2023-11-06T12:51:25-06:00 2022-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2022-01-01 680395149 Adventist Health Clearlake Hospital Inc ADVE 9164060000 15630 18th Avenue Clearlake CA 95422 Jeffrey Mock Treasurer 9164060000 2023-11-06 1 Jeffrey Mock 999009999 1 Tracy S Paglia P00366884 2099556100 2023-10-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Adventist Health Clear Lake Colleen Assavapisitkul 15630 18th Avenue Clearlake CA 95422 192356655 0 1071 X www.adventisthealth.org/clear-lake/ X 1996 CA Living God's love by inspiring health, wholeness and hope. 13 11 943 2 0 0 2984785 7292822 160733224 182562730 573573 2272129 152312 158744 164443894 192286425 456231 270625 0 0 67546475 72213247 0 0 267895 92753131 106791486 160755837 179275358 3688057 13011067 121179230 139959853 113851859 112497711 7327371 27462142 X Living God's love by inspiring health, wholeness and hope. 0 0 110310034 270625 182562730 See Schedule O 110310034 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 943 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Wing Bill Dir/Asst Secr/Vice Chair thru 01/22 0.00 50.00 X X 0 2511347 56319 Heinrich Kerry Dir/Chair/CEO as of 01/22 0.00 50.00 X X 0 2131443 75065 Hofheins Todd Dir/Vice Chair/COO as of 01/22 0.00 50.00 X X 0 1971652 72279 Jahn Andrew Care Division President thru 02/22 0.00 50.00 X 0 1409539 74100 Beaman John CFO/Asst Secretary as of 01/22 0.00 50.00 X 0 1361096 58476 Nahapetian Arby - Care Division Medical Officer thru 02/22 0.00 50.00 X 0 1334111 68537 Stevens Eric - President Northern CA/HI State Network 5.00 45.00 X 0 1315314 62845 Spenst Brett - Care Division Finance Officer thru 02/22 0.00 50.00 X 0 1322824 36101 Reiner Scott Former Dir/Chair/CEO thru 12/21 0.00 0.00 X 0 1222073 36652 Jobe Meredith Secretary 0.00 50.00 X 0 930036 39184 Byrnes John - Former Medical Officer, NCR thru 02/20 0.00 50.00 X 0 841204 65864 Howe Judson President, North Coast Network 8.30 41.70 X 0 782335 54114 Tetz Warren Treasurer 07/22 - 12/22 12.50 37.50 X 0 565355 37880 Cantrell Misty - Patient Care Executive as of 09/22 50.00 0.00 X 0 507425 64679 Cardenas Lucita RN 40.00 0.00 X 503160 0 39477 Mock Jeffrey Interim Treasurer as of 12/22 0.00 50.00 X 0 422487 97833 Assavapisitkul Colleen - Pt Cr Exec thru 05/22/Pres as of 05/22 50.00 0.00 X 0 459052 46184 Cole Delores RN 40.00 0.00 X 421517 0 27052 Jacobson Carlton - Former Treas /Asst Secr thru 12/21/Fin Off AHCL 50.00 0.00 X 0 383633 42724 Eller Jeff Former President, NCR 0.50 8.50 X 0 352684 52686 Anjejo Isaac RN, First Assistant 40.00 0.00 X 348186 0 34902 McCance David RN 40.00 0.00 X 324675 0 45886 Aleman Andrea RN Supervisor 40.00 0.00 X 319624 0 35240 Lonto Robert Former Reg HP Dir, NCR thru 02/20 0.00 50.00 X 0 270421 82148 Santos David President thru 05/22 50.00 0.00 X 0 230650 30853 Shapiro Marc Medical Officer 50.00 0.00 X 0 158109 0 Freedman John Director 0.00 4.00 X 0 26858 0 Woodson Marc Director 0.00 4.00 X 0 26728 0 Banks David Director 0.00 4.00 X 0 26478 0 Cherry Robert Director 0.00 4.00 X 0 26478 0 Davis Andrew Director 0.00 4.00 X 0 26478 0 Innocent Larry Director 0.00 4.00 X 0 26478 0 Reiner Richard Director 0.00 4.00 X 0 26478 0 Newton Bradford Director 0.00 4.00 X 0 25180 0 Salazar Velino Director 0.00 4.00 X 0 21478 0 Fehr Joy Director 0.00 4.00 X 0 430 0 Ocampo Lucy Director 0.00 4.00 X 0 430 0 1917162 20716284 1337080 170 1 1 1 Acqhire Inc 2941 Sunset Boulevard St Rancho Cordova CA 95742 Physician/medical provider 3066814 Rmg Medical Imaging Consultants 25360 Magic Mtn Pkwy Ste 270 Valencia CA 91355 Physician/medical provider 1536241 Lyons Huber Management A Medical Corp 512 Pine Hill Rd Angwin CA 94508 Physician/medical provider 1169408 Synchronous Health Inc 2021 21st Ave S Ste 400 Nashville TN 37212 Contract labor 1093014 Charles Barron PO Box 305 Middletown CA 95461 Construction 1004785 53 1704576 5588246 7292822 Patient service revenue 621110 159859620 159859620 CARES Act revenue 621110 11000000 11000000 Premium revenue 621110 8465449 8465449 Incentive/quality revenue 531120 1419872 1419872 340B Pharmacy revenue 621110 1132906 1132906 684883 684883 182562730 2277721 2277721 223382 64638 158744 158744 158744 5592 -5592 -5592 -5592 192286425 182562730 0 2430873 X 270625 270625 56281948 41492269 14598390 191289 1983268 1473895 501664 7709 10105346 7194750 2884022 26574 3842685 2901589 924053 17043 18210504 18210504 558371 558371 22035 22035 42191781 31342954 10847576 1251 317750 317750 1359967 768266 585026 6675 4929316 434119 4494603 594 4674808 3959102 712875 2831 418006 231491 177693 8822 47492 13544 32933 1015 2059507 2059507 4834564 4559931 270541 4092 999992 994110 5882 Patient care supplies 10870471 10092073 778398 Rental/leases costs equ 2694662 1093687 1600975 Quality assurance fees 85698 85698 12516562 1320389 11196173 179275358 110310034 68697429 267895 24379 103187 31360878 46019310 337360 424607 33995319 29994709 1208210 1739862 186088 49674 90590379 54221421 40813266 36368958 237616 177626 13016114 25081920 121179230 139959853 28580595 18926046 2369803 181680 1000000 0 81901461 93389985 113851859 112497711 X 6657871 26159612 669500 1302530 7327371 27462142 121179230 139959853 X 13011067 -4061337 11185041 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22035 22035 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to NL Short Public Affairs were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 680895 7048370 -17964 6398771 1312530 1278092 3372492 15218 3984907 680895 601407 4754613 -2147 4075781 1278092 610082 1733152 28727 1380823 389731 601407 661963 236726 -5590 133224 149793 610082 0.00762 0.00000 0.99238 0 0 2862339 2862339 46091478 26675022 19416456 2592553 1602194 990359 23801317 19534202 4267115 15242692 6410003 8832689 36368958 Receivables from third-party payors 17599433 Right-of-use assets 4240218 Other receivables 2404335 Receivables from related organizations 837934 25081920 Payables to related organizations 76141551 Payables to third-party payors 13635728 Other liabilities 3612706 93389985 X Part V, Line 4: Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2022 and 2021, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2019 in major tax jurisdictions. 1 1 X 1 X 1 X 1 1 1 0 1 1 1182539 1182539 0.00660 57160526 44810633 12349893 0.06890 58343065 44810633 13532432 0.07550 826725 826725 0.00460 74960 74960 0.00040 28559373 22217641 6341732 0.03540 74520 74520 0.00040 29535578 22217641 7317937 0.04080 87878643 67028274 20850369 0.11630 1266342 1266342 0.00710 5738 5738 0.00000 9851 9851 0.00010 1281931 1281931 0.00720 1 3820274 1570557 60818899 57827945 2990954 X 1 1 1 1 Adventist Health Clearlake Hospital 15630 18th Avenue Clearlake CA 95422 adventisthealth.org\clear-lake 110000174 X X X X Adventist Health Clearlake Hospital 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X 1 22 1 See Sch H Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Adventist Health Clearlake Hospital Part V, Section B, Line 5: The 2022 Community Health Needs Assessment was developed using four separate sources of primary and secondary data. This mixed methods approach is considered a preferred practice for needs assessments because it allows for the greatest understanding of community needs from the broadest range of perspectives. Primary data refers to data collected and analyzed specifically for this project, while secondary data refers to data compiled and analyzed by external groups and utilized here. Qualitative primary data collection involved focus group interviews with local service providers and service recipients and individual key informant interviews with local leaders. These were conducted in person and virtually. Direct quotes were taken from a transcription of key informant interviews and are intended to be 100% accurate but could not be verified in all situations. This information was collected by the Adventist Health Community Well Being team and evaluation consultants from the Center for Behavioral Health Integration. Secondary data was amassed and analyzed across 45 different data sets by the University of Missouri Extension Center for Applied Research and Engagement Systems (CARES). Finally, survey data sets of registered voters in the community were collected and analyzed by UC Berkeley Institute of Governmental Studies (IGS). In total, seven focus groups were conducted with 41 participants and 19 key informant interviews were held. Survey data was gathered from the North Coast region (region name defined by survey administrator, UC Berkeley IGS).Represented populations included agricultural workers (Spanish-speaking), civic government and leadership, community-based healthcare workers focusing on behavioral health, education, health and human services, higher education, providers, families, food insecure, law enforcement, low-income, medically underserved, men, older adults, public health, students, tribal health services, unhoused, and women populations. Adventist Health Clearlake Hospital Part V, Section B, Line 6a: Adventist Health Clearlake Hospital (AHCL) collaborated with Sutter Lakeside Hospital. Adventist Health Clearlake Hospital Part V, Section B, Line 6b: Participating organizations include City of Clearlake, City of Lakeport, County of Lake, Employment Development Department, Hope Rising, Lake County Aging Services, Lake County Behavioral Health, Lake County Chamber of Commerce, Lake County Health & Human Services, Lake County Sheriff's Department, Lake County Department of Public Health, Lake County Office of Education, Lake County Transit Authority, Lake County Tribal Health, Lake Family Resource Center, and Woodland Community College. Adventist Health Clearlake Hospital Part V, Section B, Line 11: The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible while ensuring the health and safety of those participating.Tax year 2022 was year three of the Implementation Strategy for the 2019 CHNA. All programs and activities provided to the community were in response to the priority health needs identified in the 2019 CHNA. Our 2019 CHNA identified four health priorities:1. Address drug abuse/substance use within the community.2. Increase housing stability and target homelessness.3. Community outreach & education for all high need and/or disenfranchised communities.4. Access to health services and increase opportunity for cancer prevention and screenings.Priority Need 1 - Address Drug Abuse/Substance Use Within the Community - the goal is to improve healthy behaviors by reducing drug dependency.Strategy 1 - Fill gaps in drug addiction recovery services continuum to improve recovery, access and outcomes.Activity 1.1 - ED Bridge and Substance Use Navigator (SUN) Program - AHCL applied for and received grant funding to provide the Medically Assisted Treatment (MAT) program to help address California's opioid epidemic in fiscal year 2020. Although most costs were covered by the grant, a small portion of community benefit expenses were associated with this program. During 2022 there were 1,534 encounters, 746 interventions, and 270 individuals who accepted treatment. 64% of patients were seen by a Substance Use Navigator and accepted treatment in 2022.Activity 1.2 - X-Wavier Training & Certification - Since starting the SUN program, lives have been impacted and 11 new providers in 2022 have received training specific for supporting patients who are ready for immediate medical assistance to begin navigating the road to recovery. Collaborative partners were Dr. Bradley - Mendocino Lakeview clinic, Sutter Lakeside Hospital, Lake County Behavioral Health, AA, NA, Celebrate Recovery, church groups throughout Lake County, and *CARE, Inc.Additional activities were placed on hold due to COVID-19.Priority Need 2 - Increase Housing Stability and Target Homelessness - The goal is to connect high utilizers of health care to housing.Strategy 1 - Grow capacity for existing programs and reduce time to secure supportive housing for program participants.Activity 1.1 - Restoration House - Project Restoration focuses on: high utilizer identification, readmission prevention, streamlined access to services for vulnerable populations, homelessness alternatives, intensive case management (through Live Well's Intensive Program), mental health options, and substance abuse support. In 2022, 16 clients were served. Additionally, under new administration in 2022, Restoration House transitioned from a medical respite care facility to recuperative care facility to better meet our goals and objectives.Activity 1.2 - Hope Center's mission is to provide individualized services for our neighbors experiencing homelessness. Through sponsorship by Adventist Health, 101 people were served and 51 people were housed in 2022.Activity 1.3 - Elijah House Collaboration - This program was closed in 2022 due to staffing shortages and COVID-19 impact.Activity 1.4 - Healthy Homes - Three individuals were housed in 2022. Priority Need 3 - Community outreach and engagement for all high need and/or disenfranchised communities, and access to health services - the goal is to increase healthy behaviors in the community.Strategy 1 - Providing services into the community and adding access points to health and social services.Activity 1.1 - Shower Trailer - The Shower Trailer serves the homeless, poorly sheltered, and others up to five days a week. In 2022, they increased their locations in Lake County to Clearlake Oaks, Big O Peer Center, Clearlake Shower Trailer site at the Senior Center, Lucerne, and Kelseyville. Two Health Outreach Events, offering COVID vaccines and testing, wound care, Narcan training and kit giveaway, dental screening, Social Services applications, haircuts, etc. were held in 2022. At each event we had nine community partners that also participated. With a local community grant, we have been able to provide clean clothes (socks, underwear, sweats, t-shirts) for our guests. In 2022, 2,388 individuals were provided showers.Activity 1.2 - Safe Sleeping for Baby & New Mothers (English & Spanish) - Baby Sleep Safe is part of the Comprehensive Perinatal Services Program (CPSP) that guides a mother through pregnancy and the postpartum journey. The program follows three assessments: health education, nutrition, and psychosocial. In 2022, there were 54 attendees with 29 English-speaking and 25 Spanish-speaking individuals. Priority Need 4 - Increase opportunity for cancer prevention and screenings - The goal is to reduce cancer mortality rates in Lake County.Strategy 1 - Increase screening opportunities by expanding early detection programming.Activity 1.1 - "AHEAD" Hereditary Cancer Screening - This program is currently on hold due to COVID-19 and staff shortagesActivity 1.2 - 3D Mammography - In 2022, a total of 2,202 screenings were provided.Activity 1.3 - Colorectal Screening (Scope) - In 2022, a total of 5,683 screenings were provided.Activity 1.4 - Prostate Cancer Screenings - This program is currently on hold due to COVID-19 and staff shortages.Additional activities - In 2022, AHCL continued to navigate the challenges of the pandemic. While there were increased numbers of 3D mammography and colorectal screenings, data for other types of cancer screenings was incomplete. The new goal of encouraging patients to schedule cancer screenings as we began to emerge from the pandemic became even more important. Due to patients' reluctance to visit medical facilities, AHCL's new expansive goal to encourage healthy lifestyle practices through the Blue Zone Project Lake County became a priority in light of these new challenges.Priority needs not addressed:For the 2020-2022 Community Health Plan (implementation strategy), AHCL elected to adopt a broad strategy that addressed all the priority needs identified. Adventist Health Clearlake Hospital Part V, Section B, Line 13h: Patients who do not meet the income criteria, may be eligible for financial assistance based on essential living expenses and resources. The following two (2) qualifications must both apply:1. Essential living expenses: Exceed fifty percent (50%) of the household income; and2. Resources: The patient's excess medical expenses (the amount that allowable medical expenses are greater than 50% of annual household income) must be greater than available qualifying assets. 33 1 - AH Clearlake - RHC 15230 Lakeside Dr Clearlake CA 95422 Internal Medicine/Family Practice and Specialty Services 2 - AH Paradise Skyway Primary Care - RHC 5125 Skyway Rd Ste G Paradise CA 95969 Primary Care 3 - AH Clearlake Dental - RHC 15230 Lakeside Dr Ste 105 Clearlake CA 95422 Dental 4 - AH Paradise Skyway Specialty - RHC 5125 Skyway Rd Ste D Paradise CA 95969 Medical Specialty 5 - AH Hidden Valley Lake - RHC 18990 Coyote Valley Rd Ste 9 Hidden Valley Lake CA 95467 Internal Medicine 6 - AH Clearlake Live Well - RHC 15230 Lakeside Dr Ste 104 Clearlake CA 95422 Live Well (psychiatry) 7 - AH Paradise Skyway Dental - RHC 5125 Skyway Rd Ste I Paradise CA 95969 Primary Care 8 - AH Clearlake Family Medicine 101- RHC 15230 Lakeside Dr Ste 101 Clearlake CA 95422 Family Practice 9 - AH Corning Solano Primary Care - RHC 155 Solano St Corning CA 96021 Family Practice 10 - AH Clearlake Hilltop Cardiology - RHC 15322 Lakeshore Dr Ste 201 Clearlake CA 95422 Medical Specialty 11 - AH Paradise Skyway Psychiatry & BH - RHC 5125 Skyway Rd Ste B Paradise CA 95969 Primary Care 12 - AH Paradise Skyway Immediate Care - RHC 5125 Skyway Rd Ste A Paradise CA 95969 Primary Care 13 - AH Paradise Primary Care Lower Level - RHC 5125 Skyway Road Paradise CA 95969 Primary Care 14 - AH Clearlake Synchronous BH - RHC 15230 Lakeshore Drive Clearlake CA 95422 Primary Care 15 - AH Clearlake Hilltop Surgical Specialties 15322 Lakeshore Dr Ste 101 Clearlake CA 95422 Specialty Surgical 16 - AH Lakeport 11th St - RHC 801 11th Street Lakeport CA 954534100 Primary Care 17 - AH Middletown - RHC 21337 Bush St Middletown CA 95461 Family Practice w/OB 18 - AH Kelseyville - RHC 5290 State St Kelseyville CA 95451 Internal Medicine 19 - AH Lucerne - RHC 6300 E Hwy 20 Lucerne CA 95458 Family Practice 20 - AH Paradise Skyway Pediatrics - RHC 5125 Skyway Rd Ste H Paradise CA 95969 Primary Care 21 - AH Corning Solano Dental - RHC 155 Solano St Corning CA 96021 Dental 22 - AH Lakeport Internal Medicine 487 South Main St Ste 122 Lakeport CA 95453 Primary Care 23 - AH Clearlake Live Well BH - RHC 15230 Lakeshore Drive Clearlake CA 95422 Live Well (psychiatry) 24 - AH Lakeport Pediatrics - RHC 487 South Main St Ste 122 Lakeport CA 95453 Primary Care 25 - AH Lower Lake Konocti - RHC 9430 Lake St Ste C Lower Lake CA 95457 Family Practice, Pediatrics 26 - AH Clearlake Hilltop - RHC 15322 Lakeshore Dr Ste 102 Clearlake CA 95422 Primary Care 27 - AH Clearlake - Ophthalmology 15322 Lakeshore Dr Clearlake CA 95422 Ophthalmology 28 - AH Paradise Skyway Live Well - RHC 5125 Skyway Road Paradise CA 95969 Live Well (psychiatry) 29 - AH Laie - RHC 55-510 Kamehameha Hwy Ste 5 Laie HI 96762 Primary Care 30 - AH Clearlake - Hilltop Cardiology 15322 Lakeshore Dr Clearlake CA 95422 Cardiology 31 - AH Clearlake - Hilltop Surgical Specialtie 15322 Lakeshore Dr Clearlake CA 95422 Specialty 32 - AH Paradise Skyway OBGYN - RHC 5125 Skyway Rd Ste C Paradise CA 95969 Medical Specialty 33 - AH Clearlake - Hilltop Family Practice 15322 Lakeshore Dr Clearlake CA 95422 Family Practice Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government. Part II, Community Building Activities: The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020 Adventist Health completed the acquisition of Blue Zones as the first step toward reaching this goal. By partnering with Blue Zones, we are able to gain ground in shifting the balance from healthcare - treating people once they are ill - to transformative well-being - changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint, and as we enter 2022 these projects are active. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. 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. In addition, 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 III, Line 2: Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2. Part III, Line 3: The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information, those accounts would have been reclassified from bad debt expense to charity care. Part III, Line 4: The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part III, Line 8: The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer. Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals. For further information, please refer to Schedule H, Part III, Section B. Part III, Line 9b: 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 VI, Line 2: The Hospital's 2022 Community Health Needs Assessment (CHNA), the 2023 Community Health Implementation Strategy (CHIS) approved in fiscal year 2023, and the 2022 Community Health Plan (CHP) updated for fiscal year 2022 are posted on the Hospital's website at: https://www.adventisthealth.org/clear-lake/about-us/community-benefit/The two most recent CHNAs, the two most recent CHIS reports and the 2020, 2021 and 2022 CHP Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The CHNA includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, our hospitals support local partners to augment our own efforts, and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of the regions we serve. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community. Part VI, Line 3: The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at: 1. https://www.adventisthealth.org/patient-resources/bill-pay/financial-assistance/ 2. https://www.adventisthealth.org/documents/financial-assistance/13863-Self-Pay-Billing-and-Collection-Policy.pdfThese documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The Hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. Part VI, Line 4: Near America's oldest lake and the recreational and outdoor activities it supports, AHCL serves a scenic, rural community with a total population of 69,918. Surrounded by mountainous terrain, Lake County is divided into two main cities, with Clearlake on the south shore and Lakeport on the north shore. Lake County is home to the following Native American Tribes: Big Valley Rancheria, Elem Indian Colony, Middletown Rancheria, Robinson Rancheria, Scotts Valley Band of Pomo Indians and Upper Lake - Habematoel, whose rich cultures bring vibrance to Lake County. The community is vibrant with art galleries, festivals, local events, and small businesses. Of the total population, 21.09% are Hispanic. The median household income for the community we serve is $50,811, and 68.05% of income is spent on housing and transportation. In this community, 23.94% of children live in poverty, compared to 16.80% in California and 17.48% in the country. Additionally, 7.83% of students are unhoused, compared to 4.25% in the state and 2.77% in the country.The following zip codes represent Sutter Health Lakeside and AHCL's primary service area (PSA), accounting for 75% of hospital discharges. Additionally, we took a collaborative approach and expanded our PSA by inviting Steering Committee members to include the zip codes of those they serve. The County of Lake CHNA market has a total population of 69,918 (based on the 2020 Decennial Census). The largest city in the service area is Clearlake, with a population of 15,250. The service area is comprised of the following zip codes: 95451, 95443, 95435, 95464, 95493, 95426, 95423, 95485, 95457, 95461, 95469, 95458, 95453, 95422, 95467. Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "Triple Aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering, in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy - even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population; 2. Factors that cause the present outcomes distribution; and 3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2. Improve care quality and patient safety, and 3. Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States CA Part VI, Other Information: In September of 2021, AHCL proudly launched Blue Zones Project Lake County (BZPLC). The BZPLC team focuses on partnering and collaborating with community leaders and organizations active in the sectors of built environment, education, economic and workforce development, mental and physical well-being, policy, and public health. Together the BZPLC team and sector leaders develop a community Blueprint that strategically aligns and leverages the actions and resources of the sectors where we live, learn, work, and play to help advance the efforts around the community's biggest Social Determinant of Health challenges while connecting them to Health-Related Social Needs organizations. Equity is a strategic priority woven throughout the Blueprint and programs. Policies and initiatives are developed in a way that honors the local culture that is focused on reaching out to all populations. Each year BZPLC sector leads come together to evaluate and update the Blueprint to ensure community alignment.In April 2022, BZPLC launched the transformation phase of the Project, focusing on People, Places, and Policy. Below is a summary of Progress Outcomes for 2022.The local BZPLC Team coordinated a Kick-off Events in 2022 to spread awareness throughout the County. A total of 1,267 unique individuals 15 years or older participated in the following Blue Zones Project activities: Blue Zones Story Speech: 1,012, Walking Moais: 12, Purpose Workshops: 104, Cooking Demos/Classes: 102, Volunteers: 17, Sharecare Digital Platform: 23. Schools: Four of the six school districts in Lake County have registered all their school sites to become Blue Zones approved and are actively working through the pledge packet process with school board approval (equating to 15 of the 23 public schools in Lake County). In addition, BZPLC team members were invited to present at the ACSA (Association of California School Administrators) local chapter meeting, which has representation from all of Lake County's school districts.Restaurants: One restaurant achieved Blue Zones Approval status in year one. Two more are registered, actively engaged in the pledge process, and nearing approval. BZPLC was invited to make a presentation at Lake County's first annual Restaurant Expo and many restaurants offer healthy, organic, plant-based entres as part of their menu options, and BZPLC utilizes their catering services whenever possible in order to highlight them. Grocery Stores: Foods Etc. in Clearlake became Blue Zones Approved in November 2022, and the team is actively seeking engagement from a second grocery store.Worksites: AHCL, one of the top employers in Lake County is pursuing Blue Zones Certification and is actively engaged in Blue Zones Project activities, with representation on BZPLC Steering Committee, Leadership Team, and Sector Committees. Built Environment: BZPLC has been participating integrally with the Parks and Rec Master Planning Community Visioning process. Food: BZPLC is collaborating with the Mendocino-Lake Food Hub in support of a business plan for the organization.Tobacco: Adventist Health and BZPLC cohosted a vaping summit on November 16, 2022. It was a monumental community leader gathering where decision-makers from both Lake County and City of Clearlake agreed to promote the adoption of smoke-free and commercial tobacco retail policies in 2023. BZPLC championed the formation of a Commercial Tobacco Joint Policy Workgroup which is promoting policy options in Lakeport, Clearlake, and County Unincorporated. This group produced a Joint Policy Platform and its innovations and strategies have influenced coalitions in Mendocino County, Yuba, Sutter and beyond. 1 California Health Fund & Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 26548 0 Hlth srvs un/underinsured pt County Of Lake 922 Bevins Court Lakeport CA 95453 Gov't 82802 0 CESH grant subcontractor Lake County Chamber Of Commerce PO Box 295 Lakeport CA 95453 680159445 501(c)(6) 17000 0 Meals on Wheels Program Lake County Wine Alliance PO Box 530 Kelseyville CA 95451 680447622 501(c)(3) 10000 0 General support North Coast Opportunities Inc 413 N State Street Ukiah CA 95482 941671958 501(c)(3) 55000 0 CESH grant subcontractor Sunrise Special Services Foundation PO Box 479 Upper Lake CA 95485 943096395 501(c)(3) 55000 0 CESH grant subcontractor Worldwide Healing Hands 8685 Main Street Kelseyville CA 95451 900758374 501(c)(3) 11000 0 General support 6 1 Part I, Line 2: Grantees are provided support based on the program for which they are soliciting funds. Our expectation is that the monies will be used accordingly, and reporting from the recipient is not required. X X X X 1 1 0 0 0 0 0 0 0 Wing Bill Dir/Asst Secr/Vice Chair thru 01/22 0 263334 0 662638 0 1585375 0 12220 0 44099 0 2567666 0 0 Heinrich Kerry Dir/Chair/CEO as of 01/22 0 1817710 0 76 0 313657 0 12220 0 62845 0 2206508 0 0 Hofheins Todd Dir/Vice Chair/COO as of 01/22 0 1358421 0 376216 0 237015 0 12220 0 60059 0 2043931 0 0 Jahn Andrew Care Division President thru 02/22 0 1047840 0 349414 0 12285 0 12220 0 61880 0 1483639 0 0 Beaman John CFO/Asst Secretary as of 01/22 0 1047636 0 298600 0 14860 0 12220 0 46256 0 1419572 0 0 Nahapetian Arby - Care Division Medical Officer thru 02/22 0 927049 0 234212 0 172850 0 12220 0 56317 0 1402648 0 0 Stevens Eric - President Northern CA/HI State Network 0 896507 0 250602 0 168205 0 12220 0 50625 0 1378159 0 0 Spenst Brett - Care Division Finance Officer thru 02/22 0 817612 0 416845 0 88367 0 12220 0 23881 0 1358925 0 0 Reiner Scott Former Dir/Chair/CEO thru 12/21 0 348458 0 870709 0 2906 0 12220 0 24432 0 1258725 0 0 Jobe Meredith Secretary 0 639741 0 154687 0 135608 0 12220 0 26964 0 969220 0 0 Byrnes John - Former Medical Officer, NCR thru 02/20 0 154814 0 187322 0 499068 0 12220 0 53644 0 907068 0 0 Howe Judson President, North Coast Network 0 523665 0 152359 0 106311 0 12220 0 41894 0 836449 0 0 Tetz Warren Treasurer 07/22 - 12/22 0 435029 0 63870 0 66456 0 12220 0 25660 0 603235 0 0 Cantrell Misty - Patient Care Executive as of 09/22 0 270061 0 61401 0 175963 0 12220 0 52459 0 572104 0 0 Cardenas Lucita RN 502849 0 311 0 0 0 12220 0 27257 0 542637 0 0 0 Mock Jeffrey Interim Treasurer as of 12/22 0 286124 0 75485 0 60878 0 12220 0 85613 0 520320 0 0 Assavapisitkul Colleen - Pt Cr Exec thru 05/22/Pres as of 05/22 0 359184 0 61531 0 38337 0 12220 0 33964 0 505236 0 0 Cole Delores RN 421441 0 76 0 0 0 12220 0 14832 0 448569 0 0 0 Jacobson Carlton - Former Treas /Asst Secr thru 12/21/Fin Off AHCL 0 286289 0 65488 0 31856 0 11509 0 31215 0 426357 0 0 Eller Jeff Former President, NCR 0 0 0 177886 0 174798 0 5337 0 47349 0 405370 0 0 Anjejo Isaac RN, First Assistant 273423 0 74763 0 0 0 10446 0 24456 0 383088 0 0 0 McCance David RN 324446 0 229 0 0 0 9740 0 36146 0 370561 0 0 0 Aleman Andrea RN Supervisor 316970 0 2654 0 0 0 9589 0 25651 0 354864 0 0 0 Lonto Robert Former Reg HP Dir, NCR thru 02/20 0 175680 0 73176 0 21565 0 8113 0 74035 0 352569 0 0 Santos David President thru 05/22 0 198774 0 0 0 31876 0 6919 0 23934 0 261503 0 0 Shapiro Marc Medical Officer 0 0 0 0 0 158109 0 0 0 0 0 158109 0 0 Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health System/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Byrnes, John - severance payment - $465,750 Wing, Bill - severance payment - $1,584,880 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Jacobson, Carlton - participant, no activity in 2022 Select executives agreed to participate in CAP-EX in place of a traditional SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life insurance participants are John Beaman, Jeff Eller, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Scott Reiner, Brett Spenst, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an of their corporate provided benefits. The balance is set aside for forfeiture and is at risk to the creditors of Adventist Health. Payouts substantial risks of forfeiture have lapsed. The plan was frozen for new amount equivalent to 41 percent of their base compensation, less the value nonvested deferred compensation that is subject to substantial risk of occur according to the participants' payment elections after all non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2022 Part II: Eller, Jeff, Former President, NCR was paid through an unrelated organization, Jeffrey D. Eller dba Mountaingate Coaching that was reported on Form 1099 and included in Schedule J, Part II. Marc Shapiro, Medical Officer was paid through an unrelated organization, Marc R. Shapiro Medical Corp that was reported on Form 1099 and included on Schedule J, Part II. Form 990, Part III, Line 4a: Adventist Health Clearlake Hospital, Inc., dba Adventist Health Clear Lake (AHCL), provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of AHCL, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following coverage will be considered when individuals who need health care cannot afford to pay: - Free care and/or subsidized care - Care to persons covered by governmental programs at/or below cost - Health/wellness activities and community education programs Not only does AHCL provide low-cost care to individuals covered by government programs, and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHCL recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2022 was $13,532,432. The following Inpatient services were provided to all our patients: - 126 babies delivered - 137 surgeries performed - 5,841 patient days The following Outpatient services were provided to all our patients: - 20,530 emergency department visits - 2,202 outpatient surgeries performed - 105,309 outpatient visits - 261,172 clinic visits AHCL recognizes it has an obligation to provide human services above and beyond its role as a healing facility. Schedule H provides more details on the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2022 was $7,317,937. Adventist Health's mission statement of living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry, as represented by the life of Jesus Christ, and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs, and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ Form 990, Part VI, Section A, line 6 The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. 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, Section A, 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. Form 990, Part VI, Section A, line 7b The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11b This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the Corporate Finance Officer and Market Financial Officer, and shared by electronic communication with the corporation's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital corporate 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 market president immediately. The System General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The System General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System General Counsel retains the COIs for all individuals. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. Form 990, Part VI, Section B, line 15 The Hospital's Board of Directors has established a Human Resources 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 presidents and finance officers 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 executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. Form 990, Part VI, Section C, line 19 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 VII, Section A: Board compensation is for Adventist Health System/West Board of Directors only - not hospital Board of Directors. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 21,259,933. Management and general expenses 8,662,091. Fundraising expenses 0. Total expenses 29,922,024. All other purchased services: Program service expenses 3,860,625. Management and general expenses 1,186,659. Fundraising expenses 1,251. Total expenses 5,048,535. Contract labor: Program service expenses 3,796,059. Management and general expenses 136,148. Fundraising expenses 0. Total expenses 3,932,207. Purchased medical services: Program service expenses 1,689,951. Management and general expenses 28,241. Fundraising expenses 0. Total expenses 1,718,192. Consulting and other management fees: Program service expenses 360,060. Management and general expenses 212,021. Fundraising expenses 0. Total expenses 572,081. Repairs and maintenance: Program service expenses 366,294. Management and general expenses 307,286. Fundraising expenses 0. Total expenses 673,580. Other professional medical fee: Program service expenses 284. Management and general expenses 226,639. Fundraising expenses 0. Total expenses 226,923. Other non-medical professional fees: Program service expenses 9,748. Management and general expenses 88,491. Fundraising expenses 0. Total expenses 98,239. Form 990, Part XI, Line 8: Prior period adjustments were a result of cash balance correction and clean up books due to prior period activities including debt service, capital expenditures, and other items. Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 845174585 Hospital CA 501(c)(3) Line 3 Stone Point Health 0 Adventist Health Physicians Network 1 Adventist Health Way Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Adventist Health SystemWest 1 Adventist Health Way Roseville CA 95661 953484589 Integrated health system CA 501(c)(3) Line 10 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital 1 Adventist Health Way Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Paradise Valley Hospital 1 Adventist Health Way Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Rideout Memorial Hospital 726 Fourth Street Marysville CA 95901 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 0 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital & Health Care Services 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Stone Point Health 1 Adventist Health Way Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 United Com-Serve 726 Fourth Street Marysville CA 95901 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health 0 Walla Walla General Hospital 1 Adventist Health Way Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 0 Western Health Resources 1 Adventist Health Way Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 0 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Blue Legacy Ventures LLC 1010 NE 2nd Avenue Miami FL 33132 871254649 Real property rental FL N/A 0 0 Blue Zones LLC 200 Southdale Center Edina MN 55435 271603327 Education MN N/A 0 0 PAR LLC dba CherryWood Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 931262371 Senior housing OR N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Senior housing OR N/A 0 0 PVHR2 LLC dba Parkview Memory Care at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Senior housing OR N/A 0 0 WWGHR LLC dba Wheatland Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Senior housing OR N/A 0 0 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center 1 Adventist Health Way Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 200 Southdale Center Edina MN 55435 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1