Form 990 for tax year 2022

Revenue

Part VIII, the statement of revenue.

• 1e · Government grants (contributions)

  $4,847,507

• 1f · All other contributions, gifts and grants

  $837,503

• 2a · Program service revenue: Patient service revenue

  total $244,192,865 · related or exempt $244,192,865

• 2b · Program service revenue: Revenue/subsidy from related orgs

  total $1,977,679 · related or exempt $1,977,679

• 2c · Program service revenue: CARES Act revenue

  total $747,294 · related or exempt $747,294

• 2d · Program service revenue: Dietary/cafeteria revenue

  total $607,020 · related or exempt $607,020

• 2e · Program service revenue: Related rental revenue

  total $531,203 · related or exempt $531,203

• 2f · All other program service revenue

  total $6,083,832 · related or exempt $5,920,842 · unrelated business $162,990

• 3 · Investment income

  total $305,286 · excluded $305,286

• 6a · Gross rents

  real property $15,338

• 6b · Less rental expenses

  real property $36,721

• 6c · Rental income or loss

  real property -$21,383

• 6d · Net rental income or loss

  total -$21,383 · excluded -$21,383

• 7a · Gross sales of assets other than inventory

  other assets $17,549

• 7b · Less cost or other basis and sales expenses

  other assets $0

• 7c · Gain or loss

  other assets $17,549

• 7d · Net gain or loss

  total $17,549 · excluded $17,549

Functional expenses

Part IX, the statement of functional expenses.

• 1 · Grants to domestic organizations and governments

  total $249,457 · program services $249,457

• 7 · Other salaries and wages

  total $82,856,714 · program services $75,373,375 · management and general $7,134,208 · fundraising $349,131

• 8 · Pension plan contributions

  total $3,473,368 · program services $3,122,831 · management and general $335,282 · fundraising $15,255

• 9 · Other employee benefits

  total $9,509,902 · program services $9,343,908 · management and general $121,640 · fundraising $44,354

• 10 · Payroll taxes

  total $5,940,504 · program services $5,409,048 · management and general $506,257 · fundraising $25,199

• 11a · Fees: management

  total $29,673,486 · management and general $29,673,486

• 11b · Fees: legal

  total $708,281 · management and general $708,281

• 11d · Fees: lobbying

  total $62,098 · program services $62,098

• 11g · Fees: other

  total $45,668,160 · program services $42,022,391 · management and general $3,645,769

• 12 · Advertising and promotion

  total $50,480 · management and general $50,480

• 13 · Office expenses

  total $640,151 · program services $640,151

• 14 · Information technology

  total $9,446,833 · program services $2,162,137 · management and general $7,284,696

• 16 · Occupancy

  total $3,936,290 · program services $3,336,213 · management and general $600,077

• 17 · Travel

  total $148,452 · program services $131,516 · management and general $16,936

• 19 · Conferences, conventions and meetings

  total $39,834 · program services $36,580 · management and general $3,254

• 20 · Interest

  total $4,463,647 · program services $4,463,647

• 22 · Depreciation, depletion and amortization

  total $9,756,712 · program services $9,693,294 · management and general $63,418

• 23 · Insurance

  total $2,210,170 · program services $2,185,803 · management and general $24,367

• 24a · Other expenses: Patient care supplies

  total $36,653,759 · program services $34,966,482 · management and general $1,687,277

• 24b · Other expenses: Quality assurance fee

  total $12,451,385 · program services $12,451,385

• 24c · Other expenses: Leased equipment expens

  total $484,462 · program services $477,786 · management and general $6,676

• 24e · All other expenses

  total $12,309,222 · program services $11,266,791 · management and general $1,042,431

Balance sheet

Part X, book values.

• 2 · Savings and temporary cash investments

  beginning of year $48,118,262 · end of year $14,374,477

• 3 · Pledges and grants receivable

  beginning of year $33,319 · end of year $122,112

• 4 · Accounts receivable

  beginning of year $40,210,645 · end of year $37,943,291

• 8 · Inventories for sale or use

  beginning of year $3,940,476 · end of year $3,597,536

• 9 · Prepaid expenses and deferred charges

  beginning of year $747,938 · end of year $422,250

• 10a · Land, buildings and equipment: cost or other basis

  $273,739,351

• 10b · Land, buildings and equipment: accumulated depreciation

  $169,132,455

• 10c · Land, buildings and equipment, net

  beginning of year $115,896,368 · end of year $104,606,896

• 13 · Investments: program-related

  beginning of year $6,498,524 · end of year $5,144,623

• 15 · Other assets

  beginning of year $38,093,706 · end of year $45,984,430

• 17 · Accounts payable and accrued expenses

  beginning of year $29,951,046 · end of year $22,706,467

• 19 · Deferred revenue

  beginning of year $135,064 · end of year $0

• 23 · Secured mortgages and notes payable

  beginning of year $411,725 · end of year $0

• 25 · Other liabilities

  beginning of year $171,127,301 · end of year $164,661,706

• 27 · Net assets without donor restrictions

  beginning of year $48,575,995 · end of year $24,183,189

• 28 · Net assets with donor restrictions

  beginning of year $3,338,107 · end of year $644,253

The filer's explanations (Part III)

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. Pickering, Christine - severance payment - $169,477 Wing, Bill - severance payment - $1,584,880 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Larsen, David - participant, no activity in 2022 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, Jeff Eller, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Scott Reiner, Brett Spenst, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an of their corporate provided benefits. The balance is set aside for forfeiture and is at risk to the creditors of Adventist Health. Payouts substantial risks of forfeiture have lapsed. The plan was frozen for new amount equivalent to 41 percent of their base compensation, less the value nonvested deferred compensation that is subject to substantial risk of occur according to the participants' payment elections after all non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2022 Eller, Jeff, Former President, NCR was paid through an unrelated organization, Jeffrey D. Eller dba Mountaingate Coaching that was reported on Form 1099 and included in Schedule J, Part II.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

• Artel LLC (dba Lodi Outpatient Surgery Center)

  Ambulatory surgical center · CA · income $2,662,111 · assets $2,426,088

  Directly controlled by Lodi Memorial Hospital Association Inc

• Endoscopy Center of Lodi LLC

  Medical services · CA · income $0 · assets $0

  Directly controlled by Artel LLC

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

• Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC)

  Related · Diagnostic imaging / MRI outpatient treatment center · CA · 100% owned · share of income $377,350 · share of assets $3,170,311

  Directly controlled by Lodi Memorial Hospital Association Inc

• Blue Legacy Ventures LLC

  Real property rental · FL

• Blue Zones LLC

  Education · MN

• PAR LLC dba CherryWood Village

  Senior housing · OR

• PVHR LLC dba Paradise Village

  Senior housing · OR

• PVHR2 LLC dba Parkview Memory Care at Paradise Village

  Senior housing · OR

• WWGHR LLC dba Wheatland Village

  Senior housing · OR

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

• Delta Radiology Inc

  C · Radiology services · CA · 100% owned · share of income $4,016,027 · share of assets $1,008,907 · controlled entity

  Directly controlled by Lodi Regional Health Systems Inc

• Lodi Regional Health Systems Inc

  C · Physician management and medical office building development & management · CA · 100% owned · share of income $5,237,862 · share of assets $11,054,184 · controlled entity

  Directly controlled by Lodi Memorial Hospital Association Inc

• AdHealth Limited

  C · Pure captive insurance · BD

• Adventist Health Plan Inc

  C · Health insurance · CA

• South Coast Medical Center

  C · Wind down after sale of hospital · CA

• Thrive Productions Inc

  C · Production company · MN