2011-11-15T21:37:22-08:00 2010-12-31 990 2010-01-01 956064971 Simi Valley Hospital & Health Care Services SIMI 8059556000 2975 N Sycamore Dr Simi Valley CA 93065 Jon Giese 2011-11-15 2010 2016-03-07 17:11:31Z Darwin Remboldt 2975 N Sycamore Dr Simi Valley CA 93065 112795261 false false X www.simivalleyhospital.com X 1960 CA 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. 13 8 1053 275 483955 -200564 347224 1218232 98222549 111070177 297173 298866 349477 62018 99216423 112649293 0 0 52112577 58943871 0 306910 51237707 57358597 103350284 116302468 -4133861 -3653175 130861798 129831471 177130613 178591775 -46268815 -48760304 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. false false 100453293 105194447 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. 100453293 true true false true false false false false false false true false false true true false false true false false false false false false true false true true false false true false false false false false false true false false false false false false false false false true false false false false true 216 0 true 1053 true false false false false false false false false false false false 0 false false false false false false false false false false false X 13 8 false false false false true false true true true false false false true true true true true true true true true true X Jon Giese 8059556000 2975 N Sycamore Dr Simi Valley CA 93065 Gary Irish 0.00 X 0 156597 19970 Mark Newmeyer 50.00 X 0 256703 64626 Caroline Esparza 50.00 X 0 213095 30616 John Beaman 50.00 X 0 325968 31636 Darwin Remboldt 50.00 X 0 1765135 65498 Rodney Wehtje 50.00 X 0 484703 160891 Scott Reiner 50.00 X 0 706956 142451 Douglas Rebok 50.00 X 0 701547 140807 Larry Dodds 50.00 X X 0 789424 159012 Robert Carmen 50.00 X X 0 1485849 256139 Max Torkelsen 1.00 X 0 1854 74 Wes Rippey MD 1.00 X 0 144704 74 Allan Reimche 1.00 X 0 1440 74 Meredith Jobe Esq 1.00 X 0 16246 74 Steven C Herber MD 1.00 X 0 146754 74 Ricardo Graham 1.00 X 0 2309 74 Christine E Friestad Esq 1.00 X 0 1311 74 Ruthita Fike 1.00 X 0 405 74 Lynn Creitz 1.00 X 0 2123 74 Larry Caviness 1.00 X 0 2505 74 Robert Bradshaw DDS 1.00 X 0 1321 74 Jeff Smith 0.00 X 154166 0 0 Joanne Bercier-Gorcey 50.00 X 170683 0 0 Kathleen Percival 50.00 X 154830 0 0 Monica Berlin 50.00 X 157173 0 0 Carol Deamer 50.00 X 188564 0 0 825416 7206949 1072460 63 true true false 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 21 485346 732886 1218232 Education 20128 20128 Other Prog Serv Revenue 900099 75541 75541 Rent 531120 610915 610915 Family Connection 624950 483955 140995 Patient Service Revenue 900099 109738643 109738643 111070177 276485 276485 0 0 0 22381 22381 22381 22381 35652 35652 35652 0 158662 145968 12694 12694 CNG INT FND -21328 -21328 ASC Interest Sold 35000 35000 13672 112649293 110445227 483955 501879 0 0 0 0 0 0 47013606 43804222 3005503 203881 1701307 1701307 6783222 6080509 667160 35553 3445736 3197673 232236 15827 0 566297 566297 313601 313601 0 0 0 4736692 3754704 958231 23757 377412 377412 16197973 15715618 466079 16276 3076172 3058721 17451 0 3647172 3298153 349019 219934 140131 77503 2300 0 47426 35930 11496 5599350 5599350 0 5057792 4986761 70966 65 1258825 1258825 Rental/lease equipment 935954 929954 6000 Other expenses 4969987 33419 4936568 Purchased services 10354010 6858016 3486743 9251 0 116302468 100453293 15542265 306910 35323 301223 8598 49019 0 14140561 14183170 2035 10871 0 0 1967286 1588225 1972525 1668999 151377453 53724715 92763388 97652738 0 0 1630871 1416371 0 18341211 12960855 130861798 129831471 12465790 11367409 13928000 15105327 150736823 152119039 177130613 178591775 X -47213717 -50858552 944902 2098248 -46268815 -48760304 130861798 129831471 X -3653175 1161686 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 14850 14850 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description Portion of California Hospital Association/Hospital Association of Southern California Dues used for direct lobbying. 6392411 6392411 104507172 33173631 71333541 843053 843053 30242694 18149583 12093111 9392123 1558448 7833675 97652738 Aspen Surgery Venture, LLC 1316250 C Sycamore Med Partners 100121 C Other Receivables 435949 Other Assets 2244074 Receivables from Related Organizations 7919403 Workers Comp 2361429 12960855 Settlements - Medicare 714782 Workers Comp Payable 2077322 Payables to Related Organizations 149326935 152119039 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Donated property and equipment $12362 Change in interest in foundation $1149324 X false Volunteer Special Event Fundraising 35652 35652 35652 35652 35652 true true X true X true X true true false false true true 2445463 150563 2294900 0.01970 11102780 10062312 1040468 0.00890 13548243 10212875 3335368 0.02860 230997 44670 186327 0.00160 2500 2500 35439 35439 0.00030 268936 44670 224266 0.00190 13817179 10257545 3559634 0.03050 757822 684584 73238 0.00060 757822 684584 73238 0.00060 true 1328923 93025 29263940 36721611 -7457671 X true true 1 0 Simi Valley Hospital

2975 N Sycamore Dr Simi Valley CA 93065

X X X Simi Valley Hospital 1 false true true 350.0000 true 350.0000 true X true true X X X X false false true false false 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. X X X X true true false false false true true false false false 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 Sch J, Part I, Line 6b Part I, Line 6b: Explanation of organization compensation contingent on net earnings from related or 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. Mark Newmyer Education Loan X 4375 4375 false true true John Beaman Education Loan X 6496 6496 false true true 10871 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 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 15b 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 12c 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 11 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 6 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. 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 false false false false false false false false false false false false false false false false false false