2017-11-15T12:45:46-06:00 2016-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2016-01-01 941044474 LODI MEMORIAL HOSPITAL ASSOCIATION INC LODI 2093343411 975 S Fairmont Avenue Lodi CA 952405118 Paul Ziegele VP/CFO 2093343411 2017-11-15 1 Tracy S Paglia P00366884 2099556100 2017-11-15 73.90.207.82 2017-11-15 02:22:46 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 189799C539B232A8D1FA5D0851A612580EB85C47 2016 2017-02-10 21:41:12Z LODI HEALTH DANIEL WOLCOTT 975 S Fairmont Avenue Lodi CA 952405118 253059370 0 X https://www.adventisthealth.org/lodimemorial/page X 1945 CA Living God's love by inspiring health, wholeness and hope. 11 7 1616 123 53503 -17 2224792 215942 204432429 231546547 4925344 681473 87377 225087 211669942 232669049 126021 75833 0 0 105013818 109753743 0 0 356051 103321076 140211372 208460915 250040948 3209027 -17371899 253223534 233497008 160987673 158334613 92235861 75162395 X Living God's love by inspiring health, wholeness and hope. 0 0 172167873 75833 225686559 LODI MEMORIAL HOSPITAL IS A NON-PROFIT, ACUTE CARE HOSPITAL PROVIDING HIGH QUALITY SERVICES THAT PROMOTE HEALTH AND REHABILITATION, PREVENT DISEASE, AND TREAT AND CARE FOR THE SICK AND INJURED. HOSPITAL STAFF, MEDICAL STAFF AND THE GOVERNING BOARD ARE DEDICATED TO TREATING ALL PATIENTS AND VISITORS AS INDIVIDUALS WITH EQUAL DIGNITY, RESPECT AND QUALITY OF CARE.LODI MEMORIAL HOSPITAL TREATS AND PROVIDES CARE TO ITS PATIENTS THROUGH INPATIENT AND OUTPATIENT SERVICES. INPATIENTS RECEIVE CARE THROUGH MEDICAL-SURGICAL, PERI-OPERATIVE, PERI-NATAL, PEDIATRIC, INTENSIVE CARE, AND ACUTE-PHYSICAL REHABILITATION SERVICES.OUTPATIENT CARE INCLUDES 24-HOUR EMERGENCY, DIAGNOSTIC SERVICES, SURGERY, REHABILITATION AND EDUCATION.LODI MEMORIAL HOSPITAL IDENTIFIES THE HEALTH-CARE AND HEALTH MAINTENANCE NEEDS AND PREFERENCES OF THE COMMUNITY IT SERVES. DIAGNOSTIC, REHABILITATIVE, EDUCATIONAL, TREATMENT AND PREVENTATIVE SERVICES ARE DEVELOPED AS APPROPRIATE FOR A HOSPITAL OF THIS SIZE AND ROLE.LODI MEMORIAL HOSPITAL, CONSISTENT WITH ITS NON-PROFIT STATUS, DEVELOPS FINANCIAL RESOURCES TO ADEQUATELY SUPPORT HEALTH MAINTENANCE AND PATIENT-CARE SERVICES; CHARITY CARE FOR THOSE UNABLE TO PAY, WORKING CAPITAL NEEDS; AND CAPITAL REQUIREMENTS OF PLANT, EQUIPMENT AND EVOLVING TECHNOLOGY. EVERY EFFORT IS MADE TO KEEP COSTS AFFORDABLE FOR PATIENTS WHILE CONTINUOUSLY STRIVING TO IMPROVE THE QUALITY OF SERVICE. 21985851 0 5859988 LODI MEMORIAL COMMUNITY CLINICS ARE LICENSED UNDER THE DEPARTMENT OF PUBLIC HEALTH SERVICES REGULATIONS, AND ARE OWNED AND OPERATED BY THE LODI MEMORIAL HOSPITAL ASSOCIATION, INC., A NOT-FOR-PROFIT ENTITY AND WILL PROVIDE MEDICAL CARE TO ANY AGE. A COMMUNITY CLINIC UNIT OFFERS SERVICES DURING POSTED HOURS OF BUSINESS, WITH AT LEAST ONE PHYSICIAN EXPERIENCED IN THE COMMUNITY CLINIC PRACTICE. SPECIALTY CONSULTATION WILL BE AVAILABLE BY PHONE OR REFERRAL TO MEMBERS OF THE MEDICAL STAFF. IN 2016, FOUR (4) COMMUNITY CLINICS WERE LICENSED AND OPERATIONAL. 194153724 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 517 0 1 1616 1 1 1 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X PAUL ZIEGELE CFO & VICE PRESIDENT 2093343411 975 S FAIRMONT AVE LODI CA 95240 X DICKINSON CHARLES AHSW Director 0.00 4.00 X 0 217464 0 FREEDMAN JOHN AHSW Director 0.00 4.00 X 0 300 0 FRIESTAD CHRISTINE AHSW Director 0.00 4.00 X 0 968 0 GABRIEL MELODY AHSW Director 0.00 4.00 X 0 2269 0 GRAHAM RICARDO AHSW Director 0.00 4.00 X 0 4246 0 HEINRICH KERRY AHSW Director 0.00 4.00 X 0 683 0 INNOCENT LARRY AHSW Director 0.00 4.00 X 0 1503 0 REIMCHE ALLAN AHSW Director 0.00 4.00 X 0 4407 0 RIPPEY WESLEY AHSW Director 0.00 4.00 X 0 129770 0 SALAZAR VELINO AHSW Director 0.00 4.00 X 0 3915 0 TORKELSEN MAX AHSW Director 0.00 4.00 X 0 4102 0 REINER SCOTT AHSW Director/Chair 0.00 50.00 X X 0 1711534 286273 WING BILL AHSW Director/Vchair/Asst Sec 0.00 50.00 X X 0 1319055 238355 JOBE MEREDITH AHSW Secretary 0.00 50.00 X 0 552085 99823 WAGNER JACK AHSW Asst Sec 0.00 50.00 X 0 1117705 41826 WOLCOTT DANIEL AHSW President/CEO 0.00 50.00 X 0 510936 53717 DEAK TERRENCE Thru 93016 AHSW VP/CFO/Asst Sec 0.00 50.00 X 0 245251 32971 ZIEGELE PAUL AHSW VP/CFO 0.00 50.00 X 0 141245 21206 MORENO DEBBE AHSW VP/CNO 0.00 50.00 X 0 260947 37622 WHITNEY JASON VP Ops/AVP Bus Dev Integration 50.00 0.00 X 176314 0 29765 BROWN MARY RN Supervisor/Nursing Admin 51.00 0.00 X 208761 0 38610 BECK ATWATER SANDRA Director Hospital Pharmacy 45.00 0.00 X 194079 0 27800 LOEHRER HEIDI RN Manager/Surgery 44.50 0.00 X 170381 0 36913 WALLACE MARK Director Human Resources 45.00 0.00 X 169202 0 36330 WALLACE KENT Director Perioperative Services 45.00 0.00 X 166225 0 33799 GILL PARAMPAL MD Former Board Member 0.00 0.00 X 308445 0 0 McLOUGHLIN TRAVERS MD Former Board Member 0.00 0.00 X 16320 0 0 SORBERA THOMAS MD Former Board Member 0.00 0.00 X 84690 0 0 HARRINGTON JOSEPH AHSW Former President/CEO 0.00 0.00 X 0 421892 20279 1494417 6650277 1035289 278 1 1 0 ADVENTIST HEALTH PHYSICIANS NETWORK 2100 DOUGLAS BLVD ROSEVILLE CA 95661 PHYSICIAN PROFESSIONAL SERVICES - CLINIC 9744107 THE REGENTS OF THE UC-DAVIS 1200 DUTTON HALL - ONE SHIELDS AVE DAVIS CA 95616 PHYSICIAN PROFESSIONAL SERVICES - HOSPIT 7037635 CEP AMERICA - ANESTHESIA PC 2100 POWELL ST SUITE 900 EMERYVILLE CA 94608 PHYSICIAN PROFESSIONAL SERVICES - ANESTH 1316473 MORPHEUS ANESTHESIA INC 999 S FAIRMONT AVE SUITE 110 LODI CA 95240 PHYSICIAN PROFESSIONAL SERVICES - ANESTH 687251 SATELLITE HEALTHCARE INC 300 SANTANA ROW SUITE 300 SAN JOSE CA 95128 MANAGEMENT FEES-DIALYSIS UNIT 624824 44 80622 135320 215942 PATIENT SVC REVENUE 621400 227417940 227417940 CAPITATION FEES 621990 3651546 3651546 Loss from Advanced Imaging Center 621400 -80445 -80445 LOSS FROM Artel LLC 621400 -474349 -474349 loss From AHPN Clinics 621400 -660736 -660736 1692591 1692591 231546547 736800 736800 76650 76650 188616 182176 6440 6440 -17 6457 20074363 1805 20190340 17805 -115977 -16000 -131977 -131977 MANAGEMENT FEES 541610 64520 53520 11000 154127 154127 218647 232669049 231546547 53503 853057 X 75833 75833 206079 149968 56111 615922 448218 167704 86622306 62877095 23525931 219280 3761821 2737547 1024274 12285273 8915418 3335770 34085 6262342 4557223 1685382 19737 289872 289872 378982 18628 360354 18500 10000 8500 15561 15561 38624323 27968372 10630134 25817 185256 134814 41721 8721 27175518 19776132 7397387 1999 3813772 2775353 1038419 9085810 6611914 2448488 25408 209765 152650 56000 1115 127281 92625 33072 1584 11991289 8726285 3265004 566965 412591 154374 Bad Debts 20855114 20855114 Hosp Medi-cal Qlty Assu 14668476 14668476 Loss on Bond Debt Refin 11120377 11120377 Dues, Subscriptions, Bo 338400 246260 82335 9805 746111 542959 203152 250040948 194153724 55531173 356051 210421 237066 38009386 21357581 372079 974714 31657599 49640461 244156 176025 3291288 3713633 1676736 1377919 264900631 121659010 152132296 143241621 10650055 0 9444962 11349737 5534556 1428251 253223534 233497008 22197349 24464570 133625000 5165324 133870043 160987673 158334613 X 91688521 74600052 547340 562343 92235861 75162395 253223534 233497008 X -17371899 240566 57867 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15561 15561 0 Part II-B, Line 1: A portion of dues paid to california hospital association & the hospital council of northern california are considered to be for lobbying activities. 9811038 9811038 614559 127143507 49402764 78355302 3243781 2369059 874722 116383063 67641370 48741693 7704683 2245817 5458866 143241621 Conditional Asset retirement 907629 Workers Compensation 4109882 Malpractice Liability 459684 Note Payable to Parent 128392848 133870043 1 1 X 1 X 1 X 1 1 1 0 1 1 0 0 492109 0 492109 0.00210 0 0 68820469 55560337 13260132 0.05790 0 0 69312578 55560337 13752241 0.06000 0 0 10088193 3865562 6222631 0.02720 112693 29864 82829 0.00040 0 0 7838992 5864475 1974517 0.00860 449081 150011 299070 0.00130 18488959 9909912 8579047 0.03750 87801537 65470249 22331288 0.09750 364923 364923 0.00160 364923 364923 0.00160 1 18930611 5679183 49743048 52524640 -2781592 X 1 1 1 ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC DIAGNOSTIC IMAGING CENTER (WITH MRI) 0.51000 0.00000 0.49000 2 Lodi Outpatient Surgery Center Ambulatory Surgery Center 0.78000 0.00000 0.22000 3 Endoscopy Center of Lodi LLC Ambulatory Surgery Center 0.78000 0.00000 0.22000 2 1 LODI MEMORIAL HOSPITAL 975 S Fairmont Ave Lodi CA 95240 adventisthealth.org 030000056 X X X GENERAL ACUTE CARE BEDS = 190 A 2 LODI MEMORIAL HOSPITAL - WEST 800 LOWER SACRAMENTO ROAD ACUTE PHYS lodi CA 95242 adventisthealth.org 030000056 X X Outpatient Departments at this Campus A Facility Reporting Group - A 0 0 1 X X X X X X X X 16 1 1 0 1 X adventisthealth.org/lodimemorial/pages/mission/community-benefits.aspx X 1 14 1 adventisthealth.org/Documents/Community%20Benefits/CHP%202017/Final_2017_CH 0 1 X 200.000000000000 400.000000000000 X 1 1 X X X 1 X https://www.adventisthealth.org/pages/financial-assistance.aspx X https://www.adventisthealth.org/pages/financial-assistance.aspx X https://www.adventisthealth.org/pages/financial-assistance.aspx X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: LODI MEMORIAL HOSPITAL, - Facility 2: LODI MEMORIAL HOSPITAL - WEST Facility Reporting Group - A Part V, Section B, line 5: Lodi Health began the health needs assessment process by partnering with Harder+Company Community Research along with a full consortium of partners in the San Joaquin County area. This collaboration allowed for a more comprehensive assessment, along with the opportunity for synergy between health systems to more fully address key issues impacting the shared community.Harder+Company Community Research is known for excellence in conducting and facilitating community health needs assessments. By facilitating the process, clients are aided in the gathering of information that provides necessary information to enable the creation and implementation of plans designed to make positive change in their community. Through collaboration, the consortium was informed of common themes throughout the global area service area as well as disparities existing within local communities. Using this data enables the collaborative to work together to achieve social impact through meaningful program evaluation and strategic planning efforts.While Harder+Company Community Research led the process, the Core Planning Group included representatives from:- Dameron Hospital Association- Community Medical Centers- Community Partnerships for Families- First 5 San Joaquin- Health Net- Health Plan of San Joaquin- Kaiser Permanente- Lodi Health- San Joaquin County Public Health Services- St. Joseph's Medical Center- Sutter Tracy Community HospitalWorking in collaboration with other health systems, insurance companies, non-hospital health providers broadened the perspective and provided a more informed process for the work group. Interviews and secondary data collection was completed by the Harder+Company Community Research team. To evalutate both the global and local findings related to the Lodi Health PSA and SSA, two committees were formed and utilized at the hospital level, the: Hospital Health Needs Assessment Committee (HHNAC) an internal team of employees at Lodi Health; and the Community Health Needs Assessment Committee (CHNAC) External stakeholders with some HHNAC representation. The CHNAC consists of key public health and community leaders representing needs of the ommunity at large as well as minority and other at risk segments.The Community Health Needs Assessment Committee consisted of community leaders with demonstrated connections within the community. These leaders also brought the ability to identify opportunities for change based on population health data, and an intimate working knowledge of the market. The CHNAC met twice and provided additional input via e-survey on this CHNA.(SEE CONTINUATION FOR PROCESS DESCRIPTION) Facility Reporting Group - A Part V, Section B, line 6a: Members of the committee included: - Daniel Wolcott, CEO of Lodi Health - Jason Whitney, AVP of Business Development - Valerie Cronin, Director of Case Management - Chris Hagen, Spiritual Care Services - Desiree Magnant, Lodi Health Community Health Needs Assessment Coordinator - Barbara Alberson, Chief, State/Local Injury Control Section at CA Dept of Public Health - Jeff Hood, City of Lodi Parks and Recreation Director - Taj Khan, California Islamic Center President - Sally Snyde, WOW Science Museum - John Gordon, Galt School Board Member - Inez Kiriu, City of Galt - Joseph Woelfel, Director of Patient Care Clinic, University of the Pacific Facility Reporting Group - A Part V, Section B, line 11: AFTER PRIORITIZING THE HEALTH NEEDS, THE HOSPITAL AND ITS COMMUNITY PLANNING GROUP DETERMINED THAT RESOURCES WERE NOT AVAILABLE TO ADDRESS ALL EIGHT HEALTH PRIORITIES IDENTIFIED IN THE CHNA. IT PRIORITIZED ITS FOCUS TO THE TOP FIVE THAT WERE MOST ALIGNED WITH THE HEALTH SYSTEM'S CORE MISSION, CAPABILITIES AND RESOURCES. THOSE SELECTED TO BE ADDRESSED WERE ACCESS TO CARE, CULTURALLY APPROPRIATE CARE, HEALTH LITERACY AND HEALTH EDUCATION, ACCESS TO MENTAL HEALTH SERVICES AND SAFE AND AFFORDABLE PLACES TO EXERCISE. THOSE THAT WILL NOT BE DIRECTLY ADDRESSED ARE RELIABLE TRANSPORTATION, AFFORDABLE DENTAL SERVICES AND ACCESS TO HEALTHY FOOD.FACILITY REPORTING GROUP ASCH H, PART V, SECTION B, LINE 5, CONTINUATION:THE PROCESS:THE LODI HEALTH BOARD OF DIRECTORS' STRATEGICPLANNING COMMITTEE IS CHARGED WITH DEVELOPING AND MONITORING THE SYSTEM'S STRATEGIC PLAN. THEIR PROCESS IS:* ANNUALLY REVIEW THE EXTERNAL HEALTHCARE ENVIRONMENT, INCLUDING NEW AND UPDATED INFORMATION FROM THE: CALIFORNIA HEALTHCARE ASSOCIATION (CHA) "VIEW OF THE FUTURE" LATEST RELEASE; AMERICAN HOSPITAL ASSOCIATION (AHA) "VISION OF THE FUTURE" LATEST RELEASE; AND MAJOR NATIONAL, STATE AND LOCAL EVENTS THAT HAVE OR MAY AFFECT OUR LOCAL MARKET.* ANNUALLY REVIEW THE INTERNAL ENVIRONMENTS, INCLUDING: AUDITED FINANCIALS FOR THE LAST THREE YEARS FOR TRENDS; MARKETSHARE INFORMATION, FOR SYSTEM AND ALL BUSINESS LINES, I.E. INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, HOMEHEALTH AGENCY, ACUTEPHYSICAL REHABILITATION AND CLINICS; PAYER MIX BY SERVICE AND ZIP CODE; UTILIZATION DATA; LIST OF MAJOR EMPLOYEE, BOARD AND MEDICAL STAFF ISSUES CURRENTLY OPEN/IN PROGRESS; COMMUNITYNEEDS ASSESSMENT AND BENEFIT PLAN; QUALITY PERFORMANCE, CLINICAL AND PATIENT SATISFACTION; EMPLOYEE SATISFACTION; PHYSICIAN SATISFACTION; AND INFORMATIONTECHNOLOGY CAPABILITIES.* REVIEW THE FINDINGS AND RECOMMENDATIONS OF THE COMMUNITYNEEDS ASSESSMENT, CONDUCTED EVERY THREE YEARS, TO DETERMINE THE COMMUNITY'S HEALTH STATUS AND NEED FOR HEALTH SERVICES AND INTEGRATE THOSE INTO THE SYSTEM'S STRATEGIC PLAN. ANNUALLY, THE NEEDSASSESSMENT FINDINGS SHALLBE REVISITED PRIOR TO EACH APRIL MEETING TO ASSESS WHETHER LODI HEALTH, WITHIN THE REALM OF ITS RESOURCES, CAN OR SHOULD DEVELOP PROGRAMS AND SERVICES TO MEET COMMUNITY NEED AND/OR WORK WITH OTHER LOCAL HEALTH PROVIDERS, SCHOOLS AND ORGANIZATIONS TO MEET COMMUNITYHEALTH NEEDS FOR WELLNESS, PREVENTION AND TREATMENT.* ANNUALLY REVIEW THE SYSTEM MISSION, VISION AND VALUES FOR BOARD APPROVAL AT ITS MAY MEETING.* ANNUALLY DEVELOP LONG AND SHORTTERM GOALS AND OBJECTIVES FOR SUBMISSION TO THE BOARD FOR APPROVAL. 8 1 - LODI MEMORIAL HOSP HOME HEALTH AGENCY 800 S LOWER SACRAMENTO RD lodi CA 95242 HOME HEALTH AGENCY 2 - LODI MEMORIAL COMM CLINIC - MILLSBRIDGE 1901 KETTLEMAN LANE SUITE 200 lodi CA 95242 COMMUNITY CLINiC 3 - LODI OUTPATIENT SURGERY CENTER 521 S HAM LANE LODI CA 95242 Ambulatory Surgical Centers 4 - Endoscopy Center of Lodi LLC 840 S FAIRMONT AVE SUITE 1 LODI CA 95240 AMBULATORY SURGERY CENTER 5 - LODI MEMORIAL COMMUNITY CLINIC - VINE 1235 W VINE ST SUITE 22 lodi CA 95240 COMMUNITY CLINiC 6 - ADV IMAGING CENTER AT LODI MEM HOSP LLC 1031 S FAIRMONT AVENUE lodi CA 95240 DIAGNOSTIC IMAGING OUTPATIENT CENTER 7 - LODI MEMORIAL SURGICAL GROUP 999 S FAIRMONT AVENUE SUITE 100 LODI CA 95240 COMMUNITY CLINC 8 - LODI MEMORIAL COMMUNITY CLINIC - TRINITY 10200 TRINITY PARKWAY SUITE 102 Stockton CA 95219 COMMUNITY CLINiC Part I, Line 7: COST IS ASSIGNED UTILIZING OUR INTERNAL COST ACCOUNTING SYSTEM (EPSI). COST IS ESTIMATED BY UTILIZING RELATIVE VALUE UNITS ASSIGNED TO EACH PRODUCT (I.E. CHARGEABLE TEST, SUPPLY, OR PROCEDURE). EACH PRODUCT'S RELATIVE VALUE IS ESTIMATED BY EACH DEPARTMENT DIRECTOR BASED ON RESOURCES EXPENDED FOR EACH DEPARTMENT PRODUCT. DEPARTMENT COSTS ARE ALLOCATED TO EACH PRODUCT BASED ON ACCUMULATED RELATIVE VALUES. EACH PATIENT ACCUMULATES PRODUCTS DURING THEIR VISIT. THE TOTAL COST FOR EACH PATIENT REPRESENTS THE SUM OF ALL THE PRODUCTS PROVIDED TO THEM DURING THEIR VISIT OR INPATIENT STAY. THE ABOVE method IS THE CALCULATION FOR HOSPITAL CHARGES. FOR COMMUNITY CLINICS, HOSPITAL BASED CLINICS, HOSPITAL BASED HOME HEALTH AGENCY AND TWO SURGERY CENTER JOINT VENTURES A COST TO CHARGE RATIO WAS CALCULATED BASED ON THE DIRECT COSTS OF THESE LINES OF BUSINESS. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 20,855,114. Part II, Community Building Activities: SAN JOAQUIN COUNTY IS AMONG THE MOST DIFFICULT COUNTIES IN THE STATE WHEN IT COMES TO RECRUITING PHYSICIANS TO PRACTICE MEDICINE, AND THE HOSPITAL DEVOTES SIGNIFICANT FINANCIAL AND HUMAN RESOURCES TO THAT EFFORT. CURRENTLY THE HOSPITAL IS ATTEMPTING TO ESTABLISH A RESIDENCY PROGRAM IN CONJUNCTION WITH THE LOCAL COUNTY HOSPITAL, A TEACHING FACILITY, IN HOPES THAT ONCE PHYSICIANS COME TO PRACTICE HERE THEY WILL APPRECIATE THE REGION AND STAY AND ESTABLISH MEDICAL PRACTICE OR AFFILIATE WITH AN EXISTING PRACTICE. TOTAL PHYSICIAN RECRUITMENT COSTS = $334,606; OTHER HARD TO FILL RECRUITMENT COSTS = $30,317 Part III, Line 3: WE PROVIDED CARE TO ALL WHO PRESENT THEMSELVES IN OUR EMERGENCY ROOM, WITHOUT ASKING FOR PROOF OF INSURANCE. IN THE THIRD YEAR OF THE ACA OUR UNINSURED POPULATION HAS INCREASED. UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGIBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE. OFTEN THE INFORMATION GATHERED IN THE MEDICAID APPLICATION WILL MAKE THIS DETERMINATION "AUTOMATIC". IF ADDITIONAL INFORMATION IS REQUIRED WE ATTEMPT TO CONTACT THE PATIENT. THOSE THAT DO NOT RESPOND WILL BE SENT TO A COLLECTION AGENCY AFTER 120 DAYS AND 4 STATEMENTS. WE ESTIMATE 30% OF OUR BAD DEBT EXPENSE SHOULD BE CONSIDERED CHARITY CARE. Part III, Line 4: COSTING METHODOLOGY:UTILIZING THE PREVIOUS COSTING METHODOLOGY AS OUTLINED IN RESPONSE TO PART I LINE 7, ALL PATIENTS ARE ASSIGNED A PAYOR CLASS (I.E. CHARITY, SELF PAY, MEDICARE, MEDI-CAL, MANAGED CARE). THE COST BY PAYOR IS A SUMMATION OF ALL PATIENTS IN THE ASSIGNED PAYOR CLASS. THE AMOUNTS WRITTEN OFF AS BAD DEBT (ASSIGNED TO A COLLECTION AGENCY) ARE NET OF ANY APPLICABLE PAYMENTS OR DISCOUNTS. ANY PAYMENTS RECEIVED AFTER AN ACCOUNT IS ASSIGNED TO A COLLECTION AGENCY REDUCE THE BAD DEBT EXPENSE IN THE PERIOD RECEIVED.OF THE TOTAL UNINSURED PATIENTS SEEN THIS YEAR: 25% QUALIFIED FOR CHARITY CARE AND 75% WERE WRITTEN OFF TO BAD DEBTS. IT IS DIFFICULT TO ASCERTAIN HOW MANY UNINSURED WRITTEN OFF TO BAD DEBTS WOULD QUALIFY FOR CHARITY CARE. ALL BAD DEBT WRITE OFFS ARE SENT TO A COLLECTION AGENCY. IF AN ACCOUNT QUALIFIES FOR CHARITY CARE AFTER BEING SENT TO AN AGENCY, NO FURTHER COLLECTION ACTIVITY IS PURSUED AND THE "BAD DEBT" ACCOUNT IS WRITTEN OFF IN FULL - WE HAVE NOT TRACKED THESE IN THE PAST AS PART OF OUR CHARITY CARE EXPENSE BUT ESTIMATE AT LEAST 30% OF OUR BAD DEBT COSTS REPRESENTS CHARITY CARE. UNCOMPENSATED CARE AND COMMUNITY BENEFIT COSTS:OUR POLICY IS TO PROVIDE SERVICE TO ALL WHO REQUIRE IT, REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, WE PROVIDE SUBSTANTIAL AMOUNTS OF UNCOMPENSATED CARE. WHEN THIS CARE IS PROVIDED TO PATIENTS WHO LACK FINANCIAL RESOURCES AND THEREFORE ARE DEEMED MEDICALLY INDIGENT, IT IS CLASSIFIED AS CHARITY CARE. WHEN IT IS PROVIDED TO PATIENTS WHO HAVE THE MEANS TO PAY, BUT DECLINE TO DO SO, IT IS CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS. SOME UNDETERMINED PORTION OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS REPRESENTS CARE TO INDIGENT PATIENTS WHO WE HAVE BEEN UNABLE TO IDENTITY AS CHARITY. CHARITY CARE CHARGES ARE NOT REFLECTED IN NET PATIENT SERVICE REVENUES. IN ADDITION, WE PROVIDE SERVICES TO POOR AND UNDERSERVED PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, INCLUDING PATIENTS INSURED UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS THAT ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND FREQUENTLY THE PAYMENTS ARE LESS THAN THE COSTS OF RENDERING THE SERVICES.PATIENT ACCOUNTS RECEIVABLE:PATIENT ACCOUNTS RECEIVABLE FOR SERVICES PROVIDED TO PATIENTS COVERED UNDER THE MEDICARE AND MEDICAID (MEDI-CAL IN CALIFORNIA) PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS (INCLUDING SELF-PAY) ARE RECORDED AT THEIR ESTIMATED REALIZABLE VALUE BASED ON CONTRACTUAL BILLING RATES OR OUR STANDARD BILLING RATES FOR OUR NON CONTRACTED PAYORS. WE REGULARLY REVIEW ACCOUNTS AND CONTRACTS AND PROVIDE APPROPRIATE ESTIMATES OF CONTRACTUAL ALLOWANCES THAT ARE THEN NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE. WE ALSO PROVIDE AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON OUR EVALUATION OF THE AGING OF OUR PATIENT ACCOUNTS RECEIVABLE, OUR HISTORICAL COLLECTION EXPERIENCE FOR EACH TYPE OF PAYOR AND OTHER RELEVANT FACTORS.OUR PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSISTS OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. WE GRANT CREDIT WITHOUT COLLATERAL TO OUR PATIENTS AND THIRD PARTY PAYORS. Part III, Line 8: THE COSTS OF PROVIDING CARE TO MEDICARE RECIPIENTS OFTEN EXCEED THE GOVERNMENT'S REIMBURSEMENT FOR THESE SERVICES. FOR COSTS ASSIGNED TO MEDICARE PATIENTS, PLEASE SEE RESPONSE IN PART III, LINE 4.COST TO CHARGE RATIOS (CCR) FROM THE FILED COST REPORT WERE UTILIZED TO CALCULATE MEDICARE COSTS. MEDICARE REVENUES FOR THESE SERVICES WERE $49,743,048; COSTS WERE $52,524,640.THE ALLOWABLE COSTS WERE CALCULATED ON THE COST REPORT BASED ON COST TO CHARGE RATIOS BY DEPARTMENT. Part III, Line 9b: UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGIBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE (FINANCIAL ASSISTANCE) POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE (FINANCIAL ASSISTANCE). Part VI, Line 2: EVERY THREE YEARS LODI MEMORIAL HOSPITAL ASSESSES COMMUNITY HEALTH NEEDS BY 1)CONSULTING WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY GROUPS TO REVIEW THE NEEDS OF EACH CONSTITUENCY; 2)REVIEWING SERVICE-AREA MORBIDITY AND MORTALITY HEALTH DATA PROVIDED BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES; 3)COMPILING SOCIO-ECONOMIC DATA TO DETERMINE WHERE THE GREATEST NEEDS EXIST WITHIN THE HOSPITAL-SERVICE AREA; AND 4)ASKING AREA RESIDENTS TO COMPLETE A HEALTH SURVEY REGARDING THEIR PERSONAL HEALTH AND NOTIONS ABOUT GOOD HEALTH. ONCE THE DATA IS COLLECTED, IT IS REVIEWED AND ASSESSED BY THE HOSPITAL'S COMMUNITY ADVISORY BOARD, BOARD OF DIRECTORS AND HOSPITAL MANAGERS TO DETERMINE WHAT SERVICES AND GAP AREAS MAY NEED ENHANCING OR ADDRESSING TO IMPROVE HEALTH WITHIN THE REALM OF THE HOSPITAL'S RESOURCES TO DO SO. Part VI, Line 3: SIGNS ARE PROMINENTLY POSTED IN THE ADMISSIONS, EMERGENCY AND BILLING DEPARTMENTS OF THE HOSPITAL, IN ADDITION TO ALL THE HOSPITAL CLINICS, TO ADVISE PATIENTS AND VISITORS THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND HOW TO WORK WITH HOSPITAL STAFF TO OBTAIN IT. THE SAME INFORMATION IS INCLUDED IN PATIENT-ADMISSION PACKETS AND POSTED ON THE HOSPITAL WEBSITE. HOSPITAL CASE MANAGERS ARE VIGILANT OF PATIENTS NEEDING FINANCIAL ASSISTANCE AND FOLLOW UP WITH THOSE IN NEED. FINANCIAL ASSISTANCE INCLUDES APPLYING FOR MEDICAID AS WELL AS CHARITY CARE. Part VI, Line 4: NEARLY ALL OF THE INDIVIDUALS SEEKING CARE FROM LODI MEMORIAL HOSPITAL RESIDE IN ONE OF FIVE COUNTIES: SAN JOAQUIN, SACRAMENTO, SOLANO, AMADOR, AND CALAVERAS. ABOUT HALF OF THE HOSPITAL'S PATIENTS RESIDES WITHIN A FIVE-MILE RADIUS OF THE HOSPITAL IN SAN JOAQUIN COUNTY. GEOGRAPHICALLY, THE HOSPITAL SITS AT THE NORTHERN END OF THE SAN JOAQUIN VALLEY WHERE THE RESIDENTS ARE AMONG THE POOREST AND LEAST EDUCATED OF ALL THE STATE'S COUNTIES. IN ADDITION, SAN JOAQUIN COUNTY HAS AMONG THE WORST UNEMPLOYMENT RATES IN THE STATE'S COUNTIES; NEARLY TWO IN 10 RESIDENTS ARE UNEMPLOYED. ALSO SAN JOAQUIN COUNTY IS GROUND-ZERO FOR THE MORTGAGE CRISIS IN THIS COUNTRY. THE COUNTY IS ALSO AMONG THE MOST VIOLENT COUNTIES IN WHICH TO LIVE IN THE COUNTRY DUE TO SIGNIFICANT GANG ACTIVITY, LOW LEVELS OF EDUCATION, AND POVERTY. HOSPITAL PATIENTS REPRESENT DIVERSITY: ABOUT 40 PERCENT ARE HISPANIC, WITH MANY OF THOSE PATIENTS BEING MONOLINGUAL SPANISH SPEAKERS. ANOTHER THREE PERCENT ARE PAKISTANI, MANY OF WHOM SPEAK ONLY URDU OR PASHTU. ADDITIONALLY THERE IS A SIGNIFICANT POPULATION OF HOSPITAL PATIENTS WHO ARE GREATER THAN 80 YEARS OF AGE. THE MAJOR HEALTH ISSUES OF PATIENTS ARE HEART DISEASE, STROKE, CANCER, DIABETES AND OBESITY. Part VI, Line 5: THE HOSPITAL CONDUCTS A MYRIAD OF ACTIVITIES TO PROMOTE COMMUNITY HEALTH. THOSE ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO: HEALTH FAIRS WITH FREE MEDICAL SCREENINGS FOR HIGH CHOLESTEROL, HIGH-BLOOD PRESSURE, DIABETES AND LOW-OXYGEN SATURATION LEVELS; REFERRALS TO FREE CLINICS OR LOCAL PHYSICIANS FOR THOSE WITH HIGH VALUES; A VARIETY OF LINKED VIDEOS TO THE HOSPITAL WEB PAGE, FACEBOOK PAGE, YOUTUBE PAGE, AND TWITTER RELATED TO HEALTH EDUCATION AND PREVENTION; A WELLNESS PROGRAM FOR HOSPITAL EMPLOYEES THAT IS ROOTED IN EXERCISE AND NUTRITION SO THAT EMPLOYEES MAY LEAD BY EXAMPLE; A MONTHLY NUTRITION COLUMN IN THE LOCAL NEWSPAPER; HOSPITAL STAFF SERVING ON THE BOARDS OF REGIONAL NGOS; DONATIONS OF MATERIALS AND EQUIPMENT TO NGOS; EMPLOYEE DONATIONS OF FOOD AND CLOTHING TO THE NEEDY. THE HOSPITAL IS ALSO THE SECOND LARGEST YEAR-ROUND EMPLOYER IN LODI, WITH EMPLOYEES REINVESTING THEIR EARNINGS IN THE LOCAL ECONOMY. THE HOSPITAL HAS ALSO ADOPTED THE MOST IMPOVERISHED, LARGEST AND MOST DIVERSE SCHOOL IN THE LOCAL SCHOOL DISTRICT TO HELP EDUCATE STUDENTS, PARENTS AND TEACHERS IN PREVENTION. IN THAT EFFORT, THE HOSPITAL HOSTS AT THE SCHOOL HEALTH AND EDUCATION FAIRS; PARTICIPATES IN CLASSROOM TEACHING AND HEALTH DEMONSTRATIONS; AND PARTICIPATES IN CAREERS FAIRS AT THE SCHOOL. DUE TO HAND-WASHING EDUCATION ALONE, THE SCHOOLS ABSENTEE RATES HAVE DECLINED DRAMATICALLY. FOR STUDENTS TO LEARN, THEY MUST BE IN SCHOOL; AND FOR SCHOOLS TO RECEIVE STATE FUNDING, THEY MUST MAINTAIN THEIR ATTENDANCE. Part VI, Line 6: 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. Part VI, Line 7, Reports Filed With States CA 1 CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K St ste 800 sacramento CA 95814 941498697 501(c)(3) 42704 HOSPITAL QA FEE PROGRAM PLEDGES 1 0 Part I, Line 2: Through the use of temporarily restricted accounts, we track and monitor the incoming receipts from grants and the utilization of grant funds. Each grant is tracked separately. Should the grantor agency require specific reports, we comply with their reporting requirements. THE GRANTS WE MONITOR ARE SPECIFIC TO THE GRANTOR'S NEEDS AND REQUESTS. X X X X 0 1 0 0 0 0 0 0 0 DICKINSON CHARLES AHSW Director 0 184932 0 0 0 32532 0 0 0 0 0 217464 0 0 REINER SCOTT AHSW Director/Chair 0 1018912 0 299575 0 393047 0 249575 0 36698 0 1997807 0 326648 WING BILL AHSW Director/Vchair/Asst Sec 0 855884 0 253689 0 209482 0 203961 0 34394 0 1557410 0 155912 JOBE MEREDITH AHSW Secretary 0 364469 0 95028 0 92588 0 74172 0 25651 0 651908 0 56774 WAGNER JACK AHSW Asst Sec 0 698200 0 200386 0 219119 0 16384 0 25442 0 1159531 0 0 WOLCOTT DANIEL AHSW President/CEO 0 370180 0 115875 0 24881 0 16180 0 37537 0 564653 0 0 DEAK TERRENCE Thru 93016 AHSW VP/CFO/Asst Sec 0 169332 0 50321 0 25598 0 14627 0 18344 0 278222 0 0 ZIEGELE PAUL AHSW VP/CFO 0 121225 0 5000 0 15020 0 6811 0 14395 0 162451 0 0 MORENO DEBBE AHSW VP/CNO 0 206307 0 43890 0 10750 0 15880 0 21742 0 298569 0 0 WHITNEY JASON VP Ops/AVP Bus Dev Integration 151271 0 24578 0 465 0 4005 0 25760 0 206079 0 0 0 BROWN MARY RN Supervisor/Nursing Admin 208761 0 0 0 0 0 10703 0 27907 0 247371 0 0 0 BECK ATWATER SANDRA Director Hospital Pharmacy 186075 0 7500 0 504 0 9421 0 18379 0 221879 0 0 0 LOEHRER HEIDI RN Manager/Surgery 170168 0 0 0 213 0 9006 0 27907 0 207294 0 0 0 WALLACE MARK Director Human Resources 161198 0 7500 0 504 0 8423 0 27907 0 205532 0 0 0 WALLACE KENT Director Perioperative Services 165760 0 0 0 465 0 8039 0 25760 0 200024 0 0 0 GILL PARAMPAL MD Former Board Member 308445 0 0 0 0 0 0 0 0 0 308445 0 0 0 McLOUGHLIN TRAVERS MD Former Board Member 16320 0 0 0 0 0 0 0 0 0 16320 0 0 0 SORBERA THOMAS MD Former Board Member 84690 0 0 0 0 0 0 0 0 0 84690 0 0 0 HARRINGTON JOSEPH AHSW Former President/CEO 0 106708 0 255520 0 59664 0 16180 0 4099 0 442171 0 0 Part I, Line 4b PRIOR TO AFFILIATION WITH ADVENTIST HEALTH, LMH HAD A 457(F) SERP WHICH IS LIMITED TO SELECT MEMBERS OF THE BOARD OF DIRECTORS OR AN AUTHORIZED OFFICER. THE AMOUNT OF THE DEFERRED SPECIFIED IN THE PARTICIPANT'S PARTICIPATION AGREEMENT OR, IF NOT SO MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. PARTICIPANTS ARE SELECTED BY COMPENSATION UNDER THE PLAN FOR A PARTICIPANT FOR A PLAN YEAR SHALL BE SPECIFIED, THE AMOUNT DETERMINED BY THE EMPLOYER FOR SUCH PLAN YEAR IN THE EMPLOYER'S SOLE AND ABSOLUTE DISCRETION. A PARTICIPANT BECOMES FULLY VESTED IN THE PARTICIPANT'S ACCOUNT UPON THE EARLIEST OF NORMAL RETIREMENT, DATE OF DEATH OR DATE OF DISABILITY WHILE STILL AN EMPLOYEE, DATE OF TERMINATION OR DEMOTION BY THE EMPLOYER IF THE EVENT OCCURS WITHIN THE TWELVE MONTH PERIOD FOLLOWING A CHANGE IN CONTROL, THE EMPLOYER'S INVOLUNTARY TERMINATION OF THE PARTICIPANT'S EMPLOYMENT WITHOUT CAUSE. IF THE PARTICIPANT CEASES TO BE AN EMPLOYEE PRIOR TO BECOMING FULLY VESTED, THE EMPLOYEE SHALL NOT BE ENTITLED TO ANY BENEFIT UNDER THIS PLAN. ANY AMOUNTS CREDITED TO A PARTICIPANT'S ACCOUNT THAT ARE NOT VESTED AT THAT TIME SHALL BE FORFEITED. DISTRIBUTIONS UNDER THE PLAN COMMENCE WITHIN 90 DAYS FOLLOWING VESTING AND NOT LATER THAN MARCH 15 OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR OF VESTING. JOSEPH P HARRINGTON, RETIRING CEO, SERP PAID OUT = $244,480 A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. REINER, SCOTT - $326,648 WING, BILL - $155,912 JOBE, MEREDITH - $56,774 Additional Information: The directors serve on the Board without compensation. Amounts reported generally are for taxable benefits. Further explanation for those directors who receive compensation for services rendered in their professional capacity is discussed for each individual as applicable. Mr. Dickinson was on the Board until June 1, 2016 at which time he tendered his resignation to accept a full-time position at Adventist Health System/West as the VP, Business Solutions. Wesley Rippey, MD is the Chief Medical Officer for Portland Adventist Medical Center. The hospital paid Dr. Rippey $66,000 for his CMO services. Additionally, Dr. Rippey provides vascular study interpretations and on call coverage for patients of the hospital. The hospital paid $61,909 for these professional services. These services were provided under contracts approved by the Board Compliance Committee. P GILL OBSTETRICS AND GYNECOLOGY >35% owned partnership by Parampal Gill, Current Board Member 206467 PHYSICIAN PROFESSIONAL SERVICE-OB CLINIC, PHYSICIAN RECUITMENT 0 Form 990, Part VI, Section A, line 6 The hospital is organized as a not-for-profit public benefit 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, Section A, line 7a The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital. Form 990, Part VI, Section A, line 7b The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Section B, line 11b The completed Form 990 is shared with members of the hospital'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 after their review but prior to filing. Form 990, Part VI, Section B, line 12c 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, Section B, line 15 THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE, WHO REVIEWS THE CEO'S PERFORMANCE AND COMPENSATION AT LEAST ANNUALLY WHOSE SPECIFIC RESPONSIBILITIES INCLUDE: SCHEDULING AND COMPLETING AN ANNUAL REVIEW OF THE CEO'S PERFORMANCE, REVIEWING AND ESTABLISHING PERFORMANCE CRITERIA FOR THE CEO, AN ANNUAL REVIEW OF THE CEO'S JOB DESCRIPTION, SOLICITING INPUT FROM OTHER SOURCES ON CEO PERFORMANCE, ANNUALLY REVIEWING MARKET AREA COMPENSATION AND BENEFITS FOR HOSPITAL CEO TO DETERMINE FAIR MARKET VALUE COMPENSATION, ANNUALLY PROVIDE VERBAL AND WRITTEN FEEDBACK TO CEO ON PERFORMANCE. THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE THAT ALSO ESTABLISHES A COMPENSATION PHILOSOPHY FOR CEO AND SENIOR MANAGEMENT, REVIEWS AND APPROVES THE CEO RECOMMENDATION FOR CAO, CNO, CFO AND VP COMPENSATION AND REVIEWS AND APPROVES MANAGEMENT COMMITTEE INCENTIVE COMPENSATION. IN ADDITION, LODI MEMORIAL HOSPITAL (LMH) PARTICIPATES IN AN ANNUAL COMPENSATION SURVEY SPONSORED BY THE CALIFORNIA HOSPITAL ASSOCIATION, THE HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA AND THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA. LMH SUBMITS THEIR WAGE AND SALARY DATA TO AN INDENDENDENT THIRD PARTY WHICH PRODUCES A REPORT BY JOB TITLE AND JOB DESCRIPTION THAT COMPARES SALARIES BY REGION WITHIN CALIFORNIA FOR ALL HOSPITALS WHO PARTICIPATE IN THE SURVEY. Form 990, Part VI, Section C, line 19 AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST. PART VII, SECTION A, LINE 1A Lodi Memorial Hospital operates community clinics as defined by the California Health and Safety Code Section 1204(a). The Hospital enters into employment agreements with physicians for the professional services provided in the community clinics to the uninsured and underinsured populations in the community. Form 990, Part IX, line 11g Physician fees: Program service expenses 14,791,301. Management and general expenses 5,520,622. Fundraising expenses 0. Total expenses 20,311,923. Repairs & maintenance: Program service expenses 2,782,524. Management and general expenses 1,038,534. Fundraising expenses 0. Total expenses 3,821,058. Professional management fees: Program service expenses 4,244,315. Management and general expenses 1,584,123. Fundraising expenses 0. Total expenses 5,828,438. Other professional fees: Program service expenses 6,150,232. Management and general expenses 2,486,855. Fundraising expenses 25,817. Total expenses 8,662,904. Form 990, Part XI, line 9: INCOME OF SUBSIDIARY - VITAL -245,860. INCOME OF SUBSIDIARY - LRHS -93,924. BOOK/TAX K-1 DIFFERENCES 397,651. Adventist Health Clearlake Hospital Inc 15630 18th Ave Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health System West 0 Castle Medical Center 640 Ulukahiki St Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 1 Adventist Health System West 0 Central Valley General Hospital 1025 N Douty St Hanford CA 93230 770324630 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Feather River Hospital 5974 Pentz Rd Paradise CA 95969 941101228 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Glendale Adventist Medical Center 1509 Wilson Ter Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Hanford Community Hospital 115 Mall Dr Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Northwest Med Fnd of Tillamook 1000 Third St Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 1 Adventist Health System West 0 Paradise Valley Hospital 2100 Douglas Blvd Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health System West 0 Portland Adventist Medical Center 10123 SE Market St Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 1 Adventist Health System West 0 St Helena Hospital 10 Woodland Rd St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Simi Valley Hospital & Health Care Serv 2975 N Sycamore Dr Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Sonora Community Hospital 1000 Greenley Rd Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Ukiah Adventist Hospital 275 Hospital Dr Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Walla Walla General Hospital 1025 S Second Ave Walla Walla WA 99362 910617726 Hospital WA 501(c)(3) Line 1 Adventist Health System West 0 White Memorial Medical Center 1720 Cesar E Chavez Ave Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Adventist Health Physicians Network 2100 Douglas Blvd Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) Line 12b, II Adventist Health System West 0 Adv Hlth So California Med Fnd 2100 Douglas Blvd Roseville CA 95661 954424391 Discontinued Operations CA 501(c)(3) Line 12c, III-FI Adventist Health System West 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Reedley Community Hospital 372 W Cypress Ave Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 1 Adventist Health System West 0 Western Health Resources 2100 Douglas Blvd Roseville CA 95661 953867863 Home Care CA 501(c)(3) Line 1 Adventist Health System West 0 Adventist Health System West 2100 Douglas Blvd roseville CA 95661 953484589 Integrated Health System CA 501(c)(3) Line 1 N/A 0 ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC (AIC) 1001 S FAIRMONT AVE lodi CA 95240 943407786 Diagnostic Imaging / MRI Outpatient Treatment Center CA N/A related -80445 421139 0 0 0.51000 LODI SURGICAL VENTURES LLC (LSV) 975 S FAIRMONT AVE LODI CA 95240 454239289 Maj. owner of LLC operating Ambulatory Surgery Centers CA N/A related -19682 0 1 ARTEL LLC 521 S HAM LANE LODI CA 95240 263513966 Ambulatory Surgical Centers CA Lodi Memorial Hospital Association Inc related -474349 1757215 0 0 0.78000 VITAL ENTERPRISES DBA MEMORIAL HOME MED-EQUIP 1115 S Fairmont Ave Suite 1 lodi CA 95240 680021729 Durable Medical Equipment Company CA N/A C 165424 373713 1.00000 1 LODI REGIONAL HEALTH SYSTEMS INC 975 S Fairmont Ave lodi CA 95240 680398894 Physician Management and Medical Office Building development & Management CA N/A C 1532410 13596505 1.00000 1 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 LODI REGIONAL HEALTH SYSTEMS INC O 301946 fMV VITAL ENTERPRISES O 255293 fMV VITAL ENTERPRISES Q 320430 FMV LODI REGIONAL HEALTH SYSTEMS INC K 108705 FMV LODI REGIONAL HEALTH SYSTEMS INC D 3616342 Outstanding Loan Balance LODI REGIONAL HEALTH SYSTEMS INC P 395454 FMV Artel LLC B 2293884 FMV VITAL ENTERPRISES A 31104 FMV