ADVENTIST HEALTH CLEARLAKE HOSPITAL INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC (EIN 68-0395149)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201443219349312754
- Schema version
- 2013v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T18:34:35-08:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680395149 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Clearlake Hospital Inc | BusinessNameLine1 |
| Business Name Line2 | dba St Helena Hospital Clear Lake | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ADVE | BusinessNameControlTxt |
| Phone | 7079946486 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15630 18th Ave | AddressLine1 |
| City | Clearlake | City |
| State | CA | State |
| ZIP Code | 95422 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Carlton Jacobson | PersonNm |
| Person Title | Treas/CFO | PersonTitleTxt |
| Signature | 2014-11-17 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | David Santos | PrincipalOfficerNm |
| Gross Receipts | $66,463,597 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/clear-lake | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | To share God's love by providing physical, mental, and spiritual healing. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 414 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $6,000 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$240 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $159,837 | PYContributionsGrantsAmt |
| CY Contributions Grants | $398,142 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $68,071,405 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $65,394,366 | CYProgramServiceRevenueAmt |
| PY Investment Income | $134,136 | PYInvestmentIncomeAmt |
| CY Investment Income | $23,108 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,215 | PYOtherRevenueAmt |
| CY Other Revenue | $5,484 | CYOtherRevenueAmt |
| PY Total Revenue | $68,368,593 | PYTotalRevenueAmt |
| CY Total Revenue | $65,821,100 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $32,587,968 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,798,886 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $315,563 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $35,359,331 | PYOtherExpensesAmt |
| CY Other Expenses | $37,158,346 | CYOtherExpensesAmt |
| PY Total Expenses | $67,947,299 | PYTotalExpensesAmt |
| CY Total Expenses | $67,957,232 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $421,294 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,136,132 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,843,951 | TotalAssetsBOYAmt |
| Total Assets EOY | $45,752,435 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $61,037,693 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $67,082,309 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$19,193,742 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$21,329,874 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To share God's love by providing physical, mental, and spiritual healing. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $59,609,118 | ExpenseAmt |
| Revenue | $65,394,366 | RevenueAmt |
| Desc | St. Helena Hospital Clear Lake provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of St. Helena Hospital Clear Lake, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of a partnership for personal community health. In keeping with this committment 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 careProviding care to persons covered by governmental programs at below costProviding health/wellness activities and community education programsNot only does St. Helena Hospital Clear Lake provide low-cost care to individuals covered by government programs and those unable to afford health care, but it also helps patients find and access private and governmental resources for health care benefits. St. Helena Hospital Clear Lake 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 2013 was $15,839,280. Inpatient services in 2013 were provided to 1,389 patients. These services included: 171 Babies delivered 266 Surgeries performed 3,735 Radiology procedures performed 837 Cardiac catheterizations and other procedures 38,659 Laboratory tests performedOutpatient services in 2013 were provided to 162,015 patients. These services included: 19,180 Emergency room visits 1,558 Outpatient surgeries performed 3,229 Radiology procedures performed 1,077 Cardiac catheterizations and other procedures 77,417 Medical clinic visits 194,252 Laboratory testsSt. Helena Hospital Clear Lake 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:Bright Start OB Program (Comprehensive Perinatal Services Progrm- CPSP)Live Well ProgramHealthy Families ProgramCommunity Health Fairs & EventsDiabetes Education | Desc |
| Total Program Service Expenses | $59,609,118 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 59 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 414 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Carlton Jacobson | PersonNm |
| Phone | 7079636552 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15630 18th Ave | AddressLine1 |
| City | Clearlake | City |
| State | CA | State |
| ZIP Code | 95422 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Caviness Larry | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $2,263 | $0 | ||||
| Dickinson Charles | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $5,021 | $0 | ||||
| Fike Ruthita | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $576 | $0 | ||||
| Friestad Christine | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $1,783 | $0 | ||||
| Gabriel Melody | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $1,443 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $3,020 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $1,410 | $0 | ||||
| Jones Helmuth | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $85,460 | $0 | ||||
| Reimche Allan | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $2,070 | $0 | ||||
| Rippey Wesley | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $96,929 | $0 | ||||
| Torkelsen Max | ||||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $2,799 | $0 | ||||
| Carmen Robert | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | $0 | $1,469,005 | $44,835 | Yes (X) | |||
| Reiner Scott | ||||||||||
| Dir/V Chair/Sec | 0.00 | 50.00 | Yes (X) | $0 | $1,075,867 | $198,380 | Yes (X) | |||
| Rebok Douglas | ||||||||||
| Asst Secretary | 0.00 | 50.00 | $0 | $787,365 | $162,365 | Yes (X) | ||||
| Wehtje Rodney | ||||||||||
| Asst Treasurer | 0.00 | 50.00 | $0 | $508,359 | $105,863 | Yes (X) | ||||
| Wing Bill | ||||||||||
| Asst Secretary | 0.00 | 50.00 | $0 | $782,125 | $172,894 | Yes (X) | ||||
| Newmyer Terrance | ||||||||||
| President | 50.00 | 0.00 | $0 | $638,878 | $107,750 | Yes (X) | ||||
| Herber Steven | ||||||||||
| Int Pres/Sr VP | 50.00 | 0.00 | $0 | $336,328 | $83,683 | Yes (X) | ||||
| McDonald Edward | ||||||||||
| Asst Sec/Sr VP | 50.00 | 0.00 | $0 | $319,210 | $85,507 | Yes (X) | ||||
| Jacobson Carlton | ||||||||||
| Treas/Asst Sec | 50.00 | 0.00 | $0 | $249,101 | $68,441 | Yes (X) | ||||
| Santos David | ||||||||||
| Asst Sec/VP Ops | 50.00 | 0.00 | $0 | $232,725 | $68,857 | Yes (X) | ||||
| Matthews Gwen | ||||||||||
| Sr VP Operations | 50.00 | 0.00 | $0 | $367,410 | $91,224 | Yes (X) | ||||
| Bockmann Rick | ||||||||||
| VP Administration | 50.00 | 0.00 | $0 | $256,647 | $108,326 | Yes (X) | ||||
| Cowan Joshua | ||||||||||
| VP Marketing | 50.00 | 0.00 | $0 | $192,475 | $37,195 | Yes (X) | ||||
| Fillman Orvin | ||||||||||
| Reg VP Behavioral Medicine | 50.00 | 0.00 | $0 | $84,795 | $13,141 | Yes (X) | ||||
| Lendaris Nia | ||||||||||
| Reg VP Patient Care Svcs | 50.00 | 0.00 | $0 | $195,297 | $27,415 | Yes (X) | ||||
| Williams Patricia | ||||||||||
| VP Business Development | 50.00 | 0.00 | $0 | $234,799 | $62,854 | Yes (X) | ||||
| Olson David | ||||||||||
| VP Physician Svcs | 50.00 | 0.00 | $0 | $224,125 | $36,128 | Yes (X) | ||||
| Shapiro Mark | ||||||||||
| CMO | 20.00 | 0.00 | $271,711 | $0 | $0 | Yes (X) | ||||
| Gumpert Norman | ||||||||||
| Pharmacist | 40.00 | 0.00 | $213,536 | $0 | $39,167 | Yes (X) | ||||
| Brunk Tammy | ||||||||||
| CNM, FNP Midwife | 40.00 | 0.00 | $172,342 | $0 | $64,472 | Yes (X) | ||||
| McCurry William | ||||||||||
| RN-IV, OP Surgery | 40.00 | 0.00 | $147,921 | $0 | $46,364 | Yes (X) | ||||
| Myers Irvin | ||||||||||
| Nuclear Med Tech | 40.00 | 0.00 | $161,425 | $0 | $20,182 | Yes (X) | ||||
| Madsen Kathleen | ||||||||||
| RN-III, Surgery | 40.00 | 0.00 | $130,268 | $0 | $42,003 | Yes (X) | ||||
| Dodds Larry | ||||||||||
| Former Dir/V Chair/Sec | 0.00 | 0.00 | $0 | $216,120 | $3,969 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,097,203 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,373,405 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,691,015 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 51 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Helmer & Sons | |||||
| PO Box 868 | Angwin | CA | 94508 | General Contractor | $4,585,800 |
| Lionakis | |||||
| 1919 19th St | Sacramento | CA | 95811 | Architect | $897,613 |
| Alliance Healthcare Services | |||||
| 100 Bayview Cir Ste 400 | Newport Beach | CA | 92660 | Imaging | $480,000 |
| Latham & Watkins LLP | |||||
| 505 Montgomery St | San Francisco | CA | 94111 | Legal | $408,820 |
| Stat Radiology | |||||
| 13915 Danielson St Ste 200 | Poway | CA | 92064 | Imaging | $158,051 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $398,142 | AllOtherContributionsAmt |
| Total Contributions | $398,142 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621110 | $64,716,050 | $64,716,050 |
| EMR Incentives | 621110 | $431,719 | $431,719 |
| Dietary | 722210 | $222,524 | $222,524 |
| Other Revenue | 900099 | $31,663 | $31,663 |
| Rental Income | 531120 | -$7,590 | -$7,590 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $65,394,366 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $54,527 | TotalRevenueColumnAmt |
| Exclusion | $54,527 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $610,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $641,919 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$31,419 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$31,419 | TotalRevenueColumnAmt |
| Exclusion | -$31,419 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $62 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $578 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$516 | TotalRevenueColumnAmt |
| Exclusion | -$516 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Physician billing service | Desc |
| Business | 561499 | BusinessCd |
| Total Revenue Column | $6,000 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $6,000 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $6,000 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,821,100 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $65,394,366 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $6,000 | UnrelatedBusinessRevenueAmt |
| Exclusion | $22,592 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,711 | TotalAmt |
| Program Services | $125,811 | ProgramServicesAmt |
| Management And General | $145,900 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,020,546 | TotalAmt |
| Program Services | $20,363,362 | ProgramServicesAmt |
| Management And General | $1,581,831 | ManagementAndGeneralAmt |
| Fundraising | $75,353 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $822,871 | TotalAmt |
| Program Services | $822,871 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,780,424 | TotalAmt |
| Program Services | $5,282,898 | ProgramServicesAmt |
| Management And General | $463,580 | ManagementAndGeneralAmt |
| Fundraising | $33,946 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,903,334 | TotalAmt |
| Program Services | $1,660,284 | ProgramServicesAmt |
| Management And General | $237,336 | ManagementAndGeneralAmt |
| Fundraising | $5,714 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $549,163 | TotalAmt |
| Management And General | $549,163 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$3,278 | TotalAmt |
| Management And General | -$3,278 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,898,852 | TotalAmt |
| Program Services | $11,615,111 | ProgramServicesAmt |
| Management And General | $221,774 | ManagementAndGeneralAmt |
| Fundraising | $61,967 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276,541 | TotalAmt |
| Program Services | $6,197 | ProgramServicesAmt |
| Management And General | $234,913 | ManagementAndGeneralAmt |
| Fundraising | $35,431 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,160,209 | TotalAmt |
| Program Services | $887,529 | ProgramServicesAmt |
| Management And General | $269,740 | ManagementAndGeneralAmt |
| Fundraising | $2,940 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,953,507 | TotalAmt |
| Program Services | $2,952,084 | ProgramServicesAmt |
| Management And General | $1,423 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,873,852 | TotalAmt |
| Program Services | $1,651,785 | ProgramServicesAmt |
| Management And General | $220,743 | ManagementAndGeneralAmt |
| Fundraising | $1,324 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,808 | TotalAmt |
| Program Services | $37,658 | ProgramServicesAmt |
| Management And General | $23,257 | ManagementAndGeneralAmt |
| Fundraising | $893 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,666 | TotalAmt |
| Program Services | $20,883 | ProgramServicesAmt |
| Management And General | $45,783 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,219,524 | TotalAmt |
| Program Services | $1,219,524 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,771,044 | TotalAmt |
| Program Services | $1,767,803 | ProgramServicesAmt |
| Management And General | $3,241 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,099 | TotalAmt |
| Program Services | $477,099 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Purchased Services | $8,567,461 | $5,235,489 | $3,236,392 | $95,580 |
| Patient Care Supplies | $4,270,075 | $4,270,075 | ||
| All Other Expenses | $1,713,488 | $940,093 | $773,395 | |
| Rentals/Leases | $302,335 | $272,562 | $27,358 | $2,415 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,957,232 | TotalAmt |
| Program Services | $59,609,118 | ProgramServicesAmt |
| Management And General | $8,032,551 | ManagementAndGeneralAmt |
| Fundraising | $315,563 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,877 | BOYAmt |
| EOY | $447,853 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,064,667 | BOYAmt |
| EOY | $634,697 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $553,366 | BOYAmt |
| EOY | $432,917 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,060,990 | BOYAmt |
| EOY | $10,401,797 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,980 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $645,925 | BOYAmt |
| EOY | $684,309 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,273 | BOYAmt |
| EOY | $127,933 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $51,611,967 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $22,960,265 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,183,496 | BOYAmt |
| EOY | $28,651,702 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $623,605 | BOYAmt |
| EOY | $599,631 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,119,772 | BOYAmt |
| EOY | $3,771,596 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,843,951 | BOYAmt |
| EOY | $45,752,435 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,889,581 | BOYAmt |
| EOY | $4,919,942 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,038,279 | BOYAmt |
| EOY | $22,576,293 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,109,833 | BOYAmt |
| EOY | $39,586,074 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,037,693 | BOYAmt |
| EOY | $67,082,309 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$19,945,520 | BOYAmt |
| EOY | -$21,319,890 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $751,778 | BOYAmt |
| EOY | -$9,984 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$19,193,742 | BOYAmt |
| EOY | -$21,329,874 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,843,951 | BOYAmt |
| EOY | $45,752,435 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,136,132 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed Section4955 Tax | false | Form4720FiledSection4955TaxInd |
| Correction Made | false | CorrectionMadeInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1i - Other Activities Description | FormAndLineReferenceDesc |
| Explanation | Portion of dues paid to membership organizations allocable to lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,353,186 | OtherCostOrOtherBasisAmt |
| Book Value | $1,353,186 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,276,818 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,650,749 | DepreciationAmt |
| Book Value | $4,626,069 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,953,505 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,350,093 | DepreciationAmt |
| Book Value | $2,603,412 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,028,458 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,959,423 | DepreciationAmt |
| Book Value | $20,069,035 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,651,702 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from Related Organizations | $964,237 |
| Other Receivables | $587,362 |
| Receivables from third-party payors | $2,219,997 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,771,596 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Workers' Comp Payable | $1,606,209 |
| Payables to Related Organizations | $36,484,261 |
| Payables to 3rd Party Payors | $1,495,604 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $39,586,074 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: Intended uses of the endowment fund. | FormAndLineReferenceDesc |
| Explanation | Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $656,475 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $656,475 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00970 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,247,034 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,226,596 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$2,979,562 | NetCommunityBenefitExpnsAmt |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,126,625 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,489,046 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,637,579 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02410 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,030,134 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $26,715,642 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$685,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03380 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $340,893 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $252,003 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $88,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,665,786 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,175,302 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,490,484 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06610 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,230 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,011,909 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,427,305 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,584,604 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06750 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $41,042,043 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $37,142,947 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,899,096 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10130 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,229 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,229 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,229 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,229 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,031,280 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $446,882 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $22,067,180 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $25,598,549 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,531,369 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adv Health Clearlake Hospital | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15630 18th Ave | AddressLine1 |
| City | Clearlake | City |
| State | CA | State |
| ZIP Code | 95422 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adv Health Clearlake Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI-Supplemental Info | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI-Supplemental Info | OtherWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Form4720 Filed | false | Form4720FiledInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400.0000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 3 - Account Input from Person Who Represent the Community | Data for the CHNA was collected through a variety of sources, including phone surveys, paper surveys, and focus groups. The data collection process of the CHNA was a collaborative effort. The list of our partners included:Community Care Management CorporationLake County Behavioral Health DepartmentLake County Board of SupervisorsLake County Office of EducationLake County Public Health DepartmentLake County Veterans ServicesLake Family Resource CenterLucerne Community ClinicPartnership Health PlanSutter Lakeside HospitalTribal Health |
| Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment | St. Helena Hospital Clear Lake collaborated with Sutter Lakeside Hospital and the Lake County Department of Public Health to retain Barbara Aved and Associates to prepare the 2013 Community Health Needs Assessment. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| St Helena Cardiology - Lake Silverado | ||||
| 15250 Lakeshore Dr Ste C | Clearlake | CA | 95422 | Outpatient Clinic |
| St Helena Therapy Services - Clearlake | ||||
| 14880 Olympic Dr | Clearlake | CA | 95422 | Outpatient Clinic |
| St Helena General Surgery - Clearlake | ||||
| 15230 Lakeshore Dr Ste 102 | Clearlake | CA | 95422 | Outpatient Clinic |
| Family Health Ctr - Clearlake | ||||
| 15230 Lakeshore Drive | Clearlake | CA | 95422 | Rural Health Clinic |
| Family Health Ctr -Kelseyville | ||||
| 5290 State St | Kelseyville | CA | 95451 | Rural Health Clinic |
| Family Health Ctr - Middletown | ||||
| 21337 Bush St | Middletown | CA | 95461 | Rural Health Clinic |
| Cardiopulmonary Care Center | ||||
| 801 Eleventh St 3B | Lakeport | CA | 95453 | Outpatient Cardiopulmonary Testing Center |
| Cardiology Clinic | ||||
| 15666 18th Ave | Clearlake | CA | 95422 | Outpatient clinic |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7 - Explanation of Costing Methodology | The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of Californias regulations and policies and the approval of the federal government. |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the hospital's bad debt expense as reported in the system-wide 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. 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, those accounts would have been reclassified from bad debt expense to charity care. |
| Part III, Line 4 - Bad Debt Expense | The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | The Medicare cost report apportions the hospitals costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care market basket is unrelated to that of the average individual consumer. Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments 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 GL:*Medicare Cost Report Revenue 26,337,124Prior Year Settlements -Cost Report Reimbursable Bad Debts 1,972,278Estimates and Accrual Variances (1,732,651)Other (4,509,571)Subtotal - Amount reported in Pt III, line 5 22,067,180Amounts include in Part 1, lines g and f -Total Medicare Revenue 22,067,180*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 three years to assess changes in the market and community perception. Data is collected through a variety of sources, 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.A copy of the hospital's 2013 CHNA study is posted on the hospital's website, https://www.adventisthealth.org/clear-lake/Pages/About-Us/community.aspx, as well as on the Adventist Health Corporate website, https://www.adventisthealth.org/Pages/About-Us/Community-Health-Needs-Assessments.aspx |
| 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 in a rural setting, predominately agricultural based. The average income is at or below the FPG. The population is predominately Caucasian, high-school educated, with a large portion over age 65. |
| 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 | We do not wait until a community member needs our services through our clinics or our Emergency Department. We are active in the community we serve. By involving ourselves in various activities, groups, and outreaches, we communicate our willingness to serve our community and our commitment to our mission. Our community health needs assessment keeps us current with changes in the health of our community. By working with other groups and agencies we are better able to assess the needs of the community then if we relied only on our own resources. |
| 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. |
| Part VI - States Where Community Benefit Report Filed | CA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 entries)
| TitleTitleTxt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dodds Larry | |||||||||||||
| Former Dir/V Chair/Sec | $216,120 | $3,969 | $220,089 | $216,120 | |||||||||
| Gumpert Norman | |||||||||||||
| Pharmacist | $213,536 | $13,130 | $26,037 | $252,703 | |||||||||
| Brunk Tammy | |||||||||||||
| CNM, FNP Midwife | $166,146 | $6,689 | $57,783 | $236,814 | $6,196 | ||||||||
| McCurry William | |||||||||||||
| RN-IV, OP Surgery | $144,745 | $8,631 | $37,733 | $194,285 | $3,176 | ||||||||
| Myers Irvin | |||||||||||||
| Nuclear Med Tech | $160,625 | $8,424 | $11,758 | $181,607 | $800 | ||||||||
| Madsen Kathleen | |||||||||||||
| RN-III, Surgery | $129,468 | $7,191 | $34,812 | $172,271 | $800 | ||||||||
| Carmen Robert | |||||||||||||
| Dir/Chair | $352,983 | $27,048 | $1,513,840 | $989,976 | $126,046 | $17,787 | |||||||
| Reiner Scott | |||||||||||||
| Dir/V Chair/Sec | $302,585 | $28,391 | $1,274,247 | $277,913 | $688,994 | $84,288 | $169,989 | ||||||
| Rebok Douglas | |||||||||||||
| Asst Secretary | $142,757 | $24,601 | $949,730 | $121,472 | $572,416 | $72,192 | $137,764 | ||||||
| Wehtje Rodney | |||||||||||||
| Asst Treasurer | $101,441 | $22,183 | $614,222 | $65,921 | $369,816 | $37,102 | $83,680 | ||||||
| Wing Bill | |||||||||||||
| Asst Secretary | $116,785 | $28,699 | $955,019 | $63,725 | $593,788 | $71,552 | $144,195 | ||||||
| Newmyer Terrance | |||||||||||||
| President | $179,998 | $746,628 | $82,326 | $458,880 | $107,750 | ||||||||
| Herber Steven | |||||||||||||
| Int Pres/Sr VP | $49,634 | $28,311 | $420,011 | $28,402 | $261,694 | $25,000 | $55,372 | ||||||
| McDonald Edward | |||||||||||||
| Asst Sec/Sr VP | $51,326 | $28,375 | $404,717 | $35,381 | $267,884 | $57,132 | |||||||
| Jacobson Carlton | |||||||||||||
| Treas/Asst Sec | $35,657 | $28,428 | $317,542 | $20,402 | $213,444 | $40,013 | |||||||
| Santos David | |||||||||||||
| Asst Sec/VP Ops | $39,911 | $30,887 | $301,582 | $25,425 | $192,814 | $37,970 | |||||||
| Matthews Gwen | |||||||||||||
| Sr VP Operations | $57,466 | $28,328 | $458,634 | $37,042 | $289,944 | $20,000 | $62,896 | ||||||
| Bockmann Rick | |||||||||||||
| VP Administration | $15,741 | $22,016 | $364,973 | $240,906 | $86,310 | ||||||||
| Cowan Joshua | |||||||||||||
| VP Marketing | $7,771 | $28,505 | $229,670 | $184,704 | $8,690 | ||||||||
| Lendaris Nia | |||||||||||||
| Reg VP Patient Care Svcs | $13,909 | $16,111 | $222,712 | $181,388 | $11,304 | ||||||||
| Williams Patricia | |||||||||||||
| VP Business Development | $37,355 | $28,272 | $297,653 | $24,950 | $197,444 | $34,582 | |||||||
| Olson David | |||||||||||||
| VP Physician Svcs | $52,163 | $23,669 | $260,253 | $171,962 | $12,459 | ||||||||
| Shapiro Mark | |||||||||||||
| CMO | $130,000 | $271,711 | $141,711 | ||||||||||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | Part VI, Line 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 directorsPart VI, 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, 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 upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (19 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Adventist Health SystemWest | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 956619002 | 953484589 | Support and Manage System-wide Activities | CA | 501(c)(3) | 1 | NA | 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 Ter | Glendale | CA | 91206 | 951816017 | Hospital | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Hanford Community Hospital | ||||||||||
| 450 Greenfield Ave | Hanford | CA | 93230 | 940535360 | Hospital | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| NW Medical Foundation of Tillamook | ||||||||||
| 1000 Third St | Tillamook | OR | 97141 | 930622075 | Hospital | OR | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Paradise Valley Hospital | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 951816034 | Wind down after sale of hospital facilities | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Portland Adventist Medical Center | ||||||||||
| 10123 SE Market St | Portland | OR | 97216 | 930429015 | Hospital | OR | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| 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 |
| Sonora Community Hospital | ||||||||||
| 1000 Greenley Rd | Sonora | CA | 95370 | 941415069 | Hospital | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Ukiah Adventist Hospital | ||||||||||
| 275 Hospital Dr | Ukiah | CA | 95482 | 941639901 | Hospital | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Walla Walla General Hospital | ||||||||||
| 1025 S Second Ave | Walla Walla | WA | 99362 | 910617726 | Hospital | WA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| White Memorial Medical Center | ||||||||||
| 1720 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Coast Medical Center | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2100 Douglas Blvd | AddressLine1 |
| City | Roseville | City |
| State | CA | State |
| ZIP Code | 95661 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 952037297 | EIN |
| Primary Activities | Wind down after sale of hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C Corp | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |