2020-11-13T16:47:22-08:00 2019-12-31 800519547 THE ACCOUNTANCY LLP 500 N Brand Blvd Fl 20 Glendale CA 91203 990 2019-01-01 453220509 Reedley Community Hospital dba Adventist Health Reedley REED 5596388155 372 W Cypress Ave Reedley CA 93654 Timothy Haydock Treasurer 2020-11-13 S Clement P01218012 8185475701 X 2019 2021-01-29 14:40:06Z Andrea Kofl 189374622 false 1071 X www.adventisthealth.org/reedley X 2011 CA Living Gods love by inspiring health, wholeness and hope. 14 12 1149 151 0 38096 184774 181126377 186611168 1028821 2578680 0 182193294 189374622 87995 76320 0 67495219 67836142 0 123283 93666221 94116794 161249435 162029256 20943859 27345366 109797921 189710925 26040846 78535362 83757075 111175563 Living Gods love by inspiring health, wholeness and hope. false false 130999341 76320 186611168 Reedley Community Hospital (AHRD) 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 Reedley Community Hospital, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths 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 careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Reedley Community Hospital provide low cost care to individuals covered by government-programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits.AHRD 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 $1,600,932.The following Inpatient services that were provided to all our patients. These services included:1,196 Babies delivered38 Surgeries performed4,318 Patient days The following Outpatient services that were provided to all our patients. These services included:40,264 Emergency department visits321 Outpatient Surgeries performed35,677 Outpatient visits 505,106 Clinic visitsAHRD 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 $3,174,464.Adventist Healths mission statement of Living Gods 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 Gods image has experienced the best health today, hope for tomorrow, and Gods love that endures forever.Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ 130999341 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 0 0 true 1149 true false false false false false false false 0 false false false false false false false X 14 12 false false false false true true true true true false false true true true true true true true true false CA X Jay Lipps 9164061092 PO Box 619135 Roseville CA 95661 X Ferch Wayne President CCR 10.00 40.00 0 4448122 47838 Reiner Scott Dir/Chair 0.00 50.00 X X 0 1995697 53734 Wing Bill Dir/A Sec/CFO 0.00 50.00 X X 0 1572253 46583 Reppert Joseph A/Sec thru 8/19 0.00 50.00 X 0 1209070 57565 Larsen David Finance Officer, CCR thru 4/28/2019 10.00 40.00 0 777379 57220 Wagner Jack Former Asst Secr 0.00 50.00 0 778475 29189 Jobe Meredith Secretary 0.00 50.00 X 0 730385 45909 Chen Steven CCR, Finance Officer 10.00 40.00 0 671517 59363 Kofl Andrea President 20.00 30.00 X 0 673752 48741 Gavini Frank Medical Officer, CVN 20.00 30.00 0 545796 0 Renteria Adalberto CCR, Medical Officer 10.00 40.00 0 481385 43990 Gruen Derrick Physician & Ambulatory Srvcs Exec, 20.00 30.00 0 442110 57222 Ayala Raul Medical Officer, CVN 20.00 30.00 0 490379 0 Haydock Timothy Treasurer 20.00 30.00 X 0 401337 59270 Hoyt Glenda Former VP Quality Patient Safety 50.00 0.00 0 373113 45220 Taggart Laurie Patient Care Executive 20.00 30.00 0 322486 46711 Gruzensky Denton Reg HP Dir, CCR 40.00 40.00 0 321342 45976 Reyna Sonja Bus Dev Exec 20.00 30.00 0 332223 34291 Plata Nina Population Health Exec 20.00 30.00 0 301245 58405 Dhaliwal Simerjit Physician Assistan 50.00 0.00 289841 0 43917 Thomas Cheryl Nurse Practitioner 50.00 0.00 283025 0 27727 Chapman Susan Patient Care Executive 20.00 30.00 0 257164 50082 Austin Katherine Physician Asst 50.00 0.00 219399 0 45136 Combs Linda Nurse Practitioner 50.00 0.00 208173 0 33224 Brown Stanton Physician Asst 50.00 0.00 213317 0 29 Pickering Christine Communication Director, CCR 10.00 40.00 0 163858 30977 Reiner Richard Director 0.00 4.00 X 0 28588 0 Davis Andrew Director 0.00 4.00 X 0 28246 0 Cherry Robert Director 0.00 4.00 X 0 26315 0 Heinrich Kerry Director 0.00 4.00 X 0 20102 0 Innocent Larry Director 0.00 4.00 X 0 18852 0 Woodson Marc Director 0.00 4.00 X 0 15000 0 Graham Ricardo Director 0.00 4.00 X 0 8848 0 Banks David Director 0.00 4.00 X 0 6382 0 Freedman John Director 0.00 4.00 X 0 2367 0 Salazar Velino Director 0.00 4.00 X 0 553 0 Philip Celeste Director 0.00 4.00 X 0 0 0 Ocampo Lucy Director 0.00 4.00 X 0 0 0 1213755 17444341 1068319 108 true true false Valley Childrens Med Grp 9300 Valley Childrens Pl Madera CA 93638 Physician Services 2165445 Vituity 2100 Powell St Ste 920 Emeryville CA 94608 Physician Services 1207344 Central Valley Health Transport PO Box 1189 Hanford CA 93230 Purchased Services 1178381 West Hills Medical Group Inc PO Box 784 Coalinga CA 93210 Physician Services 784404 CCFMG 2625 E Divisadero St Fresno CA 93721 Physician Services 769833 62 184774 184774 Dietary 722514 212140 212140 Medical Office Rentals 531120 34356 34356 Other Revenue 900099 10624 10624 Patient Care Services 900099 186354048 186354048 186611168 2556130 2556130 22550 22550 0 0 0 0 0 0 0 189374622 186611168 2578680 X 76320 76320 0 0 0 0 0 52244142 49205636 2936416 102090 1904884 1833479 70622 783 10003441 9606758 396683 3683675 3495649 181101 6925 85222 50610 34612 238051 36108 201943 5286 5286 0 0 0 33063225 33003236 59989 5728 5728 1238857 1163353 75504 1792288 1785619 6669 0 8237558 6505126 1732432 505073 367782 132522 4769 0 63254 62879 375 524274 524274 0 2885731 2847219 38512 223407 223407 Purchased Services 33122001 8237568 24878430 6003 Patient Care Supplies 10930516 10814015 113788 2713 Equipment Rentals 641298 641298 Quality Assurance 425054 425054 129971 82937 47034 162029256 130999341 30906632 123283 1363 0 41010401 64619779 0 18450202 20133491 0 0 0 476576 684331 159966 179300 85867382 23394585 21084823 62472797 166233 0 0 0 9967146 9944813 18481211 31676414 109797921 189710925 9575462 11832413 12084963 4380421 66702949 26040846 78535362 X 83721667 111143618 35408 31945 83757075 111175563 109797921 189710925 X 27345366 73122 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 8738 8738 false false Part II-B, Line 1i - Other Activities Description The organization 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. 35409 184774 182938 5331 31914 50130 28332 43054 35408 40953 30683 21506 50130 1000 79363 39410 40953 1000 1876 1876 1000 1.00000 false true true 3019137 3019137 14044430 5061153 8983277 8315264 1785257 6530007 60488551 16548175 43940376 62472797 Due from third-party payors 18294876 Other Assets 177681 Other receivables 2296977 Receivables from related organizations 10906880 31676414 Other Liabilities 33158344 Payable to third Party 1597482 Payables to related organizations 31947123 66702949 X Part V, Line 4: Intended uses of the endowment fund. 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 : FIN48 Footnote 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. true true X true X true X true true true false true true 1600932 1600932 0.00990 1600932 1600932 0.00990 1224529 1224529 0.00760 1951456 71775 1879681 0.01160 388603 318349 70254 0.00040 3564588 390124 3174464 0.01960 5165520 390124 4775396 0.02950 2171 2171 1650 1650 4137 4137 198935 198935 0.00120 206893 206893 0.00120 true 2609439 1355030 18743946 21145506 -2401560 X true true 1 1 Reedley Community Hospital 372 W Cypress Ave Reedley CA 93654 See Form 990, Pg 1, Item J 040000149 X X X X false false true X X X X X X X X X 19 true true false true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 19 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X X true X false X X X X true X false false Facility: - 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; 3. Data gathering from community members. Primary data was collected through key informant interviews, focus groups, and an online survey. Key informants and focus groups were purposefully chosen to represent medically underserved, low-income, or minority populations in our community. Their input provided insights on how to better direct our resources and form partnerships. Nearly 700 (680 total) people were surveyed to obtain input from the community in the form of 48 key informant interviews, 24 focus groups (with a total of 284 participants), and 348 online survey participants (including a Spanish option).Community Survey: The online survey was distributed to partner organizations that were not represented by key informants and advertised to the general public via a public service announcement hosted on Univision's Arriba Valle Central" show. Additionally, written comments on the previous CHNA were solicited on each hospital's website using a unique link. To date no written comments were received. Community Focus Groups: Focus group participants were end-users of programs and services provided by hospitals participating in this CHNA. Populations represented by focus group members included low-income (rural and urban) populations, homeless, seniors, youth, Hmong and Spanish speaking, LGBTQ+, and parents.Key Informant Interviews: Key informant interviews comprised key leaders in our community from an array of agencies, including those that serve children, homeless populations, LGBTQ+, veterans, seniors, tribal populations, African Americans, and Hmong and Spanish speaking populations. Other participating organizations represented public health agencies, law enforcement, health care organizations, funders, and school districts. Secondary data sources include publicly reported state and nationally recognized data sources such as Community Commons, California Department of Public Health, County Health Rankings & Roadmaps, and California Environmental Protection Agencys Office of Environmental Health Hazard Assessment. When feasible, health metrics have been further compared to averages for state or national benchmarks, such as Healthy People 2020 objectives. Facility: - Part V, Section B, Line 6a Beginning in 2011, the Hospital Council of Northern and Central California initiated a four-county (Fresno, Kings, Madera, and Tulare) community health needs assessment (CHNA) process, working collaboratively with 15 hospitals across the Central Valley region. Participating hospitals are: Adventist Health Hanford, Adventist Health Reedley, Adventist Health Selma, Clovis Community Medical Center, Coalinga Regional Medical Center (Closed), Community Regional Medical Center (includes Community Behavioral Health Center), Kaiser Permanente, Fresno Service Area, Kaweah Delta Health Care District, Madera Community Hospital, San Joaquin Valley Rehabilitation Hospital, Sierra View Medical Center, Saint Agnes Medical Center, Tulare Regional Medical Center, and Valley Childrens Healthcare. Facility: - Part V, Section B, Line 11 Our 2016 CHNA identified five areas of significant needs: access to health care, diabetes, obesity, respiratory illnesses, and mental health & substance abuse. 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 - Access to Care - Improve perception of access to care for our patients. Interventions:1. Adventist Health contracts with transportation vendors to provide round trip transportation to our clinics for patients that do not have transportation and would otherwise not be able to attend their necessary medical appointments. These rides help prevent appointment no-shows and increase access to care for our patients. Services are provided to the following Adventist Health Medical Offices: Hanford, Healthy Beginning, Hanford Residency, Hanford Specialty, Hanford Dentistry, Hanford Behavioral Health, Home Garden, Lemoore, Dinuba, Dinuba Plaza, Dinuba West, Orosi, Reedley, Reedley Childrens, Reedley Cypress, Reedley Jefferson, Reedley Womens Selma Campus and Selma Central. Number of round trips provided in 2019: 13,5512. Access to care is limited in our region due to a shortage of healthcare providers, including physicians, nurse practitioners and physician assistants. Recruitment of providers and specialists is critical to meeting the healthcare needs of our patients and rural communities. Number of providers added in 2019: 283. Across our Central Valley Network, we partner with local junior colleges and universities to allow nursing students to come to our hospitals for their clinical rotations. These program partnerships allow LVN and RN nursing students to gain hands-on experience close to home, making it easier for many students to complete their education and become licensed providers. Number of nursing students in 2019: 162 Priority Need 2 Obesity/ Healthy Eating Active Living (HEAL)/ DiabetesDecreasing trend year-over-year of patients with HgbA1c = 9%. Interventions: 1. Diabetes Among Friends, a five-week diabetes self-management education (DSME) curriculum in English and Spanish from Scripps University, debuted in our rural health clinics in July 2017. This program is approved as a (DSME) Program by the American Diabetes Association and covers all diabetes self-management topics including understanding blood sugars, nutrition, physical activity, medication management, stress management, foot care, ongoing screening tests and exams, etc. Number of program graduates: 422. Adventist Health provides healthy eating and active living education at free public outreach events, often partnering with community organizations and school districts. The goal is to increase awareness of how to incorporate healthy eating and active living behaviors into daily life in an economical and practical way. Priority Need 3 Mental HealthInterventions: 1. Adventist Health partners with Kings United Way for promoting 2-1-1 and the 2-1-1 Intelliful mobile app in our Kings and Tulare County clinics and patient care areas. 2-1-1 connects people in need to resources in the community available to themincluding mental health, substance abuse and homelessness resources. Anybody can access 2-1-1 by phone in any of our service areas. In Kings and Tulare counties, the Intelliful app as well as text to chat options are available. 2. Hosting education sessions for providers and community partner agencies on topics including Adverse Childhood Experiences (ACEs) and on the dangers of social media to our youth to highlight potential risk factors that children and young adults are facing, as well as offer solutions to providers to intervene, provide appropriate support for victims and to prevent abuse. Priority Need 4 Economic Security/ HomelessnessInterventions:1. The homeless discharge planning process, as required by SB 1152, ensures that all homeless patients who come to the hospital for care are provided with and connected to any and all needed resources. This includes providing meals, clothing, and connections with local case management programs and shelters. Number of Community Members Served: 492. UCSF- Fresno Doctors Academy in collaboration with our hospital and clinic providers, offers opportunities for local and at-risk high school students to shadow a physician in the healthcare setting. The goal is to inspire these high school students to engage with STEM studies and focus towards a career in healthcare. Number of student participants: 43. Bringing Broken Neighborhoods Back to Life is a partnership with local Selma faith and community-based organizations. Monthly events include connection with local resources for addressing the social determinants of health, health education and food bank distributions. Number of Community Members Served: 1504. Partnering with Reedley Community College, we offered two events for students called A Day in The Life. This program allows local students from Reedley College to come into our Reedley campus facility and meet a variety of healthcare professionals including nurses, doctors, respiratory therapists, occupational therapists, nutritional services management, marketing managers and volunteer coordinators. Students could ask questions about the various educational pathways and learn how they can pursue these different healthcare careers. Number of Community Members Served: 605. As part of the annual Point in Time Survey to identify and count all homeless individuals, Kings and Tulare Counties host Project Homeless Connect. This annual event provides services for the homeless including medical care, hygiene, dog vaccinations, bike repair, haircuts, state ID and social services, food, resource tables etc. Our AH team provides medical services from our Residency clinic, supplies to the Kings County event. Number of Community Members Served: 171Priority Need 5 - Maternal and Infant Health Interventions: 1. Through a partnership with the California Healthcare Collaborative, our Comprehensive Perinatal Health Workers (CPHW), under the Comprehensive Perinatal Service Program (CPSP) are able to screen participants for perinatal and postpartum mood disorders and make referrals for free mental health care as appropriate.2. Champions Young Parent Program is a referral source for young transitional age youth parents who would benefit from support and education. Adventist Health partners with Champions and refers patients to this program in Kings County.Priority Areas Not Addressed:One need identified in the CHNA, but not addressed in this plan is poverty. Our network has not specifically addressed this prioritized health need as part of this Community Health Plan due to limited resources and the need to allocate significant resources to the other priority health needs identified above. Even though we dont directly address poverty in our current year CHP, our network attempts to link patients to resources that can assist in their needs. AHCC-Reedley Jefferson 1150 E Washington Ave Reedley CA 93654 Rural Health Clinic AHCC-Cutler 40657 Road 128 Cutler CA 93615 Rural Health Clinic AHCC - Wasco 1040 7th St Wasco CA 93280 Rural health clinic-Family Practice AHCC - Shafter 406 James St Shafter CA 93263 Rural health clinic-Family Practice AHCC - Corcoran 1212 Hanna Ave Corcoran CA 93212 Rural health clinic AHCC - Taft 501 6th St Taft CA 93268 Rural Health Clinic AHCC - Healthy Beginnings 1025 N Douty St Hanford CA 93230 Outpatient clinic - prenatal, family PACT, and well women services AHCC-Reedley Cypress 372 W Cypress Ave Reedley CA 93654 Rural Health Clinic AHCC - Selma Central 2141 High St Selma CA 93662 Rural health clinic AHCC-Orange Cove 1455 Park Blvd Orange Cove CA 93646 Rural Health Clinic AHCC - Reedley 811 E 11th St Reedley CA 93654 Rural health clinic AHCC - Sanger 1939 Academy Ave Sanger CA 93657 Rural health clinic AHCC-Dinuba West 250 W El Monte Way Dinuba CA 93618 Rural Health Clinic AHCC-Orosi 41696 Road 128 Orosi CA 93647 Rural Health Clinic AHCC-Caruthers East 2357 W Tahoe Caruthers CA 93609 Rural Health Clinic AHCC-Riverdale 3567 Mt Whitney Ave Riverdale CA 93656 Rural Health Clinic AHCC - Hanford 1025 N Douty St Hanford CA 93230 Rural health clinic - primary care services AH Hanford Same Day - RHC AHRD 1025 N Douty Street Hanford CA 93230 Rural health clinic AHCC - Behavioral Health Srvs 1025 N Douty St Hanford CA 93230 Outpatient mental health services AHCC-Oakhurst 48677 Victoria Lane Oakhurst CA 93644 Rural Health Clinic AH Hanford Complex Care - RHC AHRD 1025 N Douty Street Hanford CA 93230 Rural health clinic AHCC-Avenal West 337 Kings Street Avenal CA 93204 Rural Health Clinic AHCC - Hanford Dental 1025 N Douty St Hanford CA 93230 Dental clinic - general dentistry for all ages AHCC-Oakhurst East 49063 Road 426 Ste CD Oakhurst CA 93644 Rural Health Clinic Hanford Family Practice Residency Clinic 1025 N Douty St Hanford CA 93230 Outpatient teaching clinic - family practice residents AHCC-Kerman Central 275 S Madera Ave Ste 201 Kerman CA 93630 Rural Health Clinic AHCC-Corcoran East 1310 Hanna Avenue Corcoran CA 93212 Rural Health Clinic AHCC - Coalinga 155 S 5th St Coalinga CA 93210 Rural health clinic AHCC-Dinuba Plaza 444 W El Monte Way Dinuba CA 93618 Rural Health Clinic AHCC - Selma 1041 Rose Ave Selma CA 93662 Rural health clinic AHCC - Huron 16916 5th St Huron CA 93234 Rural health clinic AHCC - Hanford Specialty Services 1025 N Douty St Hanford CA 93230 Outpatient clinic - specialists AHCC - Lemoore East 810 E D St Lemoore CA 93245 Rural health clinic AHCC - Kerman 1000 S Madera Ave Kerman CA 93630 Rural health clinic AHCC - Caruthers 2440 W Tahoe Ave Caruthers CA 93609 Rural health clinic AHCC - Dinuba 1451 E El Monte Way Dinuba CA 93618 Rural health clinic AHCC-Madera Ranchos 11976 Road 37 Madera CA 93636 Rural Health Clinic AHCC-Reedley Womens Health 550 W Cypress Ave Reedley CA 93654 Rural Health Clinic AHCC-Reedley Childrens Health 1433 N Acacia Reedley CA 93654 Rural Health Clinic - Children's AHCC - Avenal 213 Fresno St Avenal CA 93204 Rural health clinic AHCC - Home Garden 11899 Shaw Pl Hanford CA 93230 Rural health clinic AHCC-Parlier Newmark 155 S Newmark Parlier CA 93648 Rural Health Clinic AHCC - Kingsburg 1251 Draper St Kingsburg CA 93631 Rural health clinic AHCC - Fowler 119 S 6th St Fowler CA 93625 Rural health clinic Part I, Line 7 - Explanation of Costing Methodology 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 audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income) divided by 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 Californias regulations and policies and the approval of the federal government. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense 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 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 - Methodology of Estimated Amount & Rationale for Including in Community Benefit 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 - Bad Debt Expense The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals costs based on inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The healthcare market basket is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals. Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue $18,743,946Prior Year Settlements 436,880Cost Report Reimbursable Bad Debts 303,108Non-Cost Report Revenue 4,868,134Estimates and Accrual Variances (951,492)Other (607,401) __________Total Medicare Revenue $22,793,175*Note: The Medicare Cost Report Revenue includes the patient co-pay and deductible amounts, but not the bad-debt reimbursement. Adding the bad-debt reimbursement would have duplicated the revenue and deductible amounts. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients 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 - Needs Assessment The hospital's 2019 CHNA, the 2020 Community Health Plan (CHP) update for fiscal year 2019, and the 2020 Implementation Strategy are posted on the hospital's website at https://www.adventisthealth.org/about-central-valley/community-benefit/The two most recent Community Health Needs Assessments, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website athttps://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 - Patient Education of Eligibility for Assistance 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 - Community Information According to the U.S. Geological Survey, the Central Valley, also known as the Great Valley of California, covers about 20,000 square miles and is one of the more notable structural depressions in the world. Occupying a central position in California, it is bounded by the Cascade Range to the north, the Sierra Nevada to the east, the Tehachapi Mountains to the south, and the Coast Ranges and San Francisco Bay to the west. The Central Valley can be divided into two large parts: the northern one-third, known as the Sacramento valley and the southern two-thirds is called the San Joaquin Valley. The San Joaquin Valley can be split further into the San Joaquin Basin and the Tulare Basin. The hospitals participating in this assessment are nestled in the heart of Central Valley, within four contiguous countiesFresno, Kings, Madera, and Tulare. Using fewer than 1% of U.S. farmland, the Central Valley supplies 8% of U.S. agricultural output (by value) and produces 1/4 of the nation's food, including 40% of the nation's fruits, nuts, and other table foods. The Central Valley is also home to the raisin capital of the world, Selma, CA.In 2016, approximately 1,722,556 people lived in the four-county region. Fresno County comprised the largest portion. Of this population, the majority identify as Hispanic or Latino, in every county. Kings County has the largest population of veterans at 10%. The median household income ranges from $42,789 to $47,241 across the four counties.Tulare County has the largest percent of unemployed adults (8.7%) in the region and young people not in school and not working (10.7%). Comparatively, the averages for the state are 4.3% and 7.7%, respectively. Fresno County has the highest percentage of total population and children under age 18 living under the 100% of the federal poverty level, while Tulare County has the largest population that receives both SNAP benefits and public assistance income. Between 2014 and 2018, Fresno and Madera Counties experienced a 17% decrease in the total homeless population (from 2,592 to 2,144). In contrast, Visalia, Kings, and Tulare Counties experienced a 27% increase (from 763 to 967). Part VI, Line 4 - 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 VI, Line 5 - Promotion of Community Health Our hospitals mission is, Living Gods 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 todays 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 healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6 - Affilated Health Care System The hospital is a member of Adventist Health System/West, 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 tele pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7 - States Filing of Community Benefit Report CA Part VI - Additional Information Community Building Activities are an integral part of making a difference in the health of our community through numerous interventions.Interventions: 1. Inspire Hope, a partnership with World Vision, allows us to distribute new-returned merchandise from Costco to community-based organizations that can utilize the items to improve the health and lives of those who live in our communities. Each month, a semi-truck delivers goods to the hospital storage area and items delivered are distributed to community partner agencies as appropriate. Items include everything from diapers, food, furniture, clothing, appliances, and more. Items on the manifest of each delivery are a surprise, but our community partners are always happy to receive and distribute what we can share. Number of Community Members Served: 5,361 true CA Hlth Fnd & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 76320 0 Funds Transfer Hlth srvs uninsured/underinsured pt 1 0 Grantmaker's Description of How Grants are Used Grants are donations made to US tax exempt organizations, Government Entities and Civic organizations who are community partners, known to us, and present a valid purpose for their donation request. It is anticipated that no further monitoring is required. X X X X true true false false false false false false false Austin Katherine Physician Asst 219349 50 9942 35194 264535 Ayala Raul Medical Officer, CVN 490379 490379 Brown Stanton Physician Asst 213267 50 29 213346 Chapman Susan Patient Care Executive 188840 26297 42027 13544 36538 307246 Chen Steven CCR, Finance Officer 472282 90908 108327 16782 42581 730880 Combs Linda Nurse Practitioner 187504 20669 10795 22429 241397 Dhaliwal Simerjit Physician Assistan 264191 25650 16638 27279 333758 Ferch Wayne President CCR 932651 191401 3324070 16782 31056 4495960 3180848 Gavini Frank Medical Officer, CVN 545796 545796 Gruen Derrick Physician & Ambulatory Srvcs Exec, 312333 49218 80559 16782 40440 499332 Gruzensky Denton Reg HP Dir, CCR 232276 41926 47140 15932 30044 367318 Haydock Timothy Treasurer 295749 46604 58984 16782 42488 460607 Hoyt Glenda Former VP Quality Patient Safety 253229 36789 83095 16443 28777 418333 Jobe Meredith Secretary 524870 65461 140054 16782 29127 776294 Kofl Andrea President 475048 75240 123464 16782 31959 722493 Larsen David Finance Officer, CCR thru 4/28/2019 536325 110451 130603 16782 40438 834599 Pickering Christine Communication Director, CCR 146846 11637 5375 8397 22580 194835 Plata Nina Population Health Exec 231939 33695 35611 13697 44708 359650 Reiner Scott Dir/Chair 1510024 420315 65357 16782 36952 2049430 Renteria Adalberto CCR, Medical Officer 481385 16352 27638 525375 Reppert Joseph A/Sec thru 8/19 581409 187572 440088 16782 40783 1266634 Reyna Sonja Bus Dev Exec 247327 34020 50876 14930 19361 366514 Taggart Laurie Patient Care Executive 243635 34215 44636 15771 30940 369197 Thomas Cheryl Nurse Practitioner 162041 120530 454 16782 10945 310752 Wagner Jack Former Asst Secr 778475 29189 807664 Wing Bill Dir/A Sec/CFO 1200390 318717 53147 16782 29801 1618837 Arnold Plata Spouse of Key EE 70638 Employment false Susan Chapman Key EE-Owner 265215 Contract-Wmns Hlth Cntr false Linda Henry Key EE Sister 65157 Employment false Ferch Josiah Key EE Son 62021 Employment false Schedule L, Part V Supplemental Information Additional information regarding interested persons listed above:1. Arnold Plata is the husband of Key Employee, Nina Plata.2. Susan Chapman, a Key Employee is the Owner of Pali Women's Health Center which the hospital does business with.3. Linda Henry is the sister of Former Adventist Health board member and current Key Employee, Wesley Rippey.4. Josiah Ferch is the son of Key Employee Wayne Ferch. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder 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 public benefit corporation that operates as a public charity. The Hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 11b: Form 990 Review Process This Form 990, including all supporting schedules, was prepared by a public accounting firm, reviewed by the System Controller and market Finance Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts 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, Line 15a: Compensation Review & Approval Process - CEO, Top Management The hospital board of directors has established a Compensation Committee to overseethe executive compensation program. This committee is composed of independentdirectors with no conflicts of interest. The committee performs the followingfunctions: recommends a total compensation philosophy to the board; assurescompliance with the board-approved philosophy; meets annually to reviewcomparability data from outside consultants; recommends any adjustments to currentexecutive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annualgoals; recommends appropriate incentive awards to the board for approval; follows adiligent process that meets regulatory requirements for a rebuttable presumption ofreasonableness; records committee deliberations and decisions in timely minutes;selects, engages and supervises any consultant hired to advise and providecomparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and 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, Line 15b: Compensation Review and Approval Process for Officers and Key Employees See Line 15b explanation. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available 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. Other Changes In Net Assets Or Fund Balances - Other Increases Net Asset Released for operation = $73122 Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated Health System CA 501(c)(3) 10 NA false Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Medical Ctr Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 12b2 Adventist Health SystemWest false Adventist Health So CA Medical Fdtn PO Box 619135 Roseville CA 95661 954424391 Discontinued Operations CA 501(c)(3) 12b2 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki Street Kailua HI 96374 990107330 Hospital HI 501(c)(3) 3 Adventist Health SystemWest false Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Fremont- Rideout Health Group 898 Plumas Street Yuba City CA 95991 942917251 Accute Care Hospital CA 501(c)(3) 12b2 Adventist Health SystemWest false Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Lodi Memorial Hospital Assn Inc 975 So Fairmont Ave Lodi CA 95240 941044474 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Northwest Medical Fdtn of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Accute Care Hospital CA 501(c)(3) 3 Adventist Health SystemWest false St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Simi Valley Hospital & Health Care Svc 2975 No Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Stone Point Health PO Box 619135 Roseville CA 93661 823763347 Supporting Organization CA 501(C)(3) 12b2 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled Nursing/Assisted Living/Hm Care CA 501(c)(3) 12b2 Fremont Rideout Health Group false Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital WA 501(c)(3) 3 Adventist Health SystemWest false Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home Care CA 501(C)(3) 10 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Adventist Health Delano PO Box 460 Delano CA 93216 770258013 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA AHSWest C-Corp false false false false false true false false false false false false false false false true true true false true Adventist Health SystemWest e 31947123 Loan Balance Adventist Health SystemWest o 377247 Compensation Adventist Health SystemWest p 28984336 Operating Exp Adventist Health SystemWest s 23516677 Cash Mgt Funds