2018-12-23T12:24:34-08:00 2017-12-31 California Wildfires DR-4407 and IRS CA-2018-13 800519547 THE ACCOUNTANCY LLP 330 N BRAND BLVD STE 200 GLENDALE CA 912032361 990 2017-01-01 941639901 Ukiah Adventist Hospital dba Adventist Health Ukiah Valley UKIA 7074623111 275 Hospital Dr Ukiah CA 95482 Ryan Quattlebaum Treasurer 2018-12-23 true S Clement P01218012 8185475701 X 2017 2019-02-21 02:37:17Z Gwen Matthews 176578059 false false 1071 X www.adventisthealth.org/ukiah-valley X 1967 CA Living Gods love by inspiring health, wholeness and hope. 14 10 922 45 4815 -8860 1388176 1085638 164658599 173925889 1333310 1491630 -12681 64431 167367404 176567588 55448 161065 0 56653568 56688316 0 256172 90276754 96548146 146985770 153397527 20381634 23170061 160125074 182267697 60791351 73509876 99333723 108757821 Living Gods love by inspiring health, wholeness and hope. false false 131789558 161065 173921774 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 131789558 true true false true false false false false false true true false false true true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false false false false true false false false true 160 0 true 922 true true true false false false false false false 0 false false false false false false false false false false X 14 10 false false false false true false true true true false false true true true true true true true true true true X Aaron Poole 7074675270 275 Hospital Dr Ukiah CA 95482 X Banks David Director 0.00 4.00 X 0 1553 0 Cherry Robert Director 0.00 4.00 X 0 11550 0 Davis Andrew Director 0.00 4.00 X 0 10600 0 Freedman John Director 0.00 4.00 X 0 1133 0 Gabriel Melody Director 0.00 4.00 X 0 1203 0 Graham Ricardo Director 0.00 4.00 X 0 2074 0 Heinrich Kerry Director 0.00 4.00 X 0 15866 0 Innocent Larry Director 0.00 4.00 X 0 17608 0 Pedersen James Director 0.00 4.00 X 0 2101 0 Reiner Richard Director 0.00 4.00 X 0 19819 0 Rippey Wesley Director 0.00 4.00 X 0 118116 0 Salazar Velino Director 0.00 4.00 X 0 1928 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 1982804 53885 Wing Bill Dir/VCh/AsstSec 0.00 50.00 X X 0 1460244 52693 Jobe Meredith Secretary 0.00 50.00 X 0 654239 42313 McDonald Edward Asst Sec&Treas 0.00 50.00 X 0 487285 46586 Wagner Jack Asst Secretary 0.00 50.00 X 0 1070403 37117 Matthews Gwen President 50.00 0.00 X 0 593127 47464 Poole Aaron Treas/Asst Sec 50.00 0.00 X 0 315893 43701 Lonto Robert VP HR NCR 0.00 50.00 X 0 304495 53840 Van Housen Heather Patient Care Exec 50.00 0.00 X 0 279197 53373 Weiss David VP Operations 50.00 0.00 X 0 237059 49813 Eller Jeff President NCR 0.00 50.00 X 0 1037468 45013 Reppert Joseph Finance Officer NCR 0.00 50.00 X 0 610955 55941 Wood Laurie Reg Dir Bus Intel 50.00 0.00 X 250830 0 23853 Petersen Lisa RN - Surgery Lead 50.00 0.00 X 243786 0 25765 Rehm Donna RN - Surgery 50.00 0.00 X 238589 0 35330 Spencer Lindsey Admin Dir RN 50.00 0.00 X 184295 0 37335 Kilkenny Martha Nurse Practitioner 50.00 0.00 X 176516 0 18916 Rebok Douglas Former Asst Sec 0.00 0.00 X 0 120028 6244 Wehtje Rodney Former Asst Treasurer 0.00 0.00 X 0 249427 23299 1094016 9606175 752481 127 true true false Pacific Redwood Medical Group PO Box 2800 Ukiah CA 95482 Medical Services 2432015 Pacific Redwood Medical Services Inc 242 Hospital Dr Suite B Ukiah CA 95482 Medical Services 2196563 Bivens Medical Corporation 20105 Geisendorfer Applegate CA 95703 Medical Services 2175507 Locumtenenscom LLC PO Box 405547 Atlanta GA 30384 Medical Services 1887058 Accelecare Wound Centers Inc 28525 Network Place Chicago IL 60673 Medical Services 472215 14 317012 768626 1085638 Dietary 722210 381775 377660 4115 Echo Equipment Lease 532420 Other income 900099 145548 145548 Patient Service Revenue 621110 173295001 173295001 Rent-Medical Office Bldg. 531120 103565 103565 173925889 1491630 1491630 0 0 0 0 0 0 74202 10471 63731 63731 Accounting Services 541900 700 700 700 176567588 173921774 4815 1555361 X 161065 161065 0 0 0 0 0 45934260 42420124 3388713 125423 1776514 1749735 26779 5592373 4864152 708150 20071 3385169 3106086 270464 8619 0 187751 187751 5688 5688 0 0 0 24944476 24087152 857324 0 1181433 976139 202582 2712 9569530 9451103 118427 0 5390930 4984806 404579 1545 296689 164239 131639 811 0 138635 66859 71745 31 500452 500452 0 2674409 2667539 6870 262083 262083 Purchased services 32287034 17650066 14545492 91476 Patient care supplies 17559264 17559264 Miscellaneous other expenses 760642 354497 400661 5484 Rental/leases costs equipment 758387 733454 24933 30743 30743 153397527 131789558 21351797 256172 112012 804521 74698462 72740524 0 14135037 15268465 28721 0 0 0 2148627 2672796 1001756 306375 97566735 38158004 44828676 59408731 3078778 3762091 0 500000 500000 172586 172586 19420419 26631608 160125074 182267697 17239463 13960859 43551888 59549017 60791351 73509876 X 93874276 103346893 5453248 5410928 6199 99333723 108757821 160125074 182267697 X 23170061 -13745963 X false false false X false false false false false false false false false false true 6622 6622 false false Part II-B, Line 1i - Other Activities Description The organization belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. 5268630 798626 193575 4820 845083 5410928 4179423 1348696 259489 5268630 3563283 663489 1870 49219 4179423 2087526 1515900 1487 41630 3563283 1364417 897326 784 175001 2087526 1.00000 false false false 1276873 1276873 39305442 19183008 20122434 1075597 1075597 22329900 17899399 4430501 33578923 33578923 59408731 Ukiah Valley Medical Plaza 500000 C Other assets 36729 Other receivables 133861 Receivables from related organizations 6732105 Receivables from third-party payors 19728913 26631608 MOB deposits 10702 Payables to related organizations 46811429 Payables to third party payors 10396391 Workers compensation payable 2330495 59549017 true true X true X true X true true true false true true 2079699 2079699 0.01360 2079699 2079699 0.01360 546314 27595 518719 0.00340 74449 74449 0.00050 1900634 711772 1188862 0.00780 170928 170928 0.00110 2692325 739367 1952958 0.01280 4772024 739367 4032657 0.02640 22003 22003 0.00010 22003 22003 0.00010 true 859702 591647 47281886 50316108 -3034222 X true true Hospital Dr Med Plaza Assn Property management 0.33000 0.67000 1 1 Adventist Health Ukiah Valley 275 Hospital Dr Ukiah CA 95482 See Form 990, Pg 1, Item J 110000095 X X X Adventist Health Ukiah Valley 1 false false true X X X X X X X X X 16 true true true true X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X true 17 true See Sch H Part VI - Needs Assessment false false true X 200.0000 400.0000 X X X X true true X X X true X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X See Sch H Part VI-Patient Education X X X X X X true X false X X X X true X false false 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. 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 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 true CA Hlth Fnd & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 26990 0 Hlth srvs uninsured/underinsured pt Mendocino College Foundation 1000 Hensley Ukiah CA 95482 680040876 51750 0 Health related education grant North Coast Opportunities 413 N State Street Ukiah CA 95482 941671958 49500 0 Annual fundraiser 3 0 X X X X X true true false false false false false false false false Eller Jeff President NCR 647561 183480 206427 16356 28657 1082481 106335 Jobe Meredith Secretary 395752 98614 159873 16356 25957 696552 60017 Kilkenny Martha Nurse Practitioner 176031 485 9894 9022 195432 Lonto Robert VP HR NCR 224768 45904 33823 16356 37484 358335 Matthews Gwen President 358395 102668 132064 16356 31108 640591 38845 McDonald Edward Asst Sec&Treas 323166 70841 93278 16457 30129 533871 38433 Petersen Lisa RN - Surgery Lead 243200 586 14743 11022 269551 Poole Aaron Treas/Asst Sec 241060 38879 35954 16356 27345 359594 Rebok Douglas Former Asst Sec 120028 6244 126272 120028 Rehm Donna RN - Surgery 238367 222 14603 20727 273919 Reiner Scott Dir/Chair 1184750 324119 473935 16356 37529 2036689 406467 Reppert Joseph Finance Officer NCR 473244 41746 95965 16356 39585 666896 Spencer Lindsey Admin Dir RN 162325 16872 5098 10806 26529 221630 Van Housen Heather Patient Care Exec 198823 41319 39055 15896 37477 332570 Wagner Jack Asst Secretary 755988 221735 92680 11160 25957 1107520 Wehtje Rodney Former Asst Treasurer 158863 90564 213 23086 272726 79970 Weiss David VP Operations 180861 36976 19222 13094 36719 286872 Wing Bill Dir/VCh/AsstSec 953512 273121 233611 16356 36337 1512937 172851 Wood Laurie Reg Dir Bus Intel 176359 54800 19671 10654 13199 274683 Part I, Line 1a: Relevant information in regards to selections on 1a. 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 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 South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp false false false true false true false false false false false false false false false true true true false false 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.