UKIAH ADVENTIST HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- UKIAH ADVENTIST HOSPITAL (EIN 94-1639901)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-12-23
- IRS object ID
- 201813579349300301
- Schema version
- 2017v2.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-12-23T12:24:34-08:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
| Disaster Relief | California Wildfires DR-4407 and IRS CA-2018-13 | DisasterReliefTxt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 800519547 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ACCOUNTANCY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 330 N BRAND BLVD STE 200 | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 912032361 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | 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 |
| Business Name Line2 | dba Adventist Health Ukiah Valley | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UKIA | BusinessNameControlTxt |
| Phone | 7074623111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 275 Hospital Dr | 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 |
| Signature | 2018-12-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | S Clement | PreparerPersonNm |
| PTIN | P01218012 | PTIN |
| Phone | 8185475701 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Gwen Matthews | PrincipalOfficerNm |
| Gross Receipts | $176,578,059 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| 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 Gods love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 922 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $4,815 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$8,860 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,388,176 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,085,638 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $164,658,599 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $173,925,889 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,333,310 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,491,630 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$12,681 | PYOtherRevenueAmt |
| CY Other Revenue | $64,431 | CYOtherRevenueAmt |
| PY Total Revenue | $167,367,404 | PYTotalRevenueAmt |
| CY Total Revenue | $176,567,588 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $55,448 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $161,065 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $56,653,568 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $56,688,316 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $256,172 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $90,276,754 | PYOtherExpensesAmt |
| CY Other Expenses | $96,548,146 | CYOtherExpensesAmt |
| PY Total Expenses | $146,985,770 | PYTotalExpensesAmt |
| CY Total Expenses | $153,397,527 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $20,381,634 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $23,170,061 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $160,125,074 | TotalAssetsBOYAmt |
| Total Assets EOY | $182,267,697 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $60,791,351 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $73,509,876 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $99,333,723 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $108,757,821 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Living Gods love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $131,789,558 | ExpenseAmt |
| Grant | $161,065 | GrantAmt |
| Revenue | $173,921,774 | RevenueAmt |
| Desc | Ukiah Valley Medical Center 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 of Ukiah Valley Medical Center, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of a 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 programsNot only does Ukiah Valley Medical Center provide low-cost care to individuals covered by government programs and those unable to afford health care, but it also helps patients find and access private and governmental resources for health care benefits. Ukiah Valley Medical Center recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed value of providing care to these patients in 2017 was $18,275,924.Ukiah Valley Medical Center offers 24-hour emergency care, inpatient and outpatient surgical services, intensive care (including telemedicine), diagnostic services, obstetrical services, rehabilitation services, health education, and more. Ukiah Valley Rural Health Center (UVMC's Rural Health Clinic [RHC]) offers outpatient care in the following specialties: Allergy, Family Practice, General Surgery, Internal Medicine, Obstetrics & Gynecology, Oncology, Orthopedics, Pediatrics, Physical Therapy, and Urology. The RHC also features a periodic Cardiology Clinic.Services in 2017 were provided to 98,528 patients. These services included:- Babies delivered - 790- Surgeries performed - 4,042- Emergency room visits - 29,354- Medical clinics visits - 832,006Ukiah Valley Medical Center 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:-Diabetes Support Group-Smoking Cessation -Bariatric Support Group-Focus on Healing - Group art therapy-Free Children's Health Fair-Sexual Assault Response Team-Better Breaters Club-Strokevivor-Diabetes Education- English -Diabetes Education-Spanish -Sleep Better Education Series -Healthy Living Support Group -Weight Management Support Group -Living Well Walking Group | Desc |
| Total Program Service Expenses | $131,789,558 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 160 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 922 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Aaron Poole | PersonNm |
| Phone | 7074675270 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 275 Hospital Dr | AddressLine1Txt |
| City | Ukiah | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95482 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (31 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 | $1,553 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $11,550 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $10,600 | $0 | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,133 | $0 | ||||
| Gabriel Melody | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,203 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $2,074 | $0 | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $15,866 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $17,608 | $0 | ||||
| Pedersen James | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $2,101 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $19,819 | $0 | ||||
| Rippey Wesley | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $118,116 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $1,928 | $0 | ||||
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | $0 | $1,982,804 | $53,885 | Yes (X) | |||
| Wing Bill | ||||||||||
| Dir/VCh/AsstSec | 0.00 | 50.00 | Yes (X) | $0 | $1,460,244 | $52,693 | Yes (X) | |||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | $0 | $654,239 | $42,313 | Yes (X) | ||||
| McDonald Edward | ||||||||||
| Asst Sec&Treas | 0.00 | 50.00 | $0 | $487,285 | $46,586 | Yes (X) | ||||
| Wagner Jack | ||||||||||
| Asst Secretary | 0.00 | 50.00 | $0 | $1,070,403 | $37,117 | Yes (X) | ||||
| Matthews Gwen | ||||||||||
| President | 50.00 | 0.00 | $0 | $593,127 | $47,464 | Yes (X) | ||||
| Poole Aaron | ||||||||||
| Treas/Asst Sec | 50.00 | 0.00 | $0 | $315,893 | $43,701 | Yes (X) | ||||
| Lonto Robert | ||||||||||
| VP HR NCR | 0.00 | 50.00 | $0 | $304,495 | $53,840 | Yes (X) | ||||
| Van Housen Heather | ||||||||||
| Patient Care Exec | 50.00 | 0.00 | $0 | $279,197 | $53,373 | Yes (X) | ||||
| Weiss David | ||||||||||
| VP Operations | 50.00 | 0.00 | $0 | $237,059 | $49,813 | Yes (X) | ||||
| Eller Jeff | ||||||||||
| President NCR | 0.00 | 50.00 | $0 | $1,037,468 | $45,013 | Yes (X) | ||||
| Reppert Joseph | ||||||||||
| Finance Officer NCR | 0.00 | 50.00 | $0 | $610,955 | $55,941 | Yes (X) | ||||
| Wood Laurie | ||||||||||
| Reg Dir Bus Intel | 50.00 | 0.00 | $250,830 | $0 | $23,853 | Yes (X) | ||||
| Petersen Lisa | ||||||||||
| RN - Surgery Lead | 50.00 | 0.00 | $243,786 | $0 | $25,765 | Yes (X) | ||||
| Rehm Donna | ||||||||||
| RN - Surgery | 50.00 | 0.00 | $238,589 | $0 | $35,330 | Yes (X) | ||||
| Spencer Lindsey | ||||||||||
| Admin Dir RN | 50.00 | 0.00 | $184,295 | $0 | $37,335 | Yes (X) | ||||
| Kilkenny Martha | ||||||||||
| Nurse Practitioner | 50.00 | 0.00 | $176,516 | $0 | $18,916 | Yes (X) | ||||
| Rebok Douglas | ||||||||||
| Former Asst Sec | 0.00 | 0.00 | $0 | $120,028 | $6,244 | Yes (X) | ||||
| Wehtje Rodney | ||||||||||
| Former Asst Treasurer | 0.00 | 0.00 | $0 | $249,427 | $23,299 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,094,016 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $9,606,175 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $752,481 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 127 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Pacific Redwood Medical Group | |||||
| PO Box 2800 | Ukiah | CA | 95482 | Medical Services | $2,432,015 |
| Pacific Redwood Medical Services Inc | |||||
| 242 Hospital Dr Suite B | Ukiah | CA | 95482 | Medical Services | $2,196,563 |
| Bivens Medical Corporation | |||||
| 20105 Geisendorfer | Applegate | CA | 95703 | Medical Services | $2,175,507 |
| Locumtenenscom LLC | |||||
| PO Box 405547 | Atlanta | GA | 30384 | Medical Services | $1,887,058 |
| Accelecare Wound Centers Inc | |||||
| 28525 Network Place | Chicago | IL | 60673 | Medical Services | $472,215 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $317,012 | GovernmentGrantsAmt |
| All Other Contributions | $768,626 | AllOtherContributionsAmt |
| Total Contributions | $1,085,638 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Dietary | 722210 | $381,775 | $377,660 | $4,115 |
| Echo Equipment Lease | 532420 | |||
| Other income | 900099 | $145,548 | $145,548 | |
| Patient Service Revenue | 621110 | $173,295,001 | $173,295,001 | |
| Rent-Medical Office Bldg. | 531120 | $103,565 | $103,565 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $173,925,889 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,491,630 | TotalRevenueColumnAmt |
| Exclusion | $1,491,630 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $74,202 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $10,471 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,731 | TotalRevenueColumnAmt |
| Exclusion | $63,731 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Accounting Services | Desc |
| Business | 541900 | BusinessCd |
| Total Revenue Column | $700 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $700 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $700 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $176,567,588 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $173,921,774 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,815 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,555,361 | 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 | $161,065 | TotalAmt |
| Program Services | $161,065 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,934,260 | TotalAmt |
| Program Services | $42,420,124 | ProgramServicesAmt |
| Management And General | $3,388,713 | ManagementAndGeneralAmt |
| Fundraising | $125,423 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,776,514 | TotalAmt |
| Program Services | $1,749,735 | ProgramServicesAmt |
| Management And General | $26,779 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,592,373 | TotalAmt |
| Program Services | $4,864,152 | ProgramServicesAmt |
| Management And General | $708,150 | ManagementAndGeneralAmt |
| Fundraising | $20,071 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,385,169 | TotalAmt |
| Program Services | $3,106,086 | ProgramServicesAmt |
| Management And General | $270,464 | ManagementAndGeneralAmt |
| Fundraising | $8,619 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,751 | TotalAmt |
| Management And General | $187,751 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,688 | TotalAmt |
| Management And General | $5,688 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,944,476 | TotalAmt |
| Program Services | $24,087,152 | ProgramServicesAmt |
| Management And General | $857,324 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,181,433 | TotalAmt |
| Program Services | $976,139 | ProgramServicesAmt |
| Management And General | $202,582 | ManagementAndGeneralAmt |
| Fundraising | $2,712 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,569,530 | TotalAmt |
| Program Services | $9,451,103 | ProgramServicesAmt |
| Management And General | $118,427 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,390,930 | TotalAmt |
| Program Services | $4,984,806 | ProgramServicesAmt |
| Management And General | $404,579 | ManagementAndGeneralAmt |
| Fundraising | $1,545 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $296,689 | TotalAmt |
| Program Services | $164,239 | ProgramServicesAmt |
| Management And General | $131,639 | ManagementAndGeneralAmt |
| Fundraising | $811 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,635 | TotalAmt |
| Program Services | $66,859 | ProgramServicesAmt |
| Management And General | $71,745 | ManagementAndGeneralAmt |
| Fundraising | $31 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,452 | TotalAmt |
| Program Services | $500,452 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,674,409 | TotalAmt |
| Program Services | $2,667,539 | ProgramServicesAmt |
| Management And General | $6,870 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,083 | TotalAmt |
| Program Services | $262,083 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Purchased services | $32,287,034 | $17,650,066 | $14,545,492 | $91,476 |
| Patient care supplies | $17,559,264 | $17,559,264 | ||
| Miscellaneous other expenses | $760,642 | $354,497 | $400,661 | $5,484 |
| Rental/leases costs equipment | $758,387 | $733,454 | $24,933 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,743 | TotalAmt |
| Program Services | $30,743 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,397,527 | TotalAmt |
| Program Services | $131,789,558 | ProgramServicesAmt |
| Management And General | $21,351,797 | ManagementAndGeneralAmt |
| Fundraising | $256,172 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,012 | BOYAmt |
| EOY | $804,521 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,698,462 | BOYAmt |
| EOY | $72,740,524 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,135,037 | BOYAmt |
| EOY | $15,268,465 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,721 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,148,627 | BOYAmt |
| EOY | $2,672,796 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,001,756 | BOYAmt |
| EOY | $306,375 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $97,566,735 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $38,158,004 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,828,676 | BOYAmt |
| EOY | $59,408,731 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,078,778 | BOYAmt |
| EOY | $3,762,091 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | 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 | $19,420,419 | BOYAmt |
| EOY | $26,631,608 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,125,074 | BOYAmt |
| EOY | $182,267,697 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,239,463 | BOYAmt |
| EOY | $13,960,859 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,551,888 | BOYAmt |
| EOY | $59,549,017 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,791,351 | BOYAmt |
| EOY | $73,509,876 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,874,276 | BOYAmt |
| EOY | $103,346,893 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,453,248 | BOYAmt |
| EOY | $5,410,928 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,199 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,333,723 | BOYAmt |
| EOY | $108,757,821 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,125,074 | BOYAmt |
| EOY | $182,267,697 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $23,170,061 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$13,745,963 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Church | Yes (X) | ChurchInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed Section4955 Tax | false | Form4720FiledSection4955TaxInd |
| Correction Made | false | CorrectionMadeInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $6,622 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,622 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1i - Other Activities Description | FormAndLineReferenceDesc |
| Explanation | The organization 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 | $5,268,630 | 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,364,417 | BeginningYearBalanceAmt |
| Contributions | $897,326 | ContributionsAmt |
| Investment Earnings Or Losses | $784 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $175,001 | OtherExpendituresAmt |
| End Year Balance | $2,087,526 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | false | RelatedOrgListSchRInd |
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 | $39,305,442 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,183,008 | DepreciationAmt |
| Book Value | $20,122,434 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,075,597 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,075,597 | DepreciationAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,329,900 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,899,399 | DepreciationAmt |
| Book Value | $4,430,501 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $33,578,923 | OtherCostOrOtherBasisAmt |
| Book Value | $33,578,923 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $59,408,731 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Ukiah Valley Medical Plaza | Desc |
| Book Value | $500,000 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other assets | $36,729 |
| Other receivables | $133,861 |
| Receivables from related organizations | $6,732,105 |
| Receivables from third-party payors | $19,728,913 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $26,631,608 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| MOB deposits | $10,702 |
| Payables to related organizations | $46,811,429 |
| Payables to third party payors | $10,396,391 |
| Workers compensation payable | $2,330,495 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $59,549,017 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,079,699 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,079,699 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,079,699 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,079,699 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $546,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $27,595 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $518,719 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,449 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $74,449 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,900,634 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $711,772 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,188,862 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00780 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,928 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $170,928 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,692,325 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $739,367 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,952,958 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01280 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,772,024 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $739,367 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,032,657 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,003 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,003 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,003 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,003 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $859,702 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $591,647 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $47,281,886 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $50,316,108 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,034,222 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hospital Dr Med Plaza Assn | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Property management | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.33000 | OrgProfitOrOwnershipPct |
| 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 Dr | 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 | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | 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 (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assessment | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0000 | 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 (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Sch H Part VI-Patient Education | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Sch H Part VI-Patient Education | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Sch H Part VI-Patient Education | 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 (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 5 - Account Input from Persons Who Represent the Community | The 2016 CHNA data collection process can be summarized as follows: 1. review of prior CHNA reporting efforts; 2. collection of most recently available demographic, socioeconomic and health indicator data.Data gathering was accomplished by using a widely-distributed community 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. |
| Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment | Ukiah Valley Medical Center partnered with Frank R. Howard Memorial Hospital to produce the 2016 CHNA. |
| Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why | Our organization is collaborating with our Adventist Health affiliate Frank R. Howard Memorial Hospital (HMH) to meet a priority need that was identified in our community needs assessment but will not be addressed by our hospital - Advanced Aging Care with emphasis on accident prevention and orthopedic care. HMH will be undertaking an outreach and education initiative to address this community need. |
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 |
|---|---|---|---|---|
| Ukiah Adventist Health Pavillion Surgical Services | ||||
| 245 Hospital Drive Suite 100 | Ukiah | CA | 95482 | Radiology |
| Advanced Wound Center | ||||
| 415 Hospital Drive | Ukiah | CA | 95482 | Wound Care Center |
| The Cancer Treatment & Infusion Center | ||||
| 260 Hospital Drive Ste 207 | Ukiah | CA | 95482 | Rural Health Clinic |
| Ukiah Adventist Hospital - Outpatient Pavillion | ||||
| 245 Hospital Drive | Ukiah | CA | 95482 | Outpatient Surgery |
| Rahabilitation Clinic | ||||
| 271 Observatory Avenue | Ukiah | CA | 95482 | Physical and Speech Therapies |
| Mendocino Radiology | ||||
| 1165 S Dora Street Suite D | Ukiah | CA | 95482 | Radiology |
| Rapid Care at Ukiah Rural Health Center | ||||
| 260 Hospital Drive Ste 209 | Ukiah | CA | 95482 | Family Practice |
| Gastroenterology Clinic | ||||
| 234 Hospital Dr Suite A B | Ukiah | CA | 95482 | HBOC-GI |
| Ukiah Valley Rural Health | ||||
| 1050 N State St | Ukiah | CA | 95482 | Rural Health Clinic |
| Ukiah Valley Rural Health Center | ||||
| 260 Hospital Dr Suite 102 | Ukiah | CA | 95482 | Pain Management |
| Outpatient Physician Services | ||||
| 246 Hospital Drive 248-B Hospital D | Ukiah | CA | 95482 | Ophthalmology |
| Rapid Care at Ukiah Valley Rural Health Center | ||||
| 260 Hospital Drive Ste 204 | Ukiah | CA | 95482 | Pediatric Care |
| Outpatient Physician Services-Dora-ENT | ||||
| 1165 S Dora Street Ste C-2 | Ukiah | CA | 95482 | Hospital-Based Outpatient Clinic |
| Ukiah Valley Pain Management Clinic | ||||
| 260 Hospital Drive Ste 107 | Ukiah | CA | 95482 | Rural Health Clinic |
| Lakeport Cardiology | ||||
| 475 N Forbes Street | Lakeport | CA | 95453 | Hospital-Based Outpatient Clinic |
| Ukiah Valley Urology Clinic | ||||
| 260 Hospital Drive Ste 201 | Ukiah | CA | 95482 | Rural Health Clinic |
| Ukiah Valley Internal MedicineAllergy Clinic | ||||
| 260 Hospital Drive Ste 103 | Ukiah | CA | 95482 | Rural Health Clinic |
| Physical Therapy at Redwood Health Club | ||||
| 3101 S State Street | Ukiah | CA | 95453 | Physical Therapy |
| Fort Bragg Family Practice Center | ||||
| 850 Sequoia Circle | Fort Bragg | CA | 95437 | Rural Health Clinic |
| Lakeport Internal Medicine | ||||
| 487 S Main Street | Lakeport | CA | 95453 | Rural Health Clinic |
| Ukiah Valley Rural Health Center Lakeport Pediatrics | ||||
| 487 S Main Street | Lakeport | CA | 95453 | Rural Health Clinic |
| Ukiah Valley Rural Health Center-Dora-Ophthalmology | ||||
| 1165 S Dora Street B-1 | Ukiah | CA | 95482 | Hospital-Based Outpatient Clinic |
| Ukiah Adventist Hospital - Job Care | ||||
| 232 B Hospital Drive | Ukiah | CA | 95482 | Job Care |
| Phlebotomy Draw Station | ||||
| 260 Hospital Drive Suite 109 | Ukiah | CA | 95482 | Laboratory draw station |
| Coast Laboratory Services | ||||
| 483 Chestnut St | Fort Bragg | CA | 95437 | Laboratory |
| Ukiah Valley Behavioral Health Clinic | ||||
| 260 Hospital Drive Ste 101 | Ukiah | CA | 95482 | Rural Health Clinic |
| Ukiah Valley General Surgery | ||||
| 246 Hospital Drive | Ukiah | CA | 95482 | Hospital-Based Outpatient Clinic |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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 Californias regulations and policies and the approval of the federal government. |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense as reported in the system-wide audited combined financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2. |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. |
| Part III, Line 4 - Bad Debt Expense | The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | The Medicare cost report apportions the hospitals costs 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:*Medicare Cost Report Revenue 41,406,047Prior Year Settlements 769,392Cost Report Reimbursable Bad Debts 576,297Estimates and Accrual Variances 593,652Other 3,936,498Subtotal - Amount reported in Pt III, Line 5 47,281,886Amounts included in Part I, Lines f and g -Total Medicare Revenue 47,281,886*Note: The Medicare Cost Report Revenue includes the patient co-pay and deductible amounts, but not the bad-debt reimbursement. Adding the bad-debt reimbursement would have duplicated the revenue and deductible amounts. |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part VI, Line 2 - Needs Assessment | The hospital's 2016 CHNA, the 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, are posted on the hospital's website at https://www.adventisthealth.org/ukiah-valley/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/.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: 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 - 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/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 - Community Information | 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 hospitals 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 countys 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 other hospitals across the country. A very large transient population is also present in Ukiah and surrounding areas. In 2014, the countys 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 4 - Community Building Activities | The hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. |
| Part VI, Line 5 - Promotion of Community Health | Our hospitals mission is, Living Gods love by inspiring health, wholeness and hope. Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the triple aim. The Triple Aim concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given todays state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthyeven though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. |
| Part VI, Line 6 - Affilated Health Care System | The hospital is a member of Adventist Health, 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 - States Filing of Community Benefit Report | CA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CA Hlth Fnd & Trust | |||||||
| 1215 K St Ste 800 | Sacramento | CA | 95814 | 941498697 | $26,990 | $0 | Hlth srvs uninsured/underinsured pt |
| Mendocino College Foundation | |||||||
| 1000 Hensley | Ukiah | CA | 95482 | 680040876 | $51,750 | $0 | Health related education grant |
| North Coast Opportunities | |||||||
| 413 N State Street | Ukiah | CA | 95482 | 941671958 | $49,500 | $0 | Annual fundraiser |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| 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 (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Eller Jeff | |||||||||||||
| President NCR | $647,561 | $183,480 | $206,427 | $16,356 | $28,657 | $1,082,481 | $106,335 | ||||||
| Jobe Meredith | |||||||||||||
| Secretary | $395,752 | $98,614 | $159,873 | $16,356 | $25,957 | $696,552 | $60,017 | ||||||
| Kilkenny Martha | |||||||||||||
| Nurse Practitioner | $176,031 | $485 | $9,894 | $9,022 | $195,432 | ||||||||
| Lonto Robert | |||||||||||||
| VP HR NCR | $224,768 | $45,904 | $33,823 | $16,356 | $37,484 | $358,335 | |||||||
| Matthews Gwen | |||||||||||||
| President | $358,395 | $102,668 | $132,064 | $16,356 | $31,108 | $640,591 | $38,845 | ||||||
| McDonald Edward | |||||||||||||
| Asst Sec&Treas | $323,166 | $70,841 | $93,278 | $16,457 | $30,129 | $533,871 | $38,433 | ||||||
| Petersen Lisa | |||||||||||||
| RN - Surgery Lead | $243,200 | $586 | $14,743 | $11,022 | $269,551 | ||||||||
| Poole Aaron | |||||||||||||
| Treas/Asst Sec | $241,060 | $38,879 | $35,954 | $16,356 | $27,345 | $359,594 | |||||||
| Rebok Douglas | |||||||||||||
| Former Asst Sec | $120,028 | $6,244 | $126,272 | $120,028 | |||||||||
| Rehm Donna | |||||||||||||
| RN - Surgery | $238,367 | $222 | $14,603 | $20,727 | $273,919 | ||||||||
| Reiner Scott | |||||||||||||
| Dir/Chair | $1,184,750 | $324,119 | $473,935 | $16,356 | $37,529 | $2,036,689 | $406,467 | ||||||
| Reppert Joseph | |||||||||||||
| Finance Officer NCR | $473,244 | $41,746 | $95,965 | $16,356 | $39,585 | $666,896 | |||||||
| Spencer Lindsey | |||||||||||||
| Admin Dir RN | $162,325 | $5,098 | $10,806 | $26,529 | $221,630 | $16,872 | |||||||
| Van Housen Heather | |||||||||||||
| Patient Care Exec | $198,823 | $41,319 | $39,055 | $15,896 | $37,477 | $332,570 | |||||||
| Wagner Jack | |||||||||||||
| Asst Secretary | $755,988 | $221,735 | $92,680 | $11,160 | $25,957 | $1,107,520 | |||||||
| Wehtje Rodney | |||||||||||||
| Former Asst Treasurer | $158,863 | $90,564 | $213 | $23,086 | $272,726 | $79,970 | |||||||
| Weiss David | |||||||||||||
| VP Operations | $180,861 | $36,976 | $19,222 | $13,094 | $36,719 | $286,872 | |||||||
| Wing Bill | |||||||||||||
| Dir/VCh/AsstSec | $953,512 | $273,121 | $233,611 | $16,356 | $36,337 | $1,512,937 | $172,851 | ||||||
| Wood Laurie | |||||||||||||
| Reg Dir Bus Intel | $176,359 | $19,671 | $10,654 | $13,199 | $274,683 | $54,800 | |||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a: Relevant information in regards to selections on 1a. | FormAndLineReferenceDesc |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | Part VI, Line 7aThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors.Part VI, Line 7bThe 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 | The completed Form 990 is shared with members of the corporation's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board prior to filing. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees, and department directors for completion and signature. A letter of explanation accompanies the questionnaire. The letter illustrates examples of a conflict and reminds the recipient that if any perceived conflict should arise before the next annual questionnaire, the individual is to notify the CEO immediately. The internal audit staff reviews these questionnaires and disclosures each year during the audit process. |
| 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 Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital 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 executives with midpoints set at the median of the peer group and having a 50 percent spread (about 20% above and below midpoint) from minimum to maximum. The system CEO and Sr Vice Presidents (Executive Cabinet) have a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other executives have a maximum potential incentive of 25 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 available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. |
| Other Changes In Net Assets Or Fund Balances - Other Decreases | = -$13748720 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | = $2757 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health SystemWest | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 953484589 | Support and Manage System-Wide Activities | CA | 501 (c)(3) | 1 | NA | false |
| Adventist Health Clearlake Hospital Inc | ||||||||||
| Ave 18 at Hwy 53 | Clearlake | CA | 95422 | 680395149 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Castle Medical Center | ||||||||||
| 640 Ulukahiki St | Kailua | HI | 96734 | 990107330 | Hospital | HI | 501(c)(3) | 1 | NA | false |
| Feather River Hospital | ||||||||||
| 5974 Pentz Rd | Paradise | CA | 95969 | 941101228 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Glendale Adventist Medical Center | ||||||||||
| 1509 Wilson Terrace | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Hanford Community Hospital | ||||||||||
| 450 Greenfield Ave | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Northwest Medical Foundation of Tillamoo | ||||||||||
| 1000 Third St | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | 1 | NA | false |
| Paradise Valley Hospital | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 951816034 | Wind Down After Sale of Hospital Facilities | CA | 501(c)(3) | 1 | NA | false |
| Portland Adventist Medical Center | ||||||||||
| 10123 SE Market St | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | 1 | NA | false |
| St Helena Hospital | ||||||||||
| 10 Woodland Rd | St Helena | CA | 94574 | 941279779 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| San Joaquin Community Hospital | ||||||||||
| 2615 Chester Ave | Bakersfield | CA | 93301 | 952294234 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Simi Valley Hospital & Health Care Servi | ||||||||||
| 2975 N Sycamore Dr | Simi Valley | CA | 93065 | 956064791 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Sonora Community Hospital | ||||||||||
| 1000 Greenley Rd | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Walla Walla General Hospital | ||||||||||
| 1025 S Second Ave | Walla Walla | WA | 99362 | 910617726 | Hospital | WA | 501(c)(3) | 1 | NA | false |
| White Memorial Medical Center | ||||||||||
| 1720 E Ceasar Chavez Ave | Los Angeles | CA | 90033 | 952282647 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Willits Hospital Inc | ||||||||||
| 1 Marcela Dr | Willits | CA | 95490 | 680108919 | Hospital | CA | 501(c)(3) | 1 | NA | false |
| Adventist Health Physicians Network | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 680357690 | Medical Foundation | CA | 501(c)(3) | 11b, II | Adventist Health SystemWest | false |
| Reedley Community Hospital | ||||||||||
| 372 W Cypress Ave | Reedley | CA | 93654 | 453220509 | Hospital | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Western Health Resources | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 953867863 | Home care | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Lodi Memorial Hospital Association Inc | ||||||||||
| 975 S Fairmont Ave | Lodi | CA | 95240 | 941044474 | Hospital | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| Adventist Hlth Medical Ctr Tehachapi | ||||||||||
| 115 W E St | Tehachapi | CA | 93561 | 812240617 | Hospital | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
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 | 2100 Douglas Blvd | 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 Corp | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | The reporting organization, a member of Adventist Health (System), is requesting abatement of late filing penalties due to extraordinary events occurring within the System caused by the Camp Fire in Butte County, California that erupted on November 8, 2018. On November 12, 2018, President Donald J Trump issued a Presidential Major Disaster Declaration. We request that the relief provided by the Internal Revenue Service in CA-2018-13 under IRC 7508A and Regulation 301.7508A-1 be applied to the reporting organization. The System experienced a catastrophic loss to the hospital in Paradise and multiple other buildings. Included in that loss was the building that housed critical information technology infrastructure. The morning following the start of the fire, the information technology area experienced System-wide loss of service over the following two weeks. The IT function had to make changes to accommodate the losses to infrastructure due to the fire. Tax software was not functional through November 30, 2018. During 2017 the System transitioned to an Enterprise Resource Planning cloud-based system and adopted a shared services model. This change resulted in the loss of personnel knowledgeable about the organizational structure, activities, and financial reporting of the entity. The ability to aggregate data consistent with prior years' reporting was challenging. More time was required to ensure reporting was in alignment with the tax format. Inquiry and reassignment of accounts was needed as we became aware of the constraints in the new ERP environment from within which we obtained the reporting data. Rebalancing of the income statement and net assets was critical and took extensive effort to complete. | ExplanationTxt |