SAN JOAQUIN COMMUNITY HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SAN JOAQUIN COMMUNITY HOSPITAL (EIN 95-2294234)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201223209349309407
Schema version
2011v1.2
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)
Timestamp2012-11-15T16:21:03-08:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BROWN ARMSTRONG ACCOUNTANCY CORPORATIONBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14200 TRUXTUN AVE STE 300AddressLine1
CityBAKERSFIELDCity
StateCAState
ZIP Code933090668ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN952294234EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1San Joaquin Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSANJNameControl
Phone6613953000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12615 Chester AvenueAddressLine1
CityBakersfieldCity
StateCAState
ZIP Code93301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBrent SoperName
TitleVP FinanceTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameChristina M ThornburghName
Phone6613244971Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts319552297GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Group Exemption Number1071GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.sjch.usWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission Descriptionto share god's love with our community by providing physical, mental and spiritual healing.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees2308TotalNbrEmployees
Total Nbr Volunteers272TotalNbrVolunteers
Total Gross UBI12068TotalGrossUBI
Net Unrelated Business Txbl Income9886NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1354738ContributionsGrantsPriorYear
Contributions Grants Current Year2608593ContributionsGrantsCurrentYear
Program Service Revenue Prior Year265649177ProgramServiceRevenuePriorYear
Program Service Revenue CY310821431ProgramServiceRevenueCY
Investment Income Prior Year3192516InvestmentIncomePriorYear
Investment Income Current Year2820152InvestmentIncomeCurrentYear
Other Revenue Prior Year2290181OtherRevenuePriorYear
Other Revenue Current Year1933418OtherRevenueCurrentYear
Total Revenue Prior Year272486612TotalRevenuePriorYear
Total Revenue Current Year318183594TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year123252602SalariesEtcPriorYear
Salaries Etc Current Year154166930SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1158722TotalFundrsngExpCurrentYear
Other Expense Prior Year121907870OtherExpensePriorYear
Other Expenses Current Year132811574OtherExpensesCurrentYear
Total Expenses Prior Year245160472TotalExpensesPriorYear
Total Expenses Current Year286978504TotalExpensesCurrentYear
Revenues Less Expenses Prior Year27326140RevenuesLessExpensesPriorYear
Revenues Less Expenses CY31205090RevenuesLessExpensesCY
Total Assets BOY238506359TotalAssetsBOY
Total Assets EOY260121378TotalAssetsEOY
Total Liabilities BOY131345185TotalLiabilitiesBOY
Total Liabilities EOY136755114TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY107161174NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY123366264NetAssetsOrFundBalancesEOY
Mission Descriptionto share god's love with our community by providing physical, mental and spiritual healing.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense253679231Expense
Revenue310821431Revenue
DescriptionSan Joaquin Community Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of San Joaquin Community Hospital, the organization recognizes that not all individuals possess the ability to pay for essential medical services.San Joaquin Community Hospital's vision is that our service will set the standard for customer-centered, quality care. We will enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. Our mission is to carry on the healing ministry of Jesus Christ by providing quality patient care, maintaining a competent, caring, professional staff and responding to community needs. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need healthcare cannot pay: - Providing free care and/or subsidized care - Providing care to persons covered by governmental programs at below cost - Providing health/wellness activities and community education programsNot only does San Joaquin Community Hospital provide low-cost care to individuals covered by government programs and those unable to afford healthcare, but it also helps patients find and access private and governmental resources for healthcare benefits. San Joaquin Community Hospital recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed value of providing care to these patients in 2011 was $16,230,106.Inpatient services in 2011 were provided to 20,815 patients. These services included: - Acute care services for medical/surgical, pediatric, obstetric and critical care patients. - Baby deliveries totaling 2,676. - Surgery cases performed totaling 5,183, of which open-heart surgeries totaled 104. We also perform neurosurgery, ophthalmology, oral and maxillofacial surgery, otolaryngology, cosmetic surgery, thoracic and vascular surgery, urology, dental surgery and orthopedic surgery. - Radiology procedures performed - Cardiac catheterizations and other procedures - Laboratory tests performed - TCU/Intermediate care - Rehabilitation servicesOutpatient services in 2011 were provided to 76,627 patients. These services included: - Emergency room visits totaling 62,708 - Outpatient surgery cases performed totaled 4,500 - Radiology procedures performed - Cardiac catherizations and other procedures - Laboratory tests performed - OB ClinicsHome Health Care services in 2011 were provided to 1,215 unduplicated patients. These services included: - Home health - Private duty - Home medical equipment - Home infusion therapySan Joaquin Community Hospital recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission: - Business Health Network - This program meets the healthcare needs of the local industry. The program features workers' compensation case management, substance abuse screening, physicals, and wellness and educational programs. - Immunization Program - This program educates the community about childhood immunizations and makes vaccines both accessible and affordable to children in Kern County. It offers immunization clinics throughout the city for children two years of age and under. - Buck Owens Wellness Resource Center - This program provides a well-trained culturally competent staff to promote early detection, diabetes education, screening, and referral and follow up services in Bakersfield and the outlying communities.Description
Total Program Service Expense253679231TotalProgramServiceExpense
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 EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
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Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
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 IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
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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 RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
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Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096332NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees2308NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
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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
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
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
Policies Reference ChaptersfalsePoliciesReferenceChapters
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Conflict Of Interest PolicytrueConflictOfInterestPolicy
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Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBrent SoperNamePerson
Telephone Number6613953000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12615 Chester AvenueAddressLine1
CityBakersfieldCity
StateCAState
ZIP Code93301ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Helmuth Jones
Director1.00X03500
Larry Innocent
Director1.00X03500
Scott Reiner
V Chair / Sec50.00X0907841160287X
Larry Dodds
V Chair / Sec50.00X068534496060X
Robert Carmen
Chairman50.00X0174929739804X
Max Torkelsen
Director1.00X023810
Wes Rippey
Director1.00X0985030
Al Reimche
Director1.00X016370
Meredith Jobe
Director1.00X0546170
Steven Herber
Director1.00X021991241678
Ricardo Graham
Director1.00X026520
Christine Friestad
Director1.00X029270
Ruthita Fike
Director1.00X06350
Lynn Creitz
Director1.00X031230
Larry Caviness
Director1.00X026660
Robert Bradshaw
Director1.00X046520
Bill Wing
Asst Sec50.00032158189967X
Brent Soper
Treas / VP Fin50.00028067847471X
Robert Beehler
President / CEO50.000547069102979X
Rodney Wehtje
Asst Treas50.00050633695494X
Douglas Rebok
Asst Sec50.000857415147299X
Martha Samora
VP Ancillary Svr50.00024844342430X
Jarrod McNaughton
VP Mrktg & Dev50.00020553628998X
Sam Itani
VP Support Srv50.00021467834366X
Kurt Hoekendorf
VP Phys Dev50.00246846022525X
Deborah Hankins
VP / CNO50.00026714045621X
Binh Nguyen
Pharmacist37.00238914059445X
Fe Tolosa
RN Clinical Nurse54.00213534066396X
Xueyu Xu
Physical Therapist37.00204651040252X
Rafael Navaro
RN First Assist34.00203197032613X
Barry Chupa
RN First Assist36.00202854032558X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1309996TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7185763TotalReportableCompFrmRltdOrgs
Total Other Compensation1226243TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
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
Valley Anesthesia Associates
PO Box 2029BakersfieldCA93303Medical5171900
Swinerton Builders
2300 Clayton Rd Suite 800ConcordCA945202166Construction4311316
Quest Imaging Medical Association
PO BOX 2447BakersfieldCA93309Medical10638067
Kaiser foundation hospitals
5055 California AvenueBakersfieldCA93309Medical2506002
Highgrove Medical Center Inc
2701 Chester AveBakersfieldCA93301Medical2891145
FieldValueIRS element (for citing)
Number Of Contractors GT100 K64NumberOfContractorsGT100K
Government Grants627727GovernmentGrants
All Other Contributions1980866AllOtherContributions
Total Contributions2608593TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Rental-Medical Office53112011525161152516
Net Patient Revenue621110309656847309656847
Lab Fees6215001206812068
FieldValueIRS element (for citing)
Total Program Service Revenue310821431TotalProgramServiceRevenue

Investment Income InvestmentIncome

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Total Revenue Column2825206TotalRevenueColumn
Exclusion$2,825,206ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

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Other110Other

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Gain Or Loss GainOrLoss

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Other-5054Other

Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column-5054TotalRevenueColumn
Exclusion-$5,054ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

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Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn
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Gross Sales Of Inventory1363539GrossSalesOfInventory
Cost Of Goods Sold1363539CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Other Services624200418842418842
Education6241005975759757
Dietary72221014548191454819
FieldValueIRS element (for citing)
Total Other Revenue1933418TotalOtherRevenue

Total Revenue TotalRevenue

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Total Revenue Column318183594TotalRevenueColumn
Related Or Exempt Function Income312742781RelatedOrExemptFunctionIncome
Unrelated Business Revenue12068UnrelatedBusinessRevenue
Exclusion$2,820,152ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

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Grants To Domestic Individuals GrantsToDomesticIndividuals

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Total0Total

Foreign Grants ForeignGrants

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Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

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Total1563784Total
Program Services1294413ProgramServices
Management And General269371ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

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Total0Total

Other Salaries And Wages OtherSalariesAndWages

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Program Services108070729ProgramServices
Management And General8281868ManagementAndGeneral
Fundraising401405Fundraising

Pension Plan Contributions PensionPlanContributions

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Program Services2815977ProgramServices
Management And General288677ManagementAndGeneral
Fundraising10952Fundraising

Other Employee Benefits OtherEmployeeBenefits

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Program Services22528208ProgramServices
Management And General2170804ManagementAndGeneral
Fundraising84546Fundraising

Payroll Taxes PayrollTaxes

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Program Services7492603ProgramServices
Management And General429045ManagementAndGeneral
Fundraising28332Fundraising

Fees For Services Management FeesForServicesManagement

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Total0Total

Fees For Services Legal FeesForServicesLegal

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Total722197Total
Management And General722197ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

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Total74430Total
Management And General74430ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

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Total36000Total
Management And General36000ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

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Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

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Total0Total

Fees For Services Other FeesForServicesOther

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Total18294813Total
Program Services13896372ProgramServices
Management And General4181371ManagementAndGeneral
Fundraising217070Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total884052Total
Management And General880741ManagementAndGeneral
Fundraising3311Fundraising

Office Expenses OfficeExpenses

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Total3620195Total
Program Services2987209ProgramServices
Management And General603963ManagementAndGeneral
Fundraising29023Fundraising

Information Technology InformationTechnology

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Total6281701Total
Program Services6281701ProgramServices

Royalties Royalties

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Total0Total

Occupancy Occupancy

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Total4672454Total
Program Services4539523ProgramServices
Management And General132931ManagementAndGeneral

Travel Travel

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Program Services602593ProgramServices
Management And General519565ManagementAndGeneral
Fundraising12875Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

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Conferences Meetings ConferencesMeetings

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Total0Total

Interest Interest

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Total3790290Total
Program Services3790290ProgramServices

Payments To Affiliates PaymentsToAffiliates

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Total0Total

Depreciation Depletion DepreciationDepletion

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Fundraising5283Fundraising

Insurance Insurance

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Program Services1912143ProgramServices

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Purchased Services20574500136125576603630358313
Pt Care Supplies4795683747956837
Other Expenses8902626209746767975477612

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Total0Total

Total Functional Expenses TotalFunctionalExpenses

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Management And General32140551ManagementAndGeneral
Fundraising1158722Fundraising

Cash Non Interest Bearing CashNonInterestBearing

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BOY343375BOY
EOY564081EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

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EOY83961346EOY

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EOY41515052EOY

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EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

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EOY0EOY

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Inventories For Sale Or Use InventoriesForSaleOrUse

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EOY6761057EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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EOY529037EOY
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Land Buildings Equipment Basis174816533LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec69545394LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

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BOY103528456BOY
EOY105271139EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

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EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

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EOY0EOY

Investments Program Related InvestmentsProgramRelated

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EOY0EOY

Intangible Assets IntangibleAssets

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BOY11062458BOY
EOY8749507EOY

Other Assets Total OtherAssetsTotal

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BOY9378890BOY
EOY11698638EOY

Total Assets TotalAssets

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BOY238506359BOY
EOY260121378EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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BOY17217032BOY
EOY28237340EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

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BOY93503605BOY
EOY87464822EOY

Other Liabilities OtherLiabilities

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BOY20624548BOY
EOY21052952EOY

Total Liabilities TotalLiabilities

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BOY131345185BOY
EOY136755114EOY
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Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

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BOY106137824BOY
EOY120692257EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

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BOY1023350BOY
EOY2674007EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

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BOY107161174BOY
EOY123366264EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

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BOY238506359BOY
EOY260121378EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses31205090ReconcilationRevenueExpenses
Reconcilation Other Changes-15000000ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

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Church170b1 AiXChurch170b1Ai

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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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$36,000OtherActivitiesAmount
Total Lobbying Expenditures IIB36000TotalLobbyingExpendituresIIB
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
ExplanationLobbying expenses are an allocated portion of industry association membership dues as defined by the association. The Hospital has also engaged a lobbyist to advocate on our behalf when legislation is proposed so that our ability to continue serving our community is enhanced, rather than impaired.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4804594OtherCostOrOtherBasis
Book Value4804594BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis115645072OtherCostOrOtherBasis
Depreciation34509359Depreciation
Book Value81135713BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis506570OtherCostOrOtherBasis
Depreciation247465Depreciation
Book Value259105BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis53860297OtherCostOrOtherBasis
Depreciation34788570Depreciation
Book Value19071727BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings105271139TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Workers Comp Payable$2,754,782
Payables to Third Party Payors$16,520,310
Payables to Related Organizations$1,777,860
FieldValueIRS element (for citing)
Total Of Amounts21052952TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XI, Line 8Identifier
Return ReferencePart XI, Line 8: Other Changes in Net Assets or Fund BalancesReturnReference
ExplanationTransfers to related organization $ -15000000Explanation

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
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CarefalseAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense5004188TotalCommunityBenefitExpense
Net Community Benefit Expense5004188NetCommunityBenefitExpense
Percent Of Total Expense0.01740PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense43295559TotalCommunityBenefitExpense
Direct Offsetting Revenue44644745DirectOffsettingRevenue
Net Community Benefit Expense-1349186NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense526436TotalCommunityBenefitExpense
Direct Offsetting Revenue108083DirectOffsettingRevenue
Net Community Benefit Expense418353NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense48826183TotalCommunityBenefitExpense
Direct Offsetting Revenue44752828DirectOffsettingRevenue
Net Community Benefit Expense4073355NetCommunityBenefitExpense
Percent Of Total Expense0.01890PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense948733TotalCommunityBenefitExpense
Net Community Benefit Expense948733NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense100343TotalCommunityBenefitExpense
Net Community Benefit Expense100343NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1387809TotalCommunityBenefitExpense
Direct Offsetting Revenue1019690DirectOffsettingRevenue
Net Community Benefit Expense368119NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense706248TotalCommunityBenefitExpense
Net Community Benefit Expense706248NetCommunityBenefitExpense
Percent Of Total Expense0.00250PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3143133TotalCommunityBenefitExpense
Direct Offsetting Revenue1019690DirectOffsettingRevenue
Net Community Benefit Expense2123443NetCommunityBenefitExpense
Percent Of Total Expense0.00740PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense51969316TotalCommunityBenefitExpense
Direct Offsetting Revenue45772518DirectOffsettingRevenue
Net Community Benefit Expense6196798NetCommunityBenefitExpense
Percent Of Total Expense0.02630PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense8836TotalCommunityBuildingExpense
Net Community Building Expense8836NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense8836TotalCommunityBuildingExpense
Net Community Building Expense8836NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,857,235BadDebtExpenseAmount
Amount Attributable To1600052AmountAttributableTo
Amount Reimbursed By Medicare64958565AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare62735501CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall2223064MedicareSurplusOrShortfall

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 Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number0FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1San Joaquin Community HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12615 Chester AvenueAddressLine1
CityBakersfieldCity
StateCAState
ZIP Code93301ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1San Joaquin Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
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
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VI - Additional InformationSchedule H, Part V, Section B, Lines 1 through 7 is optional for the reporting organization as the tax year began prior to March 23, 2012, according to the instructions for Schedule H. Lacerte software has not provided a tool for an organization to indicate that it is opting not to complete Part V, Section B. In addition, the software has been programmed so that it populates responses when the organization chooses to provide no data inputs. Part V, Section B should be blank as the reporting organization opts to not complete it.
Part VI - States Where Community Benefit Report FiledCA
Part VI - Affilated Health Care System Roles and PromotionThe hospital is a member of Adventist Health, a health care system which provides healthcare services with other member hospitals in its geographic area, such as clinical, management, and support services. using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The corporate office provides important shared administrative support for member hospitals'rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk managment, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate adminstrative support for hospital affiliated groups that engage physicians through employment or other contracts. this provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities by all member hospitals.
Part VI - 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. Furthermore, we work with neighborhood programs, including schools, work sites, and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H.
Part VI - Community InformationThe hospital is one of the largest healthcare systems in the area serving Kern County and surrounding areas. The service area includes a small city and surrounding suburbs, small towns and rural agricultural areas. The diverse population includes Caucasian and a large minority population, both Hispanic and African-American.
Part VI - 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 are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. The hospital charity assistance policy is posted on the hospital website.
Part VI - 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 V, Line 19d - Other Billing Determination of Individuals Without InsuranceThe hospital's financial assistance policy has three income ranges for patients who received emergency medical care, which provides a discount based on Medicare rates. there are also three income ranges for patients who recieved non-emergency medical care; the two lower income ranges provide a discount based on medicare rates. the higher income range provides a discount from the balance due after the uninsured discount, that is available to all uninsured patients withouit regard to income. only five of the six income ranges are discounted based on medicare rates.Number of Hospital Faciltiy - 0
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 hospital's costs on the basis of inpatient days and ancilliary 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 infomration 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. wihtout medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between medicare payment increases and healthcare cost inflation, the highly complex medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of medicare revenue from the hospital's medicare cost report to general ledger revenue received* medicare cost report revenue 66,111,782prior year settlements (351,892)cost report reimburseable bad debts 1,267,982estimates and accrual variances (2,454,138)Other 384,831total medicare revenue 64,958,565 * 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 accoutned 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 recieve 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 1, Line 7 is mulitplied times the hospital's bad debt expense as reported in the system-wide combined audited financial statements. The resulting figure has been reproted 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-pary 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.

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 (19 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBonus Related OrgsBonusRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
Xueyu Xu
20465140252244903
Steven Herber
21246274502740014278261590
Scott Reiner
577345181404138780215071068128149092119583
Sam Itani
16775017768129952137124904429160
Rodney Wehtje
3404308712278557169376018307878452751
Robert Carmen
93434054774818150216541789101267209424494
Robert Beehler
3766007515986022169576500489531058045
Rafael Navaro
20319732613235810
Martha Samora
19740517468233101912029087333570
Larry Dodds
3035572106937908916971781404171094120139
Kurt Hoekendorf
2398121417026937170348355
Jarrod McNaughton
1699706406121641683423453429160
Fe Tolosa
21353466396279930
Douglas Rebok
533280175042128096192031004714149093123894
Deborah Hankins
21102020480287621685931276135640
Brent Soper
2294561333238606886532814937890
Binh Nguyen
23891459445298359
Bill Wing
305801157807441915548411548
Barry Chupa
20285432558235412

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Itani Design ConceptsBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipContractorRelationship
Amount Of Transaction51081AmountOfTransaction
Description Of TransactionBuilding RemodelingDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VII, Line 1a - Board CompThe directors serve on the Board without compensation. Amounts reported generally are for taxable benefits. Further explanation for those directors who receive compensation for services rendered in their professional capacity is discussed for each individual as applicable.
Form 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 available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe Adventist Health System/West board of directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary.Form 990, Part VI, Line 15b
Form 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 disclose each year during the audit process.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11: 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 11
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersForm 990, Part VI, Line 7aThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.Form 990, Part VI, Line 7bThe sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws.Form 990, Part VI, Line 7b
Form 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.Form 990, Part VI, Line 6

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Premier MSO LLC
2615 Chester AveBakersfieldCA93301271977963BILLING AND SCHEDULING FOR PREMIER IPACA4466732298701SAN JOAQUIN COMMUNITY HOSPITAL
Itani Investments LLC
2615 Chester AveBakersfieldCA93301800531044PROPERTY ACQUISITIONSCASAN JOAQUIN COMMUNITY HOSPITAL

Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
Adventist Health Physicians Network
2100 Douglas BoulevardRosevilleCA95661680357690Medical FoundationCA501(c)(3)11b, IIAdventist Health System Westfalse
Willits Hospital Inc
1 Madrone StreetWillitsCA95490680108919HospitalCA501(c)(3)1Adventist Health System Westfalse
White Memorial Medical Center
1720 Cesar E Chavez AvenueLos AngelesCA90033952282647HospitalCA501(c)(3)1Adventist Health System Westfalse
Walla Walla General Hospital
1025 South Second AvenueWalla WallaWA99362910617726HospitalWA501(c)(3)1Adventist Health System Westfalse
Ukiah Adventist Hospital
275 Hospital DriveUkiahCA95482941639901HospitalCA501(c)(3)1Adventist Health System Westfalse
St Helena Hospital
10 Woodland RoadSt HelenaCA94574941279779HospitalCA501(c)(3)1Adventist Health System Westfalse
Sonora Community Hospital
1000 Greenley RoadSonoraCA95370941415069HospitalCA501(c)(3)1Adventist Health System Westfalse
Simi Valley Hospital & Health Care Svcs
2975 North Sycamore DriveSimi ValleyCA93065956064971HospitalCA501(c)(3)1Adventist Health System Westfalse
Reedley Community Hospital
372 W Cypress AvenueReedleyCA93654453220509HospitalCA501(c)(3)1Adventist Health System Westfalse
Portland Adventist Medical Center
10123 SE Market StreetPortlandOR97216930429015HospitalOR501(c)(3)1Adventist Health System Westfalse
Paradise Valley Hospital
2100 Douglas BlvdRosevilleCA95661951816034Wind Down After Sale of Hospital FacilitiesCA501(c)(3)1Adventist Health System Westfalse
Northwest Medical Foundation - Tillamook
1000 Third StreetTillamookOR97141930622075HospitalOR501(c)(3)1Adventist Health System Westfalse
Hanford Community Hospital
115 Mall DrHanfordCA93230940535360HospitalCA501(c)(3)1Adventist Health System Westfalse
Glendale Adventist Medical Center
1509 Wilson TerraceGlendaleCA91206951816017HospitalCA501(c)(3)1Adventist Health System Westfalse
Feather River Hospital
5974 Pentz RoadParadiseCA95969941101228HospitalCA501(c)(3)1Adventist Health System Westfalse
Central Valley General Hopital
1025 N Douty StreetHanfordCA93230770324630HospitalCA501(c)(3)1Adventist Health System Westfalse
Castle Medical Center
640 Ulukahiki StreetKailuaHI96734990107330HospitalHI501(c)(3)1Adventist Health System Westfalse
Adventist Health Clearlake Hospital Inc
15630 18th AveClearlakeCA95422680395149HospitalCA501(c)(3)3Adventist Health System Westfalse
Adventist Health SystemsWest
2100 Douglas BoulevardRosevilleCA95661953484589Support and Manage System-Wide ActivitiesCA501(c)(3)1falseN/A

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
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 OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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