2018-12-23T12:24:35-08:00 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 941279779 St Helena Hospital dba Adventist Health St Helena STHE 7079633611 10 Woodland Rd St Helena CA 94574 Timothy Kares Finance Officer 2018-12-23 true S Clement P01218012 8185475701 X 2017 2019-02-21 02:37:17Z Steven Herber 256849141 false false 1071 X www.adventisthealth.org/st-helena X 1898 CA Living Gods love by inspiring health, wholeness and hope. 14 10 1605 85 158321 -90448 4893207 1049443 248492473 253205905 2180557 147603 471642 321739 256037879 254724690 21926 513318 0 89657588 100681085 0 1180523 170028587 154566847 259708101 255761250 -3670222 -1036560 199587270 209570504 161907411 87422422 37679859 122148082 Living Gods love by inspiring health, wholeness and hope. false false 209992802 513318 253206675 St. Helena Hospital 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 St. Helena Hospital, 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 and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:a) Providing free care and/or subsidized careb) Providing care to persons covered by governmental programs at below costc) Providing health/wellness activities and community education programsNot only does St. Helena Hospital 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. St. Helena Hospital 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 $44,178,892.The following statistics related to patient services are available for tax year 2017:Clinic visits - 173,589Ancillary visits - 45,227General admissions - 7,780Emergency room visits - 8,088Emergency room admissions - 1,012Surgery cases (inpatient & outpatient) - 6,207Deliveries - 207Number of patient days - 48,140GMLOS (Geometric Mean Length of Stay) - 34,429Discharges - 7,769St. Helena Hospital 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:Awaken Series - on cancer prevention and quality of life;Wellness Fair for St. Helena Unified School District - over 600 students served;Prenatal and early life nutrition classes, offered in conjunction with our prenatal education classes;Calistoga Senior Lunch & Learn event - specialty physicians provide education on diseases like heart disease;Diabetes education - provide lifestyle and interventional management;Operation Access - providediagnostic and surgical services to low-income, uninsured patients;Mentis sponsorship - provide mental health services to teens. 209992802 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 225 0 true 1605 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 Timothy Kares 7079636552 10 Woodland Rd St Helena CA 94574 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 Wagner Jack Asst Secretary 0.00 50.00 X 0 1070403 37117 Herber Steven President 50.00 0.00 X 0 613356 49449 McDonald Edward Treas/Asst Sec 50.00 0.00 X 0 487285 46586 Lonto Robert VP HR NCR 0.00 50.00 X 0 304495 53840 Lendaris Antonia SH Reg CNO 50.00 0.00 X 0 308889 31722 Kulas Paul VP Phys Svcs/CMG 50.00 0.00 X 0 290461 46957 Eller Jeff President NCR 0.00 50.00 X 0 1037468 45013 Reppert Joseph Reg SVP Fin NCR 0.00 50.00 X 0 610955 55941 Chilton Harold COO 50.00 0.00 X 0 538222 42304 Kirk Richard NP 55.00 0.00 X 287069 0 37880 Hasso Ruth RN 40.00 0.00 X 265933 0 39397 Ahmad Helaluddin Dir Pharmacy 40.00 0.00 X 256272 0 28163 Nonescan Cindy RN 40.00 0.00 X 216068 0 56254 Vichi Julie Dir Finance 50.00 0.00 X 222440 0 42299 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 1247782 9931827 791356 251 true true false Adv Hlth CA Med Grp Inc 22 Hillcrest Rd St Helena CA 94574 Physician Services 4654874 Bhaisaja PC 10 Woodland Rd St Helena CA 94574 Physician Services 2717909 Barton Associates Inc 300 Jubilee Peabody MA 01960 LocumTenens/Staffing 1983503 Patient Access Med Group 10 Woodland Rd St Helena CA 94574 ED Physician Srvs 1080000 CNPA Advertising Srvs Inc 2701 K St Sacramento CA 95816 Ad/Mrkt Mngt Srvs 1071950 60 848319 201124 1049443 Dietary 722210 869414 869414 EMR Incentives 621110 Other Revenue 900099 1717334 1717334 Patient Service Revenue 621110 249704020 249704020 Rental Income 531120 915137 915137 253205905 147603 147603 0 0 0 0 0 0 2445420 2124451 320969 158321 162648 Other revenue 900099 770 770 770 254724690 253206675 158321 310251 X 513318 513318 0 0 0 0 0 78462681 63169595 14562200 730886 2969138 2942541 26597 13628576 9698452 3806089 124035 5620690 4623464 955175 42051 0 226990 226990 261557 261557 0 0 0 25993099 24853446 1026202 113451 2950061 2950061 1430928 575935 833844 21149 6873177 6781521 27668 63988 0 6933668 6246596 680921 6151 340499 123981 210234 6284 0 38173 37284 889 4128847 4128847 0 8981492 8926690 54541 261 254247 134247 120000 Purchased services 43558244 25806016 17704248 47980 Patient care supplies 38239221 38239221 Qlty assurance (hospital) fee 12144563 12144563 Other 1190688 48198 1141598 892 1021393 998887 22506 255761250 209992802 44587925 1180523 165125 191586 2123063 20444911 0 34500200 26356314 0 0 0 4656687 4666073 1343869 831593 234760823 146903363 91902452 87857460 4350896 6137742 0 0 0 60544978 63084825 199587270 209570504 21000156 15754847 572809 330006 140334446 71337569 161907411 87422422 X -1300898 90724303 35130124 31423779 3850633 37679859 122148082 199587270 209570504 X -1036560 85504783 X false true X true false X false false false false false false false false false false true 12166 12166 false false Part II-B, Line 1i - Other Activities Description The hospital is a member of industry associations. A portion of the membership dues is used for lobbying purposes. 12255343 1049443 30008379 15379 11874007 31423779 11794102 3901050 18350 3458159 12255343 10554992 5424873 -228210 3957553 11794102 9066916 3282190 -4891 1789223 10554992 9434793 4304601 373738 5046216 9066916 1.00000 true false false 425124 425124 145909615 82105352 63804263 19957324 10928157 9029167 61888538 53869854 8018684 6580222 6580222 87857460 Interest in Consolidated Org 31754246 Other Receivables 1943465 Receivables from Related Organization 17826686 Receivables from Third Party Payors 11560428 63084825 Other Liabilities 509223 Payables to Related Organizations 57784860 Payables to third party payors 8826909 Workers Comp Liability 4216577 71337569 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporarily, and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. true true X true X true X true true true false true true 2784190 2784190 0.01090 2784190 2784190 0.01090 210256 21200 189056 0.00070 9531575 1761814 7769761 0.03040 120570 120570 0.00050 9862401 1783014 8079387 0.03160 12646591 1783014 10863577 0.04250 30000 30000 0.00010 30000 30000 0.00010 true 448521 91050 92168629 89873087 2295542 X true true 2 1 St Helena Hospital 10 Woodland Road St Helena CA 94574 adventisthealth.org/sthelena 110000073 X X X A 2 SHH Center for Behavioral Hlth 525 Oregon St Vallejo CA 94590 adventisthealth.org/sthelena 110000042 X Acute Psychiatric Hospital A A 12 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 survey, engaging with community focus groups and conducting key stakeholder interviews.Community Surveys: Analysis of over 150 health indicators from publicly available data sources such as the California Health Interview Survey, American Community Survey, and the California Healthy Kids Survey. Secondary data were organized by a framework developed from Kaiser Permanentes list of potential health needs, and expanded to include a broad list of needs relevant to Napa County.Community Focus Groups: A total of four focus groups were conducted in English and Spanish, reaching 47 residents, representing populations identified as having worse health outcomes or at risk for worse health outcomes. Key Informant Interviews: were conducted with 18 individuals selected from the local public health department, as well as leaders, representatives, and members of medically underserved, low-income, minority populations, and those with a chronic disease. Other individuals from various sectors with expertise in local health needs were also consulted. Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment We conducted the 2016 CHNA in collaboration with Kaiser Permanente and St. Joseph Health Queen of the Valley Medical Center. Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why The following areas of need were not addressed in our hospital's Community Health Improvement Plan: Develop approaches to address disparities identified throughout our needs assessment. Increase access to fresh, healthy foods, especially in schools.St. Helena Hospital Napa Valley set community benefit goals to address areas of need that could best benefit from our capabilities and resources. We are working with the LHNC collaborative to develop a countywide Community Health Improvement Plan that will address all identified priority areas of need. This plan will be completed in early 2014. St Helena Coon Joint Replacement Institute 6 Woodland Rd Ste 202 St Helena CA 94574 Outpatient 1206(d) Clinic St Helena Physical Therapy 1030 Main Street Ste 100 St Helena CA 94574 Outpatient Clinic St Helena Deer Park Pharmacy 6 Woodland Road St Helena CA 94574 Outpatient pharmacy St Helena Medical Specialties OBGYN 935 Trancas St Ste 4B Napa CA 94558 Outpatient Clinic St Helena Cardiac Rehabilitation 999 Adams Street St Helena CA 94574 Outpatient Clinic St Helena Lifestyle Medicine Institute 6 Woodland Road St Helena CA 94574 Lifestyle medicine 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 chargesThe hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of Californias regulations and policies and the approval of the federal government. Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense 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 too many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL:*Medicare Cost Report Revenue 80,293,176Prior Year Settlements 3,760,361Cost Report Reimbursable Bad Debts 367,963Estimates and Accrual Variances (302,014)Other 8,049,144Subtotal - Amount reported in Pt III, Line 5 92,168,629Amounts included in Part I, Lines f and g -Total Medicare Revenue 92,168,629*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/st-helena/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/.In addition to the CHNA, our hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level? Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our 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: Children and Weight Coalition of Napa Valley, Pacific Union College, Martin-ONeil Cancer Center, Leukemia and Lymphoma Society, St. Helena Chamber of Commerce, etc.Continued from Schedule H, Part V, Section B, Line 11:Community members served: 206 underwent low dose lung screening. 3.Provide access to education around early detection and prevention. The Martin-ONeil Cancer Center sponsors a series of educational events for the community focused on cancer prevention. In 2017, the series included topics such as quality of life, the power of prevention with a plant-based diet, among other topics. The events have brought in hundreds of community members to learn from leading experts and is relied upon for family members whose loved ones are undergoing treatment themselves. Number of community members served: 276 4.Provide access to support services to individuals undergoing treatment for cancer and/or caregivers or family members who are supporting a loved one who is undergoing cancer treatment. Integrative Cancer Support Services are an integral part of the Martin-ONeil Cancer Center. They provide patients with emotional, physical and spiritual support through all stages of cancer survivorship through services such as: acupuncture, massage therapy & aromatherapy, art therapy, Food of Love program (a complimentary food support program whereby nutrient dense, delicious meals are provided to Martin-ONeil Cancer Center patients; 960 meals were provided in 2017), nutrition counseling, patient counseling. In 2017, the support services listed above touched more than 672 people who utilized the services and participated actively in the services listed above, whether it was a patient or a family member or friend of a patient.Priority Need 5-Access to Shelter for the Homeless - through the Gasser Foundation, St. Helena Hospital will provide $100,000 in financial support in the first year for shelter beds at Medical Respite Care Facility, a location identified for patients without homes who require care after they are discharged from the hospital.Priority Areas Not Addressed:Taking existing hospital and community resources into consideration, St. Helena Hospital Napa Valley will not directly address the remaining health needs identified in the CHNA including: education, economic and housing insecurity, and substance use. The hospital cannot address all the health needs present in the community, therefore, it will focus efforts on the health needs that can most effectively be addressed given the organizations areas of focus and expertise. St. Helena Hospital Napa Valley will look for partnership opportunities that address needs not selected where it can appropriately contribute to address those needs, or where those needs align with current strategy and priorities.Part III Other community benefits not included in the health prioritiesAdventist Health St. Helena is a proud supporter of Operation Access. Together with other community partners we are able to provide quality specialty care for low-income, uninsured patients. This work improves individual lives as well as the community as a whole. Five physician volunteers provided 18 surgical and diagnostic procedures for 14 individuals and AHSH. 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/st-helena/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 St. Helena Hospital Napa Valley service area is comprised primarily of communities in Napa and Solano counties. The major communities are the upper valley cities of St. Helena and Calistoga. The demographics of the communities we serve are wide scope, including urban, suburban, and rural, and from all income levels. Although we primarily serve those in the Napa and Solano counties, our destination services also bring us patients from larger and further demographics. Napa county is an aging county and has substantial disparities in socioeconomic status. These issues present challenges for the health of its residents. 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 501(c)(3) 501543 0 Hlth srvs uninsured/underinsured pt 1 0 X X X X true true false false false false false false false false Ahmad Helaluddin Dir Pharmacy 242867 10398 3007 15272 12891 284435 Chilton Harold COO 338242 79367 120613 16356 25948 580526 Eller Jeff President NCR 647561 183480 206427 16356 28657 1082481 106335 Hasso Ruth RN 265594 339 13102 26295 305330 Herber Steven President 386641 105659 121056 16356 33093 662805 46871 Jobe Meredith Secretary 395752 98614 159873 16356 25957 696552 60017 Kirk Richard NP 287069 12256 25624 324949 Kulas Paul VP Phys Svcs/CMG 156116 52757 81588 16290 30667 337418 Lendaris Antonia SH Reg CNO 234406 44276 30207 16356 15366 340611 Lonto Robert VP HR NCR 224768 45904 33823 16356 37484 358335 McDonald Edward Treas/Asst Sec 323166 70841 93278 16457 30129 533871 38433 Nonescan Cindy RN 216068 13107 43147 272322 Rebok Douglas Former Asst Sec 120028 6244 126272 120028 Reiner Scott Dir/Chair 1184750 324119 473935 16356 37529 2036689 406467 Reppert Joseph Reg SVP Fin NCR 473244 41746 95965 16356 39585 666896 Vichi Julie Dir Finance 148151 68887 5402 13472 28827 264739 Wagner Jack Asst Secretary 755988 221735 92680 11160 25957 1107520 Wehtje Rodney Former Asst Treasurer 158863 90564 213 23086 272726 79970 Wing Bill Dir/VCh/AsstSec 953512 273121 233611 16356 36337 1512937 172851 Timothy Herber Officer Child Employment false Maria Lendaris Officer Child Employment false Tammy McDonald Officer Wife Cookie sales false 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. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The corporate internal audit staff review 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 publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency. Other Changes In Net Assets Or Fund Balances - Other Increases Change in interest - Foundation = $4345418 Other Changes In Net Assets Or Fund Balances - Other Increases Transfers from related orgs = $81159365 Adventist Health SystemWest 2100 Douglas Blvd Roseville CA 95661 953484589 Support and manage system-wide activities CA 501(c)(3) 1 NA false St Helena Hospital Foundation 10 Woodland Rd St Helena CA 94574 201384250 Fundraising and Investment Management CA 501(c)(3) 11a, I NA false Castle Medical Center 640 Ulukahiki St Kailua HI 96734 990107330 Hospital HI 501(c)(3) 1 Adventist Health SystemWest false Feather River Hospital 5974 Pentz Rd Paradise CA 95969 941101228 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Glendale Adventist Medical Center 1509 Wilson Ter Glendale CA 91206 951816017 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Hanford Community Hospital 450 Greenfield Ave Hanford CA 93230 940535360 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false NW Medical Foundation of Tillamook 1000 Third St Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 1 Adventist Health SystemWest false Paradise Valley Hospital 2100 Douglas Blvd Roseville CA 95661 951816034 Wind down after sale of hospital facilities CA 501(c)(3) 1 Adventist Health SystemWest false Portland Adventist Medical Center 10123 SE Market St Portland OR 97216 930429015 Hospital OR 501(c)(3) 1 Adventist Health SystemWest false Adventist Health Clearlake Hospital Inc Ave 18 at Hwy 53 Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Ave Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Simi Valley Hospital & Health Care Svcs 2975 N Sycamore Dr Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Rd Sonora CA 95370 941415069 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Dr Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Walla Walla General Hospital 1025 S Second Ave Walla Walla WA 99362 910617726 Hospital WA 501(c)(3) 1 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesare E Chavez Ave Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Willits Hospital Inc 1 Marcela Dr Willits CA 95490 680108919 Hospital CA 501(c)(3) 1 Adventist Health SystemWest 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 Health Med Ctr Tehachapi 115 W E Street 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 false true true false false false true true true true true true 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.