2019-11-12T10:59:49-08:00 2018-12-31 800519547 THE ACCOUNTANCY LLP 330 N BRAND BLVD STE 200 GLENDALE CA 912032361 990 2018-01-01 812240617 Adventist Health Medical Ctr Tehachapi dba Adventist Health Tehachapi Valley ADVE 6618233000 1100 Magellan Dr Tehachapi CA 93561 Steve Chen CFO/Treasurer 2019-11-12 true S Clement P01218012 8185475701 X 2018 2020-03-31 21:24:44Z Lingerfelt Jeffrey 1100 Magellan Dr Tehachapi CA 935611380 21243169 false false 1071 X www.adventisthealth.org/tehachapi-valley X 2016 CA Living Gods love by inspiring health, wholeness and hope. 12 10 261 25 0 125000 263203 22598758 20942087 59300 37879 0 22783058 21243169 25000 16192 0 12793073 14244371 0 162570 10875229 12594741 23693302 26855304 -910244 -5612135 45546060 56614928 46710492 63391495 -1164432 -6776567 Living Gods love by inspiring health, wholeness and hope. false false 19849099 16192 20942087 Adventist Health Medical Ctr Tehachapi (AHTV) 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 Adventist Health Medical Ctr Tehachapi, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does Adventist Health Medical Ctr Tehachapi 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.AHTV 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 $6,574,098.The following Inpatient services that were provided to all our patients. These services included:35,211 Patient days The following Outpatient services that were provided to all our patients. These services included:12,470 Emergency department visits7,251 Outpatient visits 14,472 Clinic visitsAHTV 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 $2,641,947Adventist Healths mission statement of Living Gods love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in Gods image has experienced the best health today, hope for tomorrow, and Gods love that endures forever.Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ 19849099 true false false true false false false false false true true false false true true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false false false false true false false false true 0 0 true 261 true false false false false false false false false 0 false false false false false false false false false false false false X 12 10 false false false false true true true true true false false true true true true true true true true false CA X Jay Lipps 9164061092 PO Box 619135 Roseville CA 95661 X Banks David Director 0.00 4.00 X 0 27620 0 Cherry Robert Director 0.00 4.00 X 0 25126 0 Davis Andrew Director 0.00 4.00 X 0 24002 0 Freedman John Director 0.00 4.00 X 0 718 0 Gabriel Melody Dir Thru 12/18 0.00 4.00 X 0 20464 0 Graham Ricardo Director 0.00 4.00 X 0 1442 0 Heinrich Kerry Director 0.00 4.00 X 0 20485 0 Innocent Larry Director 0.00 4.00 X 0 31885 0 Pedersen James Dir Thru 7/18 0.00 4.00 X 0 3625 0 Reiner Richard Director 0.00 4.00 X 0 27964 0 Rippey Wesley Dir Thru 5/18 0.00 4.00 X 0 623943 47568 Salazar Velino Director 0.00 4.00 X 0 1542 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 2458436 44472 Wing Bill Dir/Vice Chair 0.00 50.00 X X 0 1875310 49315 Jobe Meredith Secretary 0.00 50.00 X 0 666615 38328 Lingerfelt Jeffrey President 50.00 0.00 X 0 320194 41483 Chen Steven Treas/Asst Sec 12.50 37.50 X 0 432417 59921 Wagner Jack A Sec Thru 3/18 0.00 50.00 X 0 1332907 34076 Reppert Joseph CFO 0.00 50.00 X 0 953615 46846 Ferch Wayne President, CCR 8.33 41.67 X 0 1232626 21068 Larsen David Finance Officer, CCR 8.33 41.67 X 0 667033 351055 Adalberto Renteria Medical Officer, CCR 8.33 41.67 X 0 445200 35040 Tetz Warren Construction Executive 50.00 0.00 X 0 464679 67964 Cantrel Misty CNO 50.00 0.00 X 199775 0 42801 Briggs Sharlet President 12.50 37.50 X 0 595552 27623 Wehtje Ronald SCR CFO 8.33 41.67 X 0 833628 37770 Roberts George RN Supervisor 50.00 0.00 X 184941 0 26633 Bhakta Dixit Manager, Pharmacy 50.00 0.00 X 179655 0 39212 Badders Brett RN House Superviso 50.00 0.00 X 174958 0 38374 Haworth Scott Pharmacist 50.00 0.00 X 180440 0 11633 Harwick Donald Physician Assist 50.00 0.00 X 142326 0 6022 Zachary Beth Former Int President 0.00 50.00 X 0 1310581 42365 Wehtje Ronald Former Finance Officer SCR 0.00 50.00 X 0 833628 37770 Nahapetian Arby Former Reg CMO SCR 0.00 50.00 X 0 966535 51169 Fargo Roland Former SVP Reg Phys Ops 0.00 50.00 X 0 597899 32932 Kirby Juliana Former Key Employee 0.00 50.00 X 0 205595 7476 Roberts George Former Highest Paid Employee 0.00 50.00 X 0 184941 26633 Lewis Paula Former Highest Paid Employee 0.00 50.00 X 0 134084 19864 Duffield Douglas Former Int President 0.00 50.00 X 0 171938 5834 1062095 17492229 1291247 28 true true false Premier Emergency Physicians of CA MG 7032 Collection Center Dr Chicago IL 60693 Medical Svcs 668171 Harmadeep K Gill Med Corp PO Box 1507 Lancaster CA 93539 Medical Services 161946 Fusion Medical Staffing LLC PO Box 82674 Lincoln NE 68501 Medical Services 139688 Siemens Healthcare Diagnostics PO Box 121102 Dallas TX 75312 Medical Services 104236 Psychiatic Med Pract 2421 Tiverton Drive Bakersfield CA 93311 Medical - Pyshiatric 109920 5 10000 253203 263203 Dietary 722210 3188 3188 Other program related rev 900099 44943 44943 Patient serv. revenue 621110 20893956 20893956 20942087 37879 37879 0 0 0 0 0 0 0 0 21243169 20942087 37879 16192 16192 0 0 0 0 0 11719703 9367370 2262163 90170 463741 454459 5569 3713 1312157 1240171 58269 13717 748770 665900 76043 6827 1201173 116094 1085079 231997 231997 0 0 0 0 1978003 1576107 401896 40548 40548 168916 75627 91130 2159 1353470 652441 701029 0 1239068 1141305 97763 122871 43125 73107 6639 0 10601 5956 2530 2115 1283868 1283868 0 270164 270164 75908 75908 Revenue Cycle Fees 1371842 1371842 Patient Supplies 1133118 1101212 31906 Other Purchases 933536 700186 196830 36520 Quality Assurance Hospital Fee 550395 550395 629263 512619 115934 710 26855304 19849099 6843635 162570 1800 1799 1796658 0 0 5309976 6096848 0 0 0 239777 544146 85258 363044 40849508 364486 30661790 40485022 886114 979482 0 0 0 6564687 8144587 45546060 56614928 1766003 4903051 44944489 58488444 46710492 63391495 X -1389522 -7254860 225090 478293 -1164432 -6776567 45546060 56614928 -5612135 X false true X true false X false false false false false false false false false false true 3785 3785 false false Part II-B, Line 1i - Other Activities Description The organization belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. 225090 253203 478293 100125 124965 225090 100125 100125 1.00000 false true true 39585560 230000 39355560 1263948 134486 1129462 40485022 Other assets 41661 Other receivables Receivable from related orgs 941917 Receivable from third party payors 7161009 8144587 Payable to Rel Orgs 46989115 ST Financing 11290353 Worker's Comp Liability 208976 58488444 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. true true X true X true X true true true false true true 16599 16599 0.00060 10832489 4274990 6557499 0.24420 10849088 4274990 6574098 0.24480 21831 21831 0.00080 26048 26048 0.00100 3085835 491827 2594008 0.09660 60 60 3133774 491827 2641947 0.09840 13982862 4766817 9216045 0.34320 10828 10828 0.00040 10828 10828 0.00040 true 2082561 870927 6029463 9667795 -3638332 X true true 1 1 Adv Hlth Med Ctr Tehachapi 1100 Magellan Dr Tehachapi CA 93561 See Form 990, Pg 1, Item J 120000188 X X X X Adv Hlth Med Ctr Tehachapi 1 false false true X X X X X X X X X 18 false false false true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 18 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X X true X false X X X X true X false false Facility: Adv Hlth Med Ctr Tehachapi - Part V, Section B, Line 11 The Tehachapi Valley Healthcare District (TVHD) 2015 CHNA identified a number of areas of significant needs, among which access to care, chronic disease, and mental health ranked highest. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1-Access to Health Care the main goals: to expand accessibility and increase awareness of resources. Interventions:1. Flu Clinics - In response to a severe flu season in 2017, Adventist Health Tehachapi Valley expanded the number and type of clinics offering free adult flu shots to the public. This included adding a flu shot drive-thru clinics in Tehachapi Valley. Number of Community Members Served 46.2. Tehachapi Health & Senior Resource Fair - The hospital offered low-cost lab tests and screening services at this event. This included low-cost blood tests for prostate cancer and low-cost mammograms. Staff also passed out basic health information. Number of Community Members Served 100.3. Tehachapi Farmers Market - The hospital provided a cash contribution to the farmers market to encourage access to nutritious, wholesome produce. Hospital staff, who also live in the community, were given coupons redeemable for free produce. Hospital representatives distributed health information to the public. Number of Community Members Served 200.4. American Cancer Society Relay for Life Tehachapi Valley - Adventist Health Tehachapi Valley financially supported the Event. The donation helped fund groundbreaking cancer research and patient care programs. Hospital representatives distributed health information to raise cancer awareness. Number of Community Members Served 300.5. Tehachapi Gran Fondo - Adventist Health Tehachapi Valley financially supported the event, which promotes a healthy lifestyle that includes exercise. The long-distance, mass-participation cycling event is open to recreational and competitive amateur cyclists, and thousands of riders of all abilities participate. Number of Community Members Served 1,000.Priority Areas Not Addressed:Two needs identified in the CHNA, but not addressed in this plan are chronic disease and mental health. Our network has not specifically addressed these prioritized health needs as part of this Community Health Plan due to limited resources and the need to allocate significant resources to the other priority health needs identified above. Even though we dont directly address these health issues in our current year CHP, our network attempts to link patients to resources that can assist in their needs. Adventist Health Community Care-California City 9350 North Loop Blvd California City CA 93505 Rural Health Clinic Adventist Health Community Care-Mojave 2041 Belshaw Street Mojave CA 93501 Rural Health Clinic Adventist Health Community Care-Tehachapi 105 West E Street Tehachapi CA 93561 Rural Health Clinic Adventist Health Outpatient Physical Therapy 115 W E St Tehachapi CA 93561 Outpatient Physical Therapy Part I, Line 7 - Explanation of Costing Methodology The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesFeather River Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. Part III, Line 4 - Bad Debt Expense The system-wide combined audited financial statements do not contain a footnote describing bad debt expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments too many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue 6,029,463Prior Year Settlements 434,347Cost Report Reimbursable Bad Debts 143,377Estimates and Accrual Variances 197,391Other 1,127,708 _________Total Medicare Revenue 7,932,287*Note: The Medicare Cost Report Revenue includes the patient co-pay and deductible amounts, but not the bad-debt reimbursement. Adding the bad-debt reimbursement would have duplicated the revenue and deductible amounts. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest Part VI, Line 2 - Needs Assessment Tehachapi Valley Healthcare District, the prior operator of the hospital prepared a CHNA in 2015 although as a district hospital it was not required to do so. Adventist Health assumed operations of the hospital and three rural clinics in November 2016 as Adventist Health Medical Center Tehachapi. Under the IRC Section 501(r) regulations, a CHNA is not requried before 2018.The link below is for the 2017 Community Health Plan (CHP) Update/Annual Report, and the 2016 Implementation Strategy (adopted in May 2017), known as the 2017 Community Health Plan (Implementation Strategy) & 2016 Update/Annual Report: https://www.adventisthealth.org/tehachapi-valley/about-us/community-benefit/.The Implementation Strategy and the CHPs are also available on the Adventist Health Corporate website at https://www.adventisthealth.org/about-us/community-benefit/.The hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level? Building a healthy community requires multiple stakeholders working together with a common purpose. The hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. Committee/Board Participation includes: American Cancer Society, Tehachapi Farmers Market, Tehachapi Health and Senior Resource Fair. Part VI, Line 3 - Patient Education of Eligibility for Assistance The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at https://www.adventisthealth.org/tehachapi-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 - Community Information Adventist Health Medical Center Tehachapis (AHMCT) service area is comprised primarily of communities in Kern county. The major communities are the cities of Tehachapi, California City, Mojave, Rosamond, Boron, and Edwards. The demographics of the communities we serve are wide scope, including urban, suburban, and rural, and from all income levels. Although we primarily serve those in the Kern county, our destination services also bring us patients from larger and further demographics, such as Bernadino, Ventura, and Los Angeles counties. The total population served in our primary and secondary service areas is estimated to be around 80,000. The majority of residents in AHMCTs service area are adults between the ages of 25 and 64; almost 20% are children under the age of 18. The three major ethnic groups in the primary and secondary service area are Caucasian (54.2%), Hispanic (31.7%) and Black (7.4%). The unemployment rate in Kern county in 2015 was between 10 and 11%, almost double that of the country as a whole for the same period. The median household income varies between $31,483 and $57,468 in our primary and secondary service areas. Part VI, Line 4 - Community Building Activities The hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part VI, Line 5 - Promotion of Community Health Our hospitals mission is, Living Gods love by inspiring health, wholeness and hope. Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the triple aim. The Triple Aim concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given todays state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6 - Affilated Health Care System Adventist Health Medical Center Tehachapi is part of Adventist Health, a faith-based, not-for-profit, integrated health care delivery system headquartered in Roseville, California. We provide compassionate care in communities throughout California, Hawaii, Oregon and Washington.Adventist Health entities include:20 hospitals with more than 2,700 bedsMore than 235 clinics and outpatient centers14 home care agencies and 7 hospice agenciesFour joint-venture retirement centers Workforce of 28,600 includes more than 20,500 employees; 4,500 medical staff physicians; and 3,600 volunteersAdventist Health Medical Center Tehachapi believes that partnerships are effective tools in improving the health of our community. Together, we are able to leverage our resources and strengths and have a greater impact. We can build a greater sense of community and a shared commitment toward the health improvement. Part VI, Line 7 - States Filing of Community Benefit Report CA true CA Hlth Fund & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 28456 0 0 1 Additional Supplemental Information Grants are donations made to US tax exempt organizations, Government Entities and Civic organizations who are community partners, known to us, and present a valid purpose for their donation request. It is anticipated that no further monitoring is required. X true true X X X X true true false false false false false false false false Adalberto Renteria Medical Officer, CCR 400000 45200 25500 9540 480240 Badders Brett RN House Superviso 174958 10003 28371 213332 Bhakta Dixit Manager, Pharmacy 178897 758 10495 28717 218867 Briggs Sharlet President 407049 116869 71634 16682 10941 623175 Cantrel Misty CNO 95333 104442 42801 242576 Chen Steven Treas/Asst Sec 334561 54259 43597 16682 43239 492338 Duffield Douglas Former Int President 8769 163169 5834 177772 Fargo Roland Former SVP Reg Phys Ops 175272 95874 326753 10964 21968 630831 Ferch Wayne President, CCR 740094 327200 165332 21068 1253694 Haworth Scott Pharmacist 180440 9514 2119 192073 Jobe Meredith Secretary 419684 111013 135918 16682 21646 704943 Kirby Juliana Former Key Employee 154676 35050 15869 3131 4345 213071 Larsen David Finance Officer, CCR 427072 107292 132669 320716 30339 1018088 Lewis Paula Former Highest Paid Employee 132245 1839 6737 13127 153948 Lingerfelt Jeffrey President 260132 24750 35312 16382 25101 361677 Nahapetian Arby Former Reg CMO SCR 557553 165709 243273 16682 34487 1017704 Reiner Scott Dir/Chair 1339257 747881 371298 16682 27790 2502908 Reppert Joseph CFO 686470 152446 114699 16682 30164 1000461 Rippey Wesley Dir Thru 5/18 565539 58404 20249 27319 671511 Roberts George Former Highest Paid Employee 183071 1870 6822 19811 211574 Roberts George RN Supervisor 183071 1870 6822 19811 211574 Tetz Warren Construction Executive 277933 75073 111673 16682 51282 532643 Wagner Jack A Sec Thru 3/18 180671 414342 737894 11182 22894 1366983 Wehtje Ronald Former Finance Officer SCR 525772 154336 153520 16682 21088 871398 Wehtje Ronald SCR CFO 525772 154336 153520 16682 21088 871398 Wing Bill Dir/Vice Chair 1015353 603273 256685 16682 32633 1924626 Zachary Beth Former Int President 191196 270398 848987 16682 25683 1352946 Part I, Line 1a: Relevant information in regards to selections on 1a. Linda Henry Key EE Sister 59434 Employment false Brent Wagner Son of Officer 82281 Employment false Cambria Wehtje-Sim Dghtr-Fmr Ofcr 89784 Employment false Doris Tetz Dghtr-Key EE 464679 Employment false Josiah Ferch Key EE-Son 42946 Employment false Carol Jobe Officer's Spouse 4429 Employment false Schedule L, Part V Supplemental Information Additional information regarding interested persons listed above:1. Linda Henry is the daughter of Adventist Health board member, Wesley Rippey.2. Brent Wagner is the son of former Adventist Health CFO, Jack Wagner.3. Cambria Wehtje-Sim is the daughter of former officer Rodney Wehtje.4. Doris Tetz is the daughter of former key employee, Warrent Tetz.5. Josiah Ferch is the son of Key Employee Wayne Ferch.6. Carol Jobe is the wife of Meredith Jobe, an officer of Adventist Health. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder The hospital is organized as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit public charity. The hospital bylaws define its board of directors to be the same individuals who are members of Adventist Health System/West board of directors. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 11b: Form 990 Review Process This Form 990, including all supporting schedules, was prepared by a public accounting firm, reviewed by the System Controller and market Finance Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts During the first quarter of each year, the annual conflict of interest questionnaireis sent to board members for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately.The Corporate General Counsel distributes, collects, and reviews for signatures theCOIs for all board members. In addition, the foundations administration is responsible for keeping record to ensure all board members have submitted their COIs.Further inquiries on any potential significant conflicts are made as needed.Conflicts are documented and reviewed with the Board member. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management See explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The hospital board of directors has established a Compensation Committee to overseethe executive compensation program. This committee is composed of independentdirectors with no conflicts of interest. The committee performs the followingfunctions: recommends a total compensation philosophy to the board; assurescompliance with the board-approved philosophy; meets annually to reviewcomparability data from outside consultants; recommends any adjustments to currentexecutive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annualgoals; recommends appropriate incentive awards to the board for approval; follows adiligent process that meets regulatory requirements for a rebuttable presumption ofreasonableness; records committee deliberations and decisions in timely minutes;selects, engages and supervises any consultant hired to advise and providecomparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital CEO has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital. (Incentive potential is industry norm) Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available The hospital does not make its governing documents publicly available beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency. Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated Health System CA 501(C)(3) 10 NA false Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical Foundation CA 501(C)(3) 12b2 Adventist Health SystemWest false Adventist Health So CA Medical Fdtn PO Box 619135 Roseville CA 95661 954424391 Discontinued Operations CA 501(C)(3) 12b2 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) 3 Adventist Health SystemWest false Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Fremont- Rideout Health Group 898 Plumas Street Yuba City CA 95991 942917251 Acute Care Hospital CA 501(C)(3) 12b2 Adventist Health SystemWest false Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Lodi Memorial Hospital Assn Inc 975 So Fairmont Ave Lodi CA 95240 941044474 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Northwest Medical Fdtn of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Foundation OR 501(c)(3) 3 Adventist Health SystemWest false Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) 3 Adventist Health SystemWest false Reedley Community Hospital 372 Cypress Ave Reedley CA 95370 453220509 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Acute Care Hospital CA 501(c)(3) 3 Adventist Health SystemWest false St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Simi Valley Hospital & Health Care Svc 2975 No Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting Organization CA 501(C)(3) 12b2 Adventist Health SystemWest false Ukiah Adventist HospitalAdventist Health 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled Nursing/Assisted Living/Hm Care CA 501(C)(3) 12b2 Fremont Rideout Health Group false Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital WA 501(c)(3) 3 Advenstist Health System West false Western Health Resources PO Box 61935 Roseville CA 95661 953867863 Home Care CA 501(C)(3) 10 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(C)(3) 3 Adventist Health SystemWest false South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false false false false false true false false false false false false false false false true true true false false