2015-11-18T18:37:41-08:00 2014-12-31 990 2014-01-01 941415069 Sonora Community Hospital dba Sonora Regional Medical Center SONO 2095325000 1000 Greenley Rd Sonora CA 95370 Gregory McCulloch Treas/CFO/VPFin 2015-11-18 2014 2016-03-07 17:11:31Z Andrew Jahn 1000 Greenley Rd Sonora CA 95370 236852713 false false 1071 X www.sonoramedicalcenter.org X 1958 CA The hospital mission is to provide our community with physical, mental, and spiritual healing in a way that reflects God's love for all. 13 8 1565 184 139769 9832 1389535 1339443 207351153 233307879 1593058 1872007 250646 281702 210584392 236801031 160644 1103340 0 94878237 100996577 87172 2000 497606 100639115 112285742 195765168 214387659 14819224 22413372 143898807 158916445 64896691 60499596 79002116 98416849 To share Gods love by providing physical, mental and spiritual healing. false false 189406285 1103341 230110090 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.Inpatient services in 2014 were provided to approximately 5,494 patients. These services included:- Babies: 533 deliveries- Surgeries: 3,175 hours- Radiology: 13,158 procedures - Laboratory tests: 153,283 tests Outpatient services in 2014 were provided to about 287,000 patients. Including:- Emergency room: 27,565 visits- Outpatient surgeries: 4,574 hours- Radiology procedures: 70,008 performed- Laboratory tests: 279,363 performed- Medical clinics: 173,010 visitsSonora Community Hospital provides home care services in its surrounding communities. In 2014, we made 33,691 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 2014, we provided 12,287 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 4,000 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 $29,205 to 28 non-profit community service organizations in 2014. 189406285 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 true true false false false false false false false false false false false false false false false false true false false false false true 183 0 true 1565 true true true false false false false true true false 0 false false false false false false false false false false X 13 8 false false false false true false true true true false false true true true true true true true true false X Greg McCulloch 2095325000 1000 Greenley Rd Sonora CA 95370 X Larry Caviness Director 0.00 2.00 X 0 3081 0 Charles Dickinson Director 0.00 2.00 X 0 6340 0 Ruthita Fike Director 0.00 2.00 X 0 2050 0 Christine Friestad Director 0.00 2.00 X 0 2557 0 Melody Gabriel Director 0.00 2.00 X 0 2388 0 Ricardo Graham Director 0.00 2.00 X 0 7573 0 Kerry Heinrich Director 0.00 2.00 X 0 0 0 Larry Innocent Director 0.00 2.00 X 0 2388 0 Helmuth Jones Director 0.00 2.00 X 0 83882 0 Allan Reimche Director 0.00 2.00 X 0 3958 0 Wesley Rippey Director 0.00 2.00 X 0 116805 0 Max Torkelsen Director 0.00 2.00 X 0 3731 0 Robert Carmen Dir/Chair 0.00 50.00 X X 0 440880 14928 Scott Reiner Dir/Chair 0.00 50.00 X X 0 1256086 211057 Bill Wing Dir/VCh/AsstSec 0.00 50.00 X X 0 903909 198325 Meredith Jobe Esq Secretary 0.00 50.00 X 0 432115 83255 Jack Wagner Asst Secretary 0.00 50.00 X 0 535352 27472 Douglas Rebok Asst Secretary 0.00 50.00 X 0 800609 156007 Rodney Wehtje Asst Treasurer 0.00 50.00 X 0 1607163 97250 Jeff Eller President/CEO 50.00 0.00 X 0 737409 132908 Andrew Jahn Pres/CEO/Treas 50.00 0.00 X 0 365024 76907 Gregory McCulloch Treas/CFO/VPFin 50.00 0.00 X 0 255995 43218 Julie Kline Sr VP Pt Care Svcs 50.00 0.00 X 0 291425 52862 Michelle Fuentes VP Operations 50.00 0.00 X 0 206240 28915 Rick Dodds VP HR 50.00 0.00 X 0 35985 4875 Edward Clinite CMO 20.00 0.00 X 323536 0 0 Jeph Solo Lead Surgery RN 53.00 0.00 X 211281 0 22444 Nickolas Dobler Physician Assist 50.00 0.00 X 181430 0 19487 John Frank Pharmacist 41.00 0.00 X 181346 0 23929 Susan Shinkai Pharmacist 38.00 0.00 X 176328 0 19989 Katherine Anderson Registered Nurse 48.00 0.00 X 175407 0 19907 1249328 8102945 1233735 163 false true false Sierra Emergency Medical Group PO Box 4685 Sonora CA 95370 Medical Group 3247387 Sonora Anesthesia Services PO Box 845 Sonora CA 95370 Medical Group 992276 Medical Solutions 1010 N 102nd Street Omaha NE 68114 Temporary Staffing 1096522 Sound Inpatient Physicians 1123 Pacific Ave Tacoma WA 98402 Medical Group 1279526 Adventisth Health Physicians Network 2100 Douglas Blvd Roseville CA 95661 Medical Group 954558 73 1680 29200 43174 1265389 1339443 Dietary Service Revenue 722210 547564 547564 EMR Incentives 900099 1652545 1652545 Patient Service Revenue 900099 226954740 226954740 Pharmacy 446110 3646453 3646453 Rent - Medical Offices 531120 413880 413880 92697 92697 233307879 1423343 1423343 0 0 0 454144 5480 448664 448664 448664 188135 29200 46202 141933 141933 0 0 Company Store 621990 16444 16444 Retail Pharmacy 446110 78436 78436 Sonora Oxygen Service 621610 43689 43689 1200 1200 139769 236801031 230110090 139769 5211729 X 962870 962870 140470 140470 0 0 137500 137500 0 73885649 66073197 7642949 169503 2829121 2829121 18812828 16608986 2168318 35524 5331479 4785890 533313 12276 0 584961 584961 509649 509649 0 2000 2000 0 26766042 26440584 325458 478432 478432 2735596 1852248 860857 22491 8762630 8585503 174180 2947 0 6375081 5920822 454259 667568 431507 234853 1208 0 231260 179167 51482 611 1706987 1706987 0 5985612 5965937 17815 1860 1198562 1198562 Pt care supplies 33566036 33566036 Purchased services 21776642 11194168 10333288 249186 Miscellaneous 539555 441947 97608 Equipment rentals 401129 384783 16346 0 214387659 189406285 24483768 497606 474304 1105529 48374492 59340670 488790 28037294 27383757 0 0 0 3015586 3320424 1054111 857727 114361383 60592603 55902842 53768780 1455875 1420956 0 0 433978 5584303 10795834 143898807 158916445 11613140 12943121 449736 170434 3052818 2742997 49780997 44643044 64896691 60499596 X 77948071 96441031 1054045 1975818 79002116 98416849 143898807 158916445 X 22413372 -2998639 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 5230 5230 false false Part II-B, Line 1i - Other Activities Description A portion of industry association dues is allocated to lobbying activities. 1054045 1389642 140470 327399 1975818 993956 514739 134134 320516 1054045 887815 497849 98743 292965 993956 905304 378471 50891 345069 887815 708131 538837 341664 905304 1.00000 false false false 6197795 6197795 59478725 26470403 33008322 3379772 2178931 1200841 37661384 29799552 7861832 7643707 2143717 5499990 53768780 Other receivables 180381 Receivables from 3rd party payors 9352039 Receivables from related orgs 1263414 10795834 Other liabilities 184670 Payables to related orgs 37700785 Workers' comp liability 6757589 44643044 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 138525 23200 115325 2800 14638 200 9762 Golf Tournament 78810 6000 72810 1500 4633 10350 2319 217335 29200 188135 1500 4633 13150 14638 200 12081 46202 141933 true true X true X 300.000000000 true X true true false false true true 1234890 1234890 0.00580 39022380 49742457 -10720077 272362 169656 102706 0.00050 40529632 49912113 -9382481 0.00630 394883 31888 362995 0.00170 12982196 11025057 1957139 0.00910 962871 962871 0.00450 14339950 11056945 3283005 0.01530 54869582 60969058 -6099476 0.02160 25608 2652 22956 0.00010 25608 2652 22956 0.00010 true 1948804 565153 89302997 98714485 -9411488 X true true 1 1 Sonora Regional Medical Center 1000 Greenley Rd Sonora CA 95370 www.sonoramedicalcenter.org 030000094 X X X Sonora Regional Medical Center 1 false false true X X X X X X X X 13 true false true true X www.adventisthealth.org/sonora-regional/ X www.co.tuolumne.ca.us X X true 14 true https://www.adventisthealth.org/sonora-regional/Documents/So false false true X 300.0000 400.0000 X X X X X true true X X X X true X X X X X X X true false X X X X true X false false Part V, Line 5 - Account Input from Persons Who Represent the Community 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. Part V, Line 7d - Description of Making Needs Assessment Widely Available The full URL for locating the Community Health Needs Assessment on the hospital's website is: https://www.adventisthealth.org/sonora-regional/Documents/Sonora%20CHNA.pdfThe full URL for locating the Community Health Needs Assessment on the Tuolumne County Public Health website is: http://www.co.tuolumne.ca.us/DocumentCenter/View/2740The full URL for locating the Community Health Plan (implementation strategy) on the hospital's website is: https://www.adventisthealth.org/sonora-regional/Documents/Sonora%20Regional%20Medical%20Center%202013%20Community%20Health%20Plan.pdfSoftware limitations prevented these full URLs from displaying on Schedule H Part V. Part V, Line 16i - Other Means Hospital Facility Publicized the Policy Plain language summary of the hospital's financial assistance policy was located at http://www.sonoramedicalcenter.org/about-us/patient-financial-services. The summary is now located at https://www.adventisthealth.org/sonora-regional/pages/patients-and-visitors/financial-services.aspx. 41 Forest Rd Health and Wellness 193 Fairview Ln Sonora CA 95370 Primary, Specialty, Dental and Urgent Care Clinic Sonora Regional Surgery Center 905 Morning Star Dr Sonora CA 95370 Outpatient Surgery Center Sonora Regional Home Health Angels Camp 467 S Main St Angels Camp CA 95222 Home Health Agency Sonora Regional Home Health 20100 Cedar Rd N Sonora CA 95370 Home Health Agency Sonora Regional Imaging Center 12811 Covey Cir Sonora CA 95370 Diagnostic Imaging Center Sonora Care Center 538 Ponderosa Dr Sonora CA 95370 Skilled Nursing Facility Transitional Care Unit 179 S Fairview Ln Sonora CA 95370 Skilled Nursing Facility Radiation Oncology 900 Greenley Rd Ste 901 Sonora CA 95370 Radiation Therapy Center Sierra Orthopedic Institute 680 Guzzi Ln Ste 105 Sonora CA 95370 Specialty Care Clinic Sierra Cardiology 900 Greenley Rd Ste 911 Sonora CA 95370 Specialty Care Clinic Foothill Specialty Group 680 Guzzi Ln Ste 206 Sonora CA 95370 Specialty Care Clinic Community Pharmacy Forest Road 193 S Fairview Ln Ste A Sonora CA 95370 Outpatient Pharmacy Greenley Oaks Ear Nose and Throat 795 Morningstar Dr Sonora CA 95370 Specialty Care Clinic Sierra Internal Medicine Center 900 Greenley Rd Ste 922 Sonora CA 95370 Primary Care Clinic Sonora Oxygen and Medical Supply 358 W Stockton St Sonora CA 95370 Oxygen and Durable Medical Equipment Supplier Indian Rock Prompt Care 14540 Mono Wy Sonora CA 95370 Urgent Care Clinic Sierra OBGYN 680 Guzzi Ln Ste 106 Sonora CA 95370 Specialty Care Clinic Yosemite Joint Replacement 680 Guzzi Ln Ste 102 Sonora CA 95370 Specialty Care Clinic Foothill Pediatrics 12791 Cabezut Rd Sonora CA 95370 Primary Care Clinic Sierra Surgical Associates 680 Guzzi Ln Ste 204 Sonora CA 95370 Specialty Care Clinic Center for Wound Care 12811 Covey Cir Sonora CA 95370 Wound Care Clinic Angels Camp Orthopedics 23 N Main St Angels Camp CA 95222 Specialty Care Clinic Community Infusion Center 900 Greenley Rd Sonora CA 95370 Outpatient Services Angels Camp Family Medical Center 445 S Main St Angels Camp CA 95222 Primary Care Clinic Hillside Internal Medicine 690 Guzzi Ln Ste B Sonora CA 95370 Primary Care Clinic Indian Rock Physicial Therapy 14540 Mono Wy Ste 130 Sonora CA 95370 Outpatient Physical Therapy Services Sierra Cancer Center 900 Greenley Rd Ste 902 Sonora CA 95370 Specialty Care Clinic Angels Camp Prompt Care 23 N Main St Angels Camp CA 95222 Urgent Care Clinic Greenley Primary Care 19747 Greenley Rd Ste S2 Sonora CA 95370 Primary Care Clinic Bones Physicial Therapy 13808 Mono Wy Sonora CA 95370 Outpatient Physical Therapy Services Anticoagulation Clinic 193 S Fairview Ln Ste L Sonora CA 95370 Outpatient Services Job Care Occupational Health Clinic 19747 Greenley Rd Ste S2 Sonora CA 95370 Occupational Health Clinic Community Pharmacy Greenley Road 900 Greenley Rd Ste 912 Sonora CA 95370 Outpatient Pharmacy Cedarwood Internal Medicine Center 690 Guzzi Ln Ste A Sonora CA 95370 Primary Care Clinic Angels Camp Physicial Therapy 467 S Main St Angels Camp CA 95222 Outpatient Physical Therapy Services Groveland Family Medical Center 18661 Hwy 120 Groveland CA 95321 Primary Care Clinic Arnold Family Medical Center 2037 Hwy 4 Arnold CA 95223 Primary Care Clinic Mountain Medical Family Practice 680 Guzzi Ln Ste 101 Sonora CA 95370 Primary Care Clinic Sierra Vascular Surgery 690 Guzzi Ln Ste 104 Sonora CA 95370 Specialty Care Clinic Sierra Pulmonology 680 Guzzi Ln Ste 201 Sonora CA 95370 Specialty Care Clinic Cardiac and Pulmonary Rehab 19747 Greenley Rd Sonora CA 95370 Outpatient 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* 84,870,127 Prior Year Settlements 784,462 Cost Report Reimbursable Bad Debts 706,425 Estimates and Accrual Variances 2,661 Other 2,939,322 Subtotal - Amount reported in Pt III, Ln 5 89,302,997 Amounts included in Pt I, Lns g and f 0 Total Medicare Revenue 89,302,997* 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 - Needs Assessment The health system retains outside research firms every 3 years to assess changes in the market and community perception. Data is collected through a variety of vehicles, including phone surveys, paper surveys, and focus groups. Questions were added to the survey to help assess the impact of our community benefit activities and residents' barriers to access for health care services as well as unmet community needs. Part VI - Patient Education of Eligibility for Assistance At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients also are 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 - 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 rural. Agriculture, logging and tourism are the major employment opportunities. The population includes a large number of retired individuals. Part VI - Community Building Activities Our 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. And, 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 - Explanation Of How Organization Furthers Its Exempt Purpose The hospital continues to operate its 24-hour emergency department. The hospital has open medical staff to all qualified individuals. The hospital continues to expand its primary care outreach program through outpatient clinics, including a mobile clinic. The hospital operates skilled nursing facilities, which serve those who are unable to continue living without assistance due chronic medical conditions. Part VI - Affilated Health Care System Roles and Promotion 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 communites served by all member hospitals. Part VI - States Where Community Benefit Report Filed 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) 933665 0 Hlth srvs uninsured/underinsured pt 1 0 Transport and Assistance Cancer Pts 500 113465 Cash Utilities, food, other emergency assist 250 27005 Cash 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 false true false false false false false false false false Andrew Jahn Pres/CEO/Treas 311200 22899 30925 44086 32821 441931 Bill Wing Dir/VCh/AsstSec 740333 163576 168721 29604 1102234 118557 Douglas Rebok Asst Secretary 588532 212077 131335 24672 956616 122223 Edward Clinite CMO 274232 4235 45069 323536 Gregory McCulloch Treas/CFO/VPFin 197719 25000 33276 14504 28714 299213 Jack Wagner Asst Secretary 433694 101658 10660 16812 562824 Jeff Eller President/CEO 513652 58484 165273 95110 37798 870317 69418 Jeph Solo Lead Surgery RN 203780 6307 1194 12520 9924 233725 John Frank Pharmacist 175136 1737 4473 10505 13424 205275 Julie Kline Sr VP Pt Care Svcs 218297 22108 51020 34171 18691 344287 37059 Katherine Anderson Registered Nurse 172991 1886 530 9991 9916 195314 Meredith Jobe Esq Secretary 340482 91633 70330 12925 515370 46949 Michelle Fuentes VP Operations 157421 25000 23819 10508 18407 235155 Nickolas Dobler Physician Assist 84426 97004 19487 200917 Robert Carmen Dir/Chair 327030 113850 14928 455808 Rodney Wehtje Asst Treasurer 376932 1230231 74835 22415 1704413 1192595 Scott Reiner Dir/Chair 880711 375375 181681 29376 1467143 273487 Susan Shinkai Pharmacist 164917 4809 6602 10056 9933 196317 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 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.The 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 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, 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 Compensation 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 hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 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 Transfers to related organizations = -$2998639 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 Central Valley General Hospital 1025 N Douty St Hanford CA 93230 770324630 Hospital CA 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 Madrone St 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 South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 Wind down after sale of hospital CA NA C Corp false Adventist Health Plan Inc 2100 Douglas Blvd Roseville CA 95661 463833261 Insurance CA NA C Corp false false false true false true false false false false true true true true false true true true false false