2019-11-14T15:24:46-08:00 2018-12-31 800519547 THE ACCOUNTANCY LLP 330 N BRAND BLVD STE 200 GLENDALE CA 912032361 990 2018-01-01 453220509 Reedley Community Hospital dba Adventist Health Reedley REED 5596388155 372 W Cypress Ave Reedley CA 93654 Timothy Haydock Treasurer 2019-11-14 S Clement P01218012 8185475701 X 2018 2020-03-31 21:24:44Z Wayne Ferch 182193294 false false 1071 X www.adventisthealth.org/reedley X 2011 CA Living Gods love by inspiring health, wholeness and hope. 12 10 299 68 0 30683 38096 196865784 181126377 140611 1028821 0 197037078 182193294 21635 87995 0 67277388 67495219 0 114394 86005429 93666221 153304452 161249435 43732626 20943859 100490778 109797921 37658798 26040846 62831980 83757075 Living Gods love by inspiring health, wholeness and hope. false false 130239440 87995 181126377 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 2018 was $1,843,049.The following Inpatient services that were provided to all our patients. These services included:1,260 Babies delivered38 Surgeries performed4,475 Patient days The following Outpatient services that were provided to all our patients. These services included:38,516 Emergency department visits311 Outpatient Surgeries performed33,951 Outpatient visits 529,479 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 2018 was $3,335,404.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/ 130239440 true true false true false false false false false true true false false true true false false true false false false false false false false false true true true false true false false false false false false false false true false false false false false false false true false false false true 0 0 true 299 true false false false false false false false false 0 false false false false false false false false false false false false X 12 10 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 Banks David Director 0.00 4.00 X 0 27620 0 Cherry Robert Director 0.00 4.00 X 0 25126 0 Davis Andrew Director 0.00 4.00 X 0 24002 0 Freedman John Director 0.00 4.00 X 0 718 0 Gabriel Melody Dir Thru 12/18 0.00 4.00 X 0 20464 0 Graham Ricardo Director 0.00 4.00 X 0 1442 0 Heinrich Kerry Director 0.00 4.00 X 0 20485 0 Innocent Larry Director 0.00 4.00 X 0 31885 0 Pedersen James Dir Thru 7/18 0.00 4.00 X 0 3625 0 Reiner Richard Director 0.00 4.00 X 0 27964 0 Rippey Wesley Dir Thru 5/18 0.00 50.00 X 0 623943 47568 Salazar Velino Director 0.00 4.00 X 0 1542 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 2458436 38193 Wing Bill Dir/VCh/AsstSec 0.00 50.00 X X 0 1875310 40406 Jobe Meredith Secretary 0.00 50.00 X 0 666615 38328 Kofl Andrea President 25.00 25.00 X 0 710357 38806 Haydock Timothy Treasurer 25.00 25.00 X 0 321432 55132 Wagner Jack A Sec Thru 3/18 0.00 50.00 X 0 1332907 34076 Reppert Joseph CFO 0.00 50.00 X 0 953615 46846 Ferch Wayne President 8.33 41.67 X 0 1232626 16445 Larsen David FO/Asst Sec/SVP 8.33 41.67 X 0 667033 351055 Adalberto Renteria Medical Officer, CCR 8.33 41.67 X 0 445200 35040 Ayala Raul CVN Clinics 25.00 25.00 X 0 482798 0 Hoyt Glenda VP Quality Patient Safety 50.00 0.00 X 0 314371 37841 Chapman Susan VP PCE 25.00 25.00 X 0 250549 38680 Plata Nina VP CPE 25.00 25.00 X 0 264451 48624 Taggart Laurie CP Experience 25.00 25.00 X 0 277151 39432 Thomas Cheryl Nurse Practitioner 50.00 0.00 X 278593 0 23844 Dhaliwal Simerjit Physician Asst 50.00 0.00 X 272640 0 40860 Chakerian Vagan Nurse Practitioner 50.00 0.00 X 216513 0 19408 Brown Stanton Physician Asst 50.00 0.00 X 208231 0 27 Ayers Richard RN-Supervisor 50.00 0.00 X 206306 0 44720 Gruen Derrick Former VP Clinic Svcs 0.00 0.00 X 0 341823 46403 Gruzensky Denton Former VP HR 0.00 0.00 X 0 268078 36220 Combs Linda Former Nurse Practioner 0.00 0.00 X 0 180315 32823 Fults Kendall Former SVP Bus/Physician Dev 0.00 0.00 X 0 13419 663 1182283 13865302 1151440 5 true true false LTB Inc 600 N Piedra Rd Sanger CA 93657 Construction 1176603 Vituity 2100 Powell St Ste 920 Emeryville CA 94608 Physician Services 1182516 CCFMG 2625 E DIVISADERO ST FRESNO CA 93721 Physician Services 1327193 CENTRAL VALLEY HEALTH TRANSPORT PO BOX 1189 Hanford CA 93230 PURCHASED SERVICES 1289045 Valley Childrens Med Grp 9300 Valley Childrens Pl Madera CA 93638 Physician Services 1691852 56 38096 38096 Dietary 900099 86007 86007 MOB rentals 531120 33333 33333 Other revenue 900099 97121 97121 Patient service revenue 900099 180909916 180909916 181126377 1019363 1019363 9458 9458 0 0 0 0 0 0 0 182193294 181126377 1028821 X 87995 87995 0 0 0 0 0 52046700 49444714 2509423 92563 1846330 1777877 67114 1339 9887408 9761392 126016 3714781 3508358 197084 9339 11487334 3989306 7498028 213664 213664 5194 5194 0 0 0 33909873 33606987 302886 241339 241339 1873618 1687338 186280 9042930 1868146 7174784 0 7696870 6095129 1601741 555386 400633 151393 3360 0 112323 111902 421 477209 477209 0 2618230 2581214 37016 28952 28952 Patient care supplies 9889337 9594311 292186 2840 Revenue Cycle Fees 9590739 -34009 9624748 Other purchased services 4180646 3611918 563775 4953 Purchased Medical Services 668965 668965 1073612 971103 102509 161249435 130239440 30895601 114394 -69167 1363 25714378 41010401 0 23439641 18450202 0 0 0 500776 476576 139676 159966 38165820 17080997 20892477 21084823 224355 166233 0 0 9948813 9967146 19699829 18481211 100490778 109797921 12681638 9575462 12269951 12084963 12707209 4380421 37658798 26040846 X 62781850 83721667 50130 35408 62831980 83757075 100490778 109797921 X 20943859 -18764 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 11249 11249 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. 50130 28332 43054 35408 40953 30683 21506 50130 1000 79363 39410 40953 1000 1876 1876 1000 1000 18763 18763 1000 1.00000 false true true 1568068 1568068 12560277 4213590 8346687 6182255 1226168 4956087 17855220 11641239 6213981 21084823 Due from third-party payors 17168104 OTHER ASSETS 58469 Other receivables 1254638 Receivable from related orgs 18481211 Payables to related organizations 3084987 Workers comp. liability 1295434 4380421 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. true true X true X true X true true false false true true 1843049 1843049 0.01140 1843049 1843049 0.01140 1274094 1274094 0.00790 1823612 41454 1782158 0.01110 584464 305312 279152 0.00170 3682170 346766 3335404 0.02070 5525219 346766 5178453 0.03210 6248 6248 1604 1604 1951 1951 5041 5041 14844 14844 true 920954 495750 18052766 21524949 -3472183 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 16 true true true true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 18 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 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 true X false X X X X true X false false Facility: - Part V, Section B, Line 5 The 2016 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.Data gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews.Community Survey: designed by the Healthy Madera Coalition with the County Public Health Department staff. Thirty-six questions centered on key health concerns and factors that influence the health of the community. Provided to residents of Fresno, Kings, Madera, and Tulare Counties by placing it on Survey Monkey, an online web platform, in both Spanish and English.Community Focus Groups: A total of 15 focus groups were conducted ranging in size from 4 to 24 participants. They were attended by hospital and facility staff, community leaders from nonprofit and faith-based organization and elected officials and residents. These sessions were conducted primarily in English. Focus groups comprised of primarily residents, including mothers and youth were conducted in English and Spanish. Key Stakeholder Interviews: The workgroup identified approximately 95 individuals considered to be key stakeholders in the region that would be important to interview. Consultants contacted each stakeholder offering to conduct phone or in-person interviews. Thirty-five stakeholder interviews were conducted between July 20 and September 10. The format for these was identical to the focus group process. Participants in this effort included the following stakeholders in all four counties: County Public Health Directors, hospital executives and nonprofit leaders who serve the community with social, health, or educational support services. These key stakeholders were selected by the workgroup because they would provide a unique perspective on the health of the community, health care delivery systems in place and overall conditions that influence health behaviors. In addition, as per IRS guidelines the CHNA community outreach also involved the Tule River Nation Elders and Tribal Council Members in Tulare County. Facility: - Part V, Section B, Line 6a This report is the result of a unique collaboration among 15 different hospitals committed to serve the nearly 1.7 million diverse residents in the Central California counties of Fresno, Kings, Madera and Tulare. These hospitals are:1. Adventist Medical Center Hanford2. Adventist Medical Center Reedley3. Adventist Medical Center Selma4. Clovis Community Medical Center5. Coalinga Regional Medical Center6. Community Regional Medical Center7. Fresno Heart & Surgical Hospital8. Kaiser Permanente Fresno Medical Center9. Kaweah Delta Health Care District10. Madera Community Hospital11. Saint Agnes Medical Center12. San Joaquin Valley Rehabilitation Hospital13. Sierra View Medical Center14. Tulare Regional Medical Center15. 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 the overall health of the community through increased health awareness and access to needed services. Interventions:1.Central Valley Transport Services provides round trip transportation to our clinics for patients that do not have transportation to their appointments. Services are provided to the following Adventist Health Medical Offices: Hanford, Healthy Beginnings, 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 Community Members Served: 13,9092. Our Hanford Medicine Residency clinic offered clinical assessment services at free diabetes pop up clinics and a Project Homeless Connect event in Kings County. Our residency clinic not only offered these free services to those in need, but by providing training and residency opportunities to medical students, we hope to increase the number of medical providers practicing in the Central Valley. Number of Community Members Served: 3003. A big barrier to care in the Central Valley is an overall lack of providers. Physician and provider recruitment including nurse practitioners and physician assistants is critical to meeting the healthcare needs of our communities. 43 providers were added in 2018. Priority Need 2 Diabetes - Decrease glycosylated hemoglobin levels (HgbA1c) and all-cause readmission rates for those with a diagnosis of diabetes to improve health outcomes. Adventist Health was able to improve the number of patients with HgbA1c greater or equal to 8% from 38.7% in 2017 to 45.3% in 2018 through the HEDIS measure. Interventions: 1.Diabetes Among Friends, a five-week diabetes self-management education curriculum in English and Spanish from Scripps University, debuted in our rural health clinics in July 2017. This program is approved 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 exam. Number of community members served- 1022.Diabetes Case Management - Certified Diabetes Educators work as case managers for high risk rural health clinic patients with diabetes. High risk is defined as HgA1c greater than 9.0, LDL greater than 100 and blood pressure greater than 140/90. Educators work to help patients manage their diabetes including education and support with medications and clinic appointments. Number of community members served 623. Diabetes Pop-Up Clinics in Hanford and Lemoore provided free diabetes and pre diabetes screening, blood pressure and blood glucose checks, education on nutrition, lifestyles and physical activity a well as connections with residency clinic, clinic schedulers, Covered California agent and Anthem and CalViva for management medical plan information. Number of community members served 100Priority Need 3 Obesity - Decrease body mass index across community populations by providing education and resources to increase physical activity and promote healthy eating behaviors. 2018 data from the Centers for Disease Control are not available to measure obesity rates in Fresno and Kings County. Interventions:1.Creation Health teach women how to incorporate healthy lifestyle habits like nutrition, physical activity, rest, faith and even financial planning to improve overall health and wellness for families in our Reedley community. Number of community members served 142Priority Need 4 - Breathing Problems, Asthma - Decrease adult smoking rates and avoidable admissions from lung related diseases like asthma and COPD. Asthma admissions decreased from 61 in 2017 to 48 in 2018. COPD admissions decreased from 92 in 2017 to 73 in 2018. Interventions:1.Respiratory Warriors Support Group a monthly support group for those living with chronic lung diseases including asthma, COPD, pulmonary fibrosis, sleep apnea, allergies and any other lung health issue. Each month provides an opportunity for members to connect and catch up with each other while learning about resources and health topics that will help them lead healthier lives. Number of Community Members Served: 1202.Respiratory Therapy Educator who works with patients from the inpatient setting through outpatient and home visits. This educator has been able to provide educational support through the continuum of care for some of our sickest patients to ensure that they receive the medications they need and know how to use them to help them achieve their health goals as well as decrease readmission rates.3.In cooperation with the Kings County Asthma Coalition, Adventist Health hosted a community open house for clinic providers and the public to learn about asthma interventions. Topics included updates on current asthma medications, administration and inhaler use, air quality education, asthma triggers and abatement ideas and resources. Number of Community Members and Providers Served: 304. Bubble Fun Run in Kings County increased awareness for community members about asthma and available resources. This free family activity raised awareness of asthma and community resources available to support families and community members dealing with asthma. Number of Community Members Served: 135 Priority Need 5 Mental Health and Substance Abuse Interventions:1.Specialty behavioral health clinics are located in Kings and Fresno counties for our patients. Partnership with Dr. Marc Lasher to provide addiction medicine services to patients in Kings County in the hospitals and clinics. 2. Point in Time Survey participation to identify and county all homeless individuals in Kings and Tulare Counties. This annual event provides services for the homeless including medical care, hygiene, dog vaccinations, bike repair, haircuts, state ID and social services, etc. Number of community members served 2783. Adventist Health partners with Kings United Way for promoting 2-1-1 and the 2-1-1 Intelliful mobile app in our clinics and patient care areas. 2-1-1 connects people in need to resources in the community available to them including mental health, substance abuse and homelessness resources. Anybody can access 2-1-1 by phone, email and in Kings and Tulare counties, through the phone app. 4. Respite care for our homeless or inadequately housed inpatients provided for safe discharge. In 2018, we switched partners from Champions Recovery Alternative Programs Inc., which was a 30 day program in a substance use treatment facility to a 90-day board and care program with Kings Gospel Mission. Since the switch occurred in fourth quarter 2018, we have seen an increase in the number of homeless patients asking for and utilizing the respite care. Patients who are homeless and have substance abuse or mental health issues, receive wrap-around care while residing at the Kings Gospel Mission.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 didnt directly address poverty in our current year CHP, our network attempts to link patients to resources that can assist in their needs. Part V Other Community Benefits: Adventist Health Reedley is committed to not only improving the health of our community through identified health priorities but looks to improve the overall wellbeing of our community through other 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. Number of Community Members Served: 1,5952.Car safety seat checks are conducted by our certified car safety seat technicians in the Security department. These safety seat checks make sure that the car seat is current and appropriate for the child. They also check to make sure the safety seat is properly installed in the vehicle. These checks are provided at no cost at our hospitals and clinics. Number of Community Members Served: 243 AHCC-Reedley Cypress 372 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-Parlier Newmark 155 S Newmark Parlier CA 93648 Rural Health Clinic AHCC-Orange Cove 1455 Park Blvd Orange Cove CA 93646 Rural Health Clinic AHCC-Dinuba West 250 W El Monte Way Dinuba CA 93618 Rural Health Clinic AHCC-Cutler 40657 Road 128 Cutler CA 93615 Rural Health Clinic AHCC-Avenal West 337 Kings Street Avenal CA 93204 Rural Health Clinic AHCC-Caruthers East 2357 W Tahoe Caruthers CA 93609 Rural Health Clinic AHCC-Corcoran East 1310 Hanna Avenue Corcoran CA 93212 Rural Health Clinic AHCC-Kerman Central 275 S Madera Ave Ste 201 Kerman CA 93630 Rural Health Clinic AHCC-Riverdale 3567 Mt Whitney Ave Riverdale CA 93656 Rural Health Clinic AHCC-Reedley Jefferson 1150 E Washington Ave Reedley CA 93654 Rural Health Clinic AHCC-Orosi 41696 Road 128 Orosi CA 93647 Rural Health Clinic AHCC-Dinuba Plaza 444 W El Monte Way Dinuba CA 93618 Rural Health Clinic AHCC-Oakhurst 48677 Victoria Lane Oakhurst CA 93644 Rural Health Clinic AHCC-Reedley Womens Health 550 W Cypress Ave Reedley CA 93654 Rural Health Clinic AHCC-Oakhurst East 49063 Road 426 Ste CD Oakhurst CA 93644 Rural Health Clinic AHCC-Madera Ranchos 11976 Road 37 Madera CA 93636 Rural Health Clinic Hanford Family Practice Residency Clinic 1025 N Douty St Hanford CA 93230 Outpatient teaching clinic - family practice residents AHCC - Hanford Dental 1025 N Douty St Hanford CA 93230 Dental clinic - general dentistry for all ages AHCC - Huron 16916 5th St Huron CA 93234 Rural health clinic AHCC - Coalinga 155 S 5th St Coalinga CA 93210 Rural health clinic AHCC - Behavioral Health Srvs 1025 N Douty St Hanford CA 93230 Outpatient mental health services AHCC - Hanford 1025 N Douty St Hanford CA 93230 Rural health clinic - primary care services AHCC - Healthy Beginnings 1025 N Douty St Hanford CA 93230 Outpatient clinic - prenatal, family PACT, and well women services AHCC - Corcoran 1212 Hanna Ave Corcoran CA 93212 Rural health clinic AHCC - Lemoore East 810 E D St Lemoore CA 93245 Rural health clinic AHCC - Hanford Specialty Services 1025 N Douty St Hanford CA 93230 Outpatient clinic - specialists AHCC - Selma 1041 Rose Ave Selma CA 93662 Rural health clinic AHCC - Dinuba 1451 E El Monte Way Dinuba CA 93618 Rural health clinic AHCC - Caruthers 2440 W Tahoe Ave Caruthers CA 93609 Rural health clinic AHCC - Fowler 119 S 6th St Fowler CA 93625 Rural health clinic AHCC - Kerman 1000 S Madera Ave Kerman CA 93630 Rural health clinic AHCC - Selma Central 2141 High St Selma CA 93662 Rural health clinic AHCC - Home Garden 11899 Shaw Pl Hanford CA 93230 Rural health clinic AHCC - Sanger 1939 Academy Ave Sanger CA 93657 Rural health clinic AHCC - Reedley 811 E 11th St Reedley CA 93654 Rural health clinic AHCC - Kingsburg 1251 Draper St Kingsburg CA 93631 Rural health clinic AHCC - Taft 501 6th St Taft CA 93268 Rural Health Clinic AHCC - Avenal 213 Fresno St Avenal CA 93204 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 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 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 - 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.Our mission is to promote health in the community regardless of a person's ability to pay. We provide care to those with Medicare coverage who present themselves to our facility without consideration that the costs may or may not be fully reimbursed. The Medicare shortfall is a community benefit because care is provided to Medicare beneficiaries who are primarily elderly and disabled individuals on fixed incomes and who usually have no other resources with which to obtain medical care. We are thus relieving a local and federal government burden by caring for these people. *Medicare Cost Report Revenue 18,052,766Prior Year Settlements 1,433,892Cost Report Reimbursable Bad Debts 225,235Non-Cost Report Revenue 7,187,028Estimates and Accrual Variances 937,055Other (1,294,509) __________Total Medicare Revenue 26,541,467*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 2016 CHNA, the 2019 Community Health Plan (CHP) Update for fiscal year 2018, the 2018 Community Health Plan (CHP) Update for fiscal year 2017, and the 2016 Implementation Strategy (adopted in May 2017) which includes the 2017 CHP , are posted on the hospital's website at https://www.adventisthealth.org/about-us/community-benefit/The CHNA, Implementation Strategy and the CHPs are also available on the Adventist Health Corporate website at https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. Quantitative data was gathered through Kaiser Permanentes CHNA Data Platform and local county and national data. We also look at the needs of our patients by looking at trends in our admissions rates. For our CHNA, a total of 15 focus groups were conducted, ranging in size from 4 to 24 participants. In addition, interviews were conducted by phone or in person with 95 individuals considered to be key stakeholders in all four counties: County Public Health Directors, hospital executives and nonprofit leaders who serve the community with social, health, or educational support services. These key stakeholders were selected by the workgroup because they would provide a unique perspective on the health of the community, health care delivery systems in place and overall conditions that influence health behaviors. An online survey was also developed from the focus group questions. 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/patient-resources/financial-assistance/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 The Adventist Health Central Valley Network operates more than 60 sites in Kings, Tulare, Kern, Madera and southern Fresno counties. It includes some of the poorest congressional districts with some of the worst health disparities in California. Many of the communities served are rural and do not have the infrastructure that supports active lifestyles. The area largely depends on agriculture, government employment, hospitals and educational institutions for jobs.The population we serve is largely made up of Hispanic/Latino and White, non-Hispanic residents representing almost 90% of the entire population. The next largest ethnic group is Asian, estimated at 5%, African-Americans followed with 4%, American Indian, multiracial population and Pacific Islander complete the other 2%. Depending on the community the percentage ranges between the make-up of racial groups, but in our rural communities the Hispanic/Latino population often is more than 70% of the population many of whom are Spanish language speakers. 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 true CA Hlth Fnd & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 325844 0 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 true true X X X X true true false false false false false false false false Adalberto Renteria Medical Officer, CCR 400000 45200 25500 9540 480240 Ayala Raul CVN Clinics 482798 482798 Ayers Richard RN-Supervisor 203815 2491 12275 32445 251026 Brown Stanton Physician Asst 191622 16609 27 208258 Chakerian Vagan Nurse Practitioner 211588 4925 10568 8840 235921 Chapman Susan VP PCE 185841 36191 28517 13464 25216 289229 Combs Linda Former Nurse Practioner 156918 300 23097 10351 22472 213138 Dhaliwal Simerjit Physician Asst 248709 23931 16481 24379 313500 Ferch Wayne President 740094 327200 165332 16445 1249071 Fults Kendall Former SVP Bus/Physician Dev 12036 1383 663 14082 Gruen Derrick Former VP Clinic Svcs 253704 49407 38712 16682 29721 388226 Gruzensky Denton Former VP HR 216118 42087 9873 15491 20729 304298 Haydock Timothy Treasurer 240275 38762 42395 16601 38531 376564 Hoyt Glenda VP Quality Patient Safety 223427 43510 47434 16207 21634 352212 Jobe Meredith Secretary 419684 111013 135918 16682 21646 704943 Kofl Andrea President 391671 103328 215359 16682 22124 749164 Larsen David FO/Asst Sec/SVP 427072 107292 132669 320716 30339 1018088 Plata Nina VP CPE 204614 38737 21100 14474 34150 313075 Reiner Scott Dir/Chair 1339257 747881 371298 16682 21511 2496629 Reppert Joseph CFO 686470 152446 114699 16682 30164 1000461 Rippey Wesley Dir Thru 5/18 565539 58404 20249 27319 671511 Taggart Laurie CP Experience 207796 39203 30152 15267 24165 316583 Thomas Cheryl Nurse Practitioner 162226 91016 25351 14986 8858 302437 Wagner Jack A Sec Thru 3/18 180671 414342 737894 11182 22894 1366983 Wing Bill Dir/VCh/AsstSec 1015353 603273 256685 16682 23724 1915717 Part I, Line 1a: Relevant information in regards to selections on 1a. Arnold Plata Spouse of Key EE 51159 Employment false Susan Chapman Key EE-Owner 265215 Contract-Wmns Hlth Cntr false Linda Henry Key EE Sister 59434 Employment false Brent Wagner Son of Officer 82281 Employment false Cambria Wehtje-Sim Dghtr-Fmr Ofcr 89784 Employment false Ferch Josiah Key EE Son 42946 Employment false Carol Jobe Officer's Spouse 4429 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 daughter of Adventist Health board member, Wesley Rippey.4. Brent Wagner is the son of former Adventist Health CFO, Jack Wagner.5. Cambria Wehtje-Sim is the daughter of former officer Rodney Wehtje.6. Doris Tetz is the daughter of former key employee, Warrent Tetz.7. 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 not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit public charity. The hospital bylaws define its board of directors to be the same individuals who are members of Adventist Health System/West board of directors. 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. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital. 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 questionnaireis sent to board members 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 theCOIs for all board members. In addition, the foundations administration is responsible for keeping record to ensure all board members have submitted their COIs.Further inquiries on any potential significant conflicts are made as needed.Conflicts are documented and reviewed with the Board member. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management See explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees 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 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 publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency. Other Changes In Net Assets Or Fund Balances - Other Decreases Investment Losses-Restricted Assets = -$18764 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 16th 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 Acute 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 Foundation 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 Acute 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 CA 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 South Coast Medical Center 200 DOUGLAS BLVD Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false false false false false true false false false false false false false false false true true true false false