2018-12-26T06:56:31-08:00 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 941415069 Sonora Community Hospital dba Adventist Health Sonora SONO 2095325000 1000 Greenley Rd Sonora CA 95370 Gregory McCulloch Treas/Asst Sec 2018-12-26 true S Clement P01218012 8185475701 X 2017 2019-02-21 02:37:17Z Michelle Fuentes 262097549 false false 1071 X www.adventisthealth.org/sonora X 1958 CA Living Gods love by inspiring health, wholeness and hope. 14 10 1671 120 56716 13151 1723041 1362251 255164509 252403784 2072882 1892873 42007 2777891 259002439 258436799 186558 44695 0 105379905 110047260 0 545602 127623458 126345311 233189921 236437266 25812518 21999533 210800980 260052818 60222563 109492827 150578417 150559991 Living Gods love by inspiring health, wholeness and hope. false false 201512095 44695 252360994 Sonora Community Hospital (SCH) 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 SCH, the organization recognizes that not all individuals possess the ability to pay for essential medical services.SCH's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:- providing free care and/or subsidized care- providing care to persons covered by governmental programs at below cost- providing health/wellness activities and community education programsNot only does SCH 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. SCH 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 $25,373,409. Services in 2017 were provided to approximately 136,351 patients. These services included:- Babies: 565 deliveries- Surgeries: 6,142 procedures- Emergency room: 34,160 visits- Medical clinics: 1,182,526 visitsSonora Community Hospital provides home care services in its surrounding communities. In 2017, we made 29,282 individual visits for home care services. These services include, but are not limited to:- Respiratory Care- Elderly Care- Geriatric Case Management- Ostomy & Wound Care- Diabetes Care- IV Home TherapySonora Community Hospital provides hospice services in its surrounding communities. In 2017, we provided 8,239 days of hospice care.SCH 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:Project HOPE, which stands for Health, Outreach, Prevention and Education- delivers dozens of free physicals and other services to indigent children and their parents at various locations throughout California's Tuolumne County with the help of volunteer nurses and physicians.Community Events - First aid stations at the local Mother Lode Fair, Home and Garden show and the Tuolumne Me-Wuk Health Fair. Exhibits at the Groveland Family Wellness Fair and the Tuolumne County Youth Health Fair. Close to 3,000 health screenings done at the annual Tuolumne County Health Fair.Health Education and Support ProgramsThe many support groups and health education classes conducted, including but not limited to:Cancer support group, Diabetes support group, Depression Recovery Program class, Spiritual Care training, CHIP Coronary Health Improvement Project, Epilepsy/Seizure Support Group, La Leche League, Childbirth Preparation Classes, Preparation for Cesarean Birth Classes, OakPlus Wellness Seminars, Quit for Life: Tobacco Cessation Classes, Lifeline Emergency Response ProgramMaintained and monitored up to 320 Lifeline Emergency Response Units. This 24-hour-a-day system offers immediate response to those whose physical condition could otherwise limit their ability to summon help.Spiritual SupportSCH's chaplains provided over 4,000 patient visits and over 1,500 hours of patient counseling, and provided over 300 hours of employee counseling, conducted memorial services and officiated at weddings.Community SupportSCH donated $44,537.60 to 65 non-profit community service organizations in 2017. 201512095 true true false true false false false false false true true false false true true false false true false false false false false false true false true true true false true false false false false false false false false true true true false false false false false true false false false true 191 0 true 1671 true true true false false false false true true 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 false X Greg McCulloch 2095365019 1000 Greenley Rd Sonora CA 95370 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 Jahn Andrew President 50.00 0.00 X 0 658815 64229 McCulloch Gregory Treas/Asst Sec 50.00 0.00 X 0 358782 53849 Kline Julie Sr VP/Patient Care Exec 50.00 0.00 X 0 373398 42273 Fuentes Michelle VP Operations 50.00 0.00 X 0 333337 53845 Clinite Edward CMO 22.00 0.00 X 319075 0 0 Ferch Wayne President CCR 0.00 50.00 X 0 957186 45065 Larsen David Finance Officer CCR 0.00 50.00 X 0 548036 55984 Tipton Shane Dir Oncology 40.00 0.00 X 192452 0 53490 Tipton Jay CRNA 40.00 0.00 X 204274 0 25927 Mulamalla Hari Dir Pharmacy 40.00 0.00 X 180994 0 36027 Colwell Timothy Dir Finance 40.00 0.00 X 173888 0 43046 King Thomas NP 40.00 0.00 X 170223 0 46395 Wehtje Rodney Former Asst Treas 0.00 0.00 X 0 249427 23299 Rebok Douglas Former Asst Sec 0.00 0.00 X 0 120028 6244 1240906 8970250 735681 178 true true false Quiring General LLC 5118 E Clinton Way STE 201 Fresno CA 93727 Building Contractor 15792334 Sierra Emergency Medical Group PO Box 4685 Sonora CA 95370 Medical Group 3346584 Layton Construction Company LLC 9090 S Sandy Pkwy Sandy UT 84070 Building Contractor 2144786 Siemens Medical Solutions 51 Valley Stream Pkwy Malvern PA 193551406 Medical Group 1524171 Galen Inpatient Physicians Inc 2100 Powell St STE 900 Emeryville CA 94608 Medical Group 1432758 80 112295 1249956 1362251 Dietary 722210 625700 625700 Other Revenue 900099 199160 199160 Patient service revenue 900099 251485205 251442415 42790 Rent - Medical Offices 531120 93719 93719 252403784 1892873 1892873 0 0 0 0 240085 112295 112492 127593 127593 5080 5080 5080 6136760 3548258 2588502 2588502 Retail Pharmacy 446110 39306 39306 Sonora Oxygen Service 621610 17410 17410 56716 258436799 252360994 56716 4656838 X 44695 44695 0 0 0 319075 169075 150000 0 81858121 76014135 5709535 134451 3499242 3467780 31462 18421751 17060580 1321146 40025 5949071 5551724 387461 9886 0 361821 361821 0 0 0 0 29188984 26837730 2351254 476486 476486 1536090 1349888 175752 10450 10554150 10531817 20440 1893 0 8292138 7860191 429065 2882 560537 378818 170604 11115 0 200749 146268 53298 1183 741327 741327 0 5657566 5591590 64983 993 284862 284862 Pt care supplies 35148986 34406533 742453 Purchased services 31344406 9953743 21186086 204577 Miscellaneous 1758615 893014 738551 127050 Equipment rentals 238594 228325 9172 1097 0 236437266 201512095 34379569 545602 1045986 83515 89721735 108441052 674421 674421 25494105 28653397 0 0 0 3600915 4076818 502848 318374 154563258 70019205 61292688 84544053 6115191 6191383 0 0 433978 433978 21919113 26635827 210800980 260052818 16338546 20400720 1526406 1017602 42357611 88074505 60222563 109492827 X 145855667 145084588 4722750 5475403 150578417 150559991 210800980 260052818 X 21999533 -22017959 X false true X true false X false false false false false false false false false false true 6138 6138 false false Part II-B, Line 1i - Other Activities Description A portion of industry association dues is allocated to lobbying activities. 4722741 1334245 108765 472818 5475403 3333814 1848665 41754 417984 4722741 1975818 1766110 60789 347325 3333814 1054045 1389642 140470 327399 1975818 993956 514739 134134 320516 1054045 1.00000 false false false 7330024 7330024 69449268 36587271 32861997 2953785 2621040 332745 40506958 28272611 12234347 34323223 2538283 31784940 84544053 Other assets 40212 Other receivables 1671000 Receivable from related orgs 4750877 Receivables from 3rd party payors 20173738 26635827 Other liabilities 184670 Payables to related orgs 80396764 Payables to third party payors 1245166 Workers' comp liability 6247905 88074505 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. X X X X X X X true CA Gala 265050 82050 183000 18586 23589 43652 Golf Tournament 64975 17855 47120 6144 4900 8526 1 22355 12390 9965 800 4000 2295 352380 112295 240085 25530 32489 54473 112492 127593 true true X true X true X true true true false true true 1689296 1689296 0.00710 1689296 1689296 0.00710 361129 30229 330900 0.00140 305050 305050 0.00130 6594333 1711996 4882337 0.02060 28906 28906 0.00010 7289418 1742225 5547193 0.02340 8978714 1742225 7236489 0.03050 2357 2357 500 500 436538 436538 0.00180 439395 439395 0.00180 true 609981 143163 104471913 104580373 -108460 X true true 1 1 Sonora Community Hospital 1000 Greenley Rd Sonora CA 95370 www.adventisthealth.org/sonora 030000094 X X X Sonora Community Hospital 1 false false true X X X X X X X X X 16 true false 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.The data collection process of the CHNA included an initial meeting of the Tuolumne County Community Health Assessment (TCCHA) Steering Committee to plan a TCCHA project. The Steering Committee consisted of local community leaders including business owners, non-profit executive directors, seniors, county and state social service directors, health care providers, community members and law enforcement. The committee members dedicated their time, knowledge, expertise and resources throughout the 10-month process.The process of data collection was guided by the consultant and Public Health Director, and shared by each of the committees, with data analysis conducted and reviewed by the full Steering Committee and in some cases by other members of the community. Multiple meetings were conducted over a six-month period, with contributions of time and resources from the community members. Surgery Center 905 Morningstar Dr Sonora CA 95370 Outpatient Surgery Outpatient Imaging Center 900 Mono Wy Sonora CA 95370 Diagnostic Imaging Radiation Oncology 900 Greenley Rd Ste 901 Sonora CA 95370 Clinic Services Outpatient Rehabilitation 900 Mono Wy Sonora CA 95370 Physical Therapy and Rehabilitation Infusion Center 900 Greenley Rd Ste 902 Sonora CA 95370 Clinic Services Indian Rock Prompt Care 14590 Mono Wy Sonora CA 95370 Clinic Services Home Health - Sonora 20100 Cedar Rd N Sonora CA 95370 Home Health Sierra Orthopedic Institute 680 Guzzi Ln Ste 105 Sonora CA 95370 Clinic Services Bones Sports Medicine and Rehabilitation 13808 Mono Wy Sonora CA 95370 Clinic Services Sierra Care Center Unit 7 538 Ponderosa Dr Sonora CA 95370 Long-Term Care Sierra Care Center Unit 6 179 S Fairview Ln Sonora CA 95370 Long-Term Care Sierra Cardiology 900 Greenley Rd Ste 911 Sonora CA 95370 Clinic Services Center for Wound Care 12811 Covey Cir Sonora CA 95370 Clinic Services Sierra OBGYN 900 Greenley Rd Ste 922 Sonora CA 95370 Clinic Services Rural Health Primary Care 193 S Fairview Ln Ste B Sonora CA 95370 Clinic Services Oxygen and Medical Supply 220 W Stockton St Sonora CA 95370 Oxygen and Durable Medical Equipment Yosemite Orthopedics and Joint Replacement 680 Guzzi Ln Ste 102 Sonora CA 95370 Clinic Services Foothill Specialty Group 680 Guzzi Ln Ste 206 Sonora CA 95370 Clinic Services Community Pharmacy Greenley Rd 900 Greenley Rd Sonora CA 95370 Pharmacy Sierra Vascular and General Surgery Associates 900 Greenley Rd Ste 922 Sonora CA 95370 Clinic Services Sierra Vascular and General Surgery Associates 900 Greenley Rd Ste 922 Sonora CA 95370 Clinic Services Greenley Oaks Ear Nose and Throat 795 Morningstar Dr Sonora CA 95370 Clinic Services Angels Camp Orthopedics 23 N Main St Angels Camp CA 95222 Clinic Services Angels Camp Rapid Care 23 N Main St Angels Camp CA 95222 Clinic Services Rural Health Specialty Care 193 S Fairview Ln Ste C / F Sonora CA 95370 Clinic Services Rural Health Dental Care 193 S Fairview Ln Ste J Sonora CA 95370 Clinic Services Hospice - Sonora 20100 Cedar Rd N Sonora CA 95370 Hospice Services Community Pharmacy Stockton St 220 W Stockton St Sonora CA 95370 Pharmacy Foothill Pediatrics and Rheumatology 12791 Cabezut Rd Sonora CA 95370 Clinic Services Hillside Internal Medicine 1 690 Guzzi Ln Ste B Sonora CA 95370 Clinic Services Live Well Be Well Center 19747 Greenley Rd Sonora CA 95370 Clinic Services Mountain Medical Family Practice 680 Guzzi Ln Ste 106 Sonora CA 95370 Clinic Services Angels Camp Physical Therapy 457 S Main St Angels Camp CA 95222 Clinic Services Angels Camp Family Medical Office 445 S Main St Angels Camp CA 95222 Clinic Services Transitional Care Unit 179 S Fairview Ln Sonora CA 95370 Subacute Hospitalization Cancer Center 900 Greenley Rd Ste 902 Sonora CA 95370 Clinic Services Rural Health Pediatric Care 193 S Fairview Ln Ste L Sonora CA 95370 Clinic Services Greenley Primary Care 19747 Greenley Rd Sonora CA 95370 Clinic Services Sierra Internal Medicine 680 Guzzi Ln Ste 201 Sonora CA 95370 Clinic Services Arnold Family Medical Office 2037 Hwy 4 Arnold CA 95223 Clinic Services Cedarwood Internal Medicine 690 Guzzi Ln Ste A Sonora CA 95370 Clinic Services Groveland Family Medical Office 18661 Hwy 120 Groveland CA 95321 Clinic Services Mountain Medical Physicial Medicine and Rehabilitiation 680 Guzzi Ln Ste 101 Sonora CA 95370 Clinic Services Hillside Internal Medicine 2 680 Guzzi Ln Ste 204 Sonora CA 95370 Clinic Services Occupational Health 19747 Greenley Rd Sonora CA 95370 Clinic Services Sierra Pulmonology 900 Greenley Rd Ste 923 Sonora CA 95370 Clinic Services Oxygen and Medical Supply - Hanford 440 Greenfield Ave Ste A Hanford CA 93230 Oxygen and Durable Medical Equipment Pulmonary Rehabilitation 19747 Greenley Rd Sonora CA 95370 Clinic Services Cardiac Rehabilitation 19747 Greenley Rd Sonora CA 95370 Clinic Services Mother Lode Sleep Center 729 Pauline Ct Sonora CA 95370 Sleep Medicine LivingWell Fitness Center 4 S Forest Rd Sonora CA 95370 Fitness Classes Anticoagulation Clinic 19747 Greenley Rd Sonora CA 95370 Clinic Services Hospice - Angels Camp 451 S Main St Angels Camp CA 95222 Hospice Services Home Health - Angels Camp 451 S Main St Angels Camp CA 95222 Home Health Heart Failure Resource Center 19747 Greenley Rd Sonora CA 95370 Clinic Services Health Pavilion 900 Mono Wy Sonora CA 95370 Clinic Services 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 charges 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 combined audited 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 8 - Explanation Of Shortfall As Community Benefit Medicare shortfall should be considered a community benefit because our mission is to promote health in the community and we do not limit the care available to any patients, including those covered by Medicare. We are relieving a government burden by providing care to Medicare patients even though costs exceed reimbursement. Tax-exempt hospitals are expected to participate in the Medicare program.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL: Medicare Cost Report Revenue* 89,685,829 Prior Year Settlements (661,098) Cost Report Reimbursable Bad Debts 578,100 Estimates and Accrual Variances (48,076) Other 14,917,158 Subtotal - Amount reported in Pt III, Ln 5 104,471,913 Amounts included in Part I, Lines f and g - Total Medicare Revenue 104,471,913* Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Part III, Line 9b - 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/sonora/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 the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact.Committee/Board Participation includes: Tuolumne County Behavioral Health, Amador Tuolumne Community Action Agency, Tuolumne Me Wuk Indian Health Center, Area 12 Agency on Aging, Infant Child Enrichment Services, and First Five.Continued from Schedule H, Part V, Section B, Line 11:Priority Areas Not Addressed:Two additional areas that have been identified as priority areas but have not been addressed in our hospitals 2017-2019 Community Health Plan (implementation strategy), due to resource limitations, are End of Life and Redesigning the Health System.Adventist Health Sonora is committed to improving not only the health our community by addressing community health needs through the CHNA process but those additional needs seen through our senior population and chronic disease. Interventions include:1.Better Breathers Club is designed to offer community education and support to those with chronic lung disease. Meetings are open to family members and caregivers. Members of the community served 62.Oak Plus Senior Wellness is a wellness program open to the community for anyone over 65 years. Individuals receive discounts for medical services, pharmacy, medical supplies and the Live Well Fitness Center. Individuals also have access to monthly wellness lectures by health professionals. Members of the community served 2003.Live Well. Be Fit. Senior Exercise Program improve overall physical endurance, balance, strength and flexibility. Additional Senior Center Class is for those members who want to improve their lifestyle through therapeutic lifestyle changes. Members of the community served 304.Ladies Night Out in honor of breast cancer awareness month for education purposes. Member of the community served 5005.Chronic Disease classes for any member of our community that is trying to improve their health through therapeutic lifestyle change including exercise. Members of the community served 316.Speakers Bureau for Tuolumne County. Presented to area churches, community groups and local nursing program students about hospice and end of life services in Tuolumne County. Members of the community served - 123 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/sonora/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 the only health care system in the area, serving two counties and surrounding areas. In early 2009 the hospital was designated as a "sole community hospital" by Medicare. The area is predominantly rural, with agriculture, logging and tourism being the major employment opportunities. The population includes a large number of retired individuals.Tuolumne County suffered a 2.8% decrease in population in the last 15 years, which contrasts with the population numbers trends in the neighboring counties, and in the state in general. The countys population is also older than the states population, with 22% of the countys population being over 65, compared to 12% for the state. Females make up 55% of Tuolumne County residents over 64 years old. Most of our countys populations is white - 91.1%, with the remaining percentages allocated to: 2% Asian, 3% Black or African American, 4% American Indian or Alaska Native, and 11% Hispanic / Latino (or other). 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 Part VI - Additional Information Part I, Line 7b, Column(e) reflects the net amounts received for the rural health clinic(s) operated by the hospital in its rural service area for the benefit of the underserved population who would otherwise not have access to health care. The rural health clinic(s) may also offer dental and mental health services, which are frequently not readily obtainable by the underserved population. true CA Hlth Fnd & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 31945 0 Health services for un/underinsured 1 0 Grantmaker's Description of How Grants are Used Prior to issuing grants, hospital evaluates organization requesting grant and ensures alignment with hospital's exempt purpose and mission. After disbursing grant funds, hospital does not monitor use of funds. X X X X true true false false false false false false false false Clinite Edward CMO 150000 169075 319075 Colwell Timothy Dir Finance 149122 9733 15033 6440 36606 216934 Ferch Wayne President CCR 642426 183984 130776 16408 28657 1002251 104580 Fuentes Michelle VP Operations 240929 49011 43397 16356 37489 387182 Jahn Andrew President 407614 115984 135217 16356 47873 723044 52679 Jobe Meredith Secretary 395752 98614 159873 16356 25957 696552 60017 King Thomas NP 170223 9789 36606 216618 Kline Julie Sr VP/Patient Care Exec 242228 49042 82128 16356 25917 415671 20657 Larsen David Finance Officer CCR 372364 73887 101785 16421 39563 604020 32524 McCulloch Gregory Treas/Asst Sec 251548 50935 56299 16356 37493 412631 6904 Mulamalla Hari Dir Pharmacy 180556 438 10376 25651 217021 Rebok Douglas Former Asst Sec 120028 6244 126272 120028 Reiner Scott Dir/Chair 1184750 324119 473935 16356 37529 2036689 406467 Tipton Jay CRNA 203274 1000 11919 14008 230201 Tipton Shane Dir Oncology 176574 7562 8316 11406 42084 245942 Wagner Jack Asst Secretary 755988 221735 92680 11160 25957 1107520 Wehtje Rodney Former Asst Treas 158863 90564 213 23086 272726 79970 Wing Bill Dir/VCh/AsstSec 953512 273121 233611 16356 36337 1512937 172851 Edward Clinite CMO Self 67869 Bldg Lease false Schedule L, Part V Supplemental Information Edward Clinite,D.O. and his wife own property placed in a trust that is being leased by the hospital at fair market rental value. The transaction is subject to the organization's compliance program and is approved through the appropriate organizational approval process, which may include the Compliance Committee of the Board. 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 Peformance 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. The hospital files monthly/quarterly summary financial reports with the state health-planning agency that are open to public review. Other Changes In Net Assets Or Fund Balances - Other Decreases Net asset reclassification = -$1686 Other Changes In Net Assets Or Fund Balances - Other Decreases Transfers from related orgs = -$22016273 Adventist Health SystemWest 2100 Douglas Blvd Roseville CA 95661 953484589 Support / manage system-wide activities CA 501(c)(3) 1 NA false Adventist Health Clearlake Hospital Ave 18 at Hwy 53 Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest 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 Terrace 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 St Helena Hospital 10 Woodland Rd St Helena CA 94574 941279779 Hospital CA 501(c)(3) 1 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 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 St Walla Walla WA 99362 910617726 Hospital WA 501(c)(3) 1 Adventist Health SystemWest false White Memorial Medical Center 1720 Cesar 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 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 NA C Corp false false false true false true false false false false true true true true 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.