UKIAH ADVENTIST HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- UKIAH ADVENTIST HOSPITAL (EIN 94-1639901)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-11-08
- IRS object ID
- 201933129349303853
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-11-08T19:40:19-06:00 | ReturnTs |
| Tax Period End | 2018-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941639901 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ukiah Adventist Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UKIA | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 275 Hospital Drive | AddressLine1Txt |
| City | Ukiah | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95482 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ryan Quattlebaum | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2019-11-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2019-11-06 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 172.9.161.112 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-11-06 | IPDt |
| IP Tm | 23:17:20 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | F565611BDA9E00D03FA055086BAA92DB14EC1355 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-03-31 21:24:44Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Ukiah Valley | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Gwen Matthews | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 275 Hospital Drive | AddressLine1Txt |
| City | Ukiah | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95482 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $202,794,673 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/ukiah-valley/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1967 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 915 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,085,638 | PYContributionsGrantsAmt |
| CY Contributions Grants | $637,022 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $173,925,889 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $200,406,296 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,491,630 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,674,506 | CYInvestmentIncomeAmt |
| PY Other Revenue | $64,431 | PYOtherRevenueAmt |
| CY Other Revenue | $32,232 | CYOtherRevenueAmt |
| PY Total Revenue | $176,567,588 | PYTotalRevenueAmt |
| CY Total Revenue | $202,750,056 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $161,065 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $443,311 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $56,688,316 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $65,742,706 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $294,286 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $96,548,146 | PYOtherExpensesAmt |
| CY Other Expenses | $116,478,675 | CYOtherExpensesAmt |
| PY Total Expenses | $153,397,527 | PYTotalExpensesAmt |
| CY Total Expenses | $182,664,692 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $23,170,061 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $20,085,364 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $182,267,697 | TotalAssetsBOYAmt |
| Total Assets EOY | $207,274,569 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $73,509,876 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $78,431,384 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $108,757,821 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $128,843,185 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $153,934,836 | ExpenseAmt |
| Grant | $443,311 | GrantAmt |
| Revenue | $200,406,296 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $153,934,836 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 915 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jay Lipps VP System Controller | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9167465932 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $27,620 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $25,126 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $24,002 | $0 | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $718 | $0 | ||||
| Gabriel Melody | ||||||||||
| Director thru 12/2018 | 0.00 | 4.00 | Yes (X) | $0 | $20,464 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,442 | $0 | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,485 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $31,885 | $0 | ||||
| Pedersen James | ||||||||||
| Director thru 07/2018 | 0.00 | 4.00 | Yes (X) | $0 | $3,625 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $27,964 | $0 | ||||
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | $0 | $2,458,436 | $44,472 | Yes (X) | |||
| Rippey Wesley | ||||||||||
| Director thru 05/2018 | 0.00 | 50.00 | Yes (X) | $0 | $623,943 | $47,568 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,542 | $0 | ||||
| Wing Bill | ||||||||||
| Dir/Vice Chair/Asst Secr | 0.00 | 50.00 | Yes (X) | $0 | $1,875,311 | $49,315 | Yes (X) | |||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | $0 | $666,615 | $38,328 | Yes (X) | ||||
| Matthews Gwen | ||||||||||
| President | 50.00 | 0.00 | $0 | $674,861 | $16,539 | Yes (X) | ||||
| Quattlebaum Ryan | ||||||||||
| Treasurer | 50.00 | 0.00 | $0 | $237,512 | $33,980 | Yes (X) | ||||
| Wagner Jack | ||||||||||
| Asst Secr thru 03/2018 | 0.00 | 50.00 | $0 | $1,332,908 | $34,076 | Yes (X) | ||||
| Byrnes John | ||||||||||
| Medical Officer, NCR | 10.00 | 40.00 | $0 | $501,269 | $14,905 | Yes (X) | ||||
| Eller Jeff | ||||||||||
| President, NCR | 10.00 | 40.00 | $0 | $1,176,550 | $38,127 | Yes (X) | ||||
| Lang Kevin | ||||||||||
| Finance Officer, NCR | 10.00 | 40.00 | $0 | $563,108 | $0 | Yes (X) | ||||
| Lonto Robert | ||||||||||
| VP HR, NCR | 0.00 | 50.00 | $0 | $359,348 | $46,556 | Yes (X) | ||||
| Ploss David | ||||||||||
| Medical Director | 50.00 | 0.00 | $0 | $518,492 | $24,422 | Yes (X) | ||||
| Reppert Joseph | ||||||||||
| CFO, NCR | 50.00 | 0.00 | $0 | $953,615 | $46,846 | Yes (X) | ||||
| Van Housen Heather | ||||||||||
| Patient Care Exec | 0.00 | 50.00 | $0 | $309,781 | $66 | Yes (X) | ||||
| Weis David | ||||||||||
| VP Operations | 0.00 | 50.00 | $0 | $248,194 | $44,921 | Yes (X) | ||||
| Bartolomie Jill | ||||||||||
| Director, RN | 50.00 | 0.00 | $179,326 | $0 | $22,313 | Yes (X) | ||||
| Kilkenny Martha | ||||||||||
| Nurse Practitioner | 50.00 | 0.00 | $182,496 | $0 | $18,435 | Yes (X) | ||||
| Petersen Lisa | ||||||||||
| RN, Nurse lead | 50.00 | 0.00 | $281,874 | $0 | $30,875 | Yes (X) | ||||
| Rehm Donna | ||||||||||
| RN | 50.00 | 0.00 | $234,778 | $0 | $40,046 | Yes (X) | ||||
| Spencer Lindsey | ||||||||||
| Patient Care Exec | 50.00 | 0.00 | $220,966 | $0 | $40,133 | Yes (X) | ||||
| McDonald Edward | ||||||||||
| Former Treas/Asst Secr | 0.00 | 50.00 | $0 | $338,302 | $20,694 | Yes (X) | ||||
| Poole Aaron | ||||||||||
| Former Treas/Asst Secr | 0.00 | 50.00 | $0 | $327,164 | $41,356 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,099,440 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $13,350,282 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $693,973 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 154 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Herrero Builders Inc | |||||
| 2100 Oakdale Avenue | San Francisco | CA | 94124 | Construction | $11,442,549 |
| Pacific Redwood Medical Services Inc | |||||
| 242 Hospital Drive Suite B | Ukiah | CA | 95482 | Medical services | $2,614,003 |
| Bivens Medical Corporation | |||||
| 20105 Geisendorfer | Applegate | CA | 95703 | Medical services | $2,463,650 |
| Pacific Redwood Medical Group Inc | |||||
| PO Box 2800 | Ukiah | CA | 95482 | Medical services | $2,190,747 |
| Locumtenenscom LLC | |||||
| PO Box 405547 | Atlanta | GA | 30384 | Medical services | $1,718,428 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 39 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $33,075 | FundraisingAmt |
| Related Organizations | $10,000 | RelatedOrganizationsAmt |
| Government Grants | $75,636 | GovernmentGrantsAmt |
| All Other Contributions | $518,311 | AllOtherContributionsAmt |
| Total Contributions | $637,022 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621110 | $199,138,834 | $199,138,834 |
| Other program revenue | 900099 | $836,117 | $836,117 |
| Dietary | 722210 | $285,155 | $285,155 |
| Rent medical office bldg | 531120 | $134,140 | $134,140 |
| Medical records revenue | 621990 | $12,050 | $12,050 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $200,406,296 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,674,013 | TotalRevenueColumnAmt |
| Exclusion | $1,674,013 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $493 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $493 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $493 | TotalRevenueColumnAmt |
| Exclusion | $493 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $29,215 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $33,075 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $11,625 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,590 | TotalRevenueColumnAmt |
| Exclusion | $17,590 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $47,634 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $32,992 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,642 | TotalRevenueColumnAmt |
| Exclusion | $14,642 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $202,750,056 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $200,406,296 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,706,738 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,311 | TotalAmt |
| Program Services | $443,311 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,380,039 | TotalAmt |
| Program Services | $46,921,857 | ProgramServicesAmt |
| Management And General | $3,329,053 | ManagementAndGeneralAmt |
| Fundraising | $129,129 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,252,694 | TotalAmt |
| Program Services | $1,148,013 | ProgramServicesAmt |
| Management And General | $100,826 | ManagementAndGeneralAmt |
| Fundraising | $3,855 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,514,804 | TotalAmt |
| Program Services | $10,195,241 | ProgramServicesAmt |
| Management And General | $298,000 | ManagementAndGeneralAmt |
| Fundraising | $21,563 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,595,169 | TotalAmt |
| Program Services | $3,406,593 | ProgramServicesAmt |
| Management And General | $179,702 | ManagementAndGeneralAmt |
| Fundraising | $8,874 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,590,787 | TotalAmt |
| Program Services | $1,135,538 | ProgramServicesAmt |
| Management And General | $8,455,249 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,221 | TotalAmt |
| Management And General | $162,221 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,522 | TotalAmt |
| Management And General | $40,522 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,281 | TotalAmt |
| Program Services | $16,281 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,080,150 | TotalAmt |
| Program Services | $57,561,866 | ProgramServicesAmt |
| Management And General | $8,413,143 | ManagementAndGeneralAmt |
| Fundraising | $105,141 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $362,479 | TotalAmt |
| Management And General | $362,479 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,199,311 | TotalAmt |
| Program Services | $919,315 | ProgramServicesAmt |
| Management And General | $271,962 | ManagementAndGeneralAmt |
| Fundraising | $8,034 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,331,305 | TotalAmt |
| Program Services | $1,548,403 | ProgramServicesAmt |
| Management And General | $5,778,070 | ManagementAndGeneralAmt |
| Fundraising | $4,832 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,819,322 | TotalAmt |
| Program Services | $5,710,873 | ProgramServicesAmt |
| Management And General | $1,108,449 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $344,066 | TotalAmt |
| Program Services | $241,644 | ProgramServicesAmt |
| Management And General | $100,864 | ManagementAndGeneralAmt |
| Fundraising | $1,558 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,677 | TotalAmt |
| Program Services | $33,309 | ProgramServicesAmt |
| Management And General | $28,368 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,854 | TotalAmt |
| Program Services | $571,854 | ProgramServicesAmt |
| Management And General | $1,000 | ManagementAndGeneralAmt |
| Fundraising | $1,000 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,075,151 | TotalAmt |
| Program Services | $3,075,151 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,121 | TotalAmt |
| Program Services | $53,958 | ProgramServicesAmt |
| Management And General | $163 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient care supplies | $20,298,900 | $20,195,047 | $103,853 |
| Rental/lease costs equi | $846,059 | $831,426 | $14,633 |
| Sales taxes | $65,337 | $65,337 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$442,868 | TotalAmt |
| Program Services | -$140,181 | ProgramServicesAmt |
| Management And General | -$312,987 | ManagementAndGeneralAmt |
| Fundraising | $10,300 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,664,692 | TotalAmt |
| Program Services | $153,934,836 | ProgramServicesAmt |
| Management And General | $28,435,570 | ManagementAndGeneralAmt |
| Fundraising | $294,286 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $804,521 | BOYAmt |
| EOY | $117,196 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,740,524 | BOYAmt |
| EOY | $71,725,081 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,268,465 | BOYAmt |
| EOY | $16,040,043 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,672,796 | BOYAmt |
| EOY | $3,010,203 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $306,375 | BOYAmt |
| EOY | $267,252 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $120,812,707 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $41,421,760 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,408,731 | BOYAmt |
| EOY | $79,390,947 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,762,091 | BOYAmt |
| EOY | $3,850,194 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,000 | BOYAmt |
| EOY | $500,000 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $172,586 | BOYAmt |
| EOY | $172,586 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,631,608 | BOYAmt |
| EOY | $32,201,067 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,267,697 | BOYAmt |
| EOY | $207,274,569 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,960,859 | BOYAmt |
| EOY | $15,119,395 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,549,017 | BOYAmt |
| EOY | $63,311,989 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,509,876 | BOYAmt |
| EOY | $78,431,384 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,346,893 | BOYAmt |
| EOY | $127,072,956 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,410,928 | BOYAmt |
| EOY | $1,770,229 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,757,821 | BOYAmt |
| EOY | $128,843,185 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,267,697 | BOYAmt |
| EOY | $207,274,569 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $20,085,364 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $16,281 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $16,281 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,410,928 | BeginningYearBalanceAmt |
| Contributions | $567,262 | ContributionsAmt |
| Investment Earnings Or Losses | $3,220 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $13,744 | GrantsOrScholarshipsAmt |
| Other Expenditures | $4,197,437 | OtherExpendituresAmt |
| End Year Balance | $1,770,229 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,268,630 | BeginningYearBalanceAmt |
| Contributions | $798,626 | ContributionsAmt |
| Investment Earnings Or Losses | $193,575 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,820 | GrantsOrScholarshipsAmt |
| Other Expenditures | $845,083 | OtherExpendituresAmt |
| End Year Balance | $5,410,928 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,179,423 | BeginningYearBalanceAmt |
| Contributions | $1,348,696 | ContributionsAmt |
| Other Expenditures | $259,489 | OtherExpendituresAmt |
| End Year Balance | $5,268,630 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,563,283 | BeginningYearBalanceAmt |
| Contributions | $663,489 | ContributionsAmt |
| Investment Earnings Or Losses | $1,870 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $49,219 | OtherExpendituresAmt |
| End Year Balance | $4,179,423 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,087,526 | BeginningYearBalanceAmt |
| Contributions | $1,515,900 | ContributionsAmt |
| Investment Earnings Or Losses | $1,487 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $41,630 | OtherExpendituresAmt |
| End Year Balance | $3,563,283 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,276,873 | OtherCostOrOtherBasisAmt |
| Book Value | $1,276,873 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,353,492 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,177,456 | DepreciationAmt |
| Book Value | $20,176,036 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,075,597 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,075,597 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,441,542 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,168,707 | DepreciationAmt |
| Book Value | $3,272,835 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $54,665,203 | OtherCostOrOtherBasisAmt |
| Book Value | $54,665,203 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $79,390,947 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from third-party payors | $27,577,637 |
| Receivables from related organizations | $4,204,881 |
| Other receivables | $418,549 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $32,201,067 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to related organizations | $44,746,109 |
| Payables to third party payors | $16,372,622 |
| Workers' compensation liability | $2,177,326 |
| MOB deposits | $10,702 |
| Other current liabilities | $5,230 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $63,311,989 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | Board-designated and temporarily restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf tournament | Event1Nm |
| Gross Receipts Event1 | $42,122 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $33,075 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $9,047 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $195 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $4,558 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $3,038 | OtherDirectExpensesEvent1Amt |
| Event2 | Colors for cancer fun run | Event2Nm |
| Gross Receipts Event2 | $12,721 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $12,721 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $3,696 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $54,843 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $33,075 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $21,768 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $195 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,558 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,734 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $11,487 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $10,281 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,760,233 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,760,233 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01530 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,760,233 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,760,233 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01530 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $941,756 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,070 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $918,686 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $309,874 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $309,874 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,677,162 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,979 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,657,183 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02020 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $133,410 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,120 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $119,290 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,062,202 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,169 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,005,033 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,822,435 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $57,169 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,765,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04300 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,467 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,467 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,468 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $336,052 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $336,052 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $342,987 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $342,987 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $798,107 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $368,406 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $46,797,652 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $52,444,923 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,647,271 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 Hospital Dr Med Plaza Assn | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Property management | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.33000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 0.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.67000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Ukiah Valley | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 275 Hospital Drive | AddressLine1Txt |
| City | Ukiah | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95482 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | See Form 990, Pg 1, Item J | WebsiteAddressTxt |
| State License | 110000095 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Ukiah Valley | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assessment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assessment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H, Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H, Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H, Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Adventist Health Ukiah Valley | Part V, Section B, Line 5: The 2016 CHNA data collection process can be summarized as follows: Review of prior CHNA reporting effortsCollection of most recently available demographic, socioeconomic and health indicator dataData gathering was accomplished by using a widely-distributed community health survey and conducting key informant interviews.Community Health Survey: was provided to Mendocino County residents online as well as in hardcopy format. A total of 1,486 residents completed the Community Health Survey; 1,402 were completed in English, and 84 in Spanish.Key Informant Interviews: sixteen key stakeholders in the community were interviewed, including representatives of county and city government, healthcare, the courts, nonprofits, media, health and human services, and private business. Interviews were conducted in person or by phone. The questions were also provided in hardcopy format for written response. While an effort was made to have diverse representation, the opinions provided by the key informants are not necessarily representative of the county as a whole.Participants in this effort included the following stakeholders: County and city government officials with public health responsibilities, hospital executives, Health and Human Services representatives, one judge, one media representative, and several private business 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. |
| Adventist Health Ukiah Valley | Part V, Section B, Line 6a: Ukiah Valley Medical Center partnered with Frank R. Howard Memorial Hospital to produce the 2016 CHNA. |
| Adventist Health Ukiah Valley | Part V, Section B, Line 6b: Ukiah Valley Medical Center collaborated with the Alliance for Rural Community Health (ARCH), Mendocino County Health and Human Services Agency, and North Coast Opportunities to prepare the 2016 Community Health Needs Assessment. |
| Adventist Health Ukiah Valley | Part V, Section B, Line 11: Our 2016 CHNA identified three areas of significant needs: mental health, childhood obesity and family wellness, and childhood trauma. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1 - Mental health: County-wide mental health consciousness is reflected in a proactive, no-shame view of the issues. Communities, agencies, and schools take a comprehensive approach to care and case management. People with mental illnesses and their families and health practitioners have access to needed treatment and case management resources across the continuum of care. Our main goals are: (a) to educate the community about mental illness to reduce stigma and increase resilience; (b) to expand treatment and case management options and access; and (c) to improve prevention for all residents and all mental health conditions. Interventions:1. Homeless/Street Medicine Outreach: Addresses the complex care of patients with high impact social determinants of health. A team of staff and volunteers bring healthcare to homeless individuals and families in the Ukiah area. Scheduled clinic referrals from Mendocino County Health Clinic and Rural Health Clinics are made to homeless shelters, medical respite units, social services, Project Sanctuary, Manzanita and Mendocino County Aids and Viral Hepatitis Network (MCAVHN). In addition, an RN case manager was placed in the Emergency Department (ED) and the EDie/PreManage software has been implemented in the ED to provide exchange of critical information, facilitate coordination of care and alignment with the plan of care across the continuum. Number of Community Members Served by the Outreach Team: 650. 2. LiveWell Programing - launched in 2017, the Live Well Program is focused on helping patients address their chronic disease using the tools of lifestyle change. A team including the patient works to determine specific health goals and map a plan including fitness training, nutrition counseling, behavioral health counseling, diabetes education, pain management and more. This program is open to all through self-referral or provider referral. Number of Community Members Served in the Live Well Clinic: 716.3. Vertical Change Platform: In 2018, the AHUV Street Medicine team began working with a program called Vertical Change. This health record program allows for care coordination across organizations for the purpose of expediting appropriate care. With grants from the Community Foundation, AHUV was able to create a platform to share Vertical Change with interested agencies within the Ukiah Valley. During 2018, 130 clients through the Health and Human Services Department's Whole Person Care Program were signed up in Vertical Care and plans have been made to extend the program to other interested agencies in May of 2019. Number of Community Members Served by the Vertical Change Platform: 130.4. Pharmacy for Street Medicine: Working with the AHUV Pharmacy staff, the Street Medicine Team was able to create a program where basic medicines were included in the team backpacks for use at community pop-up clinics. Medicines such as stool softener and antibiotics are now available to patients at the clinics reducing their need to access emergency departments. Number of Community Members Served in the Pharmacy for Street Medicine Program: 19.Priority Need 2 - Childhood obesity and family wellness: We strive for healthy, active children in healthy families and wide access to healthy food and safe recreational opportunities. Our main goals are: (a) to increase public awareness of relevant community programs and resources and (b) to change the health environment at workplace, recreation, and community meeting venues, offering access to healthy foods. While metrics for fifth grade students at a healthy or under-weight remained the same, Mendocino County saw an almost 1.5% increase in the number of seventh graders who were physically fit. This, along with a slight increase in metrics for ninth grade students at a healthy or under-weight indicates a shift in overall health among our youth.Interventions: 1. Healthy Mendocino: Family Wellness & Childhood Obesity Team. AHUV is an active member of the Family Wellness & Childhood Obesity Action team with the goal to help improve the quality of life in Mendocino County for children and families. AHUV has sponsored the Kids Triathlon Swimming, biking and running for all levels of fitness to help fight childhood obesity and encourage physical activity in Mendocino County. Number of Community Members Served: 300.2. Ukiah on Ice: Partnership with the City of Ukiah to host an open-air ice-skating rink downtown Ukiah. The rink was used by individual citizens, ice hockey teams and area schools for field trips. Number of Community Members Served: 2,000.3. Children's Health Fair: A free children's health fair with the goal to connect local families with community resources that have a positive impact on the lives of their children and families. A bilingual event, this health fair includes screenings for diabetes, vision, hearing, and an emphasis on healthy eating with interactive community partner booths. Number of Community Members Served: 300.4. Food with Friends: Making the most of summer bounty from the garden. Sharing easy and healthy recipes. Staying hydrated during the summer months. Number of Community Members Served: 200.5. Colors for Cancer Fun Run/Walk: A family fun event to educate and raise awareness of cancer benefiting the Focus on Healing program. Number of Community Members Served: 240.Priority Need 3 - Childhood trauma: All children need to grow up in stable and supportive families, and all families must have support in times of crisis. Our main goals are: (a) to educate community members and leaders about the impact of adverse childhood experiences; (b) to increase support for at-risk families, including parents struggling with substance abuse and (c) to develop and promote local policies that strive to prevent childhood trauma. Based on statistics from the University of California at Berkeley our total population of children in child welfare programs did not change although, as would be expected the age ratios changed. Most pronounced was the increase of under one-year old's from 11 to 20. Interventions:1. Community Christmas: AHUV hosts a Christmas dinner and party for identified families who otherwise would not have the means to provide for their children and those in their care. Number of Community Members Served: 21.2. Dream It Be It: A free program hosted by Soroptimist International of Ukiah in partnership with AHUV and other community partners to provide a day-long workshop for at-risk teen girls focused on empowerment and career readiness. Number of Community Members Served: 60.3. Health Careers Exploration Summer Institute: A program designed to promote the advancement of health care workforce through quality education and service. AHUV partnered with Ukiah Unified School District to introduce local high school students to a career in the health care field. Students participated in a three-week course to observe the roles and responsibilities, scope of practice and educational requirement of 10 different hospital rotations. Number of Community Members Served: 10.Priority Areas Not Addressed:All needs were met from our CHNA.Adventist Health recognized the health needs of our community that may not be part of the CHNA. Interventions to address those needs include:1. Focus on Healing programing is a community service provided to any community member going through the cancer experience by bringing healing arts and support for healing through animal assisted therapy available to patients, staff, visitors and the public with stress reduction and Caring/Ceres Kitchen which provides nutritious meals to cancer patients and families by providing food prepared by students and volunteers. Total number of community members served: 1,361.2. Diabetes Education. Monthly classes in English and Spanish are open to anyone in the community that has been diagnosed with diabetes. Family members and support members are welcome to join and learn how to manage their diabetes and stay healthy. Education and free screenings are a major component of the interventions. Number of community members served: 1,765.3. Organ Donation Registry. The creation of an AHUV campaign to partner with local high school and community organizations to build the organ donor bank for organ, eye and tissue donations. Number of community members served: 830. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 27 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (27 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Advanced Wound Center | ||||
| 415 Hospital Drive | Ukiah | CA | 95482 | Wound care center |
| 2 - Ukiah Adventist Health Pavilion Surgica | ||||
| 245 Hospital Drive Suite 100 | Ukiah | CA | 95482 | Radiology |
| 3 - Ukiah Adventist Hospital - Outpatient Pa | ||||
| 245 Hospital Drive | Ukiah | CA | 95482 | Outpatient surgery |
| 4 - Ukiah Valley Pain Management Clinic | ||||
| 260 Hospital Drive Suite 107 | Ukiah | CA | 95482 | Rural health clinic |
| 5 - Outpatient Physician Services-Dora-ENT | ||||
| 1165 S Dora Street Suite C-2 | Ukiah | CA | 95482 | Hospital-based outpatient clinic |
| 6 - Lakeport Cardiology | ||||
| 475 N Forbes Street | Lakeport | CA | 95453 | Hospital-based outpatient clinic |
| 7 - Ukiah Valley Cardiology Clinic | ||||
| 115 Hospital Drive | Ukiah | CA | 95482 | Cardiology |
| 8 - Ukiah Valley Internal MedicineAllergy C | ||||
| 260 Hospital Drive Suite 103 | Ukiah | CA | 95482 | Rural health clinic |
| 9 - Outpatient Physician Services | ||||
| 246 Hospital Drive Suite 248-B | Ukiah | CA | 95482 | Ophthalmology |
| 10 - Rehabilitation Clinic | ||||
| 271 Observatory Avenue | Ukiah | CA | 95482 | Physical and speech therapies |
| 11 - Lakeport Internal Medicine | ||||
| 487 S Main Street | Lakeport | CA | 95453 | Rural health clinic |
| 12 - Fort Bragg Family Practice Center | ||||
| 850 Sequoia Circle | Fort Bragg | CA | 95437 | Rural health clinic |
| 13 - Ukiah Adventist Hospital - Job Care | ||||
| 232 B Hospital Drive | Ukiah | CA | 95482 | Job care |
| 14 - The Cancer Treatment & Infusion Center | ||||
| 260 Hospital Drive Suite 207 | Ukiah | CA | 95482 | Rural health clinic |
| 15 - Gastroenterology Clinic | ||||
| 234 Hospital Drive Suite A B | Ukiah | CA | 95482 | HBOIC-GI |
| 16 - Ukiah Valley General Surgery | ||||
| 246 Hospital Drive | Ukiah | CA | 95482 | Hospital-based outpatient clinic |
| 17 - Phlebotomy Draw Station | ||||
| 260 Hospital Drive Suite 109 | Ukiah | CA | 95482 | Laboratory draw station |
| 18 - Ukiah Valley Urology Clinic | ||||
| 260 Hospital Drive Suite 201 | Ukiah | CA | 95482 | Rural health clinic |
| 19 - Physical Therapy at Redwood Health Club | ||||
| 3101 S State Street | Ukiah | CA | 95453 | Physical therapy |
| 20 - Ukiah Valley Rural Health | ||||
| 1050 N State Street | Ukiah | CA | 95482 | Rural health clinic |
| 21 - Ukiah Valley Rural Health Center-Dora-Op | ||||
| 1165 S Dora Street Suite B-1 | Ukiah | CA | 95482 | Hospital-based outpatient clinic |
| 22 - Ukiah Valley Rural Health Center Lakepor | ||||
| 487 S Main Street | Lakeport | CA | 95453 | Rural health clinic |
| 23 - Mendocino Radiology | ||||
| 1165 S Dora Street Suite D | Ukiah | CA | 95482 | Radiology |
| 24 - Ukiah Valley Rural Health Center | ||||
| 260 Hospital Drive Suite 102 | Ukiah | CA | 95482 | Pain management |
| 25 - Ukiah Valley Behavioral Health Clinic | ||||
| 260 Hospital Drive Suite 101 | Ukiah | CA | 95482 | Rural health clinic |
| 26 - Rapid Care at Ukiah Valley Rural Health | ||||
| 260 Hospital Drive Suite 204 | Ukiah | CA | 95482 | Pediatric care |
| 27 - Rapid Care at Ukiah Rural Health Center | ||||
| 260 Hospital Drive Suite 209 | Ukiah | CA | 95482 | Family practice |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesUkiah Valley Medical Center is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. |
| Part II, Community Building Activities: | The Hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. |
| Part III, Line 2: | Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. |
| Part III, Line 3: | The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. |
| Part III, Line 4: | The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8: | The Medicare cost report apportions the hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments 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: Revenue Rec. *Medicare Cost Report Revenue 46,797,652Prior Year Settlements 1,096,495Cost Report Reimbursable Bad Debts 673,604Estimates and Accrual Variances (147,822)Other 4,667,806 Total Medicare Revenue 53,087,735*Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. |
| Part III, Line 9b: | When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part III - Other Community Benefit: | Adventist Health recognized the health needs of our community that may not be part of the CHNA. Interventions to address those needs include:1. Focus on Healing programing is a community service provided to any community member going through the cancer experience by bringing healing arts and support for healing through animal assisted therapy available to patients, staff, visitors and the public with stress reduction, Caring/Ceres Kitchen provides nutritious meals to cancer patients and families by providing food prepared by students and volunteers and Pet therapy is available at no cost to assist patients, staff, visitors and public with stress reduction and healing. Total number of community members served: 1,073.2. Diabetes Education. Monthly classes in English and Spanish are open to anyone in the community that has been diagnosed with diabetes. Family members and support members are welcome to join and learn how to manage their diabetes and stay healthy. Education and free screenings are a major component of the interventions. Number of community members served: 509.3. Smoking Cessation Classes are no cost for community members based on the American Lung Association guidelines. Number of community members served is 37. |
| Part VI, Line 2: | 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), that includes the 2016 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/https://www.adventisthealth.org/Pages/About-Us/Community-Health-Needs-Assessments.aspxHospital 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. Committee/Board Participation includes: Cancer Resource Centers of Mendocino County, Chronic Disease Self-Management, Community Foundation of Mendocino County, FIRST5 Mendocino, Ford Street Project, Healthy Mendocino and HHSA Advisory Board, Mendocino County AIDS/Viral Hepatitis Network, Potter Valley Youth and Community Center, Redwood Children Services, and Ukiah Valley Trails Group. |
| Part VI, Line 3: | The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at: https://www.adventisthealth.org/ukiah-valley/patient-resources/financial-services/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: | The Hospital is situated in the city of Ukiah, the county seat and largest city of Mendocino County, with a population of approximately 16,000. The hospital's primary service area, however, consists of nearly the entire rural county, which spans over 3,500 square miles. Small, geographically isolated communities make up a large part of the county's nearly 88,000 residents. The county is predominately agricultural and tourist based and is known for several unique features including the beauty of the northern California coastal terrain and a favorable climate. The Hospital serves a very high percentage of Medicare and Medicaid patients compared to otherhospitals across the country. A very large transient population is also present in Ukiah and surrounding areas. In 2014, the county's population was 66% White, 24% Hispanic/Latino, 6% Native American, 2% Asian, and 1% African American. It is expected that between 2010 and 2060, the Hispanic/Latino population will increase to 37% of the county population, while Whites will decrease from to 48% of the county population.Mendocino County experiences significant housing issues, including a lack of affordable housing, overcrowding, and homelessness. The County Health Rankings estimate that about 28% of the county population lives in substandard housing, or in crowded conditions. In addition, over one-half of Mendocino County residents who rent (52%) pay more than a third (35%) of their total income for rent. |
| Part VI, Line 5: | Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "Triple Aim." The "Triple Aim" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities. Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy.Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population;2) Factors that cause the present outcomes distribution; and3) 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, and3) Advance care coordination across the health care continuum.We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. |
| Part VI, Line 6: | The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. |
| Part VI, Line 7, Reports Filed With States | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Alex Rorabaugh Recreation Center | |||||||
| 1640 S State Street | Ukiah | CA | 95482 | 943273691 | Gov't | $7,500 | ARRC Event Sponsorship |
| CA Health Fund & Trust | |||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $324,831 | Public health grant: Health services un/underinsured patients |
| City of Ukiah | |||||||
| 411 Clay Street | Ukiah | CA | 95482 | 946000446 | Gov't | $25,300 | Sponsorship for Ukiah on Ice & Kids Triathalon |
| Mendocino College Foundation | |||||||
| 1000 Hensley | Ukiah | CA | 95482 | 680040876 | 501(c)(3) | $51,750 | Nursing Program |
| Mendocino County AIDS Volunteer Network | |||||||
| PO Box 1350 | Ukiah | CA | 95482 | 680159027 | 501(c)(3) | $7,000 | MCAVHN Event of the Heart 2018 |
| Mendocino County Office of Education | |||||||
| PO Box 45 | Redwood Valley | CA | 95470 | 946002711 | Gov't | $10,400 | Outdoor Education Project, and Snack program |
| North Coast Opportunities | |||||||
| 413 N State Street | Ukiah | CA | 95482 | 941671958 | 501(c)(3) | $10,000 | Ukiah Symphony 2018, and Caring Kitchen |
| Ukiah Senior Center | |||||||
| 497 Leslie Street | Ukiah | CA | 95482 | 237258082 | 501(c)(3) | $5,000 | Senior Center Ride Program Donation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 8 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Charitable support and assistance is provided with no reporting required by recipient. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (22 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||||||
| Dir/Chair | $0 | $1,339,257 | $0 | $747,881 | $0 | $371,298 | $0 | $16,682 | $0 | $27,790 | $0 | $2,502,908 | $0 | $289,242 |
| Rippey Wesley | ||||||||||||||
| Director thru 05/2018 | $0 | $565,539 | $0 | $0 | $0 | $58,404 | $0 | $20,249 | $0 | $27,319 | $0 | $671,511 | $0 | $0 |
| Wing Bill | ||||||||||||||
| Dir/Vice Chair/Asst Secr | $0 | $1,015,353 | $0 | $603,273 | $0 | $256,685 | $0 | $16,682 | $0 | $32,633 | $0 | $1,924,626 | $0 | $191,758 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $419,684 | $0 | $111,013 | $0 | $135,918 | $0 | $16,682 | $0 | $21,646 | $0 | $704,943 | $0 | $59,224 |
| Matthews Gwen | ||||||||||||||
| President | $0 | $378,556 | $0 | $149,560 | $0 | $146,745 | $0 | $0 | $0 | $16,539 | $0 | $691,400 | $0 | $0 |
| Quattlebaum Ryan | ||||||||||||||
| Treasurer | $0 | $187,962 | $0 | $27,982 | $0 | $21,568 | $0 | $8,891 | $0 | $25,089 | $0 | $271,492 | $0 | $0 |
| Wagner Jack | ||||||||||||||
| Asst Secr thru 03/2018 | $0 | $180,671 | $0 | $414,342 | $0 | $737,895 | $0 | $11,182 | $0 | $22,894 | $0 | $1,366,984 | $0 | $0 |
| Byrnes John | ||||||||||||||
| Medical Officer, NCR | $0 | $346,875 | $0 | $25,000 | $0 | $129,394 | $0 | $0 | $0 | $14,905 | $0 | $516,174 | $0 | $0 |
| Eller Jeff | ||||||||||||||
| President, NCR | $0 | $699,892 | $0 | $344,777 | $0 | $131,881 | $0 | $16,682 | $0 | $21,445 | $0 | $1,214,677 | $0 | $118,827 |
| Lang Kevin | ||||||||||||||
| Finance Officer, NCR | $0 | $563,108 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $563,108 | $0 | $0 |
| Lonto Robert | ||||||||||||||
| VP HR, NCR | $0 | $254,747 | $0 | $60,037 | $0 | $44,564 | $0 | $16,682 | $0 | $29,874 | $0 | $405,904 | $0 | $0 |
| Ploss David | ||||||||||||||
| Medical Director | $0 | $392,592 | $0 | $7,100 | $0 | $118,800 | $0 | $20,882 | $0 | $3,540 | $0 | $542,914 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| CFO, NCR | $0 | $686,470 | $0 | $152,446 | $0 | $114,699 | $0 | $16,682 | $0 | $30,164 | $0 | $1,000,461 | $0 | $0 |
| Van Housen Heather | ||||||||||||||
| Patient Care Exec | $0 | $221,606 | $0 | $44,090 | $0 | $44,085 | $0 | $0 | $0 | $66 | $0 | $309,847 | $0 | $0 |
| Weis David | ||||||||||||||
| VP Operations | $0 | $158,965 | $0 | $40,082 | $0 | $49,147 | $0 | $13,054 | $0 | $31,867 | $0 | $293,115 | $0 | $0 |
| Bartolomie Jill | ||||||||||||||
| Director, RN | $168,571 | $0 | $7,963 | $0 | $2,792 | $0 | $9,875 | $0 | $12,438 | $0 | $201,639 | $0 | $0 | $0 |
| Kilkenny Martha | ||||||||||||||
| Nurse Practitioner | $182,343 | $0 | $0 | $0 | $153 | $0 | $8,938 | $0 | $9,497 | $0 | $200,931 | $0 | $0 | $0 |
| Petersen Lisa | ||||||||||||||
| RN, Nurse lead | $272,828 | $0 | $0 | $0 | $9,046 | $0 | $16,682 | $0 | $14,193 | $0 | $312,749 | $0 | $0 | $0 |
| Rehm Donna | ||||||||||||||
| RN | $227,166 | $0 | $0 | $0 | $7,612 | $0 | $13,939 | $0 | $26,107 | $0 | $274,824 | $0 | $0 | $0 |
| Spencer Lindsey | ||||||||||||||
| Patient Care Exec | $24,375 | $0 | $0 | $0 | $196,591 | $0 | $12,081 | $0 | $28,052 | $0 | $261,099 | $0 | $0 | $0 |
| McDonald Edward | ||||||||||||||
| Former Treas/Asst Secr | $0 | $21,099 | $0 | $0 | $0 | $317,203 | $0 | $1,047 | $0 | $19,647 | $0 | $358,996 | $0 | $0 |
| Poole Aaron | ||||||||||||||
| Former Treas/Asst Secr | $0 | $261,059 | $0 | $27,658 | $0 | $38,447 | $0 | $16,682 | $0 | $24,674 | $0 | $368,520 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. McDonald, Edward - severance payment - $302,307 Wagner, Jack - severance payment - $598,810 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. Eller, Jeff - $118,827 Jobe, Meredith - $59,224 Reiner, Scott - $289,242 Wing, Bill - $191,758 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a | Ukiah Adventist Hospital (AHUV) 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 to AHUV, the Hospital recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does AHUV 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. AHUV 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 $2,760,233. The following Inpatient services that were provided to all our patients. These services included: - 724 Babies delivered - 652 Surgeries performed - 11,929 Patient days The following Outpatient services that were provided to all our patients. These services included: - 29,784 Emergency department visits - 3,293 Outpatient surgeries performed - 103,637 Outpatient visits - 127,077 Clinic visits AHUV 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 $5,005,033. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ |
| Form 990, Part VI, Section A, line 6 | The Hospital is organized as a public benefit 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, Section A, line 7a | The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. |
| Form 990, Part VI, Section A, line 7b | The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. |
| Form 990, Part VI, Section B, line 11b | This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Hospital's Board of Directors prior to filing. |
| Form 990, Part VI, Section B, line 12c | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The Corporate General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The Corporate General Counsel reviews all the disclosures on the board and Corporate employees' COIs. Corporate General Counsel retains the COIs for the board members. The officers and key employees' COIs are kept in their personnel files. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. |
| Form 990, Part VI, Section B, line 15 | The Hospital Board of Directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital 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, Section C, line 19 | The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. |
| Form 990, Part VII: | In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors receive compensation when their employment agreements with their employers allow such payments. For those whose employers do not allow accepting compensation for board service, the funds are directly distributed to charitable organizations as mandated by their employment agreements. In addition, amounts paid for taxable benefits are also reported. |
| Form 990, Part IX, line 11g | Physician professional fees: Program service expenses 26,867,630. Management and general expenses 141,810. Fundraising expenses 0. Total expenses 27,009,440. Other medical professional fees: Program service expenses 4,440. Management and general expenses 24,347. Fundraising expenses 0. Total expenses 28,787. Consulting and other management fees: Program service expenses 243,902. Management and general expenses 382,188. Fundraising expenses 0. Total expenses 626,090. Other professional fees non-medical: Program service expenses 23,814. Management and general expenses 51,225. Fundraising expenses 0. Total expenses 75,039. Contract labor: Program service expenses 2,494,173. Management and general expenses 34,972. Fundraising expenses 0. Total expenses 2,529,145. Purchased medical services: Program service expenses 22,019,956. Management and general expenses 0. Fundraising expenses 0. Total expenses 22,019,956. Repairs and maintenance: Program service expenses 1,068,940. Management and general expenses 110,259. Fundraising expenses 0. Total expenses 1,179,199. All other purchased services: Program service expenses 4,850,644. Management and general expenses 799,456. Fundraising expenses 105,141. Total expenses 5,755,241. Revenue cycle fees: Program service expenses -11,633. Management and general expenses 6,868,886. Fundraising expenses 0. Total expenses 6,857,253. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health Clearlake Hospital Inc | |||||||||||
| 15630 18th Avenue | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Medical Center Tehachapi | |||||||||||
| 1100 Magellan Drive | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Adventist Health Physicians Network | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| Castle Medical Center | |||||||||||
| 640 Ulukahiki Street | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Feather River Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Fremont-Rideout Health Group | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 942917251 | Acute care hospital | CA | 501(c)(3) | Line 12b, II | Stone Point Health | 0 | |
| Glendale Adventist Medical Center | |||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Hanford Community Hospital | |||||||||||
| 115 Mall Drive | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Lodi Memorial Hospital Association Inc | |||||||||||
| 975 S Fairmont Avenue | Lodi | CA | 95240 | 941044474 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Northwest Medical Foundation of Tillamook | |||||||||||
| 1000 Third Street | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Paradise Valley Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 951816034 | Discontinued operations | CA | 501(c)(3) | Line 1 | Adventist Health SystemWest | 0 | |
| Portland Adventist Medical Center | |||||||||||
| 10123 SE Market Street | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Reedley Community Hospital | |||||||||||
| 372 Cypress Avenue | Reedley | CA | 93654 | 453220509 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Rideout Memorial Hospital | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 941387866 | Acute care hospital | CA | 501(c)(3) | Line 3 | Fremont-Rideout Health Group | 0 | |
| St Helena Hospital | |||||||||||
| 10 Woodland Road | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| San Joaquin Community Hospital | |||||||||||
| 2615 Chester Avenue | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Simi Valley Hospital & Health Care Services | |||||||||||
| 2975 N Sycamore Drive | Simi Valley | CA | 93065 | 956064971 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Sonora Community Hospital | |||||||||||
| 1000 Greenley Road | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Stone Point Health | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 823763347 | Supporting organization | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| United Com-Serve | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled nursing/assisted living/home health | CA | 501(c)(3) | Line 12b, II | Fremont-Rideout Health Group | 0 | |
| Walla Walla General Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital - closed July 2017 | WA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Western Health Resources | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | Line 10 | Adventist Health SystemWest | 0 | |
| White Memorial Medical Center | |||||||||||
| 1720 Cesar E Chavez Avenue | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Willits Hospital Inc | |||||||||||
| 1 Marcela Drive | Willits | CA | 95490 | 680108919 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Coast Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 952037291 | EIN |
| Primary Activities | Wind down after sale of hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments