474,241 | ProgramServicesAmt |
| Management And General | $1,323,737 | ManagementAndGeneralAmt |
| Fundraising | $1,216 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,763 | TotalAmt |
| Program Services | $112,329 | ProgramServicesAmt |
| Management And General | $108,359 | ManagementAndGeneralAmt |
| Fundraising | $19,075 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,781 | TotalAmt |
| Program Services | $33,971 | ProgramServicesAmt |
| Management And General | $12,873 | ManagementAndGeneralAmt |
| Fundraising | $2,937 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,461,864 | TotalAmt |
| Program Services | $1,461,864 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,012,206 | TotalAmt |
| Program Services | $7,956,345 | ProgramServicesAmt |
| Management And General | $55,861 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,483 | TotalAmt |
| Program Services | $87,483 | ProgramServicesAmt |
| Management And General | $120,000 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| Patient care supplies | $44,461,524 | $44,460,255 | $1,269 | |
| Quality assurance fees | $10,942,440 | $10,942,099 | $341 | |
| Rental/lease costs | $602,270 | $597,081 | $382 | $4,807 |
| Income Taxes | $31 | $31 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $727,100 | TotalAmt |
| Management And General | $710,382 | ManagementAndGeneralAmt |
| Fundraising | $16,718 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $267,656,412 | TotalAmt |
| Program Services | $214,623,430 | ProgramServicesAmt |
| Management And General | $51,937,949 | ManagementAndGeneralAmt |
| Fundraising | $1,095,033 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,219 | BOYAmt |
| EOY | $3,109,801 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,686,706 | BOYAmt |
| EOY | $23,428,826 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,003,471 | BOYAmt |
| EOY | $21,231,701 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,317,398 | BOYAmt |
| EOY | $5,418,090 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,044,188 | BOYAmt |
| EOY | $1,568,651 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $252,200,495 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $162,849,241 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,960,890 | BOYAmt |
| EOY | $89,351,254 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,362,721 | BOYAmt |
| EOY | $9,617,361 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,785,147 | BOYAmt |
| EOY | $42,092,840 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,231,740 | BOYAmt |
| EOY | $195,818,524 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,563,963 | BOYAmt |
| EOY | $23,249,421 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,824,618 | BOYAmt |
| EOY | $87,638,083 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,388,581 | BOYAmt |
| EOY | $110,887,504 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,902,554 | BOYAmt |
| EOY | $65,171,501 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,940,605 | BOYAmt |
| EOY | $19,759,519 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,843,159 | BOYAmt |
| EOY | $84,931,020 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,231,740 | BOYAmt |
| EOY | $195,818,524 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$28,145,364 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $233,225 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $28,715 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $28,715 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $29,940,604 | BeginningYearBalanceAmt |
| Contributions | $1,550,642 | ContributionsAmt |
| Investment Earnings Or Losses | $1,795,537 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $127,557 | GrantsOrScholarshipsAmt |
| Other Expenditures | $11,399,708 | OtherExpendituresAmt |
| End Year Balance | $21,759,518 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,423,779 | BeginningYearBalanceAmt |
| Contributions | $3,296,920 | ContributionsAmt |
| Investment Earnings Or Losses | -$455,682 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $4,324,413 | OtherExpendituresAmt |
| End Year Balance | $29,940,604 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $12,255,343 | BeginningYearBalanceAmt |
| Contributions | $1,049,443 | ContributionsAmt |
| Investment Earnings Or Losses | $30,008,379 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $15,379 | GrantsOrScholarshipsAmt |
| Other Expenditures | $11,874,007 | OtherExpendituresAmt |
| End Year Balance | $31,423,779 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,794,102 | BeginningYearBalanceAmt |
| Contributions | $3,901,050 | ContributionsAmt |
| Investment Earnings Or Losses | $18,350 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,458,159 | OtherExpendituresAmt |
| End Year Balance | $12,255,343 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,554,992 | BeginningYearBalanceAmt |
| Contributions | $5,424,873 | ContributionsAmt |
| Investment Earnings Or Losses | -$228,210 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,957,553 | OtherExpendituresAmt |
| End Year Balance | $11,794,102 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.09190 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.90810 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $425,124 | OtherCostOrOtherBasisAmt |
| Book Value | $425,124 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $153,518,674 | OtherCostOrOtherBasisAmt |
| Depreciation | $91,859,560 | DepreciationAmt |
| Book Value | $61,659,114 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,008,428 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,847,294 | DepreciationAmt |
| Book Value | $7,161,134 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $68,108,225 | OtherCostOrOtherBasisAmt |
| Depreciation | $58,142,387 | DepreciationAmt |
| Book Value | $9,965,838 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,140,044 | OtherCostOrOtherBasisAmt |
| Book Value | $10,140,044 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $89,351,254 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Interest in Foundation | $29,394,361 |
| Receivables from third-party payors | $11,355,890 |
| Other receivables | $1,342,589 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $42,092,840 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $63,134,304 |
| Payables to third-party payors | $11,349,992 |
| Other liabilities | $6,899,856 |
| Lease liability | $6,253,931 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $87,638,083 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. |
| Part X, Line 2: | The principal operations of the System is exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2019 and 2018, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2015 in major tax jurisdictions. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,800,721 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,800,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01050 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,800,721 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,800,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01050 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $461,309 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $461,309 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $418,020 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $418,020 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,107,515 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,107,515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04150 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $177,916 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $177,916 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $133,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $79,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $54,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,298,260 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $79,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,219,260 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04570 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,098,981 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $79,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,019,981 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05620 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $250 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,104 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,104 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,354 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,354 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $411,764 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $57,429 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $82,998,993 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $93,645,052 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$10,646,059 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | State LicenseStateLicenseNum | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Facility Reporting GroupFacilityReportingGroupCd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|---|---|---|
| St Helena Hospital | |||||||||||
| 1 | 10 Woodland Road | St Helena | CA | 94574 | www.adventisthealth.org/sthelena | 110000073 | Yes (X) | Yes (X) | Yes (X) | A | |
| SHH Center for Behavioral Health | |||||||||||
| 2 | 525 Oregon Street | Vallejo | CA | 94590 | www.adventisthealth.org/sthelena | 110000042 | Yes (X) | A | Acute Psychiatric Hospital | ||
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Facility Reporting Group - A | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assesment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assesment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assesment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Section B | Facility Reporting Group A |
| Facility Reporting Group A consists of: | - Facility 1: St. Helena Hospital, - Facility 2: SHH Center for Behavioral Health |
| Facility Reporting Group - A Part V, Section B, line 5: | The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts;2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering from community members. Data gathering was accomplished by engaging with community focus groups and conducting key stakeholder interviews. Focus group participants were end-users of programs and services provided by AHSH. Populations represented by focus group members included Promotoras, seniors, low-income, homeless/at-risk and representatives from the education sector. The majority of focus group participants live in Napa County, specifically in Santa Rosa, Yountville, St. Helena, and Calistoga. Key informant interviews consisted of key leaders in our community from an array of agencies, including those that serve children, homeless populations, seniors and community at large populations. Additionally, key informant interviews were conducted with representatives from the non-profit, educational, homeless, law enforcement, and faith-based sectors. The majority of the people interviewed serve residents in Napa County, specifically in in Santa Rosa, Yountville, St. Helena, and Calistoga. Additional localities identified for the service areas were Rutherford, Ronald Park, Deer Park and Hope Valley. Most key informants hold titles such as Executive Directors or Presidents, Superintendent, Mayor, and Head Pastor.A significant portion of secondary data for this assessment was collected through reports generated through CARES Engagement Network CHNA (https://engagementnetwork.org/assessment/). Other sources include California Department of Public Health, County Health Rankings & Road maps, and California Environmental Protection Agency's Office of Environmental Health Hazard Assessment. When feasible, health metrics have been further compared to estimates for the state or national benchmarks, such as the Healthy People 2020 objectives. |
| Facility Reporting Group - A Part V, Section B, line 6b: | St. Helena Hospital partnered with Abode Services, Napa Valley Unified School District-St. Helena School District, Rianda House and Up Valley Center to prepare the 2019 Community Health Needs Assessment. |
| Facility Reporting Group - A Part V, Section B, line 11: | Our 2016 CHNA identified five areas of significant needs: mental health, obesity & diabetes, access to primary health & dental care, cancers, and access to shelter for the homeless. 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 - the main goals: to increase access to mental health services and to increase awareness and interventions for youth.Interventions:1. In an effort to expand access and increase awareness of mental health disorders, Adventist Health St. Helena proudly partnered with Mentis, a community partner that focuses on providing bilingual professional mental health services to people throughout the county of every age, stage and income level. Through our partnership, we have been able to implement Teens Caf, a group peer and professional support program, serving over 245 teens on the St. Helena High School campus. As of January 2019, Teens Caf expanded to include middle school aged students at Robert Louis Stephenson Middle School. Mentis' School-Based Program works closely with the Napa, Calistoga, Howell Mountain and St. Helena school districts to provide counseling to children and teens in elementary, middle and high schools struggling with depression, violence, and family conflicts that are causing emotional, behavioral and academic problems. Mentis' therapists work closely with the student and their families to address and resolve problems that are having a significant impact on high risk youth in Napa County. 2. Increased outpatient mental health services by expanding available appointments and hours: Transitioned Dr. Haycraft from part-time inpatient hospital and part-time outpatient clinic setting to full-time clinic setting allowing for additional appointments in clinic and increasing access to immediate mental health resources. Community members served: 309/senior community members served: 175.Priority Need 2 - Obesity & Diabetes - the main goals: increase accessibility to healthy, affordable foods, increase opportunities for physical activity, and increase education about healthy eating and active living. Interventions:1. Partnered with and participated in Wellness Fair for St. Helena Unified School District: Adventist Health St. Helena worked together with Robert Louis Stevenson Middle School to put together a wellness curriculum that teaches students about mind, body and spirit health. The day's events included education on healthy snacks, sleep, exercise interventions, prevention of tobacco use and the importance of hydration. The day was attended by more than 285 students and was very successful in teaching children how to make healthy choices for their long-term health. 2. Utilize physicians, integrative medicine specialists, and nutritionists to educate community on health-related topics: Adventist Health St. Helena proudly sponsored a series of educational events that helped to educate the public on variety of health topics taught by physicians and dietitians. We proudly sponsor a monthly senior health education series in Calistoga that highlights different health-related and self-care topics presented by specialists in each field. 3. Safe Walk & Roll to School Days: Adventist Health St. Helena participated in the Safe Walk & Roll to School days promoting exercise and getting outdoors to students throughout St. Helena.4. Enhance diabetes education program to accommodate more of the community: Adventist Health St. Helena provided residents in our community with access to a free four-week diabetes education class in St. Helena. The free class series helps participants learn how simple lifestyle choices can make all the difference. Plus, participants have an opportunity to meet one on one with a registered dietitian where they work together to tailor a plan around the participant's health and lifestyle. Community members served: 70.5. Provide free community exercise programs to encourage physical fitness and weight management: Together with the City of St. Helena Parks and Recreation department, we were able to provide two free exercise classes where more than 30 community members gathered on a weekly basis, encouraging community members to get outside, get moving and take control of their health. Additionally, we participated in the Park Rx coalition to promote physical activity in open spaces and parks to people to reduce stress, improve blood pressure and reduce glucose. Priority Need 3 - Access to Primary Health & Dental Care - the main goals: to expand accessibility and increase awareness of resources.Interventions:1. Dare to C.A.R.E program providing free heart and vascular screening: Adventist Heart & Vascular Institute continued the Dare to C.A.R.E program, a free screening for those who qualify to detect carotid artery disease, abdominal aortic aneurysm, renal artery disease and extremity artery disease. This ultrasound screening provides the public with education about the unrecognized risks of vascular disease. Countless lives can be saved by teaching people about vascular disease and options they have for pre-emptive treatment. In 2019, 256 patients were screened, and two large aortic aneurysms were detected, preventing a rupture. One in three participants screened are found to have disease, thus far. This program is currently run out of our clinic in Calistoga and also in Lake County.2. Operation Access - Provide specialty care and surgical services to low-income, uninsured patients: Adventist Health St. Helena is a proud partner of Operation Access. Together with other community partners we are able to provide quality specialty care for low-income, uninsured patients. This work improves individual lives as well as the community as a whole. In 2019, six surgeons/ specialists provided sixty services at AHSH, in the specialties of Gastroenterology, General Surgery, Gynecology, Plastics, and Vascular Surgery. Additionally, the anesthesia, pathology, radiology, and physician groups (Adventist Health Physicians Network, Affiliated Pathology Medical Group, Lyons Huber Anesthesia, and Valley Radiological Associates Medical Group) have agreed to waive any charges associated with Operation Access services. In 2019, Adventist Health has increased service volume from 36 to 60, an increase of 67% from the prior year.3. Senior Lyft Pilot Program: Transportation is a major barrier to healthcare access for many seniors. A recent survey by HAPI (Healthy Aging Population Initiative) indicated that transportation challenges are the leading concern from patients in this population. As a note: 24% of the population of St. Helena is senior, and 22% of Calistoga. In partnership with Rianda House and Molly's Angels, Adventist Health St. Helena sponsored a pilot with on-demand ride service Lyft for seniors facing transportation challenges getting to and from their appointments at the hospital. The program was very successful and was able to provide approximately 41 rides for seniors. |
| Part V, Section B, Line 11 (continuation): | Priority Need 4 - Cancers - the main goals: to increase access to cancer detection services and related support services and to increase awareness and interventions to prevent cancer. Interventions: 1. Partnered with ZERO Prostate Cancer to promote education and awareness of prostate cancer prevention and treatment: Adventist Health St. Helena's Martin O'Neil Cancer Center is a proud sponsor of the Zero Prostate Cancer Napa Valley, where a team of staff members, physicians and community members participate in a 5k or 10k walk/run to raise awareness and promote prostate cancer screening. All proceeds provide research for new treatments, free prostate cancer testing, and education for men and families about prostate cancer. Over 150 walkers and runners participated in the 2019 event.2. Intervention: Turkey Trot to promote the importance of early hereditary cancer screening and educate the community on the AHEAD (Adventist Health Early All Around Detection) Program for early detection and treatment of genetic cancers. Founded by Dr. Candace Westgate, an obstetrician and gynecologist, our AHEAD program sponsored the second annual Turkey Trot in St. Helena promoting health, community and the importance of early hereditary cancer screening for genetic cancers. Over 150 participants attended the event. 3. Intervention: Communitywide education through the support and education series: The Martin-O'Neil Cancer Center communitywide education and support programs throughout 2019 that focused on topics like skin cancer prevention and the importance of genetic screening. A total of 190 individuals participated in the services. During the genetic cancer discussion, the participants also had genetic screenings if indicated. In 2019, there were 1,414 mammograms completed with eight referrals to a cancer specialist. A total of 365 low dose CT screening were completed in 2019. Genetic screenings found 713 at high risk eligible patients/clients with 418 actually tested. Breakdown of those tested saw 294 with results, 82 with negative high risk and 42 with pathogenic mutations. Priority Need 5 - Access to Shelter for the Homeless Catholic Charities Nightingale House: Adventist Health St. Helena is proud to support and be a part of Catholic Charities Shelter and Housing Department's initiative to operate the Nightingale Center, a medical respite center for patients from Queen of the Valley and Adventist Health St. Helena Hospital. The center is designed to help patients who have no place to go to continue with their recovery. The Nightingale House will help patients to be released to a safe and stable environment to minimize recidivism. This facility will have 11 beds to provide temporary on-site residential medical care.Priority Areas Not Addressed:Taking existing hospital and community resources into consideration, St. Helena Hospital Napa Valley will not directly address the remaining health needs identified in the CHNA including: education, economic and housing insecurity, and substance use. The hospital cannot address all the health needs present in the community, therefore, it will focus efforts on the health needs that can most effectively be addressed given the organization's areas of focus and expertise. St. Helena Hospital Napa Valley will look for partnership opportunities that address needs not selected where it can appropriately contribute to address those needs, or where those needs align with current strategy and priorities. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 30 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (30 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AHSH - Cardiology | ||||
| 999 Adams Street Suite 106 | St Helena | CA | 94574 | Outpatient clinic |
| 2 - AHSH - Coon Joint Replacement In | ||||
| 6 Woodland Road Suite 202 | St Helena | CA | 94574 | Outpatient clinic |
| 3 - AHSH - Lifestyle Medicine | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Lifestyle medicine |
| 4 - AHSH - Martin ONeil Cancer Center | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Oncology |
| 5 - AHPN - CBO | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Lifestyle medicine |
| 6 - AHPN Calistoga | ||||
| 913 Washington Street | Calistoga | CA | 94515 | Outpatient clinic |
| 7 - AHPN Calistoga - Behavioral Health | ||||
| 821 South St Helena Highway Suite 2 | St Helena | CA | 94574 | Behavioral health |
| 8 - AHPN Hidden Valley Lake - Oncology | ||||
| 18990 Coyote Valley Road Suite 5 | Hidden Valley Lake | CA | 95467 | Oncology |
| 9 - AHPN Napa | ||||
| 1100 Trancas Street Suite 250 | Napa | CA | 94558 | Outpatient clinic |
| 10 - AHPN Napa - OBGYN | ||||
| 935 Trancas Street Suite 4B | Napa | CA | 94558 | OBGYN |
| 11 - AHPN St Helena - Gastroenterology | ||||
| 6 Woodland Road Suite 303 | St Helena | CA | 94574 | Gastroenterology |
| 12 - AHPN St Helena - Heart and Vascular Insti | ||||
| 6 Woodland Road Suite 304 | St Helena | CA | 94574 | Cardiology |
| 13 - AHPN St Helena - Lifestyle Medicine | ||||
| 6 Woodland Road Suite 101 | St Helena | CA | 94574 | Lifestyle medicine |
| 14 - AHPN St Helena - Multi Specialty | ||||
| 821 South St Helena Highway Suite 2 | St Helena | CA | 94574 | Specialty clinic |
| 15 - AHPN St Helena - Neurology | ||||
| 821 South St Helena Highway Suite 2 | St Helena | CA | 94574 | Neurology |
| 16 - AHPN St Helena - OBGYN | ||||
| 821 South St Helena Highway Suite 1 | St Helena | CA | 94574 | OBGYN |
| 17 - AHPN St Helena - Orthopedics | ||||
| 1530 Railroad Avenue | St Helena | CA | 94574 | Orthopedics |
| 18 - AHPN St Helena - Plastic Surgery | ||||
| 6 Woodland Road Suite 302 | St Helena | CA | 94574 | Plastic surgery |
| 19 - AHPN St Helena - Pulmonology | ||||
| 6 Woodland Road Suite 303 | St Helena | CA | 94574 | Pulmonology |
| 20 - AHPN St Helena - Surgical Specialties | ||||
| 6 Woodland Road Suite 205 | St Helena | CA | 94574 | Surgery |
| 21 - AHPN St Helena - Urology | ||||
| 6 Woodland Road Suite 104 | St Helena | CA | 94574 | Urology |
| 22 - AHPN Vallejo | ||||
| 1460 North Camino Alto Suite 111 | Vallejo | CA | 94589 | Outpatient clinic |
| 23 - Hidden Valley - Internal Med | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Internal medicine |
| 24 - Lifestyle Med-Peters | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Lifestyle medicine |
| 25 - Mental Health | ||||
| 913 Washington Street | Calistoga | CA | 94515 | Mental health |
| 26 - Physical Therapy Center HVL | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Physical therapy |
| 27 - St Helena Hospital Center for Health | ||||
| 10 Woodland Road | St Helena | CA | 94574 | Outpatient clinic |
| 28 - St Helena Hospital Job Care | ||||
| 600 South Glendale Avenue | Glendale | CA | 91205 | Outpatient clinic |
| 29 - St Helena Recovery Center | ||||
| 10 Woodland Road Suite 502 | St Helena | CA | 94574 | Outpatient clinic |
| 30 - Woodland Plastic Surgery P | ||||
| 6 Woodland Road Suite 302 | St Helena | CA | 94574 | Plastic surgery |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 chargesThe Hospital 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 too 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 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:*Medicare Cost Report Revenue 82,998,993Prior Year Settlements 624,725Cost Report Reimbursable Bad Debts 574,945Estimates and Accrual Variances (52,861)Other 8,600,343Total Medicare Revenue 92,746,145*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 VI, Line 2: | The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) Update for fiscal year 2019, and the 2020 Implementation Strategy (adopted in May 2020) are posted on the hospital's website at:https://www.adventisthealth.org/st-helena/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.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: | St. Helena Hospital Napa Valley service area is comprised primarily of communities in Napa and Solano counties. The major communities are the upper valley cities of St. Helena and Calistoga. The demographics of the communities we serve are wide scope, including urban, suburban, and rural, and from all income levels. Although we primarily serve those in the Napa and Solano counties, our destination services also bring us patients from larger and further demographics including Lake County. Napa County has a population of 140,314 with a median household income of $88,457. At the end of the 2017 school year, testing for fourth graders found that far more students scored not proficient or worse on standardized reading testing, than 'proficient or better in Lake County (76.4%), this average was higher than AHSH PSA (72.6%) and Napa County (59.1%). Across the two-county region, Napa County has a lower percentage of populations receiving Public Assistance Income at 1.7% and SNAP benefits at 5.1% as compared to Lake County and the state estimate of 3.6% and 11.2%, respectively. Napa County demonstrated a higher proportion of woman receiving prenatal care and adequate care at 79.7% in comparison to Lake County at 68.5%. Notably, Napa County estimates meet the Healthy People 2020 performance target of 77.9% and 77.6%, respectively. AHSH PSA Medicare population has the lowest rates of depression (16.4%) and heart disease (24.4%) as compared to Lake County (16.6% and 25.8%, respectively). AHSH PSA had higher rates of diabetes as compared to Lake and Napa County (21.6% and 22.2%, respectively). Food insecurity averages in Lake County for the overall population (15.6%) and children (23.2%) are higher than reported averages for the state (11% and 18.1%, respectively). These averages are higher than Napa County. |
| 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.aintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7, Reports Filed With States | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Saint Helena Hospital Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 Woodland Road | AddressLine1Txt |
| City | St Helena | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94574 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 201384250 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $6,311,458 | CashGrantAmt |
| Purpose Of Grant | General support | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | A grant was made to Saint Helena Hospital Foundation, a public charity that supports St. Helena Hospital. No formal monitoring of the grants is completed. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||||||
| Dir/Chair | $0 | $1,510,024 | $0 | $420,315 | $0 | $65,357 | $0 | $16,782 | $0 | $36,952 | $0 | $2,049,430 | $0 | $0 |
| Wing Bill | ||||||||||||||
| Dir/Asst Secretary/CFO | $0 | $1,200,390 | $0 | $318,717 | $0 | $53,147 | $0 | $16,782 | $0 | $29,801 | $0 | $1,618,837 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| CFO/Asst Secr thru 08/2019 | $0 | $581,409 | $0 | $187,572 | $0 | $440,088 | $0 | $16,782 | $0 | $40,783 | $0 | $1,266,634 | $0 | $0 |
| Eller Jeff | ||||||||||||||
| President, NCR | $0 | $868,316 | $0 | $193,574 | $0 | $110,192 | $0 | $16,782 | $0 | $23,415 | $0 | $1,212,279 | $0 | $0 |
| McDonald Edward | ||||||||||||||
| Former Treas/Asst Secr thru 07/2017 | $0 | $0 | $0 | $0 | $0 | $1,034,618 | $0 | $0 | $0 | $13,010 | $0 | $1,047,628 | $0 | $861,740 |
| Lang Kevin | ||||||||||||||
| Finance Officer, NCR | $0 | $0 | $0 | $0 | $0 | $1,038,744 | $0 | $0 | $0 | $0 | $0 | $1,038,744 | $0 | $0 |
| Wagner Jack | ||||||||||||||
| Former Asst Secr | $0 | $0 | $0 | $0 | $0 | $778,475 | $0 | $0 | $0 | $29,189 | $0 | $807,664 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $524,870 | $0 | $65,461 | $0 | $140,054 | $0 | $16,782 | $0 | $29,127 | $0 | $776,294 | $0 | $0 |
| Byrnes John | ||||||||||||||
| Medical Officer, NCR | $0 | $493,269 | $0 | $77,663 | $0 | $147,368 | $0 | $1,523 | $0 | $28,290 | $0 | $748,113 | $0 | $0 |
| Herber Steven | ||||||||||||||
| President | $0 | $437,117 | $0 | $49,292 | $0 | $128,707 | $0 | $16,782 | $0 | $36,952 | $0 | $668,850 | $0 | $0 |
| Lonto Robert | ||||||||||||||
| Reg HP Dir, NCR | $0 | $273,824 | $0 | $52,858 | $0 | $61,517 | $0 | $16,764 | $0 | $41,645 | $0 | $446,608 | $0 | $0 |
| Lendaris Antonia | ||||||||||||||
| Patient Care Executive thru 05/2019 | $0 | $123,429 | $0 | $21,240 | $0 | $191,490 | $0 | $14,482 | $0 | $17,140 | $0 | $367,781 | $0 | $0 |
| Kares Tim | ||||||||||||||
| Finance Officer thru 08/2019 | $0 | $196,865 | $0 | $14,998 | $0 | $142,631 | $0 | $0 | $0 | $745 | $0 | $355,239 | $0 | $0 |
| Hasso Ruth | ||||||||||||||
| RN | $251,315 | $0 | $3,594 | $0 | $629 | $0 | $15,083 | $0 | $15,901 | $0 | $286,522 | $0 | $0 | $0 |
| Olaiz Amphone | ||||||||||||||
| RN | $253,999 | $0 | $0 | $0 | $0 | $0 | $10,108 | $0 | $18,862 | $0 | $282,969 | $0 | $0 | $0 |
| Barnes Geoffrey | ||||||||||||||
| Manager, Cardiovascular | $244,561 | $0 | $2,081 | $0 | $0 | $0 | $16,136 | $0 | $18,891 | $0 | $281,669 | $0 | $0 | $0 |
| Madrid Daniel | ||||||||||||||
| Dir, Acctg & Fin thru 09/19 | $116,682 | $0 | $12,025 | $0 | $113,907 | $0 | $8,369 | $0 | $20,130 | $0 | $271,113 | $0 | $0 | $0 |
| Dickinson Elizabeth | ||||||||||||||
| Patient Care Executive as of 06/2019 | $0 | $237,538 | $0 | $2,234 | $0 | $2,520 | $0 | $11,597 | $0 | $12,007 | $0 | $265,896 | $0 | $0 |
| Butcher Sara | ||||||||||||||
| RN | $235,793 | $0 | $0 | $0 | $3,625 | $0 | $13,084 | $0 | $19 | $0 | $252,521 | $0 | $0 | $0 |
| Blethen Elisa - Interim | ||||||||||||||
| Finance Officer as of 08/2019 | $0 | $183,241 | $0 | $7,540 | $0 | $757 | $0 | $8,057 | $0 | $26,660 | $0 | $226,255 | $0 | $0 |
| Chilton Harold | ||||||||||||||
| Former COO thru 09/2017 | $0 | $66,211 | $0 | $0 | $0 | $135,001 | $0 | $13,066 | $0 | $2,936 | $0 | $217,214 | $0 | $0 |
| Lyons Timothy | ||||||||||||||
| Medical Officer | $0 | $0 | $0 | $0 | $0 | $208,230 | $0 | $0 | $0 | $0 | $0 | $208,230 | $0 | $0 |
| Kinney Jill | ||||||||||||||
| Admin Dir Marketing & Comm, NCR | $0 | $161,220 | $0 | $12,898 | $0 | $7,582 | $0 | $8,890 | $0 | $12,459 | $0 | $203,049 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. Lendaris, Antonia - severance payment - $140,267 Madrid, Daniel - severance payment - $87,199 McDonald, Edward - severance payment - $125,962 Reppert, Joseph - severance payment - $194,953 Wagner, Jack - severance payment - $778,453 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. Chilton, Harold - $89,904 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Herber Timothy | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of Officer, S. Herber | RelationshipDescriptionTxt |
| Transaction | $65,321 | TransactionAmt |
| Transaction | Employment compensation | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | St. Helena Hospital dba Adventist Health St. Helena (AHSH) 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 St. Helena Hospital dba Adventist Health St. Helena, 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 St. Helena Hospital dba Adventist Health St Helena 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. AHSH 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 $2,800,721. The following Inpatient services that were provided to all our patients. These services included: - 198 Babies delivered - 1,897 Surgeries performed - 44,538 Patient days The following Outpatient services that were provided to all our patients. These services included: - 7,577 Emergency department visits - 3,569 Outpatient Surgeries performed - 44,080 Outpatient visits - 58,918 Clinic visits AHSH 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 $12,219,260. 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's 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'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 IX, line 11g | Physician professional fees: Program service expenses 21,317,886. Management and general expenses 0. Fundraising expenses 0. Total expenses 21,317,886. Consulting and other management fees: Program service expenses 227,955. Management and general expenses 149,394. Fundraising expenses 0. Total expenses 377,349. Other professional fees non-medical: Program service expenses 262,576. Management and general expenses 119,031. Fundraising expenses 0. Total expenses 381,607. Purchased medical services: Program service expenses 24,320,201. Management and general expenses 0. Fundraising expenses 0. Total expenses 24,320,201. Repairs and maintenance: Program service expenses 2,699,377. Management and general expenses 3,522. Fundraising expenses 0. Total expenses 2,702,899. All other purchased services: Program service expenses 736,996. Management and general expenses 1,190,573. Fundraising expenses 75,439. Total expenses 2,003,008. Revenue cycle fees: Program service expenses 0. Management and general expenses 9,822,407. Fundraising expenses 0. Total expenses 9,822,407. |
| Form 990, Part XI, line 9: | Change in interest in Foundation -162,340. Split-interest agreements - change in value 395,565. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Delano | |||||||||||
| PO Box 460 | Delano | CA | 93216 | 770258013 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Physicians Network | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| Adventist Health Tulare | |||||||||||
| 869 North Cherry Street | Tulare | CA | 93274 | 832351753 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Fremont-Rideout Health Group | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 942917251 | Acute care hospital | CA | 501(c)(3) | Line 12b, II | Stone Point Health | 0 | |
| Glendale Adventist Medical Center | |||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Hanford Community Hospital | |||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| 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 | |
| Saint Helena Hospital Foundation | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 201384250 | Fundraising and investment management | CA | 501(c)(3) | Line 12a, I | 0 | N/A | |
| 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 | |
| Ukiah Adventist Hospital | |||||||||||
| 275 Hospital Drive | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| United Com-Serve | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled nursing/assisted living/home health | CA | 501(c)(3) | Line 12b, II | Fremont-Rideout Health Group | 0 | |
| Walla Walla General Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital - closed July 2017 | WA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Western Health Resources | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | Line 10 | Adventist Health SystemWest | 0 | |
| White Memorial Medical Center | |||||||||||
| 1720 Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Willits Hospital Inc | |||||||||||
| 1 Marcela Drive | Willits | CA | 95490 | 680108919 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TakeTEN LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1461 Main Street Suite 302 | AddressLine1Txt |
| City | St Helena | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94574 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 814929050 | EIN |
| Primary Activities | Outpatient health services | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Helena Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Related | PredominantIncomeTypeTxt |
| Share Of Total Income | -$5,834 | ShareOfTotalIncomeAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.50000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Coast Medical | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 952037291 | EIN |
| Primary Activities | Wind down after sale of hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | Yes (1) | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments