ST HELENA HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ST HELENA HOSPITAL (EIN 94-1279779)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201343199349300109
Schema version
2012v2.0
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

FieldValueIRS element (for citing)
Timestamp2013-11-15T02:31:44-08:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN941279779EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1St Helena HospitalBusinessNameLine1
Business Name Line2DBA St Helena Hospital Napa ValleyBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSTHENameControl
Phone7079633611Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line110 Woodland RoadAddressLine1
CitySt HelenaCity
StateCAState
ZIP Code94574ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMcDonald EdwardName
TitleTreas/Sr VP FinTitle
Date Signed2013-11-15DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTreasSr VP FinNameOfPrincipalOfficerPerson
Gross Receipts200749839GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Group Exemption Number1071GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitehttp://www.sthelenahospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1898YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionThe hospital mission is to provide our community with physical, mental, and spiritual healing in a way that reflects God's love for all.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees1638TotalNbrEmployees
Total Nbr Volunteers237TotalNbrVolunteers
Total Gross UBI348577TotalGrossUBI
Net Unrelated Business Txbl Income191267NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4470876ContributionsGrantsPriorYear
Contributions Grants Current Year4848688ContributionsGrantsCurrentYear
Program Service Revenue Prior Year192905085ProgramServiceRevenuePriorYear
Program Service Revenue CY192218714ProgramServiceRevenueCY
Investment Income Prior Year273905InvestmentIncomePriorYear
Investment Income Current Year245740InvestmentIncomeCurrentYear
Other Revenue Prior Year808298OtherRevenuePriorYear
Other Revenue Current Year1219882OtherRevenueCurrentYear
Total Revenue Prior Year198458164TotalRevenuePriorYear
Total Revenue Current Year198533024TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year27750GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY36250GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year92963970SalariesEtcPriorYear
Salaries Etc Current Year90206038SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1188668TotalFundrsngExpCurrentYear
Other Expense Prior Year97992370OtherExpensePriorYear
Other Expenses Current Year102440304OtherExpensesCurrentYear
Total Expenses Prior Year190984090TotalExpensesPriorYear
Total Expenses Current Year192682592TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7474074RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5850432RevenuesLessExpensesCY
Total Assets BOY164645756TotalAssetsBOY
Total Assets EOY174476650TotalAssetsEOY
Total Liabilities BOY115234571TotalLiabilitiesBOY
Total Liabilities EOY119258992TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY49411185NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY55217658NetAssetsOrFundBalancesEOY
Mission DescriptionTo share God's love by providing physical, mental, and spiritual healing.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense162693347Expense
Revenue192653804Revenue
DescriptionSt. Helena Hospital 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, 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 and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay:a) Providing free care and/or subsidized careb) Providing care to persons covered by governmental programs at below costc) Providing health/wellness activities and community education programsNot only does St. Helena Hospital 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 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 2012 was $5,589,365.Inpatient services in 2012 were provided to 8,058 patients. These services included:Babies delivered - 258Surgeries performed - 2,405Radiology procedures performed - 18,387Cardiac catheterization and other procedures - 8,040Laboratory tests performed - 258,681Rehabilitation Units - 1Outpatient services in 2012 were provided to 92,250 patients. These services included:Emergency Room visits - 7,446Surgeries performed - 3,796Radiology procedures performed - 31,919Cardiac catheterization procedures - 7,736Laboratory tests performed - 258,681Medical clinics - 24Home Care services in 2012 were provided to 1,075 patients. These services included:Home health visits - 12,944 St. Helena Hospital recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission:Early Intervention ProgramHealthy Beginnings ProgramHealthvan One, Project HopeSafe Sitter classesChildren's Activity CenterHealthy Families Program Teddy Bear FairsPediatric S.A.R.T. (Sexual Assault Response Team) ProgramLearning-For-Life CentersSensory Integration Summer CampAsthma CampPhoneFriendGirls Today, Women TomorrowPASS (Parents for Alternate Support Solutions)Partners for PreventionParish NursingHealth FairsBlood Pressure ClinicsDescription
Total Program Service Expense162693347TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096276NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1638NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCarlton JacobsonNamePerson
Telephone Number7079633611TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110 Woodland RoadAddressLine1
CitySt HelenaCity
StateCAState
ZIP Code94574ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (37 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Reiner Scott
V Chair/Sec0.0050.00XX0915400183744
Carmen Robert
Chairman0.0050.00XX0181444238864
Torkelsen Max
Director1.000.00X022330
Rippey Wesley
Director1.000.00X01004060
Reimche Alan
Director1.000.00X022900
Jones Helmuth
Director1.000.00X011270
Jobe Meredith
Dir/VP/Gen Cnsl1.000.00X031802173755
Innocent Larry
Director1.000.00X012730
Graham Ricardo
Director1.000.00X025560
Gabriel Melody
Director1.000.00X03000
Friestad Christine
Director1.000.00X025860
Fike Ruthita
Director1.000.00X06950
Dickinson Charles
Director1.000.00X030850
Creitz Lynn
Director1.000.00X040520
Caviness Larry
Director1.000.00X032450
McDonald Edward
Treas/Asst Sec50.000.00X0340918140630
Newmyer Terrance
President50.000.00X0721944123003
Wing Bill
Asst Secretary0.0050.00X0665195154613
Wehtje Rodney
Asst Treasurer0.0050.00X0534490210115
Rebok Douglas
Asst Secretary0.0050.00X0872315159731
Jacobson Carlton
VP Finance50.000.00023402760084X
Lundin Steven
CDO50.000.00000X
Bockmann Rick
VP Administrative50.000.00027621231647X
Matthews Gwen
Sr VP Operations50.000.00037267283402X
Williams Patricia
VP Business Dev50.000.00022984857685X
Selivanoff Paul
VP Finance50.000.00019027232038X
Olson David
VP Physician Svcs/CMG50.000.00014493432745X
Lendaris Antonia
VP Pt Care Svcs50.000.00019399426661X
Fillman Orvin
Reg VP Behav Med50.000.00020558930687X
Cowan Joshua
VP Marketing50.000.00021798436310X
Herber Steven
Executive VP/CMO50.000.00028185671326X
Coon Thomas
Medical Director40.000.003011510147X
Lundin Stephen
Chief Dev. Officer40.000.00240371035481X
Kirk Richard
Nurse Practitioner40.000.00232548029493X
Nelson Barry
CV Lab Supervisor40.000.00227135030572X
Scherencel Tobin
RN OT PT Surgery40.000.00208307027244X
Dodds Larry
Former V Chair/Sec0.000.0007884218492X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1209512TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs8732803TotalReportableCompFrmRltdOrgs
Total Other Compensation1688469TotalOtherCompensation
Number Individuals GT100 K131NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Patient Access Medical Group
PO Box 742528DallasTX75374Physician Services1080000
The Lancashire Group
PO Box 1138NewarkCA94560Security Services1104930
Quantum Healthcare
PO Box 634850CincinnatiOH45263Hospitalist Services1147029
Dreyfuss & Blackford
3540 Folsom BlvdSacramentoCA95816Construction&Design2182517
AH CA Medical Group
1001 Adams St Ste 102St HelenaCA94574Physician Services4824216
FieldValueIRS element (for citing)
Number Of Contractors GT100 K45NumberOfContractorsGT100K
Related Organizations3526997RelatedOrganizations
Government Grants21642GovernmentGrants
All Other Contributions1300049AllOtherContributions
Total Contributions4848688TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
Other Revenue900099268452268452
Dietary722210764050764050
Rental Income53112012026151185468$17,147
EMR Incentives62199025864532586453
Patient Service Revenue621990187397144187397144
FieldValueIRS element (for citing)
Total Program Service Revenue192218714TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column240212TotalRevenueColumn
Exclusion$240,212ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other5528Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other5528Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5528TotalRevenueColumn
Exclusion$5,528ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory2979632GrossSalesOfInventory
Cost Of Goods Sold2216815CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column762817TotalRevenueColumn
Unrelated Business Revenue343749UnrelatedBusinessRevenue
Exclusion$419,068ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Spa services81290048284828
Community services221000139782139782
Chg in interest in fnd900099312455312455
FieldValueIRS element (for citing)
Total Other Revenue457065TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column198533024TotalRevenueColumn
Related Or Exempt Function Income192653804RelatedOrExemptFunctionIncome
Unrelated Business Revenue348577UnrelatedBusinessRevenue
Exclusion$681,955ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total36250Total
Program Services36250ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total68134821Total
Program Services60563323ProgramServices
Management And General6902265ManagementAndGeneral
Fundraising669233Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2341214Total
Program Services2341214ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total14725925Total
Program Services12466644ProgramServices
Management And General2099409ManagementAndGeneral
Fundraising159872Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5004078Total
Program Services4477080ProgramServices
Management And General483024ManagementAndGeneral
Fundraising43974Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1596209Total
Management And General1586634ManagementAndGeneral
Fundraising9575Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total321249Total
Management And General321249ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total18351201Total
Program Services16736672ProgramServices
Management And General1576395ManagementAndGeneral
Fundraising38134Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total3270141Total
Management And General3184471ManagementAndGeneral
Fundraising85670Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3060242Total
Program Services1883155ProgramServices
Management And General1127476ManagementAndGeneral
Fundraising49611Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5414581Total
Program Services5307068ProgramServices
Management And General90636ManagementAndGeneral
Fundraising16877Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4185278Total
Program Services3866646ProgramServices
Management And General317936ManagementAndGeneral
Fundraising696Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total313479Total
Program Services201776ProgramServices
Management And General103952ManagementAndGeneral
Fundraising7751Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total80192Total
Program Services47619ProgramServices
Management And General31491ManagementAndGeneral
Fundraising1082Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total2301719Total
Program Services2301719ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total8387621Total
Program Services8358980ProgramServices
Management And General27157ManagementAndGeneral
Fundraising1484Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total461532Total
Program Services461532ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Rentals/Leases13491141349114
Other116405044240110738263117763
Purchased Services1400008310347286356585186946
Patient Care Supplies2770715927707159

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total192682592Total
Program Services162693347ProgramServices
Management And General28800577ManagementAndGeneral
Fundraising1188668Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY345684BOY
EOY3255110EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY733901BOY
EOY3394328EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY30680404BOY
EOY32088446EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2689221BOY
EOY3348898EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1262398BOY
EOY1301117EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis187218552LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec101532591LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY85007297BOY
EOY85685961EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4066161BOY
EOY3462830EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY39860690BOY
EOY41939960EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY164645756BOY
EOY174476650EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY16298703BOY
EOY13283821EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY59188BOY
EOY37130EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1800769BOY
EOY1477833EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY97075911BOY
EOY104460208EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY115234571BOY
EOY119258992EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY25330806BOY
EOY28790874EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY21554426BOY
EOY24036606EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2525953BOY
EOY2390178EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY49411185BOY
EOY55217658EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY164645756BOY
EOY174476650EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses5850432ReconcilationRevenueExpenses
Reconcilation Other Changes-43959ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Church170b1 AiXChurch170b1Ai

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$12,087OtherActivitiesAmount
Total Lobbying Expenditures IIB12087TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1iIdentifier
Return ReferencePart II-B, Line 1i - Other Activities DescriptionReturnReference
ExplanationPortion of dues paid to membership organizations allocable to political lobbying activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance7606949BeginningOfYearBalance
Contributions4272247Contributions
Investment Earnings Or Losses-559442InvestmentEarningsOrLosses
Other Expenditures1881883OtherExpenditures
Administrative Expenses3078AdministrativeExpenses
End Of Year Balance9434793EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5742337BeginningOfYearBalance
Contributions4197230Contributions
Investment Earnings Or Losses817479InvestmentEarningsOrLosses
Other Expenditures3147811OtherExpenditures
Administrative Expenses2286AdministrativeExpenses
End Of Year Balance7606949EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6577529BeginningOfYearBalance
Contributions4780055Contributions
Investment Earnings Or Losses221919InvestmentEarningsOrLosses
Other Expenditures5835218OtherExpenditures
Administrative Expenses1948AdministrativeExpenses
End Of Year Balance5742337EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5242348BeginningOfYearBalance
Contributions7782272Contributions
Investment Earnings Or Losses209056InvestmentEarningsOrLosses
Other Expenditures6654542OtherExpenditures
Administrative Expenses1605AdministrativeExpenses
End Of Year Balance6577529EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5756309BeginningOfYearBalance
Contributions5947164Contributions
Investment Earnings Or Losses-345079InvestmentEarningsOrLosses
Other Expenditures6114275OtherExpenditures
Administrative Expenses1771AdministrativeExpenses
End Of Year Balance5242348EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.30780BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.17570PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.51650TermEndowmentEOYBalance
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis426637OtherCostOrOtherBasis
Book Value426637BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis108881605OtherCostOrOtherBasis
Depreciation57243323Depreciation
Book Value51638282BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis52750165OtherCostOrOtherBasis
Depreciation38687707Depreciation
Book Value14062458BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis25160145OtherCostOrOtherBasis
Depreciation5601561Depreciation
Book Value19558584BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings85685961TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables1871830
Interest in Consolidated Org21421935
Receivables from Related Organization18646195
FieldValueIRS element (for citing)
Total Book Value Other Assets41939960TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
Other Liabilities$769,456
Payables to 3rd Party Payors$6,747,059
Workers Comp Liability$2,992,783
Payables to Related Organizations$93,950,910
FieldValueIRS element (for citing)
Total Of Amounts104460208TotalOfAmounts

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierPart V, Line 4Identifier
Return ReferencePart V, Line 4: Intended uses of the endowment fund.ReturnReference
ExplanationBoard-designated, temporarily, and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Direct Offsetting Revenue956858DirectOffsettingRevenue
Net Community Benefit Expense-956858NetCommunityBenefitExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense22233490TotalCommunityBenefitExpense
Direct Offsetting Revenue24516287DirectOffsettingRevenue
Net Community Benefit Expense-2282797NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense7178527TotalCommunityBenefitExpense
Direct Offsetting Revenue5296878DirectOffsettingRevenue
Net Community Benefit Expense1881649NetCommunityBenefitExpense
Percent Of Total Expense0.00980PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense29412017TotalCommunityBenefitExpense
Direct Offsetting Revenue30770023DirectOffsettingRevenue
Net Community Benefit Expense-1358006NetCommunityBenefitExpense
Percent Of Total Expense0.00980PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense294110TotalCommunityBenefitExpense
Direct Offsetting Revenue88067DirectOffsettingRevenue
Net Community Benefit Expense206043NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense3584167TotalCommunityBenefitExpense
Direct Offsetting Revenue4273464DirectOffsettingRevenue
Net Community Benefit Expense-689297NetCommunityBenefitExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense255741TotalCommunityBenefitExpense
Direct Offsetting Revenue119416DirectOffsettingRevenue
Net Community Benefit Expense136325NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense26459TotalCommunityBenefitExpense
Net Community Benefit Expense26459NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4160477TotalCommunityBenefitExpense
Direct Offsetting Revenue4480947DirectOffsettingRevenue
Net Community Benefit Expense-320470NetCommunityBenefitExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense33572494TotalCommunityBenefitExpense
Direct Offsetting Revenue35250970DirectOffsettingRevenue
Net Community Benefit Expense-1678476NetCommunityBenefitExpense
Percent Of Total Expense0.01170PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense24645TotalCommunityBuildingExpense
Direct Offsetting Revenue22401DirectOffsettingRevenue
Net Community Building Expense2244NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense24645TotalCommunityBuildingExpense
Direct Offsetting Revenue22401DirectOffsettingRevenue
Net Community Building Expense2244NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,352,139BadDebtExpenseAmount
Amount Attributable To283949AmountAttributableTo
Amount Reimbursed By Medicare67891639AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare76532579CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-8640940MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalOtherOtherGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24Hours
SHH Ctr for Behavioral Health
2525 Oregon StVallejoCA94590XAcute Psychiatric Hospital
St Helena Hospital
110 Woodland RdSt HelenaCA94574XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

FieldValueIRS element (for citing)
CHNA ConductedfalseCHNAConducted
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.0000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.0000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
St Helena Physical Therapy
1030 Main Street Ste 100St HelenaCA94574Outpatient Clinic
St Helena Medical Specialties Internal Medicine
18990 Coyote Valley Rd Stes 9 10Hidden Valley LakeCA95467Outpatient Clinic
Adventist Health Home Care Napa Valley
27 Woodland RdSt HelenaCA94574Home Health Agency
Adventist Health Home Care Lake County
9245 Hwy 53Lower LakeCA94574Home Health Agency
St Helena Medical Specialties OBGYN
935 Trancas St Ste 4BNapaCA94558Outpatient Clinic
St Helena Coon Joint Replacement Institute
6 Woodland Rd Ste 202St HelenaCA94574Outpatient Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part VI - States Where Community Benefit Report FiledCA
Part VI - Affilated Health Care System Roles and PromotionThe hospital is a member of a larger health care system, which provides services in diversified areas of the Western United States. The hospital shares some services with other hospitals in its geographic area. Using today's technology, hospitals outside the geographic area are able to support the hospital by providing remote services such as telepharmacy and robotics surgery. The Corporate Office provides support for the rural health clinics, quality of care, and other clinical needs.
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeWe 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 - Community Building ActivitiesOur 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 - Community InformationThe hospital primarily serves the people of Napa, Lake, and Solano counties in California. Additionally, the hospital attracts patients from outside our geographic area with specialized destination medicine programs.
Part VI - Patient Education of Eligibility for AssistanceAt 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 and other communiques are posted and displayed throughout the hospital 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 - Needs AssessmentThe health system retains outside research firms to assess changes in the market and community perception. Data is collected through a variety of vehicles, including phone surveys, paper surveys, and focus groups. Questions were added to the survey to help assess the impact of our community benefit activities and residents' barriers to access for health care services as well as unmet community needs.
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsWhen 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 III, Line 8 - Explanation Of Shortfall As Community BenefitThe 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 too 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 $69,063,455Prior Year Settlements (25,821)Cost Report Reimbursable Bad Debts 357,698Estimates and Accrual Variances (1,240,438)Other (263,255)Subtotal - Amount reported in Pt. III, line 5 $67,891,639Amounts included in Part 1, lines g and f -Total Medicare Revenue $67,891,639*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 4 - Bad Debt ExpenseUncollected 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 audited combined financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2.The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.The system-wide audited combined financial statements do not contain a footnote describing bad debt expense.
Part I, Line 7 - Explanation of Costing MethodologyThe 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained
Total Nbr Of501 C3 And Govt Grants0TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantPsych Intern StipendsTypeOfGrant
Number Of Recipients5NumberOfRecipients

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGrantmaker's Description of How Grants are UsedIdentifier
ExplanationGrants are made to student interns working alongside licensed psychiatric clinicians at our mental health facility. The grant funds are given to help defray general living costs while the students are actively working in the facility and are only given during the the period of their internship.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (24 entries)

TitleTitleComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Jacobson Carlton
VP Finance18844221351242343718522899294111
Bockmann Rick
VP Administrative23127031915130271289818749307859
Matthews Gwen
Sr VP Operations279250934226044722955456074
Williams Patricia
VP Business Dev19100026912119363478322902287533
Selivanoff Paul
VP Finance172394963582431102721011222310
Olson David
VP Physician Svcs/CMG12338221552684425901177679
Lendaris Antonia
VP Pt Care Svcs1757151226960101131115350220655
Fillman Orvin
Reg VP Behav Med1751002217483151197218715236276
Cowan Joshua
VP Marketing17951125697127761341522895254294
Herber Steven
Executive VP/CMO2527502402950774838722939353182
McDonald Edward
Treas/Asst Sec25819035221475071176872294348154831182
Newmyer Terrance
President448840917631813411020662093784494779806
Wing Bill
Asst Secretary554320771973367813187622737819808
Wehtje Rodney
Asst Treasurer362899715821000091912881882774460563809
Rebok Douglas
Asst Secretary561780137623172912138641210901032046116805
Reiner Scott
V Chair/Sec65400014953411186616071923025109914442890
Carmen Robert
Chairman98257124068059119115298235661853306472760
Jobe Meredith
Dir/VP/Gen Cnsl262685553365635817397391776
Scherencel Tobin
RN OT PT Surgery2078075001260514639235551
Nelson Barry
CV Lab Supervisor2266355001391316659257707
Kirk Richard
Nurse Practitioner220000125481075818735262041
Lundin Stephen
Chief Dev. Officer2403711405421427275852
Coon Thomas
Medical Director301151147301298
Dodds Larry
Former V Chair/Sec7828056235641492897334

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Cambria Wehtje-Sim
Officer Child92117Employmentfalse
Maria Lendaris
Officer Child65957Employmentfalse
Gregory Williams
Officer Spouse32568Consulting Servicesfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part XI, Line 9Other Changes In Net Assets Or Fund Balances - Other DecreasesChange in value of split interest agreements = -$663932
Form 990, Part XI, Line 9Other Changes In Net Assets Or Fund Balances - Other IncreasesChg in interest of fnd rest net assets = $619973
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThe 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 publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe 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 15aForm 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top ManagementSee explanation of process for setting CEO compensation below on Form 990, Part VI, Line 15b explanation.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsDuring 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 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessThe 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 7bForm 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.The sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (20 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Reedley Community Hospital
372 W Cypress AveReedleyCA93654453220509HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Adventist Health Physicians Network
2100 Douglas BlvdRosevilleCA95661680357690Medical FoundationCA501(c)(3)11b, IIAdventist Health SystemWestfalse
Willits Hospital Inc
1 Madrone StWillitsCA95490680108919HospitalCA501(c)(3)1Adventist Health SystemWestfalse
White Memorial Medical Center
1720 Cesare E Chavez AveLos AngelesCA90033952282647HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Walla Walla General Hospital
1025 S Second AveWalla WallaWA99362910617726HospitalWA501(c)(3)1Adventist Health SystemWestfalse
Ukiah Adventist Hospital
275 Hospital DrUkiahCA95482941639901HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Sonora Community Hospital
1000 Greenley RdSonoraCA95370941415069HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Simi Valley Hospital & Health Care Svcs
2975 N Sycamore DrSimi ValleyCA93065956064971HospitalCA501(c)(3)1Adventist Health SystemWestfalse
San Joaquin Community Hospital
2615 Chester AveBakersfieldCA93301952294234HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Adventist Health Clearlake Hospital Inc
Ave 18 at Hwy 53ClearlakeCA95422680395149HospitalCA501(c)(3)3Adventist Health SystemWestfalse
Portland Adventist Medical Center
10123 SE Market StPortlandOR97216930429015HospitalOR501(c)(3)1Adventist Health SystemWestfalse
Paradise Valley Hospital
2100 Douglas BlvdRosevilleCA95661951816034Wind down after sale of hospital facilitiesCA501(c)(3)1Adventist Health SystemWestfalse
NW Medical Foundation of Tillamook
1000 Third StTillamookOR97141930622075HospitalOR501(c)(3)1Adventist Health SystemWestfalse
Hanford Community Hospital
450 Greenfield AveHanfordCA93230940535360HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Glendale Adventist Medical Center
1509 Wilson TerGlendaleCA91206951816017HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Feather River Hospital
5974 Pentz RdParadiseCA95969941101228HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Central Valley General Hospital
1025 N Douty StHanfordCA93230770324630HospitalCA501(c)(3)1Adventist Health SystemWestfalse
Castle Medical Center
640 Ulukahiki StKailuaHI96734990107330HospitalHI501(c)(3)1Adventist Health SystemWestfalse
St Helena Hospital Foundation
10 Woodland RdSt HelenaCA94574201384250Fundraising and Investment ManagementCA501(c)(3)11a, INAfalse
Adventist Health SystemWest
2100 Douglas BlvdRosevilleCA95661953484589Support and manage system-wide activitiesCA501(c)(3)1NAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1South Coast Medical CenterBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12100 Douglas BlvdAddressLine1
CityRosevilleCity
StateCAState
ZIP Code95661ZIPCode
FieldValueIRS element (for citing)
EIN952037291EIN
Primary ActivityWind down after sale of hospitalPrimaryActivity
Legal Domicile StateCALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityC CorpTypeOfEntity
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetstrueExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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