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Nonprofiteer
← ADVENTIST HEALTH CLEARLAKE HOSPITAL INC

Form 990 for tax year 2022

Filed by ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.

Totals

Total revenue
$192,286,425
Total expenses
$179,275,358
Contributions and grants received
$7,292,822
Grants paid
$270,625
Program service revenue
$182,562,730
Investment income
$2,272,129
Other revenue
$158,744
Total assets, end of year
$139,959,853
Total liabilities, end of year
$112,497,711
Net assets or fund balances, end of year
$27,462,142
Program services expenses (Part IX)
$110,310,034
Management and general expenses
$68,697,429
Fundraising expenses
$267,895
Program service expenses (Part III)
$110,310,034

Program services were 61.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Wing Bill

    Dir/Asst Secr/Vice Chair thru 01/22

    Total calculated
    $2,567,666
    From this org
    $0
    From related orgs
    $2,511,347
    Other
    $56,319
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $263,334 related
    Bonus
    $0 + $662,638 related
    Other
    $0 + $1,585,375 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $44,099 related
    Filer's total
    $0 + $2,567,666 related

  • Heinrich Kerry

    Dir/Chair/CEO as of 01/22

    Total calculated
    $2,206,508
    From this org
    $0
    From related orgs
    $2,131,443
    Other
    $75,065
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,817,710 related
    Bonus
    $0 + $76 related
    Other
    $0 + $313,657 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $62,845 related
    Filer's total
    $0 + $2,206,508 related

  • Hofheins Todd

    Dir/Vice Chair/COO as of 01/22

    Total calculated
    $2,043,931
    From this org
    $0
    From related orgs
    $1,971,652
    Other
    $72,279
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,358,421 related
    Bonus
    $0 + $376,216 related
    Other
    $0 + $237,015 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $60,059 related
    Filer's total
    $0 + $2,043,931 related

  • Jahn Andrew

    Care Division President thru 02/22

    Total calculated
    $1,483,639
    From this org
    $0
    From related orgs
    $1,409,539
    Other
    $74,100
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,047,840 related
    Bonus
    $0 + $349,414 related
    Other
    $0 + $12,285 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $61,880 related
    Filer's total
    $0 + $1,483,639 related

  • Beaman John

    CFO/Asst Secretary as of 01/22

    Total calculated
    $1,419,572
    From this org
    $0
    From related orgs
    $1,361,096
    Other
    $58,476
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,047,636 related
    Bonus
    $0 + $298,600 related
    Other
    $0 + $14,860 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $46,256 related
    Filer's total
    $0 + $1,419,572 related

  • Nahapetian Arby - Care

    Division Medical Officer thru 02/22

    Total calculated
    $1,402,648
    From this org
    $0
    From related orgs
    $1,334,111
    Other
    $68,537
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $927,049 related
    Bonus
    $0 + $234,212 related
    Other
    $0 + $172,850 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $56,317 related
    Filer's total
    $0 + $1,402,648 related

  • Stevens Eric - President

    Northern CA/HI State Network

    Total calculated
    $1,378,159
    From this org
    $0
    From related orgs
    $1,315,314
    Other
    $62,845
    Hours/week
    5 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $896,507 related
    Bonus
    $0 + $250,602 related
    Other
    $0 + $168,205 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $50,625 related
    Filer's total
    $0 + $1,378,159 related

  • Spenst Brett - Care Division

    Finance Officer thru 02/22

    Total calculated
    $1,358,925
    From this org
    $0
    From related orgs
    $1,322,824
    Other
    $36,101
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $817,612 related
    Bonus
    $0 + $416,845 related
    Other
    $0 + $88,367 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $23,881 related
    Filer's total
    $0 + $1,358,925 related

  • Reiner Scott

    Former Dir/Chair/CEO thru 12/21

    Total calculated
    $1,258,725
    From this org
    $0
    From related orgs
    $1,222,073
    Other
    $36,652
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $348,458 related
    Bonus
    $0 + $870,709 related
    Other
    $0 + $2,906 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $24,432 related
    Filer's total
    $0 + $1,258,725 related

  • Jobe Meredith

    Secretary

    Total calculated
    $969,220
    From this org
    $0
    From related orgs
    $930,036
    Other
    $39,184
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $639,741 related
    Bonus
    $0 + $154,687 related
    Other
    $0 + $135,608 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $26,964 related
    Filer's total
    $0 + $969,220 related

  • Byrnes John - Former

    Medical Officer, NCR thru 02/20

    Total calculated
    $907,068
    From this org
    $0
    From related orgs
    $841,204
    Other
    $65,864
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $154,814 related
    Bonus
    $0 + $187,322 related
    Other
    $0 + $499,068 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $53,644 related
    Filer's total
    $0 + $907,068 related

  • Howe Judson

    President, North Coast Network

    Total calculated
    $836,449
    From this org
    $0
    From related orgs
    $782,335
    Other
    $54,114
    Hours/week
    8.3 + 41.7 related

    Schedule J breakdown matched by us

    Base
    $0 + $523,665 related
    Bonus
    $0 + $152,359 related
    Other
    $0 + $106,311 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $41,894 related
    Filer's total
    $0 + $836,449 related

  • Tetz Warren

    Treasurer 07/22 - 12/22

    Total calculated
    $603,235
    From this org
    $0
    From related orgs
    $565,355
    Other
    $37,880
    Hours/week
    12.5 + 37.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $435,029 related
    Bonus
    $0 + $63,870 related
    Other
    $0 + $66,456 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $25,660 related
    Filer's total
    $0 + $603,235 related

  • Cantrell Misty - Patient

    Care Executive as of 09/22

    Total calculated
    $572,104
    From this org
    $0
    From related orgs
    $507,425
    Other
    $64,679
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $270,061 related
    Bonus
    $0 + $61,401 related
    Other
    $0 + $175,963 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $52,459 related
    Filer's total
    $0 + $572,104 related

  • Cardenas Lucita

    RN

    Total calculated
    $542,637
    From this org
    $503,160
    From related orgs
    $0
    Other
    $39,477
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $502,849
    Bonus
    $311
    Other
    $0
    Deferred
    $12,220
    Nontaxable benefits
    $27,257
    Filer's total
    $542,637

  • Mock Jeffrey

    Interim Treasurer as of 12/22

    Total calculated
    $520,320
    From this org
    $0
    From related orgs
    $422,487
    Other
    $97,833
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $286,124 related
    Bonus
    $0 + $75,485 related
    Other
    $0 + $60,878 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $85,613 related
    Filer's total
    $0 + $520,320 related

  • Assavapisitkul Colleen - Pt

    Cr Exec thru 05/22/Pres as of 05/22

    Total calculated
    $505,236
    From this org
    $0
    From related orgs
    $459,052
    Other
    $46,184
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $359,184 related
    Bonus
    $0 + $61,531 related
    Other
    $0 + $38,337 related
    Deferred
    $0 + $12,220 related
    Nontaxable benefits
    $0 + $33,964 related
    Filer's total
    $0 + $505,236 related

  • Cole Delores

    RN

    Total calculated
    $448,569
    From this org
    $421,517
    From related orgs
    $0
    Other
    $27,052
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $421,441
    Bonus
    $76
    Other
    $0
    Deferred
    $12,220
    Nontaxable benefits
    $14,832
    Filer's total
    $448,569

  • Jacobson Carlton - Former Treas

    /Asst Secr thru 12/21/Fin Off AHCL

    Total calculated
    $426,357
    From this org
    $0
    From related orgs
    $383,633
    Other
    $42,724
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $286,289 related
    Bonus
    $0 + $65,488 related
    Other
    $0 + $31,856 related
    Deferred
    $0 + $11,509 related
    Nontaxable benefits
    $0 + $31,215 related
    Filer's total
    $0 + $426,357 related

  • Eller Jeff

    Former President, NCR

    Total calculated
    $405,370
    From this org
    $0
    From related orgs
    $352,684
    Other
    $52,686
    Hours/week
    0.5 + 8.5 related

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0 + $177,886 related
    Other
    $0 + $174,798 related
    Deferred
    $0 + $5,337 related
    Nontaxable benefits
    $0 + $47,349 related
    Filer's total
    $0 + $405,370 related

  • Anjejo Isaac

    RN, First Assistant

    Total calculated
    $383,088
    From this org
    $348,186
    From related orgs
    $0
    Other
    $34,902
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $273,423
    Bonus
    $74,763
    Other
    $0
    Deferred
    $10,446
    Nontaxable benefits
    $24,456
    Filer's total
    $383,088

  • McCance David

    RN

    Total calculated
    $370,561
    From this org
    $324,675
    From related orgs
    $0
    Other
    $45,886
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $324,446
    Bonus
    $229
    Other
    $0
    Deferred
    $9,740
    Nontaxable benefits
    $36,146
    Filer's total
    $370,561

  • Aleman Andrea

    RN Supervisor

    Total calculated
    $354,864
    From this org
    $319,624
    From related orgs
    $0
    Other
    $35,240
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $316,970
    Bonus
    $2,654
    Other
    $0
    Deferred
    $9,589
    Nontaxable benefits
    $25,651
    Filer's total
    $354,864

  • Lonto Robert

    Former Reg HP Dir, NCR thru 02/20

    Total calculated
    $352,569
    From this org
    $0
    From related orgs
    $270,421
    Other
    $82,148
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $175,680 related
    Bonus
    $0 + $73,176 related
    Other
    $0 + $21,565 related
    Deferred
    $0 + $8,113 related
    Nontaxable benefits
    $0 + $74,035 related
    Filer's total
    $0 + $352,569 related

  • Santos David

    President thru 05/22

    Total calculated
    $261,503
    From this org
    $0
    From related orgs
    $230,650
    Other
    $30,853
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $198,774 related
    Bonus
    $0
    Other
    $0 + $31,876 related
    Deferred
    $0 + $6,919 related
    Nontaxable benefits
    $0 + $23,934 related
    Filer's total
    $0 + $261,503 related

  • Shapiro Marc

    Medical Officer

    Total calculated
    $158,109
    From this org
    $0
    From related orgs
    $158,109
    Other
    $0
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $158,109 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $158,109 related

  • Freedman John

    Director

    Total calculated
    $26,858
    From this org
    $0
    From related orgs
    $26,858
    Other
    $0
    Hours/week
    0 + 4 related

  • Woodson Marc

    Director

    Total calculated
    $26,728
    From this org
    $0
    From related orgs
    $26,728
    Other
    $0
    Hours/week
    0 + 4 related

  • Banks David

    Director

    Total calculated
    $26,478
    From this org
    $0
    From related orgs
    $26,478
    Other
    $0
    Hours/week
    0 + 4 related

  • Cherry Robert

    Director

    Total calculated
    $26,478
    From this org
    $0
    From related orgs
    $26,478
    Other
    $0
    Hours/week
    0 + 4 related

  • Davis Andrew

    Director

    Total calculated
    $26,478
    From this org
    $0
    From related orgs
    $26,478
    Other
    $0
    Hours/week
    0 + 4 related

  • Innocent Larry

    Director

    Total calculated
    $26,478
    From this org
    $0
    From related orgs
    $26,478
    Other
    $0
    Hours/week
    0 + 4 related

  • Reiner Richard

    Director

    Total calculated
    $26,478
    From this org
    $0
    From related orgs
    $26,478
    Other
    $0
    Hours/week
    0 + 4 related

  • Newton Bradford

    Director

    Total calculated
    $25,180
    From this org
    $0
    From related orgs
    $25,180
    Other
    $0
    Hours/week
    0 + 4 related

  • Salazar Velino

    Director

    Total calculated
    $21,478
    From this org
    $0
    From related orgs
    $21,478
    Other
    $0
    Hours/week
    0 + 4 related

  • Fehr Joy

    Director

    Total calculated
    $430
    From this org
    $0
    From related orgs
    $430
    Other
    $0
    Hours/week
    0 + 4 related

  • Ocampo Lucy

    Director

    Total calculated
    $430
    From this org
    $0
    From related orgs
    $430
    Other
    $0
    Hours/week
    0 + 4 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

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. Byrnes, John - severance payment - $465,750 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. Jacobson, Carlton - participant, no activity in 2022 Select executives agreed to participate in CAP-EX in place of a traditional SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life insurance 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 Part II: 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. Marc Shapiro, Medical Officer was paid through an unrelated organization, Marc R. Shapiro Medical Corp that was reported on Form 1099 and included on Schedule J, Part II.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

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

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2022
Filed
6 November 2023
IRS schema version
2022v5.0
Source object
202303109349302275

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