2024-11-05T13:59:54-06:00 2023-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2023-01-01 680108919 Willits Hospital Inc WILL 9164060000 1 Marcela Drive Willits CA 954905769 Jeffrey Mock Treasurer 9164060000 2024-11-01 1 0 Tracy S Paglia P00366884 2099556100 2024-11-01 2023 2024-10-15 13:58:12Z Adventist Health Howard Memorial Judson Howe 1 Marcela Drive Willits CA 954905769 96656602 0 1071 X www.adventisthealth.org/howard-memorial/ X 1986 CA Living God's love by inspiring health, wholeness and hope. 13 11 410 28 0 0 918685 130644 87493806 95152282 3965854 1373676 0 0 92378345 96656602 97433 59186 0 0 36632870 40007941 0 0 0 52848599 51544216 89578902 91611343 2799443 5045259 123933006 134193908 50834882 52630760 73098124 81563148 X Living God's love by inspiring health, wholeness and hope. 0 0 74387132 59186 95152282 See Schedule O 74387132 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 0 410 1 0 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 0 CA X John Beaman CFO 9164060000 1 Adventist 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 - Former Care Division President thru 02/22 0.00 50.00 X 0 1465906 103785 Nahapetian Arby - Former Care Division Medical Off thru 02/22 0.00 50.00 X 0 1482294 69613 Wells Jason Former President thru 12/20 0.00 50.00 X 0 1470582 37177 Wing Bill - Former Dir/Asst Secr/Vice Chair thru 01/22 0.00 0.00 X 0 1438460 40073 Charpentier Paul Physician 40.00 0.00 X 1351494 0 51436 Jobe Meredith Secretary 0.00 50.50 X 0 959488 59410 Howe Judson - President AHHM Pres, North Coast Network thru 03/22 8.30 41.70 X 0 808895 28997 Tetz Warren - Former Treas/Asst Secr thru 12/22 0.00 0.00 X 0 560025 58835 Eberhart Gregory Area Medical Officer 12.50 37.50 X 0 582946 27959 Spenst Brett - Former Care Division Finance Officer thru 02/22 0.00 50.00 X 0 520625 45847 Mock Jeffrey Treasurer/Asst Secr as of 09/23 10.00 40.50 X 0 470391 67797 Shepardson Dean - Treasurer Asst Secr from 03/23 thru 09/23 12.50 37.50 X 0 461843 55761 Assadian Hoda Operations Executive 16.70 33.30 X 0 460925 52377 Givens Linda Patient Care Executive/Administrator 50.00 0.00 X 0 402990 67969 D'Anis Matthew Director, Pharmacy 40.00 0.00 X 285786 0 80285 Radell Raymond Certified RN Anesthetist 40.00 0.00 X 288209 0 34581 Niderost Gregory Certified RN Anesthetist 40.00 0.00 X 278661 0 43629 Buckingham Amy Associate Patient Care Executive 50.00 0.00 X 0 257621 63465 Ramirez Johann - Admin Director, Business Dev & Strategy 40.00 0.00 X 262252 0 58563 Byrnes John - Former Medical Officer, NCR thru 02/20 0.00 0.00 X 0 263659 34955 Parker Bessant - Former Area Medical Officer thru 03/22 0.00 0.00 X 0 211890 52366 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 Newton Bradford 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 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 2466402 20851244 1401323 123 1 1 0 Pacific Redwood Medical Group Inc 242 Hospital Drive Suite B Ukiah CA 95482 Medical services 2049206 Galen Inpatient Physicians Inc 2100 Powell St Ste 400 Emeryville CA 94608 Medical services 1244736 RMG Medical Imaging Consultants PO Box 86348 Los Angeles CA 90086 Medical services 1096505 Aya Healthcare Inc 5930 Cornerstone Court West San Diego CA 92121 Contract labor services 690596 Anesthesia Services LLC 617 Park Boulevard Ukiah CA 94582 Medical services 643720 20 13011 117633 15000 130644 Patient service revenue 621110 89716855 89716855 Premium revenue 621110 3685913 3685913 340B Pharmacy revenue 456110 687586 687586 Dietary/cafeteria revenue 722514 469540 469540 Revenue/subsidy from related orgs 621400 348586 348586 243802 243802 95152282 1373676 1373676 96656602 95152282 0 1373676 X 59186 59186 31966126 27019881 4946245 1151597 966418 185179 4741512 4075448 666064 2148706 1826766 321940 7776044 7776044 286199 286199 8061 8061 17966068 17313734 652334 18239 18239 393257 253038 140219 2484177 529751 1954426 2510933 2506037 4896 156904 101389 55515 25717 22444 3273 943433 943433 4548210 4543282 4928 737711 737711 Patient care supplies 11662008 11623088 38920 Quality assurance fees 139874 139874 Rental/leases costs equ 116502 116502 1770879 1601089 169790 91611343 74387132 17224211 0 2960 5545 50831699 60094043 159379 181613 12847228 11372335 1137864 1624922 68019 91009 86152272 47749200 40973137 38403072 17912720 22421369 123933006 134193908 7061753 8117338 0 34487 43773129 44478935 50834882 52630760 X 72549574 81051024 548550 512124 73098124 81563148 123933006 134193908 X 5045259 3571765 -152000 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 8061 8061 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. 548550 119735 156161 512124 520110 750204 -1374 720390 548550 504186 713261 1706 699043 520110 497890 134937 128641 504186 457504 371562 303063 28113 497890 0.00000 0.00000 1.00000 1 0 60728633 26907442 33821191 1894784 1318528 576256 23528855 19523230 4005625 38403072 Receivables from third-party payors 11585217 Right-of-use assets 9501772 Receivables from related organizations 1276736 Other receivables 57644 22421369 Payables to related organizations 31613998 Lease liabilities 8447425 Payables to third-party payors 4417512 44478935 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, 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 (Exempt Organization Business Income Tax Return) 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 1 X 1 X 1 X 1 1 1 0 1 1 324341 324341 0.00350 21685180 14244952 7440228 0.08120 22009521 14244952 7764569 0.08470 527134 9600 517534 0.00560 52663 52663 0.00060 11281466 8191498 3089968 0.03370 11861263 8201098 3660165 0.03990 33870784 22446050 11424734 0.12460 381324 381324 0.00420 156640 156640 0.00170 537964 537964 0.00590 1 411379 126720 33600837 32759736 841101 X 1 1 1 1 Willits Hospital Inc DBA Adventist Health Howard Memorial 1 Marcela Dr Willits CA 95490 www.adventisthealth.org/howard-memoria 110000013 X X X X Willits Hospital Inc DBA Adventist Hea 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 Willits Hospital, Inc. DBA Adventist Health Howard Part V, Section B, Line 5: The 2022 Community Health Needs Assessment for Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) 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, nine focus groups were conducted with 40 participants, and seven key informant interviews were held. Survey data was gathered from the North Coast region (region name defined by survey administrator, UC Berkeley IGS).The CHNA Steering Committee identified vulnerable populations and worked with local organizations to coordinate focus groups and key informant interviews to ensure that minority populations - the voices of those with chronic disease, low incomes, and the underserved - were heard. In total, nine focus groups were conducted with 40 participants, and seven key informant interviews were held. Civic government & leadership, community-based organizations focusing on early education, education, low-income, medically underserved, minority populations, older adults, provider, substance use, students, workforce representatives, and unhoused populations were represented in the primary data collection. Willits Hospital, Inc. DBA Adventist Health Howard Part V, Section B, Line 6a: Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial Hospital (AHHM) and Adventist Health Mendocino Coast (AHMC) worked together to produce the 2022 CHNA. Willits Hospital, Inc. DBA Adventist Health Howard Part V, Section B, Line 6b: Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) collaborated with Building Bridges, Head Start, Housing Action Team, Mendocino Area Parks Association, Mendocino County Department of Public Health, Mendocino County Office of Education, Mendocino County Probation Department, Mendocino County Farm Bureau, Mendonoma Health Alliance, Rural Communities Housing Development Corporation, and Willits Senior Center. Willits Hospital, Inc. DBA Adventist Health Howard Part V, Section B, Line 11: Tax year 2023 was Year One of the Implementation Strategy for the 2022 Community Health Needs Assessment (CHNA). Programs and activities provided to the community were in response to the priority health needs identified in the 2022 CHNA. Our 2022 CHNA identified three areas of significant need: Access to Care; Financial Stability and Health Risk Behaviors. Priority Need One: Access to Care - Barriers.Goal is to provide medical services to community members with no transportation. Strategy is to provide medical services to the homeless population through street medicine. FY 2023 Community Impact Activities and Outcomes:Throughout 2023, Adventist Health Street Medicine Program, a collaborative effort of the Adventist Health COMPASS Street Medicine Team and the Adventist Health Family Medicine Residency Street Medicine Active Resident Training (SMART) Track Program, provided and coordinated vital services for people experiencing homelessness (PEH) within Mendocino County. Through collaboration with community partners (Redwood Community Service's Building Bridges Homeless Resource Center, Redwood Gospel Mission's Center for Hope, and the Ukiah Community Food Bank), medical care was provided at over 100 Street Medicine clinics during 2023. Over 400 individuals received care totaling more than 1,000 encounters. The COMPASS Street Medicine team is a multidisciplinary care team with a registered nurse, care coordinator, social worker, physician, nurse practitioner, and licensed therapist. The SMART Track program trains family medicine physicians to competently and compassionately work within a team to provide health care services (including but not limited to MAT, Hepatitis C treatment, and place-based care) to homeless individuals. Three physician residents and multiple resident faculty physicians participated in the program in 2023.The Street Medicine Program also took a new collaborative step forward in 2023 when Mendocino Community Health Clinics' (MCHC) care management staff began integrating into existing clinics. This collaboration has helped improve the quality of care provided via the Street Medicine clinics for patients already established at MCHC for primary care and expanded the primary care access options for person experiencing homelessness (PEH) in Mendocino County.Further amplifying their impact on Street Medicine access in Mendocino County, the COMPASS Team spearheaded the planning for the inaugural Mendocino County Street Medicine Collaborative meeting to be held in February of 2024. This landmark event will convene a diverse group of partner agencies, including MCHC, MCHC's Ryan White Program, MCHC's Community Care Program, MCHC's Medication-Assisted Treatment (MAT) Program, Consolidated Tribal Health Project Outreach, Mendocino Coast Clinic's Street Medicine Program, Mendocino Coast Hospitality Center's Street Medicine Project, AHUV's Family Medicine Residency, Adventist Health's Substance Use Navigation (SUN) program, and Mendocino County AIDS/Viral Hepatitis Network. The goal of this effort is to improve the health and well- being of Mendocino County's PEH via expanded access to physical, mental and social health services through increased community collaboration.After a mid-year needs assessment, the COMPASS Street Medicine team reevaluated its resources and identified better locations to increase the number of PEH being served. This included expanding the amount of time and resources dedicated to outreach to homeless encampments.Priority Need One: Access to Care - Insurance.Goal is to verify/re-verify MediCal eligibility for vulnerable populations.Strategy is to provide education and outreach to medical providers (Registrars, Community Health Workers, Substance Use Navigators) to identify those medically eligible patients and help enroll or re-enroll them in available benefits and direct them to ongoing services.FY 2023 Community Impact Activities and Outcomes:During 2023, AHUV, AHHM and AHMC collaborated with multiple community agencies and organizations to mitigate the potential disruption in healthcare access for Medi-Cal members during the unwinding of the Pandemic Era Medicaid Continuous Coverage Requirement. The restart of Medicaid (Medi-Cal) renewals necessitated a proactive approach to ensure smooth access to healthcare services for individuals with lapsed Medi-Cal coverage needing assistance with the renewal process, as well as those needing assistance applying for other coverage if found to be ineligible for Medi-Cal.A multi-faceted strategy was implemented. A marketing campaign was launched across multiple media platforms, both internally for Adventist Health associates as well as a public media campaign which included social media blasts and educational materials in the form of banners, posters, flyers, and handouts posted and made available in the three hospitals and many ambulatory care clinics run by AHMC. Front-line Adventist Health associates working in patient registration, scheduling and insurance verification were provided training to help navigate patients toward Medi-Cal renewal or to Covered California for other coverage options. Adventist Health collaborated with its revenue cycle management partner to expand the population scope for its insurance navigation program. When appropriate, Adventist Health associates collaborated with other agencies to provide navigation support to patients at high risk of losing their Medi-Cal coverage for procedural reasons (change in address, homelessness, disability, language barrier, etc).Additional programs/activities not included in the 2023 Community Health Implementation Strategy that promote access to care that were provided by AHUV, AHHM, and AHMC included physician recruitment efforts.Almost 77% of the population of Mendocino County live in an area affected by a shortage of primary care providers. This shortage contributes to access to care and health status issues within the community. In an effort to combat a shortage of providers, AHUV, AHHM, and AHMC has strived to recruit and retain primary care, dental and mental health professionals. In 2023, AHUV onboarded four primary care advanced practice providers; two primary care physicians; one ophthalmologist; one advanced practice provider specializing in hematology/oncology and one advanced practice provider specializing in psychiatry. AHMC onboarded two primary care advanced practice providers; two advanced practice providers of which one is an orthopedic specialty and the other is a psychologist. AHHM onboarded one primary care advanced practice provider: one advanced practice provider in orthopedics and two general surgeons. In addition, the Incubate Program which is a collaborative effort between the three Hospitals and the community was commenced in 2023. Its goals extended beyond immediate support for physicians to create a long-term vision of a sustainable healthcare environment in Ukiah Valley. Key factors identified during the quarterly summits included the need to foster collaboration between various stakeholders, including healthcare providers and public health organizations; a focus on diversity, equity, and inclusion; and the priority of physician wellness by ensuring they have the support they need to thrive in their community as well as in their work.Priority Need Two: Financial Stability.Goal is to identify vulnerable, unstably housed community members and connect with Community Health Workers for Support services through CalAIM funding.Strategy is to utilize the COMPASS Street Medicine team identify unstably housed clients and connect them with services within the county that afford financial assistance.FY 2023 Community Impact Activities and Outcomes:With more than a dozen contracted CalAIM provider organizations in Mendocino County, AHUV, AHHM, and AHMC identified the need for increased navigation support for people experiencing homelessness (PEH) who are desperately in need of the services provided through CalAIM. The COMPASS team provided care coordination to PEH accessing services across multiple healthcare providers; including Adventist Health Hospitals, primary care and specialty clinics, Mendocino Community Health Clinics, Consolidated Tribal Health Project, Round Valley Health Center, and Mendocino Coast Clinics.The COMPASS team participates in multiple monthly meetings with other community agencies and organizations where the delivery of services is coordinated and planned, including the Mendocino County Homeless Service Continuum of Care (a collaborative of over 31 agencies throughout Mendocino County), the Mendocino County CalAIM Collaborative, and Mendocino County Adult Protective Services. Part V, Section B, Line 11, continuation: In 2023, the COMPASS team provided ongoing care management services to 320 people experiencing homelessness. Of those served, 57% were medically complex with a severe mental health diagnosis and 81% were medically complex with substance use disorder. The population served had a 36% reduction in hospitalizations, 64% reduction in emergency room visits, and a 27% increase in primary care visits.In 2023, the COMPASS team received and provided specialized palliative care and advanced care planning training for marginalized populations. COMPASS provided these trainings to multiple organizations serving PEH, including Hospitality House Homeless Shelter, Consolidated Tribal Health Project, Redwood Community Services' Building Bridges Homeless Resource Center, Mendocino County Adult Protective Services, and Mendocino Community Health Clinic and their Ryan White Program. The COMPASS team also formed the Mendocino County Hospice and Palliative Care Collaborative, which brought together multiple hospice and palliative care providers to discuss care collaboration instead of competition. VyncaCare, Hospice of Ukiah, Madrone Care Network, and RCMS Community Healthcare all attended these quarterly meetings in 2023.Further amplifying their impact, the COMPASS team spearheaded the inaugural Mendocino County Street Medicine Collaborative meeting to be held in February of 2024. This landmark event will convene a diverse group of partner agencies, including Mendocino Community Health Clinic, the MCHC Ryan White Program, MCHC Community Care, MCHC Medication-Assisted Treatment (MAT) Program, Consolidated Tribal Health Project Outreach, Mendocino Coast Clinics Street Medicine Program, Mendocino Coast Hospitality Center's Street Medicine Project, Adventist Health Ukiah Valley Family Medicine Residency, Adventist Health COMPASS Street Medicine and Substance Use Navigation (SUN) program, and Mendocino County AIDS/Viral Hepatitis Network. This collaborative effort will be dedicated to improving the health and well-being of Mendocino County's PEH through community collaboration.All three Adventist Health Hospitals work with the COPE Health Scholar program to provide educational opportunities for individuals interested in making a difference in health care by working together to advance their careers through firsthand experience in clinical and administrative health care settings to become an integral part of the care delivery team. Cope Scholars assist with basic care for patients alongside nurses, physicians and other members of the care delivery team, and have opportunities to learn the "business" of health care, preparing them for a health care career and helping earn volunteer hours for medical school, nursing school, and other graduate programs while positioning students well for entry-level positions in healthcare.Priority Need Three: Health Risk Behaviors - Diet.Goal is to reduce the obesity rate among teens and adults through targeted food and diet education.Strategy is to improve health food and beverage access.FY 2023 Community Impact and Activities: Working closely with the Blue Zones Project Mendocino County team, the City of Ukiah Update Plan included the implementation of three food policy initiatives: 1. Adopted Healthy food and beverage standards and wellness policies at all city facilities. 2. Adopted institutional wellness policies that reduce and/or eliminate sugar-sweetened beverages in out-of-school programs, as well as parks and recreation sites and programs. 3. Adopted policy to incentivize landowners to allow community-based agriculture on their nonproductive property. In addition, work was done in 2023 to plan and host the reinstitution of the North Coast Farmers' Convergence, an annual gathering of producers and consumers to strengthen long-term capacity and collaboration across food systems-focused organizations and initiatives.Priority Need Three: Health Risk Behaviors - Illicit Drugs.Goal is to increase access to treatment in a community with high substance use and overdose rates.Strategy is to create policies and spaces for the treatment of substance use disorders and reduce harm to people who use substances.FY 2023 Community Impact and Activities: In 2023, AHUV, AHHM, and AHMC continued the CA Bridge model of care for addiction treatment, the Substance Use Navigator provides brief screening and intervention for people with substance use and behavioral health needs in the emergency department, inpatient setting and community members in need. The SUN team provided navigation 1,282 times, which resulted in 385 referrals to treatment: 137 into MAT treatment, 77 to Behavioral Health services, and 171 to residential treatment. SUN navigators also participate in Mendocino County Jail discharge planning and meet weekly to coordinate reentry directly to MAT and residential treatment services.All three Adventist Health Hospitals in Mendocino County participate in the SafeRx Mendocino program and the Naloxone Distribution Project. Mendocino County's SafeRx program tackles the opioid crisis through a two-pronged approach: prescriber education and harm reduction. For medical professionals, SafeRx offers training on safe opioid prescribing practices, encouraging the use of the CURES 2.0 prescription monitoring database to prevent overprescribing. The program also focuses on patient education, providing resources to help people understand their opioid prescriptions and navigate conversations with their doctors. Additionally, SafeRx works on harm reduction by facilitating access to naloxone (Narcan), a medication that can reverse opioid overdoses. Through these efforts, Mendocino County's SafeRx program aims to prevent opioid misuse and addiction while equipping the community to respond to potential overdoses. In 2021, Mendocino County had the highest fatal overdose rate of any county in California, at 54.7 per 100,000 residents. Data through the third quarter of 2023 shows that rate had dropped to 44.0 per 100,000 residents.Priority Need Three: Health Risk Behaviors - Tobacco Use.Strategy One: Decrease youth tobacco use and availability of cigarettes, e-cigarettes, and all flavored tobacco products.Strategy Two: Create systems and supports that target tobacco use prevention and cessation.FY 2023 Community Impact and Activities:AHUV, AHHM, and AHMC and the Blue Zones Project worked closely with the City of Ukiah to adopt policies pertaining tobacco use in Mendocino County. One policy was to provide a smoke-free multi-unit housing policy to include individual units, balconies, patios, and common indoor and outdoor areas and the adoption of outdoor policies that eliminate secondhand smoke and aerosol exposure including dining areas, entryways, public events, recreation areas, service areas, sidewalks, and outdoor worksites. The City of Ukiah adopted a Tobacco Retail License (TRL) that includes ending the sale of flavored tobacco products including fruit, candy, mint, and menthol flavors and eliminate possession, use and purchase (PUP) penalties.The City of Willits adopted a Tobacco Retail License (TRL) that includes ending the sale of flavored tobacco products including fruit, candy, mint, and menthol flavors and eliminate possession, use and purchase (PUP) penalties. Significant needs not met:No hospital can address all the health needs identified in its community. AHUV, AHHM and AHMC are committed to serving the community by adhering to its mission, and using its skills, expertise and resources to provide a range of community benefit programs. Areas of significant health needs that will not be directly addressed at this time include housing, mental health, food security, environment & infrastructure, inclusion & equity, COVID, education, community vitality and community safety. While these health needs are not addressed directly, they will likely benefit from the collective efforts of our community partnerships. 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. 3 1 - Adventist Health Howard Memorial - RHC 3 Marcela Drive Suite C Willits CA 95490 RHC 2 - Adventist Health Howard Memorial - OP 3 Marcela Drive Suite D Willits CA 95490 O/P physical therapy 3 - Adventist Health Howard Memorial - Retai 3 Marcela Drive Suite B Willits CA 95490 Retail pharmacy 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 a 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 acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be 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. In 2022, these projects were active and growing. In 2023, we saw tremendous growth in several of our markets promoting walking moais, worksite wellness, Blue Zones Project school pledges to create an environment that instills healthy lifestyle choices for our children and Blue Zones Project restaurant pledges to provide healthy options. 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. 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. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. 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 from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt. Part III, Line 4: The Adventist Health 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: Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) promote access to their 2022 Community Health Needs Assessment (CHNA), the 2023 Community Health Implementation Strategy (CHIS) approved in fiscal year 2023, and the Year One Update, FY 2023 for the Community Health Implementation Strategy by posting their reports on the Hospital's website at:https://www.adventisthealth.org/howard-memorial/about-us/community-benefit/The two most recent Community Health Needs Assessments, the two most recent Implementation Strategy reports and the 2021, 2022 and 2023 Community Health Plan Updates are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (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, Adventist Health supports 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 our region. 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.In addition to the CHNA, the Hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level. Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. 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: https://www.adventisthealth.org/patient-resources/bill-pay/financial-assistance/ The documents are available in multiple languages. The link to the Hospital's Self-Pay Billing and Collection Policy is posted at:https://www.adventisthealth.org/documents/system/13863-self-pay-billing-and-collection-policy.pdfAt 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's 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: From spectacular ocean views, redwood forests, and picturesque towns, the CHNA service area for Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) is a breathtaking community with a total population of 116,095. Throughout the County people enjoy activities such as the Mendocino Art Center, Theatre Company, and music and film festivals. The median household income is $56,401. The largest segment of the population (37.2%) is made up of residents aged over age 55. The community is known as a location focused on the well-being of its residents with support in the built environment, grocery stores and access to care while also implementing a Blue Zones Project. Among this population, 59.95% of an individual's income is spent on housing and transportation, while 20.66% of children live in poverty and 6.67% of students are unhoused, compared to the state average of 4.25% and national average of 2.77%. 15.9% of the population smoke tobacco, which is a higher rate than in California (11.5%). The teen birth rate is 21.4 per 1,000 females, which is greater than the state's teen birth rate of 15.6 and the national rate of 19.3. The percentage of infants with low birth weight is significantly greater, with Mendocino's rate at 15.1% compared to the state at 6.9%.The AHUV, AHHM, and AHMC CHNA market has a total population of 116,095 (based on the 2020 Decennial Census). The largest city in the service area is Ukiah, with a population of 16,075. The service area is comprised of the following zip codes: 95415, 95463, 95410, 95445, 95460, 95428, 95488, 95449, 95437, 95425, 95453, 95589, 95427, 95456, 95469, 95459, 95468, 95432, 95490, 95429, 95417, 95482, 95587, 95466, 95470, 95494, 95420, 95454, 95585. 62.33% of the population owns their home and 37.67% of the population rent their home. Total Population by age groups: Age 0-4: 5.8%, Age 5-17:14.9%, Age 18-24: 7.4%, Age 25-34: 11.1%, Age 35-44: 11.7%, Age 45-54: 11.9%, Age 55-64: 14.6%, Age 65+: 22.6%. 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, and3. 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, and3. 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 tele-pharmacy 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: Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM), and Adventist Mendocino Coast (AHMC) are proud sponsors of Blue Zones. From May through December 2021, the Blue Zones Project Mendocino County (BZPMC) team assessed Mendocino County's readiness to undertake the community well-being transformation initiative where the healthy option becomes the easy option through permanent changes in environment, policy, and social networks. The Blue Zones Project team conducted a comprehensive analysis of the current state of well-being and met with local leaders and stakeholders across all sectors to learn about the strengths, challenges, and opportunities for improving well-being in Mendocino County and summarized their findings in the Blue Zones Project Discovery Report. The findings in that report were coupled with expert-led discovery meetings in the policy areas of built environment, tobacco, and food policy to inform the Blueprint for Blue Zones Project implementation in Mendocino County. Here is a summary of progress outcomes for 2023 for the three main pillars of engagement of people, places, and policy. PEOPLEIn 2023 over 3,600 unique individuals 15 years or older participated in Blue Zones Project (BZP) activities. Those activities are as follows: - 1,582 individuals completed the RealAge Test, our Community Wellbeing Survey. The local team advocated for paper surveys to reach community members with no access to internet/email. Because of this, we were able to reach a more diverse population than we did in our baseline year when we didn't have the option of paper surveys.- 14% of people engaged have participated in multiple BZP activities.- The Engagement Committee has broad representation geographically and demographically including inland and Coastal representation consisting of Indigenous, Latino, older adults, parent, and people with disabilities. - Partnerships with Tribal, Latino and the Recovery communities to include participation in purpose moais at Brush Meadows housing complex for migrant farm workers; Zumba Muevete port u Salud; Annual Dia del Nino and Hispanic Heritage events; Spirit Walkers (recovery group) walking moais and purpose workshops; Round Valley Earth Day Celebration; Redwood Valley Little River Band of Pomo Indians Spirit run; Pinoleville Pomo Nation BZP story speech; and attending walking moais, a health fair and the Gathering of Native Americans with the Coyote Valley Band of Pomo Indians. - Partnership with Mendocino Community College (MCC) to include participation at the Dia de Los Muertos; Latino student retreat; cooking demonstrations with MCC CalFresh food distribution program in partnership with Mendocino County CalFresh Healthy Living Program; MCC walking moais (inland and Coast); Native American Heritage Celebration; and the Healthy Body/Healthy Mind educational series.- Facilitated the second largest Purpose Workshop with 180 staff members for all North Coast Opportunities (NCO) employees in partnership with Blue Zones Project Lake County. - Alternative Education High School Engagement with: Big Picture Ukiah Blue Zones Story Speech, Big Picture Fort Bragg cooking demonstrations series, Sanhedrin High School Willits purpose workshop, and Willits High School Community Learning Center (adults with disabilities).- Signature Blue Zones Project events in 2023 included attendance at: Blue Zones story speeches with 6,140 individuals; 11 walking moais with 120 individuals; six purpose workshops with 78 individuals; 28 cooking demonstration/classes with 90 individuals; five volunteer events with 186 individuals and 25 people downloading the Sharecare digital platform. PLACESSchools: Dana Gray Elementary School and Big Picture Alternative High School in Fort Bragg Unified School District achieved BZP Approval status in 2023 and one is in progress for approval early in 2024.Brookside Elementary School and Sanhedrin Alternative High School in Willits Unified School District achieved BZP Approval status in 2023 and one is in progress for approval early in 2024. The BZPMC team is working to set up a planning meeting to create an implementation plan for 2024 in the Ukiah Unified School District.Restaurants: Brickhouse Coffee in Willits, Cafe One in Fort Bragg and Roots Cafe AHHM all achieved Blue Zones Approval status in 2023. Three more are registered, actively engaged in the pledge process, and nearing approval in early 2024.Grocery Stores: Harvest Market in Fort Bragg became Blue Zones approved in October 2023, and the team is actively seeking engagement from two additional grocery stores.Worksites: North Coast Opportunities became Blue Zones Approved in July 2023. Six additional employers are actively working through the pledge process with four approvals expected in early 2024.POLICY Built Environment: Worked with the City of Ukiah General Plan Update to include three built environment policy Initiatives: 1. Active Transportation Plan, 2. Great Redwood Trail connectivity and expansion, and 3. Complete Streets Policy Also, the City of Ukiah requested technical assistance from the BZPMC team in the form of conceptual design for the Perkins and Gobbi Gateway Project, a project that focuses on safety for all modes of transportation and placemaking elements.Capacity Building: Hosted three Complete Streets Workshops for the City of Fort Bragg, the City of Willits, and Mendocino County; joined the Technical Advisory Committee for Mendocino Council of Governments' (MCOG) Mobility Solutions Feasibility Study to define challenges and find solutions for unincorporated Mendocino County communities with no access to public transportation; and worked with the City of Ukiah Clara Avenue Construction Project for a remodel of existing throughfares to include bicycle and pedestrian infrastructure for Complete Streets implementation. 1 CA Health Fund & Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 34115 0 General Support 1 0 Part I, Line 2: Annual assistance is provided with no reporting required by recipient. 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 - Former Care Division President thru 02/22 0 1044420 0 406990 0 14496 0 53160 0 50625 0 1569691 0 0 Nahapetian Arby - Former Care Division Medical Off thru 02/22 0 967385 0 329621 0 185288 0 13296 0 56317 0 1551907 0 0 Wells Jason Former President thru 12/20 0 892808 0 337640 0 240134 0 13296 0 23881 0 1507759 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 Charpentier Paul Physician 1332294 0 19200 0 0 0 12672 0 38764 0 1402930 0 0 0 Jobe Meredith Secretary 0 660525 0 168715 0 130248 0 13296 0 46114 0 1018898 0 0 Howe Judson - President AHHM Pres, North Coast Network thru 03/22 0 538154 0 186337 0 84404 0 13296 0 15701 0 837892 0 0 Tetz Warren - Former Treas/Asst Secr thru 12/22 0 17731 0 125629 0 416665 0 13296 0 45539 0 618860 0 0 Eberhart Gregory Area Medical Officer 0 516674 0 19931 0 46341 0 13296 0 14663 0 610905 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 Mock Jeffrey Treasurer/Asst Secr as of 09/23 0 344451 0 53131 0 72809 0 13296 0 54501 0 538188 0 0 Shepardson Dean - Treasurer Asst Secr from 03/23 thru 09/23 0 307500 0 25000 0 129343 0 13296 0 42465 0 517604 0 0 Assadian Hoda Operations Executive 0 329595 0 101331 0 29999 0 13296 0 39081 0 513302 0 0 Givens Linda Patient Care Executive/Administrator 0 305709 0 60305 0 36976 0 13296 0 54673 0 470959 0 0 D'Anis Matthew Director, Pharmacy 239925 0 23159 0 22702 0 10344 0 69941 0 366071 0 0 0 Radell Raymond Certified RN Anesthetist 281540 0 6669 0 0 0 11163 0 23418 0 322790 0 0 0 Niderost Gregory Certified RN Anesthetist 271949 0 6712 0 0 0 7931 0 35698 0 322290 0 0 0 Buckingham Amy Associate Patient Care Executive 0 229280 0 27036 0 1305 0 13296 0 50169 0 321086 0 0 Ramirez Johann - Admin Director, Business Dev & Strategy 91778 0 30600 0 139874 0 8699 0 49864 0 320815 0 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 Parker Bessant - Former Area Medical Officer thru 03/22 0 0 0 0 0 211890 0 10594 0 41772 0 264256 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 Parker, Bessant - severance payment - $212,500 Ramirez, Johann - severance payment - $112,232 Tetz, Warren - severance payment - $416,673 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 Form 990, Part III, Line 4a: Willits Hospital Inc., DBA Adventist Health Howard Memorial (AHHM), 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 AHHM, 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 AHHM 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. AHHM 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 2023 was $7,764,569. The following Inpatient services were provided to all our patients: - 589 surgeries performed - 6,101 patient days The following Outpatient services were provided to all our patients: - 14,574 emergency department visits - 958 outpatient surgeries performed - 33,677 outpatient visits - 20,277 clinic visits AHHM 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 2023 was $3,660,165. 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/ A conversation with Judson Howe By Karen Rifkin for The Ukiah Daily Journal reported May 5, 2023: According to the Soil Test Report, commissioned by Adventist Health last December, to determine the viability of the community to recruit and sustain primary care doctors, "...Ukiah is home to 19,000 residents... known for its beautiful views, great climate, recreational activities, and wineries. Despite these attributes, AHUV struggles with provider recruitment and retention national report revealed that nearly one in five health care workers have left their jobs during the COVID-19 pandemic, citing environmental strains related to the pandemic, poor pay, and burnout as primary reasons." Judson Howe is the President of Adventist Health's North Coast Network that includes six facilities operating in burnout and loss of purpose which is causing us to question why we make the sacrifices we make every day; and it's especially challenging under these circumstances to find and recruit physicians. With the needs being greater than what physicians can provide, creating human suffering that cannot be solved or cured, he is seeking solutions for breaking out of this cycle, a situation not unique to Mendocino County but of national import. According to an article from the Press Democrat dated March 6, 2021, Lake County had the highest rate of fatal overdoses statewide in 2019 with more than 60 deaths per 100,000 people, more than triple the statewide average rate of 19.6. Mendocino County came second on the list with an overdose death rate of just over 40 fatalities per 100,000, followed by San Francisco County. Howe adds to these statistics: the county is burdened with severe impairments in the social determinants of health; adverse childhood experiences four times the national norm; alcohol use two times the national norm; and severe mental illness that is worsening. He estimates there are 50 primary care providers in the county with a need for 25 more and he is looking for a way for the hospital and community to come together to break out of this impasse and develop a viable method of recruiting and retaining physicians, to support, appreciate and acknowledge what they do and to build capacity for them to preserve themselves for tomorrow. The Soil Test Report identifies that some of the biggest challenges are stability of physician workforce, call/practice coverage, mental health, spousal satisfaction and specialist availability. Corporate medicine is identified as a problem. "We're seeing a loss of empathy and kindness in the medical space; at AHUV we often fail to put a human face to our business," he says. The report points out the importance of doctors having access to specialists, allowing them to practice full spectrum medicine - the way doctors practiced in an earlier era, with a broader spectrum of practice as opposed to hyper-specialization. "The idea that health care is a relationship between the patient and the provider and to build that continuity within the same visit are what full spectrum residencies are going for. We're a full spectrum program, cradle to the grave." But that is not their present reality. "It can take weeks or months to see a doctor and there are not enough. Our current health inequities are massive to the point where senior citizens cannot get in to see a provider." Howe is currently working with Benjamin Anderson, formerly the CEO of Kearney County Hospital in rural, western Kansas, who developed a successful model for medical provider recruitment. Anderson says they developed a culture that allowed them to recruit medical staff - everything from a sustainable on-call structure to building a sense of trust between medical providers and administration. He says by way of providing support, he and his wife babysat a physician's two-year-old daughter; and that most important is communicating that they care about their team members and their families. Howe says, "Everyone needs to stop competing and create access for health care together - not just Adventist Health but Mendocino Community Health Clinic and other stakeholders and providers, as well. We need to be willing to be accessible and humble, to create a safe vulnerable space so we can have a conversation about the collective health needs of the community. "Recruiting on wine, Redwoods and the coast is not sufficient; we have to recruit differently to missional providers, those who realize there's a problem and want to be a part of the solution; we need to initiate a community-led approach to health care with community resources augmenting the physician. That's what we're doing with the Incubate Program." The Incubate Program is a county-wide, collaborative task force sponsored by Mendocino County Health Clinic; Adventist Health; Ukiah Valley Residency Program; North Coast Opportunities; and the Mendocino County Public Health Department to cultivate a supportive training environment for full-scope family medicine in Ukiah, connecting provider and community well-being. Its volunteer members meet twice a quarter with the intention of uniting diverse stakeholders and constructing a supportive environment for physician residents and their families. Their goals include summarizing the current state of workforce challenges, implementing collaborative solutions and developing multi-year strategies. "We need to have housing - viable, sticky neighborhoods where physicians can stay, help connect them to our community, appreciate them and...we need to support local medicine. Every time a patient leaves the community, it takes away a local job. "I want to gather people who want to be part of the conversation, who want to be part of the solution." 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 IX, line 11g Physician professional fees: Program service expenses 8,479,629. Management and general expenses 61,652. Fundraising expenses 0. Total expenses 8,541,281. All other purchased services: Program service expenses 3,311,873. Management and general expenses 250,365. Fundraising expenses 0. Total expenses 3,562,238. Contract labor: Program service expenses 3,149,061. Management and general expenses 27,759. Fundraising expenses 0. Total expenses 3,176,820. Other medical professional fees: Program service expenses 584,970. Management and general expenses 0. Fundraising expenses 0. Total expenses 584,970. Purchased medical services: Program service expenses 403,723. Management and general expenses 1,794. Fundraising expenses 0. Total expenses 405,517. Consulting and other management fees: Program service expenses 134,727. Management and general expenses 255,880. Fundraising expenses 0. Total expenses 390,607. Repairs and maintenance: Program service expenses 1,244,737. Management and general expenses 5,416. Fundraising expenses 0. Total expenses 1,250,153. Other professional fees non-medical: Program service expenses 5,014. Management and general expenses 49,468. Fundraising expenses 0. Total expenses 54,482. 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 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 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 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 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 E Cesar E Chavez Avenue Los Angeles CA 90033 952282647 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 1 1 0 1 1 1 1 1