SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES (EIN 95-6064971)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201113209349300106
- Schema version
- 2010v3.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T21:37:22-08:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956064971 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hospital & Health Care | BusinessNameLine1 |
| Business Name Line2 | Services | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SIMI | NameControl |
| Phone | 8059556000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1 |
| City | Simi Valley | City |
| State | CA | State |
| ZIP Code | 93065 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jon Giese | Name |
| Title | Treas/CFO | Title |
| Date Signed | 2011-11-15 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Darwin Remboldt | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1 |
| City | Simi Valley | City |
| State | CA | State |
| ZIP Code | 93065 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 112795261 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.simivalleyhospital.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1960 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | The mission of Simi Valley Hospital is to demonstrate God's love by providing exceptional service and quality care to meet the physical, mental and spiritual needs of our community. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1053 | TotalNbrEmployees |
| Total Nbr Volunteers | 275 | TotalNbrVolunteers |
| Total Gross UBI | 483955 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -200564 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 347224 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1218232 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 98222549 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 111070177 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 297173 | InvestmentIncomePriorYear |
| Investment Income Current Year | 298866 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 349477 | OtherRevenuePriorYear |
| Other Revenue Current Year | 62018 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 99216423 | TotalRevenuePriorYear |
| Total Revenue Current Year | 112649293 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 52112577 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 58943871 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 306910 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 51237707 | OtherExpensePriorYear |
| Other Expenses Current Year | 57358597 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 103350284 | TotalExpensesPriorYear |
| Total Expenses Current Year | 116302468 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -4133861 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3653175 | RevenuesLessExpensesCY |
| Total Assets BOY | 130861798 | TotalAssetsBOY |
| Total Assets EOY | 129831471 | TotalAssetsEOY |
| Total Liabilities BOY | 177130613 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 178591775 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -46268815 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -48760304 | NetAssetsOrFundBalancesEOY |
| Mission Description | The mission of Simi Valley Hospital is to demonstrate God's love by providing exceptional service and quality care to meet the physical, mental and spiritual needs of our community. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 100453293 | Expense |
| Revenue | 105194447 | Revenue |
| Description | In support of the hospital's mission statement, Simi Valley Hospital & Health Care Services (SVHHCS) 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 Simi Valley 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 community and our patients in a new definition of a 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:providing free care and/or subsidized careproviding care to persons covered by governmental programs at below costproviding health/wellness activities and community education programsNot only does SVHHCS 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. SVHHCS 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 2010 was $3,599,004.Inpatient services in 2010 were provided to 6,770 patients. These services included:Babies deliveredSurgeries performedRadiology procedures performedLaboratory tests performedSkilled nursing facilitiesTCU/Intermediate careOutpatient services in 2010 were provided to 88,156 patients. These services included:Emergency room visitsOutpatient surgeries performedRadiology procedures performedLaboratory tests performedHome Care services in 2010 admitted 423 patients. These services included:Home healthHospicePrivate dutyHome medical equipmentHome infusion therapy SVHHCS 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:LifelineFlu VaccinesBlood Pressure ClinicsWellness ClassesHealth Education ClassesHealth FairsVisit our website at www.simivalleyhospital.com for more information about Simi Valley Hospital and Health Services. | Description |
| Total Program Service Expense | 100453293 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 216 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1053 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Quid Pro Quo Disclosure | false | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Jon Giese | NamePerson |
| Telephone Number | 8059556000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1 |
| City | Simi Valley | City |
| State | CA | State |
| ZIP Code | 93065 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | FormerFormer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | OfficerOfficer | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Gary Irish | |||||||||
| Former President/CEO | 0.00 | X | 0 | 156597 | 19970 | ||||
| Mark Newmeyer | |||||||||
| Sr VP Str Op | 50.00 | 0 | 256703 | 64626 | X | ||||
| Caroline Esparza | |||||||||
| Sr VP/CNO | 50.00 | 0 | 213095 | 30616 | X | ||||
| John Beaman | |||||||||
| Treas/CFO | 50.00 | 0 | 325968 | 31636 | X | ||||
| Darwin Remboldt | |||||||||
| President/CEO | 50.00 | 0 | 1765135 | 65498 | X | ||||
| Rodney Wehtje | |||||||||
| Asst Treas | 50.00 | 0 | 484703 | 160891 | X | ||||
| Scott Reiner | |||||||||
| Asst Sec | 50.00 | 0 | 706956 | 142451 | X | ||||
| Douglas Rebok | |||||||||
| Asst Sec | 50.00 | 0 | 701547 | 140807 | X | ||||
| Larry Dodds | |||||||||
| Dir/V Chair/Sec | 50.00 | 0 | 789424 | 159012 | X | X | |||
| Robert Carmen | |||||||||
| Dir/Chair | 50.00 | 0 | 1485849 | 256139 | X | X | |||
| Max Torkelsen | |||||||||
| Director | 1.00 | 0 | 1854 | 74 | X | ||||
| Wes Rippey MD | |||||||||
| Director | 1.00 | 0 | 144704 | 74 | X | ||||
| Allan Reimche | |||||||||
| Director | 1.00 | 0 | 1440 | 74 | X | ||||
| Meredith Jobe Esq | |||||||||
| Director | 1.00 | 0 | 16246 | 74 | X | ||||
| Steven C Herber MD | |||||||||
| Director | 1.00 | 0 | 146754 | 74 | X | ||||
| Ricardo Graham | |||||||||
| Director | 1.00 | 0 | 2309 | 74 | X | ||||
| Christine E Friestad Esq | |||||||||
| Director | 1.00 | 0 | 1311 | 74 | X | ||||
| Ruthita Fike | |||||||||
| Director | 1.00 | 0 | 405 | 74 | X | ||||
| Lynn Creitz | |||||||||
| Director | 1.00 | 0 | 2123 | 74 | X | ||||
| Larry Caviness | |||||||||
| Director | 1.00 | 0 | 2505 | 74 | X | ||||
| Robert Bradshaw DDS | |||||||||
| Director | 1.00 | 0 | 1321 | 74 | X | ||||
| Jeff Smith | |||||||||
| Dir. Surgery | 0.00 | 154166 | 0 | 0 | X | ||||
| Joanne Bercier-Gorcey | |||||||||
| Admin Dir. Nursing | 50.00 | 170683 | 0 | 0 | X | ||||
| Kathleen Percival | |||||||||
| Dir. Quality & Edu | 50.00 | 154830 | 0 | 0 | X | ||||
| Monica Berlin | |||||||||
| Dir. Ambulatory Sv | 50.00 | 157173 | 0 | 0 | X | ||||
| Carol Deamer | |||||||||
| Pharmacy Dir | 50.00 | 188564 | 0 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 825416 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 7206949 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1072460 | TotalOtherCompensation |
| Number Individuals GT100 K | 63 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Advani Sharmeela MD | |||||
| 10515 Balboa Blvd 390 | Granada Hills | CA | 91344 | Physician | 301242 |
| Dialysis Stat Medical Group | |||||
| PO Box 940838 | Simi Valley | CA | 93094 | Dialysis | 368775 |
| Latham Watkins | |||||
| 355 South Grand Avenue | Los Angeles | CA | 90071 | Legal Services | 410469 |
| Devenney Group LTD | |||||
| 201 West Indian School Road | Phoenix | AZ | 85013 | Architect | 440636 |
| SODEXO INC & AFFILIATES | |||||
| PO Box 43283 | LOS ANGELES | CA | 90088 | Plant Ops & Food Sv | 2800080 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 21 | NumberOfContractorsGT100K |
| Government Grants | 485346 | GovernmentGrants |
| All Other Contributions | 732886 | AllOtherContributions |
| Total Contributions | 1218232 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Business CodeBusinessCode | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Education | 20128 | 20128 | |||
| Other Prog Serv Revenue | 75541 | 75541 | 900099 | ||
| Rent | 610915 | 610915 | 531120 | ||
| Family Connection | 624950 | 483955 | $140,995 | ||
| Patient Service Revenue | 109738643 | 109738643 | 900099 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 111070177 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 276485 | TotalRevenueColumn |
| Exclusion | $276,485 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 22381 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 22381 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22381 | TotalRevenueColumn |
| Exclusion | $22,381 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 35652 | GrossIncomeFundraisingEvents |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 35652 | TotalRevenueColumn |
| Exclusion | $35,652 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 158662 | GrossSalesOfInventory |
| Cost Of Goods Sold | 145968 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12694 | TotalRevenueColumn |
| Exclusion | $12,694 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|
| CNG INT FND | -21328 | -$21,328 |
| ASC Interest Sold | 35000 | $35,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 13672 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 112649293 | TotalRevenueColumn |
| Related Or Exempt Function Income | 110445227 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 483955 | UnrelatedBusinessRevenue |
| Exclusion | $501,879 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47013606 | Total |
| Program Services | 43804222 | ProgramServices |
| Management And General | 3005503 | ManagementAndGeneral |
| Fundraising | 203881 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1701307 | Total |
| Program Services | 1701307 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6783222 | Total |
| Program Services | 6080509 | ProgramServices |
| Management And General | 667160 | ManagementAndGeneral |
| Fundraising | 35553 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3445736 | Total |
| Program Services | 3197673 | ProgramServices |
| Management And General | 232236 | ManagementAndGeneral |
| Fundraising | 15827 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 566297 | Total |
| Management And General | 566297 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 313601 | Total |
| Management And General | 313601 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4736692 | Total |
| Program Services | 3754704 | ProgramServices |
| Management And General | 958231 | ManagementAndGeneral |
| Fundraising | 23757 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 377412 | Total |
| Management And General | 377412 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16197973 | Total |
| Program Services | 15715618 | ProgramServices |
| Management And General | 466079 | ManagementAndGeneral |
| Fundraising | 16276 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3076172 | Total |
| Program Services | 3058721 | ProgramServices |
| Management And General | 17451 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3647172 | Total |
| Program Services | 3298153 | ProgramServices |
| Management And General | 349019 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 219934 | Total |
| Program Services | 140131 | ProgramServices |
| Management And General | 77503 | ManagementAndGeneral |
| Fundraising | 2300 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47426 | Total |
| Program Services | 35930 | ProgramServices |
| Management And General | 11496 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5599350 | Total |
| Program Services | 5599350 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5057792 | Total |
| Program Services | 4986761 | ProgramServices |
| Management And General | 70966 | ManagementAndGeneral |
| Fundraising | 65 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1258825 | Total |
| Program Services | 1258825 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Rental/lease equipment | 935954 | 929954 | 6000 | |
| Other expenses | 4969987 | 33419 | 4936568 | |
| Purchased services | 10354010 | 6858016 | 3486743 | 9251 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116302468 | Total |
| Program Services | 100453293 | ProgramServices |
| Management And General | 15542265 | ManagementAndGeneral |
| Fundraising | 306910 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35323 | BOY |
| EOY | 301223 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8598 | BOY |
| EOY | 49019 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14140561 | BOY |
| EOY | 14183170 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2035 | BOY |
| EOY | 10871 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1967286 | BOY |
| EOY | 1588225 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1972525 | BOY |
| EOY | 1668999 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 151377453 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 53724715 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 92763388 | BOY |
| EOY | 97652738 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1630871 | BOY |
| EOY | 1416371 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18341211 | BOY |
| EOY | 12960855 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130861798 | BOY |
| EOY | 129831471 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12465790 | BOY |
| EOY | 11367409 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13928000 | BOY |
| EOY | 15105327 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 150736823 | BOY |
| EOY | 152119039 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 177130613 | BOY |
| EOY | 178591775 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -47213717 | BOY |
| EOY | -50858552 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 944902 | BOY |
| EOY | 2098248 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -46268815 | BOY |
| EOY | -48760304 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130861798 | BOY |
| EOY | 129831471 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -3653175 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1161686 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Church170b1 Ai | X | Church170b1Ai |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $14,850 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 14850 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i | Identifier |
| Return Reference | Part II-B, Line 1i - Other Activities Description | ReturnReference |
| Explanation | Portion of California Hospital Association/Hospital Association of Southern California Dues used for direct lobbying. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6392411 | OtherCostOrOtherBasis |
| Book Value | 6392411 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 104507172 | OtherCostOrOtherBasis |
| Depreciation | 33173631 | Depreciation |
| Book Value | 71333541 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 843053 | OtherCostOrOtherBasis |
| Depreciation | 843053 | Depreciation |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30242694 | OtherCostOrOtherBasis |
| Depreciation | 18149583 | Depreciation |
| Book Value | 12093111 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9392123 | OtherCostOrOtherBasis |
| Depreciation | 1558448 | Depreciation |
| Book Value | 7833675 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 97652738 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| Aspen Surgery Venture, LLC | 1316250 | C |
| Sycamore Med Partners | 100121 | C |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other Receivables | 435949 |
| Other Assets | 2244074 |
| Receivables from Related Organizations | 7919403 |
| Workers Comp | 2361429 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 12960855 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Settlements - Medicare | $714,782 |
| Workers Comp Payable | $2,077,322 |
| Payables to Related Organizations | $149,326,935 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 152119039 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part XI, Line 8 | Identifier |
| Return Reference | Part XI, Line 8: Other Changes in Net Assets or Fund Balances | ReturnReference |
| Explanation | Donated property and equipment $12362 Change in interest in foundation $1149324 | Explanation |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | false | AgreementRefFundraising |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Volunteer Special Event Fundraising | NameOfEvent1 |
| Gross Receipts Event1 | 35652 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 35652 | GrossRevenueEvent1 |
| Gross Receipts Total | 35652 | GrossReceiptsTotal |
| Gross Revenue Total Events | 35652 | GrossRevenueTotalEvents |
| Net Income Summary | 35652 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2445463 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 150563 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2294900 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01970 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11102780 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10062312 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1040468 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00890 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13548243 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10212875 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3335368 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02860 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 230997 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44670 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 186327 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2500 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 35439 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 35439 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 268936 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44670 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 224266 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13817179 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10257545 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3559634 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03050 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 757822 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 684584 | DirectOffsettingRevenue |
| Net Community Building Expense | 73238 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 757822 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 684584 | DirectOffsettingRevenue |
| Net Community Building Expense | 73238 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,328,923 | BadDebtExpenseAmount |
| Amount Attributable To | 93025 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 29263940 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 36721611 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7457671 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 0 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2975 N Sycamore Dr | AddressLine1 |
| City | Simi Valley | City |
| State | CA | State |
| ZIP Code | 93065 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Simi Valley Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 350.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 350.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | false | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part VI - Additional Information | Supplemental Part I 3aDue to a software issue, we are unable to reflect our organization's use of 350%.Supplemental for Part III, Line 8Reconciiliation of Medicare Revenue from the hospital's Medicare Cost Report to GL*Medicare Cost Report Revenue $28,124,777Prior Year Settlements $(224,016)Cost Report Reimbursable Bad Debts $411,987Estimates and Accrual Variances $168,786Other $168,786subtotal - Amount reported in Pt III, line 5 $29,263,940Amounts included in Part 1, lings g and f $0Total Medicare Revenue $29,263,940Part V, Section BSchedule H, Part V, Section B is optional for the reporting organization as the tax year began prior to March 23, 2010. Further, IRS Announcement 2011-37 states the entire Part V, Section B is optional for the 2010 Form 990. 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 Filed | CA |
| Part VI - Affilated Health Care System Roles and Promotion | The 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 - Community Building Activities | Our hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. And, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. |
| Part VI - Community Information | Community is defined as the primary service area for SVH and includes three ZIP codes in the cities of:Simi Valley (ZIP codes 93063 and 93065)Moorpark (ZIP code 93021)DEMOGRAPHICS Based on data from the 2000 census and the City of Simi Valley, SVH's Primary Service Area is described as follows:PRIMARY SERVICE AREA - SUMMATION 1.The PSA is relatively young -8% of population is 65 and older compared to 15% nationally-Median age is 35 compared to 37 for County and State and 39 Nationally2.Relatively Affluent-$83,000 median income vs. $65,000 in County, $49,000 in State and $42,000 Nationally3.Predominantly White and Hispanic-68% White and 21% Hispanic4.Steadily Growing-1.6% annual growth compared to 1.3% in the County and State and 0.90% Nationally-Will result in a growing demand for health care services |
| Part VI - Patient Education of Eligibility for Assistance | At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients also are orally informed of their right to request charity assistance. Signs and other communiqus 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. |
| Part VI - Needs Assessment | The health system retains outside research firms every three years to assess changes in the market and community perception. Data is collected through a variety of 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 Patients | When a patient has requested screening for charity care, the hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income" and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.Caring for Medicare patients fulfills a community need and relives a government burden as these patients typically have low and/or fixed incomes. Medicare does not provide sufficient reimbursement to cover the cost of providing care for these patients and that shortfall of $16,353,559 should be included as community benefit. |
| Part III, Line 4 - Bad Debt Expense | The combined audited financial statement footnotes do not contain a bad debt expense footnote.Costing Methodology: The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense. We estimate that $93,025 of bad debt should be included as community benefit. As a tax-exempt hospital we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. As part of our community needs assessment, we studied the income characteristics of the uninsured population in our community. As part of this study, we also looked at what portion of uninsured individuals in the hospital's service area would be eligible for the hospital's financial assistance policy. We applied this percentage to our total amount of bad debt for self-pay patients to estimate the portion of self-pay bad debt that was likely attributable to individuals eligible for the hospital's financial assistance policy. We subtracted the actual amount of financial assistance provided from this figure. The remainder is the estimated amount entered on Part III, line 3. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | true | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | true | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|---|---|---|
| Mark Newmeyer | ||||||||
| 200800 | 37170 | 18733 | 42586 | 22040 | 321329 | |||
| Caroline Esparza | ||||||||
| 169300 | 29655 | 14140 | 12628 | 17988 | 243711 | |||
| John Beaman | ||||||||
| 207695 | 101580 | 16693 | 10114 | 21522 | 357604 | |||
| Darwin Remboldt | ||||||||
| 311580 | 90476 | 1363079 | 54567 | 10931 | 1830633 | 1322981 | ||
| Rodney Wehtje | ||||||||
| 324430 | 71576 | 88697 | 144827 | 16064 | 645594 | 54524 | ||
| Scott Reiner | ||||||||
| 510580 | 135332 | 61044 | 122323 | 20128 | 849407 | |||
| Douglas Rebok | ||||||||
| 512780 | 137782 | 50985 | 122488 | 18319 | 842354 | |||
| Larry Dodds | ||||||||
| 588930 | 152891 | 47603 | 142912 | 16100 | 948436 | |||
| Robert Carmen | ||||||||
| 920840 | 235922 | 329087 | 235392 | 20747 | 1741988 | 211163 | ||
| Jeff Smith | ||||||||
| 154166 | 154166 | |||||||
| Joanne Bercier-Gorcey | ||||||||
| 170683 | 170683 | |||||||
| Kathleen Percival | ||||||||
| 154830 | 154830 | |||||||
| Monica Berlin | ||||||||
| 157173 | 157173 | |||||||
| Carol Deamer | ||||||||
| 188564 | 188564 | |||||||
| Gary Irish | ||||||||
| 156597 | 9088 | 10882 | 176567 | |||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch J, Part I, Line 6b | Identifier |
| Return Reference | Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or | ReturnReference |
| Explanation | An incentive plan is included as part of the board-approved compensation plan for hospital executives. The hospital has a similar plan for department directors. The purpose of these plans is to provide incentives to hospital management to accomplish the financial, operational, quality, and mission objectives of the hospital during each fiscal year. Each member of the management team is evaluated against pre-determined objectives to arrive at the incentive amount, if any, for the fiscal year. See Schedule O for additional detail. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| Mark Newmyer | ||||||
| Education Loan | X | $4,375 | 4375 | false | true | true |
| John Beaman | ||||||
| Education Loan | X | $6,496 | 6496 | false | true | true |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 10871 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Line 7a | The hospital bylaws define its board of directors to be the same individuals who are members of the Adventist health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital. | |
| Form 990, Part VII, Line 1a - Board Comp | The 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 follows. Steven Herber, MD is the Chief Medical Officer for St. Helena Hospital. The hospital paid Dr. Herber $104,004 for his services. The CMO services were provided under contract approved by the Board Compliance Committee.Jobe & Stoterau, a law practice with which Meredith Jobe is affiliated, provided legal services regarding real estate matters to White Memorial Medical Center in the amount of $13,791. Wes Rippey, MD is the Chief Medical Officer for Portland Adventist Medical Center. The hospital paid Dr. Rippey $57,600 for his services. Additionally, Dr. Rippey provides vascular study interpretations and on call coverage for patients of the hospital. The hospital paid $85,818 for these professional services. These services were provided under contract approved by the Board Compliance Committee. | |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy available upon request, but does file monthly/quarterly summary financial reports with the state health planning agency. | Form 990, Part VI, Line 19 |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The hospital board of directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data.The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary.(This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary. | Form 990, Part VI, Line 15b |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation, to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The corporate internal audit staff review these questionnaires and disclosures each year during the audit process. | Form 990, Part VI, Line 12c |
| Form 990, Part VI, Line 11: Form 990 Review Process | The completed Form 990 is shared with members of the hospital's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board after their review but prior to filing. | Form 990, Part VI, Line 11 |
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. | Form 990, Part VI, Line 6 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (20 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| WILLITS HOSPITAL INC | ||||||||||
| 1 Madrone St | Willits | CA | 95490 | 680108919 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| WHITE MEMORIAL MEDICAL CENTER | ||||||||||
| 1720 Cesar E Chavez Ave | Los Angeles | CA | 90033 | 952282647 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| WALLA WALLA GENERAL HOSPITAL | ||||||||||
| 1025 S Second Ave | Walla Walla | WA | 99362 | 910617726 | HOSPITAL | WA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| UKIAH ADVENTIST HOSPITAL | ||||||||||
| 275 Hospital Dr | Ukiah | CA | 95482 | 941639901 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| SOUTH COAST MEDICAL CENTER | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 952037291 | HOSPITAL | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| SONORA COMMUNITY HOSPITAL | ||||||||||
| 1000 Greenley Rd | Sonora | CA | 95370 | 941415069 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| Simi Valley Hospital Foundation | ||||||||||
| 2975 N Sycamore Dr | Simi Valley | CA | 93065 | 912135595 | FUNDRAISING FOR HOSPITAL | CA | 501(c)(3) | 11a, I | Western Health Resources | false |
| SELMA COMMUNITY HOSPITAL INC | ||||||||||
| 1141 Rose Ave | Selma | CA | 93662 | 770509133 | SUPPORTING HANFORD COMMUNITY HOSPITAL | CA | 501(C)(3) | 11c, III-FI | Adventist Health SystemWest | false |
| SAN JOAQUIN COMMUNITY HOSPITAL | ||||||||||
| 2615 Chester Ave | Bakersfield | CA | 93301 | 952294234 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| ST HELENA HOSPITAL | ||||||||||
| 10 Woodland Rd | St Helena | CA | 94574 | 941279779 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| PORTLAND ADVENTIST MEDICAL CENTER | ||||||||||
| 10123 SE Market St | Portland | OR | 97216 | 930429015 | HOSPITAL | OR | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| PARADISE VALLEY HOSPITAL | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 951816034 | WIND DOWN AFTER SALE OF HOSPITAL FACILITIES | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| NORTHWEST MEDICAL FOUNDATION OF TILLAMOO | ||||||||||
| 1000 Third St | Tillamook | OR | 97141 | 930622075 | HOSPITAL | OR | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| HANFORD COMMUNITY HOSPITAL | ||||||||||
| 450 Greenfield Ave | Hanford | CA | 93230 | 940535360 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| GLENDALE ADVENTIST MEDICAL CENTER | ||||||||||
| 1509 Wilson Ter | Glendale | CA | 91206 | 951816017 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| FEATHER RIVER HOSPITAL | ||||||||||
| 5974 Pentz Rd | Paradise | CA | 95969 | 941101228 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| CENTRAL VALLEY GENERAL HOSPITAL | ||||||||||
| 1025 N Douty St | Hanford | CA | 93230 | 770324630 | HOSPITAL | CA | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| CASTLE MEDICAL CENTER | ||||||||||
| 640 Ulukahiki St | Kailua | HI | 96734 | 990107330 | HOSPITAL | HI | 501(c)(3) | 1 | Adventist Health SystemWest | false |
| ADVENTIST HEALTH CLEARLAKE HOSPITAL INC | ||||||||||
| Ave 18 at Hwy 53 | Clearlake | CA | 95422 | 680395149 | HOSPITAL | CA | 501(c)(3) | 3 | Adventist Health SystemWest | false |
| ADVENTIST HEALTH SYSTEMWEST | ||||||||||
| 2100 Douglas Blvd | Roseville | CA | 95661 | 953484589 | SUPPORT AND MANAGE SYSTEM-WIDE ACTIVITIES | CA | 501(c)(3) | 1 | NA | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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