2024-11-05T13:51:49-06:00 2023-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2023-01-01 941101228 Feather River Hospital FEAT 9164060000 1 Adventist Health Way Roseville CA 956613266 Meredith Jobe Treasurer 9164060000 2024-11-01 1 1 Tracy S Paglia P00366884 2099556100 2024-11-01 2023 2024-10-15 13:58:12Z Adventist Health Feather River Todd Hofheins 1 Adventist Health Way Roseville CA 956613266 3461394 0 1071 X www.adventisthealth.org/feather-river/ X 1947 CA Living God's love by inspiring health, wholeness and hope. X 13 11 0 0 2075063 1854389 67684 29391 883417 135941 7862737 3022091 100345351 273971 109159189 3461394 0 166281000 0 0 4509 251 0 0 0 1779032 1766840 1783541 168048091 107375648 -164586697 199941800 19442995 18450180 166256 181491620 19276739 X Living God's love by inspiring health, wholeness and hope. 0 0 167857160 166281000 135941 See Schedule O 167857160 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 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 1 0 0 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 Heinrich Kerry Dir/Chair/CEO 0.00 50.50 X X 0 3302428 57395 Hofheins Todd Dir/Vice Chair/COO 0.00 50.50 X X 0 2272592 76141 Beaman John CFO/Assistant Secretary 0.00 50.50 X 0 1680553 73355 Stevens Eric - President Northern CA/HI State Network 5.00 45.50 X 0 1526293 59552 Jahn Andrew - Pres AHFR Former Care Division Pres thru 02/22 0.00 50.00 X 0 1465906 103785 Nahapetian Arby - Former Care Division Medical Officer thru 02/22 0.00 50.00 X 0 1482294 69613 Wing Bill - Former Dir/Asst Secr/Vice Chair thru 01/22 0.00 0.00 X 0 1438460 40073 Jobe Meredith Secretary/Treasurer 0.00 50.50 X 0 959488 59410 Ashlock Ryan Former Treasurer thru 04/19 0.00 50.00 X 0 616479 66141 Spenst Brett - Former Care Division Finance Officer thru 02/22 0.00 50.00 X 0 520625 45847 Thordarson Heidar Finance Officer 2.00 50.00 X 0 464717 45670 Gonzalez Eduardo Former Finance Officer thru 06/22 0.00 0.00 X 0 333115 38505 Byrnes John - Former Medical Officer, NCR thru 02/20 0.00 0.00 X 0 263659 34955 Fullerton Jacqueline Nurse Operating Director thru 01/19 0.00 50.00 X 0 201027 53713 Freedman John Director 0.00 4.00 X 0 26770 0 Cherry Robert Director 0.00 4.00 X 0 26611 0 Davis Andrew Director 0.00 4.00 X 0 26611 0 Innocent Larry Director 0.00 4.00 X 0 26611 0 Reiner Richard Director 0.00 4.00 X 0 26611 0 Salazar Velino Director 0.00 4.00 X 0 26611 0 Newton Bradford Director 0.00 4.00 X 0 26611 0 Banks David Director 0.00 4.00 X 0 26181 0 Woodson Marc Director 0.00 4.00 X 0 21611 0 Wagner Jack Director 0.00 4.00 X 0 16180 0 Fehr Joy Director 0.00 4.00 X 0 430 0 Ocampo Lucy Director thru 08/23 0.00 4.00 X 0 0 0 0 16778474 824155 0 1 1 0 0 29391 29391 Related rental revenue 531120 135941 135941 135941 3022091 2075063 947028 Gain from disc ops 621110 273971 273971 273971 3461394 135941 2075063 1220999 166281000 166281000 251 251 716 716 36653 15531 21122 70400 69053 1347 2363 2363 286110 121704 164406 64 64 169627 169627 407276 407276 500 500 Disc ops inventory adj 529152 529152 Patient charge deductio 142376 142376 UBI taxes 46014 46014 Patient care supplies 1199 1199 74390 73000 1390 168048091 167857160 190931 0 182778782 1509434 0 6962 11767148 2512454 9542167 9254694 7620851 8671905 199941800 19442995 419839 20491 29391 0 18000950 145765 18450180 166256 X 179290194 16626081 2201426 2650658 181491620 19276739 199941800 19442995 X -164586697 3824028 -1452212 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3356466 565366 202123 222734 3901221 4050505 86441 -705994 74486 3356466 3779391 255482 160593 144961 4050505 3172524 454729 390559 238421 3779391 6181700 482293 398293 178363 3711399 3172524 0.32056 0.00000 0.67944 0 1 1 2154440 2154440 9612708 2512454 7100254 9254694 Receivables from third-party payors 4528487 Other assets 4046977 Receivables from related organizations 80567 Other receivables 12559 Right-of-use assets 3315 8671905 Payables to related organizations 90120 Income taxes payable 55645 145765 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, 2023 and 2022, 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 2020 in major tax jurisdictions. 1 Adventist Health SystemWest 1 Adventist Health Way Roseville CA 95661 953484589 501(c)(3) 166281000 0 Transfer of net assets due to wind down 1 0 Part I, Line 2: Funding provided to other organizations is provided to recipients with the understanding that the funds are being used only for the designated purposes. No formal monitoring of the grants is completed. X X X X 1 1 0 0 0 0 0 0 0 Heinrich Kerry Dir/Chair/CEO 0 2017000 0 1208880 0 76548 0 13296 0 44099 0 3359823 0 0 Hofheins Todd Dir/Vice Chair/COO 0 1389462 0 735265 0 147865 0 13296 0 62845 0 2348733 0 0 Beaman John CFO/Assistant Secretary 0 1091769 0 569149 0 19635 0 13296 0 60059 0 1753908 0 0 Stevens Eric - President Northern CA/HI State Network 0 1045616 0 319995 0 160682 0 13296 0 46256 0 1585845 0 0 Jahn Andrew - Pres AHFR Former Care Division Pres thru 02/22 0 1044420 0 406990 0 14496 0 53160 0 50625 0 1569691 0 0 Nahapetian Arby - Former Care Division Medical Officer thru 02/22 0 967385 0 329621 0 185288 0 13296 0 56317 0 1551907 0 0 Wing Bill - Former Dir/Asst Secr/Vice Chair thru 01/22 0 0 0 0 0 1438460 0 13296 0 26777 0 1478533 0 0 Jobe Meredith Secretary/Treasurer 0 660525 0 168715 0 130248 0 13296 0 46114 0 1018898 0 0 Ashlock Ryan Former Treasurer thru 04/19 0 460550 0 129090 0 26839 0 13296 0 52845 0 682620 0 0 Spenst Brett - Former Care Division Finance Officer thru 02/22 0 259692 0 250809 0 10124 0 13296 0 32551 0 566472 0 0 Thordarson Heidar Finance Officer 0 394981 0 52217 0 17519 0 13296 0 32374 0 510387 0 0 Gonzalez Eduardo Former Finance Officer thru 06/22 0 0 0 76 0 333039 0 13296 0 25209 0 371620 0 0 Byrnes John - Former Medical Officer, NCR thru 02/20 0 0 0 0 0 263659 0 13183 0 21772 0 298614 0 0 Fullerton Jacqueline Nurse Operating Director thru 01/19 0 195165 0 450 0 5412 0 5914 0 47799 0 254740 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 - $262,731 Gonzalez, Eduardo - severance payment - $337,144 Wing, Bill - severance payment - $1,440,800 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, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Brett Spenst, Jack Wagner, 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 amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2023 Cash 2023-11-13 166281000 Net book value 953484589 Adventist Health SystemWest 1 Adventist Health Way Roseville CA 95661 501(c)(3) 1 0 0 0 Part II, Line 2e: Explanation of Involvement: Board members: David Banks, Robert Cherry, Andrew Davis, Joy Fehr, John Freedman, Larry Innocent, Bradford Newton, Lucy Ocampo, Richard Reiner, Velino Salazar, Jack Wagner, Marc Woodson Officers: John Beaman, Kerry Heinrich, Todd Hofheins, and Meredith JobeKey Employees: Jacqueline Fullteron Heldar Thordarson, Andrew Jahn, Arby Nahapetian, Brett Spenst, Eric StevensAll of the board members, officers, and key employees of Feather River Hospital served concurrent roles during 2023 at Adventist Health System/West. Form 990, Part III, Line 4a: 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. Form 990, Part VI, Section A, line 4 The Hospital's Articles of Incorporation were amended for the following: 1. Article III was updated to allow for the Board of Directors of the Hospital to have sole authority to amend or repeal the Articles of Incorporation, subject to the additional approval of the Board of Directors of Adventist Health System/West. The Hospital has no members within the meaning of Section 5056 of the California Corporations Code. The Hospital's Bylaws were amended for the following: 1. Article 2 was removed and the Hospital has no members. All sections relating to the membership were removed. 2. Article 5 was revised to indicate that only directors may serve as the chair of the Board and that the vice chair of the Board is designated by the Chief Executive Officer 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 Board of Directors of the Hospital shall have sole authority to amend or repeal the Articles of Incorporation, subject to the additional approval of the Board of Directors of Adventist Health System/West. The Hospital does not have any Members. 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 or the System General Counsel 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 at least 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 60th 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: Board compensation is for Adventist Health System/West Board of Directors only - not hospital Board of Directors. Form 990, Part XI, line 9: Net change from change in interest in Foundation 622,851. Partnership UBI not recorded on books -2,075,063. 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 Hwy Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Foundation 1 Adventist Health Way Roseville CA 95661 680002188 Charitable foundation CA 501(c)(3) Line 7 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 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 Mid-Columbia Medical Center 1700 E 19th Street The Dalles OR 97058 930386936 Hospital OR 501(c)(3) Line 3 Stone Point Health 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 3 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 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 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 10 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 E 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 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1