2024-11-05T15:01:40-06:00 2023-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2023-01-01 943015356 United Com-Serve UNIT 9164060000 726 Fourth Street Marysville CA 95901 Chris Champlin President/CEO 9164060000 2024-11-01 1 0 Tracy S Paglia P00366884 2099556100 2024-11-01 2023 2024-10-15 13:58:12Z Chris Champlin 726 Fourth Street Marysville CA 95901 30982780 0 X www.adventisthealth.org/rideout/ X 1985 CA Living God's love by inspiring health, wholeness, and hope. 4 2 261 7 0 0 0 26563 25488765 25475609 4244949 5478568 510 2040 29734224 30982780 0 0 0 0 14604504 15184810 0 0 0 15840143 15786088 30444647 30970898 -710423 11882 76593893 76313365 25142255 24849845 51451638 51463520 Living God's love by inspiring health, wholeness, and hope. 0 0 21070325 0 21399511 The Fountains is a 145-bed skilled nursing facility and serves as a continuing care provider for patients requiring rehabilitation services subsequent to acute care hospital stay and as a long-term care provider. 2508372 0 2547561 The Courtyard is a 54-bed assisted living community for seniors who require assistance to maintain their highest level of independence. 1505023 0 1528537 The Gardens is a 44-bed assisted living community providing Alzheimer's and dementia residents with a safe and nurturing home environment with personal attention from professional caregivers. 25083720 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 261 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 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 0.00 50.50 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 Officer thru 02/22 0.00 50.00 X 0 1482294 69613 Wing Bill - Former Dir/Chair thru 01/22 0.00 0.00 X 0 1438460 40073 Jobe Meredith Secretary 0.00 50.50 X 0 959488 59410 Champlin Christopher President 9.00 41.00 X 0 854712 52508 Heard Alexander Medical Officer 2.00 48.00 X 0 695602 67194 Spencer Lindsey Operations Executive 2.00 48.00 X 0 564751 51445 Spenst Brett - Former Care Division Finance Officer thru 02/22 0.00 50.00 X 0 520625 45847 Gordon Cyndy Patient Care Executive 0.00 50.00 X 0 465159 52285 Thordarson Heidar Treasurer 9.00 41.00 X 0 464717 45670 Oliver Robin Business Development Executive 2.00 48.00 X 0 359451 53712 Gonzalez Eduardo Former Treasurer 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 Pannu Devinder Director, RN, Extended Care 40.00 0.00 X 233862 0 34404 Miceli Joseph - Administrator Skilled Nursing Facility 40.00 0.00 X 201606 0 46132 Arrowsmith Monica - Former Bus Development Leader thru 12/20 0.00 40.00 X 0 168606 62781 Gill Narjeet RN 40.00 0.00 X 159021 0 48959 Kaur Paramjit RN 40.00 0.00 X 176374 0 27675 Bottger Ofelia RN 40.00 0.00 X 198714 0 1017 Innocent Larry Director 0.00 4.00 X 0 26611 0 Reiner Richard Director 0.00 4.00 X 0 26611 0 969577 18871633 1202413 22 1 1 0 Sodexo Inc and Affiliates PO Box 360170 Pittsburgh PA 152516170 Nutritional services 2603964 Intergro Rehab Services Inc PO Box 69268 Baltimore MD 212649268 Therapy services 1502356 CEP America California 2100 Powell Street Suite 400 Emeryville CA 94608 Medical services 540000 Interim HealthCare Staffing PO Box 492557 Redding CA 960492557 Medical services 353811 Healthcare Services Group Inc PO Box 829677 Philadelphia PA 191829677 Housekeeping services 261067 5 26563 26563 Patient service revenue 623000 25246179 25246179 Dietary service revenue 621400 14620 14620 214810 214810 25475609 5478568 5478568 2040 0 2040 2040 2040 30982780 25475609 0 5480608 X 11133353 9481614 1651739 435761 400952 34809 2792002 2603080 188922 823694 704798 118896 2905808 2905808 65 65 6086689 6006554 80135 82884 30768 52116 801639 71551 730088 747718 722107 25611 4449 624 3825 4538 1168 3370 812706 812706 966503 966503 195000 195000 Patient care supplies 2055945 2017345 38600 Leased equipment expens 51696 36698 14998 1070448 1032252 38196 30970898 25083720 5887178 0 61762663 62523234 3227604 3061695 21728 0 128204 141025 34179565 24203863 10941765 9975702 511929 611709 76593893 76313365 2336002 2241091 2290 3300 22803963 22605454 25142255 24849845 X 51451638 51463520 51451638 51463520 76593893 76313365 11882 0 X 0 1 X 1 1 1 X X 1 Rideout Memorial Hospital 941387866 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1111122 1111122 29911841 21165802 8746039 1432465 1432465 0 1724137 1605596 118541 9975702 Payables to related organizations 22341339 Other liabilities 264115 22605454 X 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 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 Officer thru 02/22 0 967385 0 329621 0 185288 0 13296 0 56317 0 1551907 0 0 Wing Bill - Former Dir/Chair thru 01/22 0 0 0 0 0 1438460 0 13296 0 26777 0 1478533 0 0 Jobe Meredith Secretary 0 660525 0 168715 0 130248 0 13296 0 46114 0 1018898 0 0 Champlin Christopher President 0 594895 0 170695 0 89122 0 13296 0 39212 0 907220 0 0 Heard Alexander Medical Officer 0 498148 0 70366 0 127088 0 13296 0 53898 0 762796 0 0 Spencer Lindsey Operations Executive 0 450442 0 59341 0 54968 0 13296 0 38149 0 616196 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 Gordon Cyndy Patient Care Executive 0 361225 0 55383 0 48551 0 13296 0 38989 0 517444 0 0 Thordarson Heidar Treasurer 0 394981 0 52217 0 17519 0 13296 0 32374 0 510387 0 0 Oliver Robin Business Development Executive 0 308769 0 27798 0 22884 0 13296 0 40416 0 413163 0 0 Gonzalez Eduardo Former Treasurer 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 Pannu Devinder Director, RN, Extended Care 189121 0 12369 0 32372 0 3794 0 30610 0 268266 0 0 0 Miceli Joseph - Administrator Skilled Nursing Facility 188356 0 6405 0 6845 0 6315 0 39817 0 247738 0 0 0 Arrowsmith Monica - Former Bus Development Leader thru 12/20 0 50522 0 13318 0 104766 0 8430 0 54351 0 231387 0 0 Gill Narjeet RN 157437 0 1584 0 0 0 4111 0 44848 0 207980 0 0 0 Kaur Paramjit RN 173800 0 2574 0 0 0 4858 0 22817 0 204049 0 0 0 Bottger Ofelia RN 196860 0 1574 0 280 0 0 0 1017 0 199731 0 0 0 Part I, Line 3 The filing organization did not compensate its top management official, any officers or key employees during the tax year. Compensation was determined and paid by a related organization using one or more methods reported in Line 3. 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. Arrowsmith, Monica - severance payment - $104,252 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 participants are John Beaman, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Brett Spenst, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an 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 VI, Section A, line 6 The sole member of the Organization is Rideout Memorial Hospital, a California nonprofit public benefit corporation. Form 990, Part VI, Section A, line 7a Each individual who is a director of the board of Stone Point Health shall automatically be a director of United Com-Serve, and shall serve as a director of United Com-Serve until such time as that person is no longer a director of Stone Point Health. Form 990, Part VI, Section A, line 7b The sole corporate member, Rideout Memorial Hospital, must approve all changes to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11b This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the Corporate Finance Officer and Market Financial Officer, and shared by electronic communication with the Corporation's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital corporate officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the market president 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 C, line 19 The Organization does not make its governing documents, conflict of interest policy, or financial statements available to the public. Form 990, Part VII, Section A: Board compensation is for Adventist Health System/West Board of Directors only - not the Organization's Board of Directors. Form 990, Part IX, line 11g Other medical professional fees: Program service expenses 1,518,856. Management and general expenses 4,850. Fundraising expenses 0. Total expenses 1,523,706. Consulting and other management fees: Program service expenses 50,268. Management and general expenses 7,825. Fundraising expenses 0. Total expenses 58,093. Physician professional fees: Program service expenses 126,000. Management and general expenses 0. Fundraising expenses 0. Total expenses 126,000. Contract labor: Program service expenses 411,971. Management and general expenses 0. Fundraising expenses 0. Total expenses 411,971. Purchased medical services: Program service expenses 411,355. Management and general expenses 7,728. Fundraising expenses 0. Total expenses 419,083. Repairs and maintenance: Program service expenses 63,019. Management and general expenses 14,652. Fundraising expenses 0. Total expenses 77,671. All other purchased services: Program service expenses 3,425,085. Management and general expenses 45,080. Fundraising expenses 0. Total expenses 3,470,165. 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 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 FRD Management Company LLC PO Box 2128 Marysville CA 95901 943335136 Operation of cancer center CA N/A 0 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 Fremont-Rideout Management Services Organization Inc 726 Fourth Street Marysville CA 95901 271350379 DME Sales CA N/A C 0 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center 1 Adventist Health Way Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 200 Southdale Center Edina MN 55435 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1