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        <BusinessNameLine2>dba St Helena Hospital Clear Lake</BusinessNameLine2>
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      <PersonNm>Carlton Jacobson</PersonNm>
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      <SignatureDt>2014-11-17</SignatureDt>
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    <BuildTS>2015-11-30 17:44:51Z</BuildTS>
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      <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 &amp; EventsDiabetes Education</Desc>
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        <PersonNm>Fillman Orvin</PersonNm>
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        <PersonNm>Lendaris Nia</PersonNm>
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        <PersonNm>Williams Patricia</PersonNm>
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        <PersonNm>Olson David</PersonNm>
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        <PersonNm>Shapiro Mark</PersonNm>
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        <PersonNm>McCurry William</PersonNm>
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        <PersonNm>Myers Irvin</PersonNm>
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        <PersonNm>Madsen Kathleen</PersonNm>
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        <TotalAmt>1713488</TotalAmt>
        <ProgramServicesAmt>940093</ProgramServicesAmt>
        <ManagementAndGeneralAmt>773395</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Rentals/Leases</Desc>
        <TotalAmt>302335</TotalAmt>
        <ProgramServicesAmt>272562</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27358</ManagementAndGeneralAmt>
        <FundraisingAmt>2415</FundraisingAmt>
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      <AllOtherExpensesGrp>
        <TotalAmt>0</TotalAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>59609118</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8032551</ManagementAndGeneralAmt>
        <FundraisingAmt>315563</FundraisingAmt>
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        <EOYAmt>447853</EOYAmt>
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        <EOYAmt>634697</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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        <EOYAmt>432917</EOYAmt>
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      <AccountsReceivableGrp>
        <BOYAmt>7060990</BOYAmt>
        <EOYAmt>10401797</EOYAmt>
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        <EOYAmt>684309</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>127933</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>51611967</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>22960265</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>28651702</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
        <BOYAmt>623605</BOYAmt>
        <EOYAmt>599631</EOYAmt>
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      <InvestmentsOtherSecuritiesGrp>
        <EOYAmt>0</EOYAmt>
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      <InvestmentsProgramRelatedGrp>
        <EOYAmt>0</EOYAmt>
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      <IntangibleAssetsGrp>
        <EOYAmt>0</EOYAmt>
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      <OtherAssetsTotalGrp>
        <BOYAmt>5119772</BOYAmt>
        <EOYAmt>3771596</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>41843951</BOYAmt>
        <EOYAmt>45752435</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>5889581</BOYAmt>
        <EOYAmt>4919942</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
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        <EOYAmt>22576293</EOYAmt>
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      <OtherLiabilitiesGrp>
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        <EOYAmt>39586074</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>61037693</BOYAmt>
        <EOYAmt>67082309</EOYAmt>
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      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>-19945520</BOYAmt>
        <EOYAmt>-21319890</EOYAmt>
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      <TemporarilyRstrNetAssetsGrp>
        <BOYAmt>751778</BOYAmt>
        <EOYAmt>-9984</EOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>-19193742</BOYAmt>
        <EOYAmt>-21329874</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>41843951</BOYAmt>
        <EOYAmt>45752435</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>-2136132</ReconcilationRevenueExpnssAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA" softwareId="13000170" softwareVersion="2013v3.1">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleC documentId="IRS990ScheduleC" softwareId="13000170" softwareVersion="2013v3.1">
      <Form4720FiledSection4955TaxInd>false</Form4720FiledSection4955TaxInd>
      <CorrectionMadeInd>false</CorrectionMadeInd>
      <VolunteersInd>false</VolunteersInd>
      <PaidStaffOrManagementInd>false</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>false</MediaAdvertisementsInd>
      <MailingsMembersInd>false</MailingsMembersInd>
      <PublicationsOrBroadcastInd>false</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>false</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>false</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>false</RalliesDemonstrationsInd>
      <OtherActivitiesInd>false</OtherActivitiesInd>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <Form4720Filed4912TaxInd>false</Form4720Filed4912TaxInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II-B, Line 1i - Other Activities Description</FormAndLineReferenceDesc>
        <ExplanationTxt>Portion of dues paid to membership organizations allocable to lobbying activities.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="IRS990ScheduleD" softwareId="13000170" softwareVersion="2013v3.1">
      <LandGrp>
        <OtherCostOrOtherBasisAmt>1353186</OtherCostOrOtherBasisAmt>
        <BookValueAmt>1353186</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>16276818</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>11650749</DepreciationAmt>
        <BookValueAmt>4626069</BookValueAmt>
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      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>11953505</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>9350093</DepreciationAmt>
        <BookValueAmt>2603412</BookValueAmt>
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      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>22028458</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1959423</DepreciationAmt>
        <BookValueAmt>20069035</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>28651702</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Receivables from Related Organizations</Desc>
        <BookValueAmt>964237</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Other Receivables</Desc>
        <BookValueAmt>587362</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Receivables from third-party payors</Desc>
        <BookValueAmt>2219997</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>3771596</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Workers' Comp Payable</Desc>
        <Amt>1606209</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Payables to Related Organizations</Desc>
        <Amt>36484261</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Payables to 3rd Party Payors</Desc>
        <Amt>1495604</Amt>
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      <TotalLiabilityAmt>39586074</TotalLiabilityAmt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part V, Line 4: Intended uses of the endowment fund.</FormAndLineReferenceDesc>
        <ExplanationTxt>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>
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      <WrittenPolicyInd>true</WrittenPolicyInd>
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      <FPGReferenceFreeCareInd>true</FPGReferenceFreeCareInd>
      <Percent200Ind>X</Percent200Ind>
      <FPGReferenceDiscountedCareInd>true</FPGReferenceDiscountedCareInd>
      <Percent200DInd>X</Percent200DInd>
      <FreeCareMedicallyIndigentInd>true</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>true</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>false</ExpensesExceedBudgetInd>
      <UnableToProvideCareInd>false</UnableToProvideCareInd>
      <AnnualCommunityBnftReportInd>true</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>true</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>656475</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>656475</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00970</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>20247034</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>23226596</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>-2979562</NetCommunityBenefitExpnsAmt>
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      <UnreimbursedCostsGrp>
        <TotalCommunityBenefitExpnsAmt>5126625</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>3489046</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>1637579</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.02410</TotalExpensePct>
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      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>26030134</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>26715642</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>-685508</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.03380</TotalExpensePct>
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      <CommunityHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>340893</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>252003</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>88890</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00130</TotalExpensePct>
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        <NetCommunityBenefitExpnsAmt>4490484</NetCommunityBenefitExpnsAmt>
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      <CashAndInKindContributionsGrp>
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        <NetCommunityBenefitExpnsAmt>5230</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00010</TotalExpensePct>
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        <DirectOffsettingRevenueAmt>10427305</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>4584604</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.06750</TotalExpensePct>
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      <TotalCommunityBenefitsGrp>
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        <DirectOffsettingRevenueAmt>37142947</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>3899096</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.10130</TotalExpensePct>
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      <CommunitySupportGrp>
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        <NetCommunityBenefitExpnsAmt>52229</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00080</TotalExpensePct>
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      <TotalCommuntityBuildingActyGrp>
        <TotalCommunityBenefitExpnsAmt>52229</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>52229</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00080</TotalExpensePct>
      </TotalCommuntityBuildingActyGrp>
      <BadDebtExpenseReportedInd>true</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>2031280</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>446882</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>22067180</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>25598549</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-3531369</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <CostToChargeRatioInd>X</CostToChargeRatioInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>true</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>true</FinancialAssistancePrvsnInd>
      <HospitalFacilitiesCnt>1</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1>Adv Health Clearlake Hospital</BusinessNameLine1>
        </BusinessName>
        <USAddress>
          <AddressLine1>15630 18th Ave</AddressLine1>
          <City>Clearlake</City>
          <State>CA</State>
          <ZIPCode>95422</ZIPCode>
        </USAddress>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <CriticalAccessHospitalInd>X</CriticalAccessHospitalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1>Adv Health Clearlake Hospital</BusinessNameLine1>
        </HospitalFacilityName>
        <FacilityNum>1</FacilityNum>
        <CHNAConductedInd>true</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <CHNAConductedYr>13</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>true</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>true</CHNAConductedWithOtherFcltsInd>
        <CHNAReportWidelyAvailableInd>true</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>See Sch H Part VI-Supplemental Info</OwnWebsiteURLTxt>
        <OtherWebsiteInd>X</OtherWebsiteInd>
        <OtherWebsiteURLTxt>See Sch H Part VI-Supplemental Info</OtherWebsiteURLTxt>
        <RptAvailableUponRequestInd>X</RptAvailableUponRequestInd>
        <DevelopCommunityWidePlanInd>X</DevelopCommunityWidePlanInd>
        <PrioritizeHealthNeedsInd>X</PrioritizeHealthNeedsInd>
        <PrioritizeServicesInd>X</PrioritizeServicesInd>
        <AllNeedsAddressedInd>true</AllNeedsAddressedInd>
        <OrganizationIncurExciseTaxInd>false</OrganizationIncurExciseTaxInd>
        <Form4720FiledInd>false</Form4720FiledInd>
        <EligCriteriaExplainedInd>true</EligCriteriaExplainedInd>
        <FPGUsedDeterEligFreeCareInd>true</FPGUsedDeterEligFreeCareInd>
        <FPGFamilyIncmLmtFreeCarePct>200.0000</FPGFamilyIncmLmtFreeCarePct>
        <FPGUsedDetermEligDscntCareInd>true</FPGUsedDetermEligDscntCareInd>
        <FPGFamilyIncmLmtDscntCarePct>400.0000</FPGFamilyIncmLmtDscntCarePct>
        <ExplainedBasisInd>true</ExplainedBasisInd>
        <IncomeLevelInd>X</IncomeLevelInd>
        <MedicalIndigencyInd>X</MedicalIndigencyInd>
        <InsuranceStatusInd>X</InsuranceStatusInd>
        <UninsuredDiscountInd>X</UninsuredDiscountInd>
        <MedicaidMedicareInd>X</MedicaidMedicareInd>
        <StateRegulationInd>X</StateRegulationInd>
        <AppFinancialAsstExplnInd>true</AppFinancialAsstExplnInd>
        <IncludesPublicityMeasuresInd>true</IncludesPublicityMeasuresInd>
        <PostedOnWebsiteInd>X</PostedOnWebsiteInd>
        <AttachedToInvoiceInd>X</AttachedToInvoiceInd>
        <PostedInEmergencyRoomInd>X</PostedInEmergencyRoomInd>
        <PostedInAdmissionOfficeInd>X</PostedInAdmissionOfficeInd>
        <ProvidedOnAdmissionInd>X</ProvidedOnAdmissionInd>
        <AvailableOnRequestInd>X</AvailableOnRequestInd>
        <FAPActionsOnNonpaymentInd>true</FAPActionsOnNonpaymentInd>
        <CollectionActivitiesInd>false</CollectionActivitiesInd>
        <NondisEmergencyCarePolicyInd>true</NondisEmergencyCarePolicyInd>
        <MedicareRatesInd>X</MedicareRatesInd>
        <AmountsGenerallyBilledInd>false</AmountsGenerallyBilledInd>
        <GrossChargesInd>false</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Line 3 - Account Input from Person Who Represent the Community</FormAndLineReferenceDesc>
        <ExplanationTxt>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</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>8</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>St Helena Cardiology - Lake Silverado</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>15250 Lakeshore Dr Ste C</AddressLine1>
            <City>Clearlake</City>
            <State>CA</State>
            <ZIPCode>95422</ZIPCode>
          </USAddress>
          <FacilityTxt>Outpatient Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>St Helena Therapy Services - Clearlake</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>14880 Olympic Dr</AddressLine1>
            <City>Clearlake</City>
            <State>CA</State>
            <ZIPCode>95422</ZIPCode>
          </USAddress>
          <FacilityTxt>Outpatient Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>St Helena General Surgery - Clearlake</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>15230 Lakeshore Dr Ste 102</AddressLine1>
            <City>Clearlake</City>
            <State>CA</State>
            <ZIPCode>95422</ZIPCode>
          </USAddress>
          <FacilityTxt>Outpatient Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Family Health Ctr - Clearlake</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>15230 Lakeshore Drive</AddressLine1>
            <City>Clearlake</City>
            <State>CA</State>
            <ZIPCode>95422</ZIPCode>
          </USAddress>
          <FacilityTxt>Rural Health Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Family Health Ctr -Kelseyville</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>5290 State St</AddressLine1>
            <City>Kelseyville</City>
            <State>CA</State>
            <ZIPCode>95451</ZIPCode>
          </USAddress>
          <FacilityTxt>Rural Health Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Family Health Ctr - Middletown</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>21337 Bush St</AddressLine1>
            <City>Middletown</City>
            <State>CA</State>
            <ZIPCode>95461</ZIPCode>
          </USAddress>
          <FacilityTxt>Rural Health Clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Cardiopulmonary Care Center</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>801 Eleventh St 3B</AddressLine1>
            <City>Lakeport</City>
            <State>CA</State>
            <ZIPCode>95453</ZIPCode>
          </USAddress>
          <FacilityTxt>Outpatient Cardiopulmonary Testing Center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Cardiology Clinic</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>15666 18th Ave</AddressLine1>
            <City>Clearlake</City>
            <State>CA</State>
            <ZIPCode>95422</ZIPCode>
          </USAddress>
          <FacilityTxt>Outpatient clinic</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7 - Explanation of Costing Methodology</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3 - Methodology of Estimated Amount &amp; Rationale for Including in Community Benefit</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4 - Bad Debt Expense</FormAndLineReferenceDesc>
        <ExplanationTxt>The system-wide audited combined financial statements do not contain a footnote describing bad debt expense.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8 - Explanation Of Shortfall As Community Benefit</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b - Provisions On Collection Practices For Qualified Patients</FormAndLineReferenceDesc>
        <ExplanationTxt>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</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Needs Assessment</FormAndLineReferenceDesc>
        <ExplanationTxt>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</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Patient Education of Eligibility for Assistance</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Community Information</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Community Building Activities</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Explanation Of How Organization Furthers Its Exempt Purpose</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - Affilated Health Care System Roles and Promotion</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI - States Where Community Benefit Report Filed</FormAndLineReferenceDesc>
        <ExplanationTxt>CA</ExplanationTxt>
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        <PersonNm>Shapiro Mark</PersonNm>
        <TitleTxt>CMO</TitleTxt>
        <BaseCompensationFilingOrgAmt>130000</BaseCompensationFilingOrgAmt>
        <OtherCompensationFilingOrgAmt>141711</OtherCompensationFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>271711</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO" softwareId="13000170" softwareVersion="2013v3.1">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b: Form 990 Review Process</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15a: Compensation Review &amp; Approval Process - CEO, Top Management</FormAndLineReferenceDesc>
        <ExplanationTxt>See explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19: Other Organization Documents Publicly Available</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
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          <BusinessNameLine1>Adventist Health SystemWest</BusinessNameLine1>
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          <AddressLine1>2100 Douglas Blvd</AddressLine1>
          <City>Roseville</City>
          <State>CA</State>
          <ZIPCode>956619002</ZIPCode>
        </USAddress>
        <EIN>953484589</EIN>
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          <BusinessNameLine1>NA</BusinessNameLine1>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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          <BusinessNameLine1>Castle Medical Center</BusinessNameLine1>
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          <AddressLine1>640 Ulukahiki St</AddressLine1>
          <City>Kailua</City>
          <State>HI</State>
          <ZIPCode>96734</ZIPCode>
        </USAddress>
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        <PublicCharityStatusTxt>1</PublicCharityStatusTxt>
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          <AddressLine1>1025 N Douty St</AddressLine1>
          <City>Hanford</City>
          <State>CA</State>
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          <AddressLine1>1509 Wilson Ter</AddressLine1>
          <City>Glendale</City>
          <State>CA</State>
          <ZIPCode>91206</ZIPCode>
        </USAddress>
        <EIN>951816017</EIN>
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          <BusinessNameLine1>Hanford Community Hospital</BusinessNameLine1>
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          <City>Hanford</City>
          <State>CA</State>
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          <BusinessNameLine1>NW Medical Foundation of Tillamook</BusinessNameLine1>
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          <State>OR</State>
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          <City>Roseville</City>
          <State>CA</State>
          <ZIPCode>95661</ZIPCode>
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          <BusinessNameLine1>Portland Adventist Medical Center</BusinessNameLine1>
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          <AddressLine1>10123 SE Market St</AddressLine1>
          <City>Portland</City>
          <State>OR</State>
          <ZIPCode>97216</ZIPCode>
        </USAddress>
        <EIN>930429015</EIN>
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        <LegalDomicileStateCd>OR</LegalDomicileStateCd>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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        <DisregardedEntityName>
          <BusinessNameLine1>St Helena Hospital</BusinessNameLine1>
        </DisregardedEntityName>
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          <City>St Helena</City>
          <State>CA</State>
          <ZIPCode>94574</ZIPCode>
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        <EIN>941279779</EIN>
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        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
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        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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          <BusinessNameLine1>San Joaquin Community Hospital</BusinessNameLine1>
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          <City>Bakersfield</City>
          <State>CA</State>
          <ZIPCode>93301</ZIPCode>
        </USAddress>
        <EIN>952294234</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>1</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>Adventist Health SystemWest</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>Simi Valley Hospital &amp; Health Care Svcs</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>2975 N Sycamore Dr</AddressLine1>
          <City>Simi Valley</City>
          <State>CA</State>
          <ZIPCode>93065</ZIPCode>
        </USAddress>
        <EIN>956064971</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>1</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1>Adventist Health SystemWest</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>Sonora Community Hospital</BusinessNameLine1>
        </DisregardedEntityName>
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          <AddressLine1>1000 Greenley Rd</AddressLine1>
          <City>Sonora</City>
          <State>CA</State>
          <ZIPCode>95370</ZIPCode>
        </USAddress>
        <EIN>941415069</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
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          <BusinessNameLine1>Adventist Health SystemWest</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>Ukiah Adventist Hospital</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>275 Hospital Dr</AddressLine1>
          <City>Ukiah</City>
          <State>CA</State>
          <ZIPCode>95482</ZIPCode>
        </USAddress>
        <EIN>941639901</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CA</LegalDomicileStateCd>
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        <DisregardedEntityName>
          <BusinessNameLine1>Walla Walla General Hospital</BusinessNameLine1>
        </DisregardedEntityName>
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          <AddressLine1>1025 S Second Ave</AddressLine1>
          <City>Walla Walla</City>
          <State>WA</State>
          <ZIPCode>99362</ZIPCode>
        </USAddress>
        <EIN>910617726</EIN>
        <PrimaryActivitiesTxt>Hospital</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WA</LegalDomicileStateCd>
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          <BusinessNameLine1>Adventist Health SystemWest</BusinessNameLine1>
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      <IdRelatedTaxExemptOrgGrp>
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          <BusinessNameLine1>White Memorial Medical Center</BusinessNameLine1>
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          <City>Los Angeles</City>
          <State>CA</State>
          <ZIPCode>90033</ZIPCode>
        </USAddress>
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          <BusinessNameLine1>Willits Hospital Inc</BusinessNameLine1>
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          <City>Willits</City>
          <State>CA</State>
          <ZIPCode>95490</ZIPCode>
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        </DirectControllingEntityName>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>Adventist Health Physicians Network</BusinessNameLine1>
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          <AddressLine1>2100 Douglas Blvd</AddressLine1>
          <City>Roseville</City>
          <State>CA</State>
          <ZIPCode>95661</ZIPCode>
        </USAddress>
        <EIN>680357690</EIN>
        <PrimaryActivitiesTxt>Medical Foundation</PrimaryActivitiesTxt>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>Reedley Community Hospital</BusinessNameLine1>
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          <State>CA</State>
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        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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          <City>Roseville</City>
          <State>CA</State>
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        </USAddress>
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      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
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