2025-11-06T11:07:52-06:00 2024-12-31 390859910 Baker Tilly Advisory Group LP 2882 Prospect Park Dr Ste 300 Rancho Cordova CA 95670 990 2024-01-01 941639901 Ukiah Adventist Hospital UKIA 9164060000 275 Hospital Drive Ukiah CA 95482 Richard Riter Treasurer 9164060000 2025-10-25 1 1 Lauren A Haverlock P00545829 9165038100 2025-10-25 2024 2025-03-06 01:10:19Z Adventist Health Ukiah Valley Parker Pridgen 275 Hospital Drive Ukiah CA 95482 282524932 0 1071 X www.adventisthealth.org/ukiah-valley/ X 1967 CA Living God's love by inspiring health, wholeness and hope. 14 13 967 0 79967 0 3253922 6195584 255410857 269792705 2822575 6487853 0 0 261487354 282476142 249848 832429 0 0 84485456 94355521 0 0 92457 171926716 180985998 256662020 276173948 4825334 6302194 261031343 269457052 105934809 109293252 155096534 160163800 X Living God's love by inspiring health, wholeness and hope. 0 0 229309550 832429 269712738 See Schedule O 229309550 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 0 967 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Heinrich Kerry Dir/Chair/CEO 0.00 50.00 X X 0 3974195 57975 Hofheins Todd Dir/Vice Chair/COO 0.00 50.50 X X 0 2407675 65992 Freedman John Director 0.00 4.00 X 0 27203 0 Newton Bradford Director 0.00 4.00 X 0 26939 0 Cherry Robert Director 0.00 4.00 X 0 26611 0 Davis Andrew Director 0.00 4.00 X 0 26611 0 Innocent Larry Director 0.00 4.00 X 0 26611 0 Reiner Richard Director 0.00 4.00 X 0 26611 0 Wagner Jack Director 0.00 4.00 X 0 21611 0 Woodson Marc Director 0.00 4.00 X 0 21611 0 Salazar Velino Director thru 09/24 0.00 4.00 X 0 21181 0 Fehr Joy Director 0.00 4.00 X 0 18680 0 Beckett Ann Director as of 01/24 0.00 4.00 X 0 17930 0 Daggett Jonathan Director as of 01/24 0.00 4.00 X 0 16180 0 Jutzy Kenneth Director as of 01/24 0.00 4.00 X 0 16180 0 Cress John Director as of 10/24 0.00 4.00 X 0 430 0 Beaman John CFO/Assistant Secretary 0.00 50.50 X 0 1980861 79808 Jobe Meredith Secretary 0.00 50.50 X 0 1221104 57975 Howe Judson - Pres AHUV Pres, N Coast Ntwk thru 07/24 8.30 41.70 X 0 830097 79497 Mock Jeffrey-TreasAsst Secr Ops Exec, N Coast Svc Ar as of 09/24 10.00 40.00 X 0 568248 35835 Stevens Eric-Pres AHUV 0724 Pres, N Coast Svc Ar as of 07/24 5.00 45.50 X 0 1886146 57975 Eberhart Gregory Area Medical Officer thru 04/24 12.50 37.50 X 0 670753 73606 Assadian Hoda Operations Executive thru 06/24 16.70 33.30 X 0 498153 60421 Bartolomie Jill Patient Care Executive thru 04/24 50.00 0.00 X 0 358771 38096 Buckingham Amy - Associate Patient Care Executive as of 12/24 25.00 25.00 X 0 356296 30007 Leighton David Administrator 40.00 0.00 X 340838 0 38034 Winter Carrie Multi-Site Director Pharmacy 40.00 0.00 X 300052 0 50479 Denoeu Rebecca Director, Emergency Services 40.00 0.00 X 279398 0 53337 Woodruff Nicole Director, Perioperative Services 40.00 0.00 X 272035 0 36417 Loi Victor Pharmacist 40.00 0.00 X 254527 0 17630 Wells Jason Former President thru 12/20 0.00 50.00 X 0 1543056 79808 Shepardson Dean - Former Treas/Asst Secr thru 09/23 0.00 50.00 X 0 651222 76490 Wing Bill - Former Dir Asst Secr/Vice Chair thru 01/22 0.00 0.00 X 0 273263 0 Nahapetian Arby - Former Care Division Medical Officer thru 02/22 0.00 50.00 X 0 1759258 79808 Jahn Andrew - Former Care Division President thru 02/22 0.00 50.00 X 0 693217 59411 Spencer Lindsey - Former Operations Executive thru 05/22 0.00 50.00 X 0 603528 79808 1446850 20570232 1208409 254 1 1 0 Pacific Redwood Medical Group Inc 242 Hospital Drive Suite B Ukiah CA 95482 Medical Services 3135125 Anesthesia Management Services of CA In 617 Park Boulevard Ukiah CA 94582 Medical Services 2957412 Galen Inpatient Physicians Inc 2100 Powell St Ste 400 Emeryville CA 94608 Medical Services 2953241 RMG Medical Imaging Consultants PO Box 86348 Los Angeles CA 90086 Medical Services 2704740 CHG Companies Inc PO Box 972651 Dallas TX 75397 Staffing Services 2170589 46 5883253 312331 6195584 Patient service revenue 621110 210796468 210796468 Premium revenue 900099 43430126 43430126 340B Pharmacy 456110 12532678 12452711 79967 Intercompany revenue 621990 1152486 1152486 Incentive and quality revenue 621990 1083345 1083345 797602 797602 269792705 6536643 6536643 48790 -48790 -48790 -48790 282476142 269712738 79967 6487853 X 832429 832429 73466045 61616242 11793707 56096 2841574 2383239 456166 2169 12712996 10307455 2393519 12022 5334906 4608679 720987 5240 16887986 225 16887761 240791 240791 18937 18937 73730904 71220173 2504021 6710 87910 87910 1799432 1492871 305711 850 11742579 1495556 10247023 9600623 8931116 669507 371003 240253 130750 55802 24680 31122 2202879 2202879 8717678 8656736 60942 1346143 1346143 Patient care supplies 50228390 50219020 9370 Quality assurance fees 1123309 1123309 Rental/lease costs equi 530524 521408 9116 UBI taxes 27388 27388 2273720 2040812 232908 276173948 229309550 46771941 92457 11891 11601 106483965 102877596 236448 142282 24986359 31219990 4874713 2819864 225052 110833 148023951 74567732 70306778 73456219 28618 0 500000 500000 172586 172586 53204933 58146081 261031343 269457052 15443679 20449139 294282 220960 90196848 88623153 105934809 109293252 X 151257858 157213006 3838676 2950794 155096534 160163800 261031343 269457052 X 6302194 1314539 -2549467 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 18937 18937 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. 3838676 584721 1472603 2950794 5698375 32085 1891784 3838676 1320654 7225833 -4123 2843989 5698375 1291863 1023959 5118 1000286 1320654 1311452 822627 842216 1291863 0.00000 0.00000 1.00000 0 0 1276873 1276873 104567027 45707562 58859465 2548711 1224698 1324013 39631340 27635472 11995868 73456219 Receivables from third-party payors 43259684 Right-of-use assets 11426988 Other receivables 2921013 Receivables from related organizations 530396 Other assets 8000 58146081 Payables to related organizations 67046075 Payables to third party payors 11777895 Lease liability 9799183 88623153 X Part V, Line 4: Board-designated and temporarily 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, 2024 and 2023, 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 2021 in major tax jurisdictions. 1 1 X 1 X 1 X 1 1 1 0 1 1 853506 853506 0.00310 853506 853506 0.00310 951700 73368 878332 0.00320 3032281 1001163 2031118 0.00740 43134521 29460836 13673685 0.04950 52747 52747 0.00020 47171249 30535367 16635882 0.06030 48024755 30535367 17489388 0.06340 397138 397138 0.00140 161314 161314 0.00060 558452 558452 0.00200 1 1444305 527839 51659626 62566834 -10907208 X 1 1 1 Hospital Dr Med Plaza Assn Property management 0.33000 0.00000 0.67000 1 1 Adventist Health Ukiah Valley 275 Hospital Drive Ukiah CA 95482 See Form 990, Pg 1, Item J 110000095 X X X X Adventist Health Ukiah Valley 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X 1 22 1 See Sch H Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X Sch H, Part VI-Patient Educ X Sch H, Part VI-Patient Educ X Sch H, Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Adventist Health Ukiah Valley 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. Adventist Health Ukiah Valley 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. Adventist Health Ukiah Valley 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. Adventist Health Ukiah Valley Part V, Section B, Line 11: Tax Year 2024 was Year Two 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. Tax Year 2024 Community Impact Activities and Outcomes:The Adventist Health Street Medicine Program, a collaboration between the COMPASS Street Medicine Team and the SMART Track Program, continued its vital work in 2024, providing essential services to people experiencing homelessness (PEH) in Mendocino County. Building upon the foundation established in 2023, the program saw significant growth and expansion.Continued Outreach and Care: The program maintained its commitment to providing accessible healthcare, conducting over 100 Street Medicine clinics throughout the year. Over 400 individuals received care, resulting in more than 1,000 encounters, demonstrating the program's significant reach.Multidisciplinary Team: The COMPASS Street Medicine team, consisting of a registered nurse, care coordinator, social worker, nurse practitioner, licensed therapist, and physicians, ensured comprehensive care delivery. The SMART Track program continued to train two family medicine residents, equipping them with the skills to serve PEH effectively. All six first year residents spent time with the team as part of their community medicine rotation.Enhanced Collaboration: The program strengthened its partnership with Mendocino Community Health Clinics (MCHC), integrating MCHC's care management staff into Street Medicine clinics. The inaugural Mendocino County Street Medicine Collaborative meeting, held in February 2024, fostered greater collaboration among various community agencies. Meetings continued quarterly throughout the year. On September 26, 2024, Adventist Health, in partnership with various community organizations, hosted a training session focused on improving care for individuals experiencing homelessness. The event, led by experts from USC Keck School of Medicine, aimed to equip healthcare providers and community workers with the knowledge and skills necessary to effectively address the unique needs of this vulnerable population.Expanded Outreach: In late 2024, the COMPASS Street Medicine team initiated bi-weekly outreach clinics to an encampment in southern Ukiah, providing direct medical care and care coordination. Due to positive reception and need, encampment outreach frequency will increase to weekly in early 2025, and additional outreach sites are being identified.Enhanced Service Delivery: A collaborative "medication backpack" project, in partnership with the AHUV pharmacy team, will be implemented in Q1 2025, enabling the team to address a wider range of medical conditions on-site. A point-of-care testing program, bringing essential diagnostic tests directly to PEH, is anticipated to be operational in Q1 and Q2 of 2025.Priority Need One: Access to Care - Insurance.Goal is to verify/re-verify Medi-Cal 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. In 2024, AHMC continued its proactive efforts to mitigate disruptions in healthcare access for Medi-Cal members in Mendocino County, building upon the foundation laid in 2023 during the unwinding of the Pandemic Era Medicaid Continuous Coverage Requirement. The focus remained on ensuring smooth transitions for individuals facing Medi-Cal renewal or needing to explore alternative coverage options.Tax Year 2024 Community Impact Activities and Outcomes:Building on 2023 Efforts: Adventist Health continued the multi-faceted strategy established in 2023, which involved collaboration with community agencies, targeted marketing campaigns, and staff training. The organization maintained its commitment to providing support for individuals needing assistance with Medi-Cal renewal or applications for other coverage.Targeted Outreach and Communication: In early 2024, Adventist Health leveraged data analysis to create a mailing list of over 3,000 Mendocino County households that had lost Medi-Cal coverage in 2023. A letter campaign was launched to provide these households with up-to-date resources for renewal or alternative insurance. Updated Medi-Cal navigation resources from the California Department of Health Care Services were incorporated into new banners, posters, and flyers distributed throughout Adventist Health's facilities. A social media campaign was implemented in October. In November of 2024, a mailer was deployed to over 7,000 households in Mendocino County, providing Medi-Cal enrollment and re-enrollment guidance in both English and Spanish.Expanded Support and Navigation: Front-line Adventist Health associates received ongoing training to guide patients through Medi-Cal renewal and Covered California options. Collaboration with our revenue cycle management partner continued to expand the scope of the insurance navigation program. Adventist Health associates worked with community agencies to provide navigation support for high-risk individuals facing procedural barriers.Community Collaboration: Adventist Health continued to collaborate with community partners to identify opportunities for enrollment events within the communities most impacted by the reenrollment process. Our Hospital's commitment to providing clear and accessible information ensured that Mendocino County residents were equipped to navigate the complexities of healthcare coverage.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.Tax Year 2024 Community Impact Activities and Outcomes:CalAIM and Holistic Healthcare through Enhanced Care Management (ECM): ECM is an essential component of California Advancing and Innovating Medi-Cal (CalAIM). ECM is a Medi-Cal managed care benefit providing community-based care management for individuals experiencing homelessness, behavioral health needs, substance use, children involved in child welfare, and individuals transitioning from incarceration. Lead Care Managers work individually with enrolled patients to provide up to one year or more of case management services, linking them to community resources such as but not limited to, transportation to medical appointments, food support, access to medical and mental health services, and other to improve health outcomes and overall well-being. AHUV, AHHM and AHMC remained dedicated to the CalAIM program's goals of integrating medical care with essential social services to address the social determinants of health through dedicated Adventist Health staff. The organization recognized the critical role of Enhanced Care Management (ECM), and Community Supports (CS) in providing comprehensive care for high-need individuals. In 2024, 25 members were enrolled. COMPASS Team's Core Functions: The COMPASS team continued to serve as a vital navigation resource for PEH, connecting them with services across various healthcare providers in Mendocino County, including Adventist Health facilities, Mendocino Community Health Clinics, Anchor Health Management, Redwood Community Services, and others. The team actively participated in collaborative meetings with community agencies, including the Mendocino County Homeless Service Continuum of Care, the Mendocino County CalAIM Collaborative, and Mendocino County Adult Protective Services.Enhanced Collaboration and Service Integration: The collaboration with the MCHC Connections to Care team at clinics held at Redwood Gospel Mission's Center for Hope and the Ukiah Community Food Bank was strengthened, increasing navigation capacity. The COMPASS team expanded staffing support for weekly clinics at the Building Bridges Shelter, resulting in improved connections to housing, social security, food stamps, and other vital resources. In 2024, the COMPASS team provided care management services to 480 people experiencing homelessness, with significant proportions facing medical complexity, mental health diagnoses, and substance use disorders. Part V, Section B, Line 11, continuation: Palliative Care and Training: Building on 2023's specialized palliative care and advanced care planning training, the COMPASS team continued to share expertise with organizations serving PEH. The Mendocino County Hospice and Palliative Care Collaborative, formed by the COMPASS team, fostered collaboration among hospice and palliative care providers.Expanded Assistance: The strategies used to help with Medi-Cal renewal and enrollment also helped patients apply for CalFresh, and other cash aid programs, due to the shared state portal.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.Tax Year 2024 Community Impact and Activities: AHUV, AHHM, and AHMC, local organizations and the Blue Zones Project worked closely on the implementation of two food policy initiatives. The City of Willits Land Use Element policy included incentivizing landowners to allow community-based agriculture on their nonproductive property and amending zoning regulations to reduce prevalence and accessibility of fast-food restaurants. They also achieved the following: 1. Fort Bragg Unified School District adopted an updated Wellness Policy. 2. The architecture design for commercial kitchen for North Coast Opportunities' Caring Kitchen Project. 3. A business plan for North Coast Opportunities' Mendo Lake Food Hub, a dual county initiative with BZP Lake. 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.Tax Year 2024 Community Impact and Activities: In 2024, 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. In Q1 of 2024, the SUN team integrated with the COMPASS team increasing collaboration. 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 2024, Dr. Cara Eberhart joined AHUV as a Family Medicine physician specializing in addition medicine and actively collaborated with the SUN team, providing addiction consultation services and joined the COMPASS Street Medicine team offering outpatient addiction medicine services. CDC data shows a 31.51% decrease in provisional drug overdose deaths for the 12-month period ending in June 2024 compared to the peak 12-month period in 2021.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.Tax Year 2024 Community Impact and Activities:AHUV, AHHM, and AHMC, local organizations and the Blue Zones Project worked closely to create the Mendocino County Tobacco Policy Platform which was adopted by the Mendocino County Tobacco Prevention Coalition (County-wide: Willits, Fort Bragg, and Ukiah). The Mendocino County Tobacco Policy Platform was established to address the significant health risks associated with tobacco use and exposure to secondhand smoke. The policy platform focuses on several key areas:Tobacco Prevention and Youth Education: Initiatives aimed at reducing tobacco use among youth through educational programs and community outreach. These efforts are designed to inform young people about the dangers of tobacco use and to prevent the initiation of smoking and vaping.Secondhand Smoke Reduction: Measures to protect the public from the harmful effects of secondhand smoke. This includes the implementation of smoke-free policies in public spaces and workplaces, as well as educational campaigns to raise awareness about the risks of secondhand smoke exposure.Tobacco Use Education: Programs that provide information and resources to help individuals quit smoking and reduce their dependence on tobacco products. These programs often include support groups, counseling services, and access to nicotine replacement therapies.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-19, 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. 29 1 - Outpatient Clinics Hematology and O 260 Hospital Drive Suite 207 Ukiah CA 95482 Oncology 2 - Outpatient Clinics Wound Care Clini 415 Hospital Drive Ukiah CA 95482 Wound care center 3 - Outpatient Clinics Ambulatory Surge 245 Hospital Drive Ukiah CA 95482 Outpatient surgery 4 - Outpatient Clinics Radiology or Imagin 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology 5 - Outpatient Clinics Radiology or Imagin 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology/MRI 6 - Outpatient Clinics Radiology or Imagin 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology/ultrasound 7 - Outpatient Clinics 415A Hospital Drive Ukiah CA 95482 Pre-op clinic 8 - Retail Pharmacy (AHHM) 3 Marcela Drive Suite B Willits CA 95490 Retail pharmacy 9 - Outpatient Clinics Radiology or Imagin 1165 S Dora Street Suite D-1 Ukiah CA 95482 Mendo radiology 10 - Outpatient Clinics Rehab Clinic Phys 271 Observatory Avenue Ukiah CA 95482 Physical therapy 11 - Outpatient Clinics Cardiology Clinic 115 Hospital Drive Ukiah CA 95482 Cardiology 12 - Outpatient Clinics Rural Health Clin 1050 N State Street Ukiah CA 95482 Family practice 13 - Outpatient Clinics Surgical Clinic 246 Hospital Drive Ukiah CA 95482 General surgery 14 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 209 Ukiah CA 95482 Family practice 15 - Outpatient Clinics Ophthalmology Clin 248 B Hospital Drive Ukiah CA 95482 Ophthalmology 16 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 102 Ukiah CA 95482 Pain management 17 - Outpatient Clinics Radiology or Imagin 245 Hospital Drive Suite 100 Ukiah CA 95482 Radiology/mammography 18 - Outpatient Clinics Nephrology or Urolo 260 Hospital Drive Suite 201 Ukiah CA 95482 Urology 19 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 107 Ukiah CA 95482 Orthopedics 20 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 204 Ukiah CA 95482 Pediatrics 21 - Outpatient Clinics Rehab Clinic Phys 3101 South State Street Ukiah CA 95482 Physical therapy 22 - Outpatient Clinics Gastroenterology Cl 234 Hospital Drive Suite A B Ukiah CA 95482 HBOC-GI 23 - Outpatient Clinics Rural Health Clinic 850 Sequoia Circle Fort Bragg CA 954375490 Family medicine 24 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 101 Ukiah CA 95482 Behavioral clinic 25 - Outpatient Clinics Rehab Clinic Phys 271 Observatory Avenue Ukiah CA 95482 Speech therapy 26 - Outpatient Clinics Rheumatology 260 Hospital Drive Suite 207 Ukiah CA 95482 Rheumatology 27 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 101 Ukiah CA 95482 Live well 28 - Outpatient Clinics Central Office 238 Hospital Drive Suite A Ukiah CA 95482 Billing - clinics 29 - Outpatient Clinics Rural Health Clinic 260 Hospital Drive Suite 103 Ukiah CA 95482 Internal medicine 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. 2024 saw continued transformation of our six community Blue Zones Projects through policy initiatives around built environment, tobacco use and food. 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 Tax Year 2023, and the Year Two Update, Tax Year 2024 for the Community Health Implementation Strategy by posting their reports on the Hospital's website at:https://www.adventisthealth.org/ukiah-valley/about-us/community-benefit/The two most recent Community Health Needs Assessments, the two most recent Implementation Strategy reports and the 2022, 2023 and 2024 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%. Approximately 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. Approximately 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 2024 for the three main pillars of engagement of people, places, and policy. PEOPLE: 2,700 unique individuals aged 15 years or older participated in Blue Zones Project activities in 2024, with 8,488 over the Project period. A total of 852 individuals completed the RealAge Test, our Community Wellbeing Survey. Engagement Committee representation geographically and demographically included inland and coast representation, Native American, Latino, older adults, parents, and people with disabilities. Community outreach events with the Tribal and Latino community included: 1. Brush Meadows (housing for migrant farm workers) purpose moai and Zumba Muevete por tu Salud2. Annual Dia del Nino, Dia Del Reyes, Dia De Los Muertos, and Hispanic Heritage events 3. Wellbriety (recovery group) walking moai4. Cooking demo/series with tribal youth camp, Redwood Valley Rancheria, Consolidated Tribal Health Project 5. Blue Zones Story Speech at the Sherwood Valley Band of Pomo Indians Big Time Event, Pinoleville Band of Pomo Indians Health Fair, Cahto Tribe Health and Wellness Fair and Coyote Valley Band of Pomo Indians Earth DaySignature Blue Zone Project Event Breakdown 2024: 1. Blue Zones Story Speech: 33 events, serving 1402. Walking Moais: six events, serving 763. Purpose Moais: two events, serving 28 4. Innovative Moais: four events, serving 116 5. Purpose Workshops: five events, serving 996. Cooking Demos/Classes: 22 events, serving 1,1147. Volunteers: six events, 239 individualsPLACES: Three schools achieved Blue Zones Project approval status in 2024: Fort Bragg Unified School District/Redwood Elementary School, Willits Unified School District/Blosser Lane Elementary School, and Ukiah Unified School District/Instilling Goodness Divine Virtue School. Seven restaurants achieved Blue Zones status: Cucina Verona/Fort Bragg, Harbor View Bistro & Bar/Fort Bragg, Jyun Kang Vegetarian Restaurant/Ukiah, Oco Timr/Ukiah, Patrona's/Ukiah, Princess Seafood/Fort Bragg and Ukiah Natural Foods Cafe/Ukiah. Seven worksites became Blue Zones status: AHMC/Fort Bragg, Blosser Lane Elementary School/Willits, Brookside Elementary School/Willits, County of Mendocino in Willits and Fort Bragg, Fort Bragg Unified School District/Fort Bragg, Mendocino College Ukiah/County-wide and Savings Bank of Mendocino County/Ukiah. POLICY: Policy work around built environment accomplished in 2024: 1. Complete Streets Policy codified in Willits Land Use Element, General Plan (Willits) 2. Commercial Street Improvement Plan reflected complete streets principles and practices (Willits) 3. Plans and policies to increase access to, and ridership of, public transportation codified in Willits Land Use Element, General Plan (Willits)4. Plans and policies to increase access to, and ridership of, public transportation codified in Willits Land Use Element, General Plan (Willits)5. Chief Celeri Drive improvement designs reflected complete streets principles and practices (Fort Bragg)6. Plans and policies to advance placemaking efforts to improve downtowns and other public spaces codified in Willits Land Use Element, General Plan (Willits) 1 City of Ukiah 411 W Clay Street Ukiah CA 95482 Government 10000 0 Sponsorship Greater Ukiah Business and Tourism Alliance 200 S School Street Ukiah CA 95482 940940846 501(c)(6) 10000 0 Membership Mendocino College 1000 Hensley Creek Road Ukiah CA 95482 680040876 501(c)(3) 130500 0 Funding for Nursing Program The One Project 8931 Eureka Grove Circle Granite Bay CA 95746 475638974 501(c)(3) 10000 0 Sponsorship Ukiah Valley Trail Group 759 S State Street NBR 25 Ukiah CA 95482 201098878 501(c)(3) 25000 0 Sponsorship Ukiah Seventh - Day Adventist Church 1390 Laurel Avenue Ukiah CA 95482 946003975 501(c)(3) 6000 0 Donation California Health Fund & Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 640929 0 Health services un/underinsured patients 6 1 Part I, Line 2: Charitable support and 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 2342000 0 1586113 0 46082 0 13296 0 44679 0 4032170 0 0 Hofheins Todd Dir/Vice Chair/COO 0 1474000 0 888115 0 45560 0 13296 0 52696 0 2473667 0 0 Beaman John CFO/Assistant Secretary 0 1261000 0 698818 0 21043 0 13296 0 66512 0 2060669 0 0 Stevens Eric-Pres AHUV 0724 Pres, N Coast Svc Ar as of 07/24 0 1196000 0 495682 0 194464 0 13296 0 44679 0 1944121 0 0 Nahapetian Arby - Former Care Division Medical Officer thru 02/22 0 1111000 0 458435 0 189823 0 13296 0 66512 0 1839066 0 0 Wells Jason Former President thru 12/20 0 968000 0 423321 0 151735 0 13296 0 66512 0 1622864 0 0 Jobe Meredith Secretary 0 796100 0 281132 0 143872 0 13296 0 44679 0 1279079 0 0 Howe Judson - Pres AHUV Pres, N Coast Ntwk thru 07/24 0 326174 0 206444 0 297479 0 13296 0 66201 0 909594 0 0 Jahn Andrew - Former Care Division President thru 02/22 0 281190 0 407001 0 5026 0 55610 0 3801 0 752628 0 0 Eberhart Gregory Area Medical Officer thru 04/24 0 152608 0 136017 0 382128 0 7630 0 65976 0 744359 0 0 Shepardson Dean - Former Treas/Asst Secr thru 09/23 0 414258 0 116611 0 120353 0 13296 0 63194 0 727712 0 0 Spencer Lindsey - Former Operations Executive thru 05/22 0 459988 0 88601 0 54939 0 13296 0 66512 0 683336 0 0 Mock Jeffrey-TreasAsst Secr Ops Exec, N Coast Svc Ar as of 09/24 0 414258 0 90747 0 63243 0 13296 0 22539 0 604083 0 0 Assadian Hoda Operations Executive thru 06/24 0 190000 0 88964 0 219189 0 9500 0 50921 0 558574 0 0 Bartolomie Jill Patient Care Executive thru 04/24 0 83942 0 62890 0 211939 0 4197 0 33899 0 396867 0 0 Buckingham Amy - Associate Patient Care Executive as of 12/24 0 247494 0 105568 0 3234 0 12375 0 17632 0 386303 0 0 Leighton David Administrator 302947 0 33912 0 3979 0 13296 0 24738 0 378872 0 0 0 Winter Carrie Multi-Site Director Pharmacy 276763 0 22622 0 667 0 13296 0 37183 0 350531 0 0 0 Denoeu Rebecca Director, Emergency Services 260120 0 19278 0 0 0 13104 0 40233 0 332735 0 0 0 Woodruff Nicole Director, Perioperative Services 245872 0 25023 0 1140 0 12294 0 24123 0 308452 0 0 0 Wing Bill - Former Dir Asst Secr/Vice Chair thru 01/22 0 0 0 0 0 273263 0 0 0 0 0 273263 0 0 Loi Victor Pharmacist 249527 0 5000 0 0 0 12496 0 5134 0 272157 0 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. Assadian, Hoda - severance payment - $190,000 Bartolomie, Jill - severance payment - $203,228 Eberhart, Gregory - severance payment - $369,472 Howe, Judson - severance payment - $258,685 Jahn, Andrew - severance payment - $15,065 Wing, Bill - severance payment - $271,535 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, Jack Wagner, Jason Wells, 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 2024 Form 990, Part III, Line 4a: Ukiah Adventist Hospital, DBA Adventist Health Ukiah Valley (AHUV), provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. AHUV is a faith-based, not-for-profit health and wellbeing organization located in the county seat of Mendocino County. It is operated as a 68-bed hospital with 642 associates, 513 medical staff members, and 17 affiliated clinics offering both specialty and primary care services to Mendocino County and surrounding Lake County communities. Although reimbursement for services rendered is critical to the operation and stability of AHUV, 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 AHUV 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. AHUV 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 2024 was $853,506. The following services were provided to all our patients: - 126,909 clinic visits - 714 deliveries - 3,194 discharges - 31,530 emergency room visits - 462 inpatient surgeries - 99,734 outpatient hospital visits - 3,542 outpatient surgeries - 11,500 patient days AHUV 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 2024 was $13,673,685. AHUV's quality and performance awards include: Five-star rating from Centers for Medicare/Medicaid Services 2024, Leapfrog "Grade A" Spring 2024 and Fall 2024 Hospital Safety Score, Opioid Care Honor Roll by Cal Hospital Compare, Get with the Guidelines Rural Stroke - Bronze, and Gold Plus Quality Achievement Award, Geriatric Emergency Department accreditation, Primary Stroke Center accreditation from Joint Commission, Ranked #4 in the nation for social responsibility and #1 in California from Lown Institute for 2024. Adventist Health's mission statement of living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry, as represented by the life of Jesus Christ, and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs, and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ Form 990, Part VI, Section A, line 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 Chief Legal Officer/General Counsel immediately. The System Chief Legal Officer/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 Chief Legal Officer/General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System Chief Legal Officer/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 Adventist Health Board of Directors has established a Executive Compensation 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; 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 40 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 37,649,176. Management and general expenses 268,020. Fundraising expenses 0. Total expenses 37,917,196. Purchased medical services: Program service expenses 25,844,084. Management and general expenses 42,734. Fundraising expenses 0. Total expenses 25,886,818. All other purchased services: Program service expenses 1,291,497. Management and general expenses 714,392. Fundraising expenses 6,710. Total expenses 2,012,599. Contract labor: Program service expenses 4,107,688. Management and general expenses 148,929. Fundraising expenses 0. Total expenses 4,256,617. Consulting and other management fees: Program service expenses 297,127. Management and general expenses 443,598. Fundraising expenses 0. Total expenses 740,725. Repair and maintenance: Program service expenses 1,799,845. Management and general expenses 527,225. Fundraising expenses 0. Total expenses 2,327,070. Other professional fees non-medical: Program service expenses 9,588. Management and general expenses 356,623. Fundraising expenses 0. Total expenses 366,211. Other professional fees medical: Program service expenses 221,168. Management and general expenses 2,500. Fundraising expenses 0. Total expenses 223,668. 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. 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