2015-11-17T08:18:29-08:00 2014-12-31 BROWN ARMSTRONG ACCOUNTANCY CORPORATION 4200 TRUXTUN AVE STE 300 BAKERSFIELD CA 933090668 990 2014-01-01 952294234 San Joaquin Community Hospital SANJ 6613953000 2615 Chester Avenue Bakersfield CA 93301 Michael Lukens CFO/Treasurer 2015-11-17 true Christina M Thornburgh P00544382 6613244971 2014 2016-04-25 22:37:26Z Douglas Duffield 2615 Chester Ave Bakersfield CA 93301 370021147 false false 1071 X www.sjch.us X 1964 CA to share god's love with our community by providing physical, mental and spiritual healing. 13 8 2411 463 156562 -121381 1410628 1063377 331195023 366141601 1508742 1837816 418941 365847 334533334 369408641 245500 176500 0 160451468 163199297 0 614547 174928130 181082479 335625098 344458276 -1091764 24950365 269318638 283553571 126936787 119396783 142381851 164156788 to share god's love with our community by providing physical, mental and spiritual healing. false false 287439755 176500 366114433 San Joaquin Community Hospital provides quality medical healthcare 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 San Joaquin Community Hospital, the organization recognizes that not all individuals possess the ability to pay for essential medical services.San Joaquin Community Hospital's vision is that our service will set the standard for customer-centered, quality care. We will 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. Our mission is to carry on the healing ministry of Jesus Christ by providing quality patient care, maintaining a competent, caring, professional staff and responding to community needs. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need healthcare 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 San Joaquin Community Hospital provide low-cost care to individuals covered by government programs and those unable to afford healthcare, but it also helps patients find and access private and governmental resources for healthcare benefits. San Joaquin Community Hospital recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed value of providing care to these patients in 2014 was $22,983,595.Inpatient services in 2014 were provided to 19,051 patients. These services included: - Acute care services for medical/surgical, pediatric, obstetric and critical care patients. - Baby deliveries totaling 3,419. - Surgery cases performed totaling 5,329, of which open-heart surgeries totaled 104. We also perform neurosurgery, ophthalmology, oral and maxillofacial surgery, otolaryngology, cosmetic surgery, thoracic and vascular surgery, urology, dental surgery and orthopedic surgery. - Radiology procedures performed - Cardiac catheterizations and other procedures - Laboratory tests performed - TCU/Intermediate care - Rehabilitation servicesOutpatient services in 2014 were provided to 95,273 patients. These services included: - Emergency room visits totaling 78,442 - Outpatient surgery cases performed totaled 8,086 - Radiology procedures performed - Cardiac catherizations and other procedures - Laboratory tests performed - OB ClinicsHome Health Care services in 2014 were provided to 55 unduplicated patients. These services included: - Home health - Private duty - Home medical equipment - Home infusion therapySan Joaquin Community Hospital recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission: - Business Health Network - This program meets the healthcare needs of the local industry. The program features workers' compensation case management, substance abuse screening, physicals, and wellness and educational programs. - Immunization Program - This program educates the community about childhood immunizations and makes vaccines both accessible and affordable to children in Kern County. It offers immunization clinics throughout the city for children two years of age and under. - Buck Owens Wellness Resource Center - This program provides a well-trained culturally competent staff to promote early detection, diabetes education, screening, and referral and follow up services in Bakersfield and the outlying communities. 287439755 true true false true false false false false false true true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false true false false false false false true true false false false false true 227 0 false 2411 true true true false false false false false 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 Doug Duffield 6613953000 2615 Chester Avenue Bakersfield CA 93301 X 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 Larry Innocent Director 0.00 2.00 X 0 2388 0 Kerry Heinrich Director 0.00 2.00 X 0 0 0 Helmuth Jones Director 0.00 2.00 X 80750 3132 0 Allan Reimche Director 0.00 2.00 X 0 3958 0 Wesley Rippey Director 0.00 2.00 X 113053 116805 0 Max Torkelsen Director 0.00 2.00 X 0 3731 0 Robert Carmen Director/Chair 0.00 50.00 X X 0 440880 14928 Scott Reiner Vice Chairman 0.00 50.00 X X 0 1256086 211057 Meredith Jobe Secretary 0.00 50.00 X X 0 432115 83255 Jack Wagner Asst Sec 0.00 50.00 X X 0 535352 27472 Larry Caviness Director 0.00 2.00 X 0 3081 0 Charles Dickinson Director 0.00 2.00 X 0 6340 0 Douglas Rebok Asst Sec 0.00 50.00 X X 0 800609 156007 Rodney Wehtje Asst Treas 0.00 50.00 X X 0 1607163 97250 Bill Wing Vice Chairman 0.00 50.00 X X 0 903909 198325 Douglas Duffield President/CEO 0.00 50.00 X 0 437219 109301 Michael Lukens VP Finance 0.00 50.00 X 0 136017 29300 Sharlet Briggs VP Organizational Excellence 0.00 50.00 X 0 227930 24961 Mohamad Itani VP Support Services 0.00 50.00 X 0 229884 49291 Harold Chilton Interim President/COO 0.00 50.00 X 0 291353 38797 Kurt Hoekendorf VP Physical Development 50.00 0.00 X 261342 0 27346 Donald Cornforth CMO 21.00 0.00 X 162868 0 0 Margaret White VP/CNO 0.00 50.00 X 0 230249 27903 Katie Delmore Interim VP Finance/Exec Dir Fin 50.00 0.00 X 159564 0 20928 Robert Chirk Pharmacist 38.00 0.00 X 216074 0 47735 Barry Chupa RN First Asst 36.00 0.00 X 215849 0 33212 Steven Dzierba Clinical Pharm Crd 36.00 0.00 X 218233 0 48212 Rafael Navarro RN First Assist 34.00 0.00 X 218887 0 33679 Adrian Gonzales Dir Pharmacy 37.00 0.00 X 225864 0 49898 Robert Beehler Former President/CEO 0.00 50.00 X 0 516462 95636 Brent Soper Former Treasurer 0.00 50.00 X 0 308741 62626 Deborah Hankins Former VP/CNO 0.00 50.00 X 0 191880 27979 Martha Samora Former VP Ancillary Srvcs 0.00 50.00 X 0 111785 7156 1872484 8811637 1522254 9 true true false Swinerton Builders 2300 Clayton Road Suite 800 Concord CA 94520 Construction 6299133 Quest Imaging Medical Assoc PO Box 2447 Bakersfield CA 93303 Medical 5189093 Crothal Srvc Group 955 Chesterbrook Blvd Ste 300 Wayne PA 19087 Cleaning Service 1618041 Sound Inpatient Physicians PO Box 742936 Los Angeles CA 90074 Medical 4578194 Houchin Comm Bld Bank 11515 Bolthouse Drive Bakersfield CA 93311 Medical 2113499 53 431387 631990 1063377 DIETARY 621110 1693483 1693483 MEDICAID EHR INCENTIVES 621500 2009611 2009611 NET PATIENT REVENUE 621110 361228996 361228996 OTHER SERVICES 621500 132412 132412 RENTAL - MEDICAL OFFICES 531120 1049931 1049931 27168 27168 366141601 1314779 1314779 0 0 0 522037 1000 522037 1000 523037 523037 0 0 848959 612506 236453 236453 PREMIER MSO-BILLING FEES 129394 129394 129394 369408641 366114433 156562 2074269 176500 176500 0 0 0 602287 602287 0 125788779 113574273 11928769 285737 3454692 3218006 236686 24393810 21575524 2766588 51698 8959729 8154466 785542 19721 0 286194 286194 832815 832815 0 0 0 21689738 16839641 4837479 12618 1071547 1071397 150 2825054 2018762 780830 25462 13841868 13841868 0 6472075 6391006 81069 1428390 602267 810254 15869 0 0 2199131 2199131 0 15283198 14955937 326781 480 2159252 2159252 PT CARE SUPPLIES 58451562 58451562 PURCHASED SERVICES 30839811 19008460 11662111 169240 QUALITY ASSURANCE MGMT FEES 18408477 18408477 OTHER EXPENSES 3636947 2617285 986090 33572 1656420 1655815 605 344458276 287439755 56403974 614547 248640 473232 40172030 43148542 1144200 1060141 46671247 55223115 0 0 150000 150000 7006336 6191772 968227 648571 269274497 105958233 157653710 163316264 0 0 0 3738737 2012957 11565511 11328977 269318638 283553571 25887092 23620212 79482571 78481582 21567124 17294989 126936787 119396783 X 138564834 161770488 3817017 2386300 142381851 164156788 269318638 283553571 X 24950365 -3175428 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 11570 11570 false false Part II-B, Line 1i - Other Activities Description Lobbying expenses are an allocated portion of industry association membership dues as defined by the association. 3817017 1063377 2494095 2386299 3096145 1410628 689756 3817017 2674007 3997323 3575185 3096145 1023350 2608593 957936 2674007 1319672 1354738 1651060 1023350 false false false 8958711 8958711 179453161 51123445 128329716 933999 467514 466485 79928626 54367274 25561352 163316264 PAYABLES TO RELATED ORGANIZATIONS 3915158 PAYABLES TO THIRD PARTY PAYORS 9292613 WORKERS COMPENSATION PAYABLE 4087218 17294989 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. true true X true X true X true false false false true true 905512 905512 0.00260 90606840 81748421 8858419 0.02570 91512352 81748421 9763931 0.02830 1141153 1141153 0.00330 36116 36116 0.00010 8005363 5584215 2421148 0.00700 243182 243182 0.00070 9425814 5584215 3841599 0.01110 100938166 87332636 13605530 0.03940 true 2577225 1572107 73573271 72397325 1175946 X true true 1 1 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 X X X false false true X X X X X X X 14 true true false true X WWW.SJCH.US X true 14 false false false true X 200.0000 400.0000 X X X X true true true X X X true false true X false false Part V, Line 5 - Account Input from Persons Who Represent the Community THE PRIMARY QUALITATIVE DATA COLLECTION PROCESS INCLUDED TWO SURVEYS WITH A TOTAL OF 1,170 PARTICIPANTS (200 IN THE DELANO COMMUNITY ALLIANCE NEEDS ASSESSMENT SURVEY AND 970 IN THE COMMUNITY SURVEY). A TOTAL OF 27 INDIVIDUAL INTERVIEWS WERE CONDUCTED WITH KEY STAKEHOLDERS IN THE COMMUNITY TO GATHER A PERSONAL PERSPECTIVE FROM THOSE WHO HAD INSIGHT INTO THE HEALTH OF A COMMUNITY OR THE REGION.THE SECONDARY QUANTITATIVE DATA COLLECTION PROCESS INCLUDED A COMPREHENSIVE COLLECTION AND REVIEW OF HEALTH AND QUALITY OF LIFE DATA, COLLECTED AND ANALYZED THROUGH THE USE OF THE HEALTHY COMMUNITIES NETWORK SYSTEM, A WEB-BASED COMMUNITY HEALTH DATA PLATFORM DEVELOPED BY HEALTHY COMMUNITIES INSTITUTE. Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment THE 2014 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY THROUGH THE KERN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE. MEMBERS INCLUDED: - BAKERSFIELD FAMILY MEDICAL CENTER - BOYS AND GIRLS CLUB OF KERN COUNTY - DELANO REGIONAL MEDICAL CENTER - DIGNITY HEALTH (MERCY AND MEMORIAL HOSPITALS) - GREATER BAKERSFIELD LEGAL ASSISTANCE - KAISER PERMANENTE - KERN COMMUNITY FOUNDATION - KERN COUNTY PUBLIC HEALTH SERVICES DEPARTMENT - KERN HEALTH SYSTEMS - PACIFIC HEALTH EDUCATION CENTER - SAN JOAQUIN COMMUNITY HOSPITAL - ST FRANCIS CATHOLIC CHURCH - UNITED WAY OF KERN COUNTY Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why Chronic Disease (Asthma, Obesity, Diabetes) and Infectious Disease (STDs): Although SJCH provides education and support services in these disease areas, the hospital has decided to center its outreach strategies on higher acuity illnesses that include heart disease, stroke and cancer. However, SJCH does have an American Diabetes Association-accredited education course available to insured patients. Overall, however, the hospital does not have a comprehensive community benefits program to reach the community in these areas. In some cases, i.e. sexually transmitted diseases, a hospital is not as equipped to impact change as other community organizations, such as the Public Health Department and highly focused non-profit organizations. Healthy Mothers, babies and children (low birth weight, infant mortality, pre-term birth): Over the past few years, SJCH has helped Kern County make significant leaps in this area, mostly through the opening of a new 9-bed Neonatal Intensive Care Unit which opened in 2009. In a community starved for NICU beds, SJCHs new facility continues to operate at a high capacity. Through work with the March of Dimes, the hospital also joined with other community health care facilities to implement a policy prohibiting elective birth prior to 39 weeks, which has been proven to alleviate many complications arising from premature birth. Moving forward, SJCH is working toward becoming a Baby Friendly Hospital. In part, this program places a strong emphasis on breast-feeding. Although progress is being made toward the accreditation, there is not a specific timeline for completion. 10 SJCH dba Adventist Health Home Care Svcs 2800 K Street Bakersfield CA 93301 Home Health SJCH dba Community Diagnostic Center 2615 Chester Avenue Bakersfield CA 93301 MCI / CT Scan SJCH dba Bariatric Solutions 2819 H Street Suite B Bakersfield CA 93301 Hospital Department SJCH dba Buck Owens Wellness Resource Center 1524 27th Street 101 Bakersfield CA 93301 Hospital Department SJCH dba Grossman Burn Center dba Area Clinic 2819 Chester Avenue Suite A Bakersfield CA 93301 Hospital Department managed by Grossman Burn Center, LLC SJCH dba Imaging Center DBA Quest Imaging Center 9602 Stockdale Highway Bakersfield CA 93309 Hospital Department SJCH Medical Building Association 2615 Chester Avenue Bakersfield CA 93301 100% owned by SJCH, not operational as of 3/94 but still registered with the State of California. Premier MSO LLC 2615 Chester Avenue Bakersfield CA 93301 SJCH is the sole member. Quest Imaging - Adventist Health 2700 Chester Avenue Bakersfield CA 93301 Radiology and Diagnostic Imaging Services Quest Imaging - Adventist Health 1150 E Lerdo Highway Suite A Shafter CA 93263 Radiology and Diagnostic Imaging Services Part I, Line 7 - Explanation of Costing Methodology The hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of Californias regulations and policies and the approval of the federal government. Part III, Line 4 - Bad Debt Expense The system-wide combined audited financial statements do not contain a footnote describing bad debt expense. Part III, Line 8 - Explanation Of Shortfall As Community Benefit The medicare cost report apportions the hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor, and evolving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Since the 1997 balanced budget act, medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as medicaid. the benefit to the community for healthier medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between medicare payment increases and healthcare cost inflation, the highly complex medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of medicare revenue from the hospital's medicare cost report to general ledger Revenue ReceivedMedicare Cost Report Revenue* $ 68,047,397.Prior Year Settlements 105,183.Cost Report Reimbursable Bad Debts 1,370,393.Estimates and Accrual Variances ( 2,134,989.)Other 6,185,287. ---------------Total Medicare Revenue $ 73,573,271. * 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 In Kern County, the not-for-profit hospitals have a long history of working together to actively engage in a number of practices that aim to improve the health of the community. A Community Health Needs Assessment was completed in order to gain insight into the current conditions and trends of various health indicators and to identify areas for improvement. As a companion to the report, an interactive website was created in 2010 that contains detailed information concerning the residents of Kern County. This site is located at healthykern.org. SJCH is working hard to listen to our community and identify needs and assets in our region. In an effort to accomplish this, the team employed both qualitative and quantitative data collection and analysis methods. The quantitative secondary data collection process included a comprehensive collection and review of health and quality of life data, collected and analyzed through the use of Healthy Communities Network System, a web-based community health data platform developed by Healthy Communities Institute. The system is hosted on the Healthy Kern website located at healthykern.org. It includes a comprehensive dashboard of approximately 140 community indicators from over 12 state and national public data sources, covering over 20 topics in the areas of health, determinants of health, and quality of life. In order to determine community needs, each of the approximately 140 available indicators was analyzed on the following criteria.1.Was Kern County in the worst performing half of all counties in the state or nation?2.Did Kern County fail to meet the national Healthy People 2020 goals?3.Was there an apparent health disparity?When over 80% of the indicators met at least one of these criteria, the highest priority needs were identified and included in the study. The primary data collection process in Kern County included two surveys with a total of 1,170 participants (200 in the Delano Community Alliance Needs Assessment Survey and 970 in the Community Survey). The Needs Assessment Survey was conducted by Strategy Solutions to support the CHNA process. To validate the data, and to ensure a broad representation of the community, qualitative data was collected through a total of 27 individual interviews with key stakeholders in the community. These interviews helped gather a personal perspective from those who have insight into the health of the community and region. The interviews were designed to gain insights from diverse community groups and underrepresented populations. These individuals also provided suggested activities from improving the health of the region. 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. The hospital charity assistance policy is posted on the hospital website. Part VI - Community Information The hospital is one of the largest healthcare systems in the area serving Kern County and surrounding areas. The service area includes a small city and surrounding suburbs, small towns and rural agricultural areas. The diverse population includes Caucasian and a large minority population, both Hispanic and African-American. 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. Furthermore, 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 - Affilated Health Care System Roles and Promotion The hospital is a member of Adventist Health, a health care system which provides healthcare 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 managment, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate adminstrative support for hospital affiliated 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 by all member hospitals. Part VI - States Where Community Benefit Report Filed CA true American Cancer Society 1831 Truxtun Ave Ste 150 Bakersfield CA 93301 941170350 501(c)(3) 30000 0 VH GALA/MSABC FLAGSHIP SPONSORSHIP American Heart Association 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 25000 0 SAVINGS STROKES/GO RED FOR WOMEN Bakersfield Adventist Academy 333 Bernard St Bakersfield CA 93306 952545140 501(c)(3) 10000 0 CONFERENCE SPONSORSHIP Bakersfield Christmas Parade PO Box 22344 Bakersfield CA 93390 202848089 501(c)(3) 7500 0 PARADE GRAND TITLE SPONSORSHIP BARC 2240 S Union Avenue Bakersfield CA 93307 721549925 501(c)(3) 5400 0 CELEBRITY WAITERS/GIVE AWAY BAGS Central California Conference 2820 Willow Avenue Clovis CA 93612 941279781 501(c)(3) 33000 0 CAMP WAWONA MEDICAL BLDG First 5 Kern 2724 L Street Bakersfield CA 93301 770529128 501(c)(3) 10000 0 MEDICALLY VULNERABLE CARE PROJ. Greater Bksfld Chamber of Com 1725 Eye Street Bakersfield CA 93301 950521125 501(c)(3) 10600 0 BUSINESS EXPOS/LEADERSHIP LUNCH Jesus Shack Inc 1326 30th St B Bakersfield CA 93301 770496214 501(c)(3) 15000 0 MOBILE MEDICAL CLINIC JJs Legacy PO BOX 12793 Bakersfield CA 93389 273546375 501(c)(3) 20000 0 PLATINUM SPONSOR Links for Life 1706 Chester Avenue Ste 200 Bakersfield CA 93301 931088003 501(c)(3) 10000 0 PAINT THE TOWN PINK SPONSORSHIP 11 0 X X X X true true false false false false false false false false Adrian Gonzales Dir Pharmacy 225864 49898 275762 Barry Chupa RN First Asst 215849 33212 249061 Bill Wing Vice Chairman 740333 163576 168721 29604 1102234 118557 Brent Soper Former Treasurer 264938 43803 49746 12880 371367 38126 Deborah Hankins Former VP/CNO 168815 23065 11233 16746 219859 Donald Cornforth CMO 162868 162868 Douglas Duffield President/CEO 411974 25245 79925 29376 546520 Douglas Rebok Asst Sec 588532 212077 131335 24672 956616 122223 Harold Chilton Interim President/COO 278098 13255 15860 22937 330150 Jack Wagner Asst Sec 433694 101658 10660 16812 562824 Katie Delmore Interim VP Finance/Exec Dir Fin 157918 1646 7528 13400 180492 Kurt Hoekendorf VP Physical Development 258912 2430 10985 16361 288688 Margaret White VP/CNO 220132 10117 13207 14696 258152 Martha Samora Former VP Ancillary Srvcs 92668 19117 7156 118941 Meredith Jobe Secretary 340482 91633 70330 12925 515370 46949 Michael Lukens VP Finance 105818 25000 5199 16403 12897 165317 Mohamad Itani VP Support Services 200762 29122 20018 29273 279175 Rafael Navarro RN First Assist 218887 33679 252566 Robert Beehler Former President/CEO 371352 145110 73223 22413 612098 80682 Robert Carmen Director/Chair 327030 113850 14928 455808 Robert Chirk Pharmacist 216074 47735 263809 Rodney Wehtje Asst Treas 376932 1230231 74835 22415 1704413 1192595 Scott Reiner Vice Chairman 880711 375375 181681 29376 1467143 273487 Sharlet Briggs VP Organizational Excellence 221482 6448 12107 12854 252891 Steven Dzierba Clinical Pharm Crd 218233 48212 266445 Wesley Rippey Director 113053 116805 113053 116805 Ghina Itani KE Wife 43416 Interior Design false Edna Cornforth KE Wife 60000 OP Radiology Manager false Graham Chilton KE Son 42709 Employment false Schedule L, Part V Supplemental Information DR. DONALD CORNFORTH, A KEY EMPLOYEE, OWNS 50% OF C&F PROPERTIES (NOW KNOWN AS CORNFITZ INVESTMENTS, LLC). SAN JOAQUIN COMMUNITY HOSPITAL RENTS MEDICAL OFFICE BUILDING AND PAID $600,000 IN 2014.DR. DONALD CORNFORTH, A KEY EMPLOYEE, OWNS 80% OF PREMIER PPA. PREMIER MSO, LLC, AN LLC OWNED SOLELY BY SAN JOAQUIN COMMUNITY HOSPITAL, PROVIDES BILLING SERVICES TO PREMIER PPA. PREMIER PPA'S OUTSTANDING PAYABLE AS OF 12/31/14 WAS $87,152. 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 Form 990, 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. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.Form 990, 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 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 disclose 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 Adventist Health System/West 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 upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. Other Changes In Net Assets Or Fund Balances - Other Decreases TRANSFERS TO AFFILIATES = -$3175428 Form 990, Schedule H, Part V, Section B, Line 5a - Hospital's Website https://www.adventisthealth.org/Documents/Forms/DispForm.aspx?ID=12 Premier MSO LLC 2615 Chester Ave Bakersfield CA 93301 271977963 BILLING AND SCHEDULING FOR PREMIER IPA CA -4613 249394 SAN JOAQUIN COMMUNITY HOSPITAL Adventist Health Systems West 2100 Douglas Boulevard Roseville CA 95661 953484589 Support and Manage System-Wide Activities CA 501(c)(3) 1 N/A false Adventist Health Clearlake Hospital Inc 15630 18th Ave Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health System West false Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) 1 Adventist Health System West false Central Valley General Hopital 1025 N Douty Street Hanford CA 93230 770324630 Hospital CA 501(c)(3) 1 Adventist Health System West false Feather River Hospital 5974 Pentz Road Paradise CA 95969 941101228 Hospital CA 501(c)(3) 1 Adventist Health System West false Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) 1 Adventist Health System West false Hanford Community Hospital 115 Mall Dr Hanford CA 93230 940535360 Hospital CA 501(c)(3) 1 Adventist Health System West false Northwest Medical Foundation Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 1 Adventist Health System West 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 System West false Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) 1 Adventist Health System West false Reedley Community Hospital 372 W Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) 1 Adventist Health System West false Simi Valley Hospital & Health Care Svcs 2975 North Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 1 Adventist Health System West false Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) 1 Adventist Health System West false St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) 1 Adventist Health System West false Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 1 Adventist Health System West false Walla Walla General Hospital 1025 South Second Avenue Walla Walla WA 99362 910617726 Hospital WA 501(c)(3) 1 Adventist Health System West false White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) 1 Adventist Health System West false Willits Hospital Inc 1 Madrone Street Willits CA 95490 680108919 Hospital CA 501(c)(3) 1 Adventist Health System West false Adventist Health Physicians Network 2100 Douglas Boulevard Roseville CA 95661 680357690 Medical Foundation CA 501(c)(3) 11b, II Adventist Health System West false South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 wind down after sale of hospital CA N/A C Corp false false false false false false false false false false true false false false false false true true true true