2023-11-01T13:01:17-05:00 2022-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2022-01-01 941101228 Feather River Hospital FEAT 9164060000 1 Adventist Health Way Roseville CA 956613266 Meredith Jobe Treasurer 9164060000 2023-10-25 1 Meredith Jobe 999009999 1 Tracy S Paglia P00366884 2099556100 2023-10-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Adventist Health Feather River Andrew Jahn 1 Adventist Health Way Roseville CA 956613266 111433279 0 1071 X www.adventisthealth.org/feather-river/ X 1947 CA Living God's love by inspiring health, wholeness and hope. 13 11 0 0 172336 154202 7078 67684 -7742392 883417 1904916 7862737 10068876 100345351 4238478 109159189 5541520 0 0 0 9287 4509 0 0 0 3587029 1779032 9137836 1783541 -4899358 107375648 102819341 199941800 19908170 18450180 82911171 181491620 X Living God's love by inspiring health, wholeness and hope. 0 1 1365185 0 883417 Adventist Health Feather River was a non-profit hospital that was partially destroyed by a natural disaster. The Hospital has closed and ceased operations due to the damage of the hospital and the significant decline of the surrounding population. The surviving clinics were transferred to Adventist Health Clearlake. The hospital continues to have residual expenses related to utilities and security of the property. 1365185 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 1 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 1 1 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Wing Bill Dir/Vice Chair/Asst Secr 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 - President AHFR Care Division President thru 02/22 2.00 48.00 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/Treasurer 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 Ashlock Ryan Former Treasurer thru 04/19 0.00 50.00 X 0 563364 50369 Thordarson Heidar Finance Officer as of 06/22 2.00 48.00 X 0 561895 23851 Gonzalez Eduardo Finance Officer thru 06/22 10.00 40.00 X 0 440206 46492 Eller Jeff Former President, NCR 0.00 9.00 X 0 352684 52686 Lonto Robert Former Reg HP Dir, NCR thru 02/20 0.00 50.00 X 0 270421 82148 Fullerton Jacqueline Nurse Operating Director thru 01/19 0.00 50.00 X 0 191476 54097 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 0 18964179 955065 0 1 1 1 0 51667 16017 67684 Patient service revenue 621110 763131 763131 Related rental revenue 531120 104497 104497 Dietary revenue 722514 15196 15196 593 593 883417 6136827 6136827 4000000 2274090 1725910 1725910 172336 1553574 Insurance proceeds 621110 100001286 100001286 Gain from discontinued operations 621110 344065 344065 100345351 109159189 883417 172336 108035752 X 3029 3029 1480 1480 78664 78664 142 142 192656 19302 173354 81268 79045 2223 5706 5706 282235 122771 159464 242 242 571013 571013 539666 539666 Income taxes 21454 21454 Patient care supplies 5982 5982 Quality assurance fee 4 4 1783541 1365185 418356 0 78252843 182778782 342877 0 129 0 11767148 2224981 10312359 9542167 13911133 7620851 102819341 199941800 1004168 419839 97075 29391 18806927 18000950 19908170 18450180 X 80372506 179290194 2538665 2201426 82911171 181491620 102819341 199941800 X 107375648 -8044917 -41340 -708942 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4050505 86441 -705994 74486 3356466 3779391 255482 160593 144961 4050505 3172524 454729 390559 238421 3779391 6181700 482293 398293 178363 3711399 3172524 6231134 915228 -683177 281485 6181700 0.34412 0.00000 0.65588 0 1 1 2154440 2154440 9612708 2224981 7387727 9542167 Payables to related organizations 17914299 Other liabilities 76651 Income taxes payable 10000 18000950 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 is 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. X X X X 1 1 0 0 0 0 0 0 0 Wing Bill Dir/Vice Chair/Asst Secr 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 - President AHFR 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/Treasurer 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 Ashlock Ryan Former Treasurer thru 04/19 0 412865 0 98290 0 52209 0 12220 0 38149 0 613733 0 0 Thordarson Heidar Finance Officer as of 06/22 0 336809 0 69116 0 155970 0 12220 0 11631 0 585746 0 0 Gonzalez Eduardo Finance Officer thru 06/22 0 187406 0 66841 0 185959 0 12220 0 34272 0 486698 0 0 Eller Jeff Former President, NCR 0 0 0 177886 0 174798 0 5337 0 47349 0 405370 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 Fullerton Jacqueline Nurse Operating Director thru 01/19 0 187115 0 3500 0 861 0 5744 0 48353 0 245573 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 Gonzalez, Eduardo - severance payment - $162,089 Wing, Bill - severance payment - $1,584,880 Select executives agreed to participate in CAP-EX in place of a traditional insurance 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. Form 990, Part III, line 3 The Hospital has closed and ceased operations due to the damage of the hospital and the significant decline of the surrounding population. The surviving clinics were transferred to Adventist Health Clearklake. Form 990, Part VI, Section A, line 6 The Hospital is organized as a religious corporation and was operated as a not-for-profit hospital until its closure in 2019 as a result of a natural disaster. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The Hospital was operated as an affiliate of Adventist Health System/West. Form 990, Part VI, Section A, line 7a The Hospital's 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. Form 990, Part VII: Board compensation is for Adventist Health System/West Board of Directors only - not hospital Board of Directors. Form 990, Part IX, line 11g Repairs & maintenance: Program service expenses 19,302. Management and general expenses 43,151. Fundraising expenses 0. Total expenses 62,453. Other purchased services: Program service expenses 0. Management and general expenses 38,228. Fundraising expenses 0. Total expenses 38,228. Other Professional Fees: Program service expenses 0. Management and general expenses 91,975. Fundraising expenses 0. Total expenses 91,975. Form 990, Part XI, line 9: Change in interest in Foundation -708,942. Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 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 Adventist Health Foundation fka Feather River Health Foundation 5974 Pentz Road Paradise CA 95969 680002188 Fundraising for hospital CA 501(c)(3) Line 12a, I Western Health Resources 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 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 and 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 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 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 1 1 1 1 1 1