TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) BANKS DAVID...................................................................... DIRECTOR	0.00 ................. 4.00	X		1,553	0
(2) CHERRY ROBERT...................................................................... DIRECTOR	0.00 ................. 4.00	X		11,550	0
(3) DAVIS ANDREW...................................................................... DIRECTOR	0.00 ................. 4.00	X		10,600	0
(4) FREEDMAN JOHN...................................................................... DIRECTOR	0.00 ................. 4.00	X		1,133	0
(5) GABRIEL MELODY...................................................................... DIRECTOR	0.00 ................. 4.00	X		1,203	0
(6) GRAHAM RICARDO...................................................................... DIRECTOR	0.00 ................. 4.00	X		2,074	0
(7) HEINRICH KERRY...................................................................... DIRECTOR	0.00 ................. 4.00	X		15,866	0
(8) INNOCENT LARRY...................................................................... DIRECTOR	0.00 ................. 4.00	X		17,608	0
(9) PEDERSEN JAMES...................................................................... DIRECTOR	0.00 ................. 4.00	X		2,101	0
(10) REINER RICHARD...................................................................... DIRECTOR	0.00 ................. 4.00	X		19,819	0
(11) RIPPEY WESLEY...................................................................... DIRECTOR	0.00 ................. 4.00	X		118,116	0
(12) SALAZAR VELINO...................................................................... DIRECTOR	0.00 ................. 4.00	X		1,928	0
(13) REINER SCOTT...................................................................... DIRECTOR/CHAIR	0.00 ................. 50.00	X	X	1,982,804	53,885
(14) WING BILL...................................................................... DIR/VICE CHAIR/ASST. SEC.	0.00 ................. 50.00	X	X	1,460,244	52,693
(15) FRIESTAD CHRISTINE...................................................................... AHSW DIRECTOR (THRU 2/2017)	0.00 ................. 4.00	X		0	0
(16) WOLCOTT DANIEL...................................................................... PRESIDENT	50.00 ................. 0.00		X	583,001	62,757
(17) ZIEGELE PAUL...................................................................... CFO & VP	50.00 ................. 0.00		X	296,135	53,804

(A) Name and business address	(B) Description of services	(C) Compensation
THE REGENTS OF THE UC-DAVIS 1200 DUTTON HALL - ONE SHIELDS AVE DAVIS,CA95616	PHYSICIAN PROFESSIONAL SERVICES - HOSPIT	7,579,331
ADVENTIST HEALTH PHYSICIANS NETWORK 2100 DOUGLAS BLVD ROSEVILLE,CA95661	PHYSICIAN PROFESSIONAL SERVICES - CLINIC	4,692,717
CEP AMERICA - ANESTHESIA PC 2100 POWELL ST SUITE 900 EMERYVILLE,CA94608	PHYSICIAN PROFESSIONAL SERVICES - ANESTH	1,983,052
FLEXCARE MEDICAL STAFFING 990 RESERE DRIVE SUITE 250 ROSEVILLE,CA95678	CONTRACT LABOR/NURSING TEMPORARY STAFF	971,160
P GILL OBSTETRICS & GYNECOLOGY MEDICAL 999 S FAIRMONT AVE SUITE 110 LODI,CA95240	PHYSICAN PRO FEE - OB & GYN	467,149
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 40

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization LODI MEMORIAL HOSPITAL ASSOCIATION INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization LODI MEMORIAL HOSPITAL ASSOCIATION INC		Employer identification number 94-1044474

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization LODI MEMORIAL HOSPITAL ASSOCIATION INC			Employer identification number 94-1044474
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

11,329

Total. Add lines 1c through 1i ....................................................................................................

11,329

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	THE ORGANIZATION BELONGS TO INDUSTRY AND PROFESSIONAL ASSOCIATIONS FOR WHICH A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	562,343	547,340	599,512	822,332	736,801
b	Contributions ...	89,003	148,830	2,186,902	110,229	363,885
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...	3,000
e	Other expenditures for facilities and programs ...	46,323	133,827	2,239,075	333,049	278,354
f	Administrative expenses ....
g	End of year balance ......	602,023	562,343	547,339	599,512	822,332

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

0 %

Term endowment SchDMd Bullet

100.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....		9,811,038		9,811,038
b	Buildings ....	614,559	125,538,792	50,409,397	75,743,954
c	Leasehold improvements		3,208,760	2,584,655	624,105
d	Equipment ....		106,777,170	64,493,585	42,283,585
e	Other .....		6,770,739	2,528,095	4,242,644
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					132,705,326

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)INVESTMENT IN VITAL ENTERPRISES	364,037	C
(2)INVESTMENT IN ADVANCED IMAGING CENTER	145,064	C
(3)INVESTMENT IN LODI REGIONAL HEALTH SYSTEM	9,419,361	C
(4)INVESTMENT IN ARTEL	1,923,975	C
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	11,852,437

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	138,311,041
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	BOARD-DESIGNATED, TEMPORARY AND PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE FOR SPECIFIED OPERATING AND CAPITAL PROJECTS. THE FUNDS ARE RELEASED AS PROJECT COSTS ARE EXPENDED.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	0	0	646,143	0	646,143	0.290 %
b	Medicaid (from Worksheet 3, column a) . . . . .	0	0	85,412,772	61,851,032	23,561,740	10.400 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			86,058,915	61,851,032	24,207,883	10.690 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	0	0	55,436	150	55,286	0.020 %
f	Health professions education (from Worksheet 5) . . .	0	0	281,170	30,686	250,484	0.110 %
g	Subsidized health services (from Worksheet 6) . . . .	0	0	2,865,187	549,536	2,315,651	1.020 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	0	0	26,550	350	26,200	0.010 %
j	Total. Other Benefits . .			3,228,343	580,722	2,647,621	1.160 %
k	Total. Add lines 7d and 7j .			89,287,258	62,431,754	26,855,504	11.850 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	263,688	0	263,688	0.120 %
9	Other
10	Total	263,688		263,688	0.120 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,759,818

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

361,291

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

61,244,577

Enter Medicare allowable costs of care relating to payments on line 5.....

65,319,944

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-4,075,367

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
11 ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC	DIAGNOSTIC IMAGING CENTER (WITH MRI)	51.000 %	0 %	0 %
22 LODI OUTPATIENT SURGERY CENTER	AMBULATORY SURGERY CENTER	78.000 %	0 %	22.000 %
33 ENDOSCOPY CENTER OF LODI LLC	AMBULATORY SURGERY CENTER	78.000 %	0 %	22.000 %
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)	Facility reporting group
1	LODI MEMORIAL HOSPITAL ASSOCIATION INC DBA AHLM 975 S FAIRMONT AVE LODI,CA95240 WWW.ADVENTISTHEALTH.ORG/LODI-MEMORIAL/ 030000056	X	X	X		A
2	LODI MEMORIAL HOSPITAL - WEST DBA AHLM 800 LOWER SACRAMENTO ROAD ACUTE PHYS LODI,CA95242 WWW.ADVENTISTHEALTH.ORG/LODI-MEMORIAL/ 030000056	X	X		OUTPATIENT DEPARTMENTS AT THIS CAMPUS	A

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE SCH. H PART VI - NEEDS ASSESSMENT

Other website (list url): SEE SCH. H PART VI - NEEDS ASSESSMENT

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SCH. H PART VI - NEEDS ASSESSMENT

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SCH H PART VI-PATIENT EDUCATION

The FAP application form was widely available on a website (list url):

SEE SCH H PART VI-PATIENT EDUCATION

A plain language summary of the FAP was widely available on a website (list url):
PART VI-PATIENT EDUCATION

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 1: LODI MEMORIAL HOSPITAL ASSOCIATION, INC. DBA A, - FACILITY 2: LODI MEMORIAL HOSPITAL - WEST DBA AHLM
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:	ADVENTIST HEALTH LODI MEMORIAL (AHLM) BEGAN THE HEALTH NEEDS ASSESSMENT PROCESS BY PARTNERING WITH HARDER+COMPANY COMMUNITY RESEARCH ALONG WITH A FULL CONSORTIUM OF PARTNERS IN THE SAN JOAQUIN COUNTY AREA. THIS COLLABORATION ALLOWED FOR A MORE COMPREHENSIVE ASSESSMENT, ALONG WITH THE OPPORTUNITY FOR SYNERGY BETWEEN HEALTH SYSTEMS TO MORE FULLY ADDRESS KEY ISSUES IMPACTING THE SHARED COMMUNITY.HARDER+COMPANY COMMUNITY RESEARCH IS KNOWN FOR EXCELLENCE IN CONDUCTING AND FACILITATING COMMUNITY HEALTH NEEDS ASSESSMENTS. BY FACILITATING THE PROCESS, CLIENTS ARE AIDED IN THE GATHERING OF INFORMATION THAT PROVIDES NECESSARY INFORMATION TO ENABLE THE CREATION AND IMPLEMENTATION OF PLANS DESIGNED TO MAKE POSITIVE CHANGE IN THEIR COMMUNITY. THROUGH COLLABORATION, THE CONSORTIUM WAS INFORMED OF COMMON THEMES THROUGHOUT THE GLOBAL AREA SERVICE AREA AS WELL AS DISPARITIES EXISTING WITHIN LOCAL COMMUNITIES. USING THIS DATA ENABLES THE COLLABORATIVE TO WORK TOGETHER TO ACHIEVE SOCIAL IMPACT THROUGH MEANINGFUL PROGRAM EVALUATION AND STRATEGIC PLANNING EFFORTS.WHILE HARDER+COMPANY COMMUNITY RESEARCH LED THE PROCESS, THE CORE PLANNING GROUP INCLUDED REPRESENTATIVES FROM:- DAMERON HOSPITAL ASSOCIATION- COMMUNITY MEDICAL CENTERS- COMMUNITY PARTNERSHIPS FOR FAMILIES- FIRST 5 SAN JOAQUIN- HEALTH NET- HEALTH PLAN OF SAN JOAQUIN- KAISER PERMANENTE- AHLM- SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES- ST. JOSEPH'S MEDICAL CENTER- SUTTER TRACY COMMUNITY HOSPITALWORKING IN COLLABORATION WITH OTHER HEALTH SYSTEMS, INSURANCE COMPANIES, NON-HOSPITAL HEALTH PROVIDERS BROADENED THE PERSPECTIVE AND PROVIDED A MORE INFORMED PROCESS FOR THE WORK GROUP. INTERVIEWS AND SECONDARY DATA COLLECTION WAS COMPLETED BY THE HARDER+COMPANY COMMUNITY RESEARCH TEAM. TO EVALUTATE BOTH THE GLOBAL AND LOCAL FINDINGS RELATED TO THE AHLM PSA AND SSA, TWO COMMITTEES WERE FORMED AND UTILIZED AT THE HOSPITAL LEVEL, THE: - HOSPITAL HEALTH NEEDS ASSESSMENT COMMITTEE (HHNAC) - AN INTERNAL TEAM OF EMPLOYEES AT AHLM; AND THE - COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) - EXTERNAL STAKEHOLDERS WITH SOME HHNAC REPRESENTATION. THE CHNAC CONSISTS OF KEY PUBLIC HEALTH AND COMMUNITY LEADERS REPRESENTING NEEDS OF THE COMMUNITY AT LARGE AS WELL AS MINORITY AND OTHER AT RISK SEGMENTS.THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE CONSISTED OF COMMUNITY LEADERS WITH DEMONSTRATED CONNECTIONS WITHIN THE COMMUNITY. THESE LEADERS ALSO BROUGHT THE ABILITY TO IDENTIFY OPPORTUNITIES FOR CHANGE BASED ON POPULATION HEALTH DATA, AND AN INTIMATE WORKING KNOWLEDGE OF THE MARKET. THE CHNAC MET TWICE AND PROVIDED ADDITIONAL INPUT VIA E-SURVEY ON THIS CHNA.(SEE CONTINUATION FOR PROCESS DESCRIPTION)
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:	MEMBERS OF THE COMMITTEE INCLUDED: - DANIEL WOLCOTT, CEO OF AHLM - JASON WHITNEY, AVP OF BUSINESS DEVELOPMENT - VALERIE CRONIN, DIRECTOR OF CASE MANAGEMENT - CHRIS HAGEN, SPIRITUAL CARE SERVICES - DESIREE MAGNANT, AHLM COMMUNITY HEALTH NEEDS ASSESSMENT COORDINATOR - BARBARA ALBERSON, CHIEF, STATE/LOCAL INJURY CONTROL SECTION AT CA DEPT OF PUBLIC HEALTH - JEFF HOOD, CITY OF LODI PARKS AND RECREATION DIRECTOR - TAJ KHAN, CALIFORNIA ISLAMIC CENTER PRESIDENT - SALLY SNYDE, WOW SCIENCE MUSEUM - JOHN GORDON, GALT SCHOOL BOARD MEMBER - INEZ KIRIU, CITY OF GALT - JOSEPH WOELFEL, DIRECTOR OF PATIENT CARE CLINIC, UNIVERSITY OF THE PACIFIC
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:	ST. JOSEPH'S MEDICAL CENTERSUTTER TRACY COMMUNITY HOSPITALDAMERON HOSPITAL ASSOCIATION
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:	IDENTIFIED COMMUNITY NEEDSTHE RESULTS OF THE CHNA GUIDED THE CREATION OF THIS DOCUMENT AND AIDED US IN HOW WE COULD BEST PROVIDE FOR OUR COMMUNITY AND THE MOST VULNERABLE AMONG US. THUS, ADVENTIST HEALTH LODI MEMORIAL HAS ADOPTED THE FOLLOWING PRIORITY AREAS FOR OUR COMMUNITY HEALTH INVESTMENTS FOR 2017-2019: -WELLNESS (DIABETES AND OBESITY PREVENTION) -ACCESS TO CARE (INCLUDING MENTAL HEALTH) -YOUTH DEVELOPMENTADDITIONALLY, AS WE ENGAGE IN A PROCESS OF CONTINUOUS QUALITY IMPROVEMENT, WE ASK THE FOLLOWING QUESTIONS FOR EACH PRIORITY AREA:-ARE OUR INTERVENTIONS MAKING A DIFFERENCE IN IMPROVING HEALTH OUTCOMES?- ARE WE PROVIDING THE APPROPRIATE RESOURCES IN THE APPROPRIATE LOCATIONS?- WHAT CHANGES OR COLLABORATIONS WITHIN OUR SYSTEM NEED TO BE MADE? -HOW ARE WE USING TECHNOLOGY TO TRACK OUR HEALTH IMPROVEMENTS AND PROVIDE RELEVANT FEEDBACK AT THE LOCAL LEVEL? -DO WE HAVE THE RESOURCES AS A REGION TO ELEVATE THE POPULATION'S HEALTH STATUS?BUILDING A HEALTHY COMMUNITY REQUIRES MULTIPLE STAKEHOLDERS WORKING TOGETHER WITH A COMMON PURPOSE. WE INVITE YOU TO EXPLORE HOW WE INTEND TO ADDRESS HEALTH CHALLENGES IN OUR COMMUNITY AND PARTNER TO ACHIEVE CHANGE. MORE IMPORTANTLY THOUGH, WE HOPE YOU IMAGINE A HEALTHIER REGION AND WORK WITH US TO FIND SOLUTIONS ACROSS A BROAD RANGE OF SECTORS TO CREATE COMMUNITIES WE ALL WANT FOR OURSELVES AND OUR FAMILIES.PRIORITY NEED - WELLNESS (DIABETES AND OBESITY PREVENTION) NUTRITION EDUCATIONGOAL 1: INCREASE COMMUNITY KNOWLEDGE OF HEALTHY NUTRITION- OBJECTIVE 1: CONDUCT EDUCATIONAL PROGRAMMING BOTH FREE AND FEE-BASED- OBJECTIVE 2: PARTNER WITH COMMUNITY ORGANIZATIONS AND FAITH-CONGREGATIONS TO CONDUCT CHILDREN-FOCUSEDNUTRITIONAL EDUCATION.- OBJECTIVE 3: COLLABORATE WITH AREA ORGANIZATIONS AND CHURCHES TO CONDUCT HEALTHY EATING LECTURE EVENTS.PRIORITY NEED - WELLNESS (DIABETES AND OBESITY PREVENTION) ACTIVE LIFESTYLEGOAL 2: INCREASE ACCESS TO PHYSICAL ACTIVITY- OBJECTIVE 1: OFFER SUPPORT SERVICES TO ENHANCE PHYSICAL ACTIVITY- OBJECTIVE 2: PARTNER WITH AREA ORGANIZATIONS TO INCREASE OPPORTUNITY FOR ACTIVITY IN OUR COMMUNITY.- OBJECTIVE 3: COLLABORATE WITH AREA ORGANIZATIONS TO PROMOTE A BROADER AWARENESS ABOUT THE IMPORTANCE OF ACTIVITY.PRIORITY NEED ACCESS TO CARE (INCLUDING MENTAL HEALTH)GOAL 1: INCREASE ACCESS TO PRIMARY CARE- OBJECTIVE 1: RECRUIT NEW PRIMARY CARE PROVIDERS TO THE ADVENTIST HEALTH LODI MEMORIAL PRIMARY SERVICE AREA.- OBJECTIVE 2: CONTINUE TO OFFER THE WEROC FREE CLINIC FOR THE COMMUNITY.GOAL 2: IMPACT LACK OF KNOWLEDGE- OBJECTIVE 1: PROVIDE EDUCATION ON CARE ACCESS POINTS FOR AT-RISK POPULATIONSGOAL 3: INCREASE CONTINUED INSURANCE ENROLLMENT- OBJECTIVE 1: PROMOTE ENROLLMENT OF UNINSURED INTO APPROPRIATE GOVERNMENT PROGRAMSPRIORITY NEED ACCESS TO CARE MENTAL HEALTHGOAL 1: CREATE AN ASSET INVENTORY OF MENTAL HEALTH RESOURCES AND PROMOTE THEM.- OBJECTIVE 1: CREATE AN INFORMATION RESOURCE COLLATERAL SHEET FOR SHARING- OBJECTIVE 2: ADD A MENTAL HEALTH RESOURCE TAB TO THE LODIHEALTH.ORG WEBSITEPRIORITY NEED YOUTH DEVELOPMENT -WE ENVISION A COMMUNITY WHERE THE YOUTH WILL THRIVE.GOAL 1: MAKE AN IMPACT ON EARLY YOUTH DEVELOPMENT WITH AN EMPHASIS ON LITERACY.- OBJECTIVE 1: PROMOTE CAMP HUTCHINS PRE-SCHOOL PROGRAMMING- OBJECTIVE 2: PROVIDE EDUCATION AND MENTORSHIP- OBJECTIVE 3: SPONSOR AND SUPPORT ORGANIZATIONS DEDICATED TO HELPING YOUTH IN THE COMMUNITY.MORE DETAILS CAN BE FOUND AT: HTTPS://WWW.ADVENTISTHEALTH.ORG/LODIMEMORIAL/PAGES/MISSION/COMMUNITYBENEFIT.ASPX

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?18
Name and address		Type of Facility (describe)
1	1 - AHLM PEDIATRIC CARE 2415 W VINE ST STE 100 LODI,CA95242	OUTPATIENT CLINIC
2	2 - AHLM PRENATAL CARE 2415 W VINE ST STE 103 LODI,CA95242	OUTPATIENT CLINIC
3	3 - AHLM PHARMACY 2415 W VINE ST STE 104B LODI,CA95242	RETAIL PHARMACY
4	4 - AHLM FAMILY MEDICINE 2415 W VINE ST STE 105 LODI,CA95242	OUTPATIENT CLINIC
5	5 - AHLM WOUND & HYPERBARIC CARE 2415 W VINE ST STE 106 LODI,CA95242	OUTPATIENT CLINIC
6	6 - AHLM CARDIOLOGY & PULMONOLOGY 845 S FAIRMONT AVE STE 8 LODI,CA95240	OUTPATIENT CLINIC
7	7 - AHLM - GALT PRENATAL & MULTISPECIALTY CARE 387 CIVIC DR GALT,CA95632	OUTPATIENT CLINICS
8	8 - AHLM - IONE FAMILY MEDICINE 305 PRESTON AVE IONE,CA95640	OUTPATIENT CLINIC
9	9 - AHLM - TRINITY MULTISPECIALTY CARE 10200 TRINITY PKWY STE 102 STOCKTON,CA95219	COMMUNITY CLINIC
10	10 - AHLM - MILLSBRIDGE FAMILY MEDICINE 1901 KETTLEMAN LN STE 200 LODI,CA95242	COMMUNITY CLINIC
11	11 - URGENT CARE - LODI 1235 W VINE ST STE 20 LODI,CA95240	URGENT CARE
12	12 - AHLM - ORTHOPEDICSSPORTS MEDICINE 1235 W VINE ST STE 22 LODI,CA95240	COMMUNITY CLINIC
13	13 - ADVENTIST HEALTH HOME CARE SERVICES - LODI 800 S LOWER SACRAMENTO RD LODI,CA95242	HOME CARE SERVICES
14	14 - AHLM - OCCUPATIONAL MEDICINE 800 S LOWER SACRAMENTO RD LODI,CA95242	OCCUPATIONAL MEDICINE CLINIC
15	15 - AHLM WALTER E REISS OUTREACH CLINIC 300 W OAK ST LODI,CA95240	FREE CLINIC
16	16 - LODI OUTPATIENT SURGICAL CENTER 521 S HAM LN STE F LODI,CA95242	AMBULATORY SURGICAL CENTER
17	17 - ADVANCED IMAGING CENTER AT LODI MEM HOSP 1031 S FAIRMONT AVE LODI,CA95240	DIAGNOSTIC IMAGING OUTPATIENT CENTER
18	18 - ENDOSCOPY CENTER OF LODI LLC 840 S FAIRMONT AVE STE 1 LODI,CA95240	AMBULATORY SURGICAL CENTER, ENDOSCOPY SERVICES

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 7:	SPECIFIC RATIOS OF COSTS TO CHARGES ARE UTILIZED FOR EACH DEPARTMENT. WHERE APPLICABLE THE SOURCE OF THESE RATIOS ARE THE MEDICARE COST REPORT.
PART II, COMMUNITY BUILDING ACTIVITIES:	SAN JOAQUIN COUNTY IS AMONG THE MOST DIFFICULT COUNTIES IN THE STATE WHEN IT COMES TO RECRUITING PHYSICIANS TO PRACTICE MEDICINE, AND THE HOSPITAL DEVOTES SIGNIFICANT FINANCIAL AND HUMAN RESOURCES TO THAT EFFORT. CURRENTLY THE HOSPITAL IS ATTEMPTING TO ESTABLISH A RESIDENCY PROGRAM IN CONJUNCTION WITH THE LOCAL COUNTY HOSPITAL, A TEACHING FACILITY, IN HOPES THAT ONCE PHYSICIANS COME TO PRACTICE HERE THEY WILL APPRECIATE THE REGION AND STAY AND ESTABLISH MEDICAL PRACTICE OR AFFILIATE WITH AN EXISTING PRACTICE. TOTAL PHYSICIAN RECRUITMENT COSTS = $263,688.
PART III, LINE 3:	WE PROVIDED CARE TO ALL WHO PRESENT THEMSELVES IN OUR EMERGENCY ROOM, WITHOUT ASKING FOR PROOF OF INSURANCE. IN THE THIRD YEAR OF THE ACA OUR UNINSURED POPULATION HAS INCREASED. UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGIBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE. OFTEN THE INFORMATION GATHERED IN THE MEDICAID APPLICATION WILL MAKE THIS DETERMINATION "AUTOMATIC". IF ADDITIONAL INFORMATION IS REQUIRED WE ATTEMPT TO CONTACT THE PATIENT. THOSE THAT DO NOT RESPOND WILL BE SENT TO A COLLECTION AGENCY AFTER 120 DAYS AND 4 STATEMENTS. WE ESTIMATE 21% OF OUR BAD DEBT EXPENSE (CALCULATED AT COST) SHOULD BE CONSIDERED CHARITY CARE - OUR BAD DEBT ACCOUNTS ARE ANAYLZED BY A THIRD PARTY TO DETERMINE THIS AMOUNT.
PART III, LINE 4:	COSTING METHODOLOGY:UTILIZING THE PREVIOUS COSTING METHODOLOGY AS OUTLINED IN RESPONSE TO PART I LINE 7, ALL PATIENTS ARE ASSIGNED A PAYOR CLASS (I.E. CHARITY, SELF PAY, MEDICARE, MEDI-CAL, MANAGED CARE). THE COST BY PAYOR IS A SUMMATION OF ALL PATIENTS IN THE ASSIGNED PAYOR CLASS. THE AMOUNTS WRITTEN OFF AS BAD DEBT (ASSIGNED TO A COLLECTION AGENCY) ARE NET OF ANY APPLICABLE PAYMENTS OR DISCOUNTS. ANY PAYMENTS RECEIVED AFTER AN ACCOUNT IS ASSIGNED TO A COLLECTION AGENCY REDUCE THE BAD DEBT EXPENSE IN THE PERIOD RECEIVED.UNCOMPENSATED CARE AND COMMUNITY BENEFIT COSTS:OUR POLICY IS TO PROVIDE SERVICE TO ALL WHO REQUIRE IT, REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, WE PROVIDE SUBSTANTIAL AMOUNTS OF UNCOMPENSATED CARE. WHEN THIS CARE IS PROVIDED TO PATIENTS WHO LACK FINANCIAL RESOURCES AND THEREFORE ARE DEEMED MEDICALLY INDIGENT, IT IS CLASSIFIED AS CHARITY CARE. WHEN IT IS PROVIDED TO PATIENTS WHO HAVE THE MEANS TO PAY, BUT DECLINE TO DO SO, IT IS CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS. SOME UNDETERMINED PORTION OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS REPRESENTS CARE TO INDIGENT PATIENTS WHO WE HAVE BEEN UNABLE TO IDENTITY AS CHARITY. CHARITY CARE CHARGES ARE NOT REFLECTED IN NET PATIENT SERVICE REVENUES. IN ADDITION, WE PROVIDE SERVICES TO POOR AND UNDERSERVED PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, INCLUDING PATIENTS INSURED UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS THAT ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND FREQUENTLY THE PAYMENTS ARE LESS THAN THE COSTS OF RENDERING THE SERVICES.PATIENT ACCOUNTS RECEIVABLE:PATIENT ACCOUNTS RECEIVABLE FOR SERVICES PROVIDED TO PATIENTS COVERED UNDER THE MEDICARE AND MEDICAID (MEDI-CAL IN CALIFORNIA) PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS (INCLUDING SELF-PAY) ARE RECORDED AT THEIR ESTIMATED REALIZABLE VALUE BASED ON CONTRACTUAL BILLING RATES OR OUR STANDARD BILLING RATES FOR OUR NON CONTRACTED PAYORS. WE REGULARLY REVIEW ACCOUNTS AND CONTRACTS AND PROVIDE APPROPRIATE ESTIMATES OF CONTRACTUAL ALLOWANCES THAT ARE THEN NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE. WE ALSO PROVIDE AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON OUR EVALUATION OF THE AGING OF OUR PATIENT ACCOUNTS RECEIVABLE, OUR HISTORICAL COLLECTION EXPERIENCE FOR EACH TYPE OF PAYOR AND OTHER RELEVANT FACTORS.OUR PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSISTS OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. WE GRANT CREDIT WITHOUT COLLATERAL TO OUR PATIENTS AND THIRD PARTY PAYORS.
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 EVEREXPANDING 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. SINCE THE 1997 BALANCED BUDGET ACT, 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.RECONCILIATION OF MEDICARE REVENUE FROM THE HOSPITAL'S MEDICARE COST REPORT TO GL: REVENUE REC. MEDICARE COST REPORT REVENUE 61,244,577 PRIOR YEAR SETTLEMENTS (27,277) COST REPORT REIMBURSABLE BAD DEBTS 754,131 ESTIMATES AND ACCRUAL VARIANCES (365,457) OTHER 22,879,399 SUBTOTAL - AMOUNT REPORTED IN PT III, LINE 5 84,485,373 AMOUNTS INCLUDE IN PART 1, LINES G AND F - TOTAL MEDICARE REVENUE 84,485,373NOTE: THE MEDICARE COST REPORT REVENUE DOES NOT INCLUDE THE BAD DEBT REIMBURSEMENT. THE COST REPORT REVENUE DOES INCLUDE THE PATIENT CO-PAY AND DEDUCTIBLE AMOUNTS. ADDING THE BAD DEBT REIMBURSEMENT WOULD HAVE DUPLICATED THE REVENUE ALREADY ACCOUNTED FOR IN THE CO-PAY AND DEDUCTIBLE AMOUNTS.ALLOWABLE COSTS ARE CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT AND PAID CLAIM SUMMARIES OBTAINED FROM THE MEDICARE PROGRAM.
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:	EVERY THREE YEARS LODI MEMORIAL HOSPITAL ASSESSES COMMUNITY HEALTH NEEDS BY 1) CONSULTING WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY GROUPS TO REVIEW THE NEEDS OF EACH CONSTITUENCY; 2) REVIEWING SERVICE-AREA MORBIDITY AND MORTALITY HEALTH DATA PROVIDED BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES; 3) COMPILING SOCIO-ECONOMIC DATA TO DETERMINE WHERE THE GREATEST NEEDS EXIST WITHIN THE HOSPITAL-SERVICE AREA; AND 4) ASKING AREA RESIDENTS TO COMPLETE A HEALTH SURVEY REGARDING THEIR PERSONAL HEALTH AND NOTIONS ABOUT GOOD HEALTH. ONCE THE DATA IS COLLECTED, IT IS REVIEWED AND ASSESSED BY THE HOSPITAL'S COMMUNITY ADVISORY BOARD, BOARD OF DIRECTORS AND HOSPITAL MANAGERS TO DETERMINE WHAT SERVICES AND GAP AREAS MAY NEED ENHANCING OR ADDRESSING TO IMPROVE HEALTH WITHIN THE REALM OF THE HOSPITAL'S RESOURCES TO DO SO.CHNA CAN BE FOUND AT THE FOLLOWING WEBSITES: HTTPS://WWW.ADVENTISTHEALTH.ORG/DOCUMENTS/LODIMEMORIAL/COMMUNITY-BENEFIT/FINAL_2016_CHNA_LMH.PDFIMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING WEBSITE:HTTPS://WWW.ADVENTISTHEALTH.ORG/DOCUMENTS/LODIMEMORIAL/COMMUNITY-BENEFIT/2017-18_CHP-ANNUAL-REPORT_LODIMEMORIAL.PDF
PART VI, LINE 3:	SIGNS ARE PROMINENTLY POSTED IN THE ADMISSIONS, EMERGENCY AND BILLING DEPARTMENTS OF THE HOSPITAL, IN ADDITION TO ALL THE HOSPITAL CLINICS, TO ADVISE PATIENTS AND VISITORS THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND HOW TO WORK WITH HOSPITAL STAFF TO OBTAIN IT. THE SAME INFORMATION IS INCLUDED IN PATIENT-ADMISSION PACKETS AND POSTED ON THE HOSPITAL WEBSITE. HOSPITAL CASE MANAGERS ARE VIGILANT OF PATIENTS NEEDING FINANCIAL ASSISTANCE AND FOLLOW UP WITH THOSE IN NEED. FINANCIAL ASSISTANCE INCLUDES APPLYING FOR MEDICAID AS WELL AS CHARITY CARE.FAP, FAP APPLICATION AND A PLAIN LANGUAGE SUMMARY CAN BE FOUND AT THE FOLLOWING WEBSITE:HTTPS://WWW.ADVENTISTHEALTH.ORG/PAGES/FINANCIAL-ASSISTANCE.ASPX
PART VI, LINE 4:	NEARLY ALL OF THE INDIVIDUALS SEEKING CARE FROM LODI MEMORIAL HOSPITAL RESIDE IN ONE OF FIVE COUNTIES: SAN JOAQUIN, SACRAMENTO, SOLANO, AMADOR, AND CALAVERAS. ABOUT HALF OF THE HOSPITAL'S PATIENTS RESIDES WITHIN A FIVE-MILE RADIUS OF THE HOSPITAL IN SAN JOAQUIN COUNTY. GEOGRAPHICALLY, THE HOSPITAL SITS AT THE NORTHERN END OF THE SAN JOAQUIN VALLEY WHERE THE RESIDENTS ARE AMONG THE POOREST AND LEAST EDUCATED OF ALL THE STATE'S COUNTIES. IN ADDITION, SAN JOAQUIN COUNTY HAS AMONG THE WORST UNEMPLOYMENT RATES IN THE STATE'S COUNTIES; NEARLY TWO IN 10 RESIDENTS ARE UNEMPLOYED. ALSO SAN JOAQUIN COUNTY WAS GROUND-ZERO FOR THE MORTGAGE CRISIS IN THIS COUNTRY. THE COUNTY IS ALSO AMONG THE MOST VIOLENT COUNTIES IN WHICH TO LIVE IN THE COUNTRY DUE TO SIGNIFICANT GANG ACTIVITY, LOW LEVELS OF EDUCATION, AND POVERTY. HOSPITAL PATIENTS REPRESENT DIVERSITY: ABOUT 40 PERCENT ARE HISPANIC, WITH MANY OF THOSE PATIENTS BEING MONOLINGUAL SPANISH SPEAKERS. ANOTHER THREE PERCENT ARE PAKISTANI, MANY OF WHOM SPEAK ONLY URDU OR PASHTU. ADDITIONALLY THERE IS A SIGNIFICANT POPULATION OF HOSPITAL PATIENTS WHO ARE GREATER THAN 80 YEARS OF AGE. THE MAJOR HEALTH ISSUES OF PATIENTS ARE HEART DISEASE, STROKE, CANCER, DIABETES AND OBESITY.
PART VI, LINE 5:	THE HOSPITAL CONDUCTS A MYRIAD OF ACTIVITIES TO PROMOTE COMMUNITY HEALTH. THOSE ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO: HEALTH FAIRS WITH FREE MEDICAL SCREENINGS FOR HIGH CHOLESTEROL, HIGH-BLOOD PRESSURE, DIABETES AND LOW-OXYGEN SATURATION LEVELS; REFERRALS TO FREE CLINICS OR LOCAL PHYSICIANS FOR THOSE WITH HIGH VALUES; A VARIETY OF LINKED VIDEOS TO THE HOSPITAL WEB PAGE, FACEBOOK PAGE, YOUTUBE PAGE, AND TWITTER RELATED TO HEALTH EDUCATION AND PREVENTION; A WELLNESS PROGRAM FOR HOSPITAL EMPLOYEES THAT IS ROOTED IN EXERCISE AND NUTRITION SO THAT EMPLOYEES MAY LEAD BY EXAMPLE; A MONTHLY NUTRITION COLUMN IN THE LOCAL NEWSPAPER; HOSPITAL STAFF SERVING ON THE BOARDS OF REGIONAL NGOS; DONATIONS OF MATERIALS AND EQUIPMENT TO NGOS; EMPLOYEE DONATIONS OF FOOD AND CLOTHING TO THE NEEDY. THE HOSPITAL IS ALSO THE SECOND LARGEST YEAR-ROUND EMPLOYER IN LODI, WITH EMPLOYEES REINVESTING THEIR EARNINGS IN THE LOCAL ECONOMY. THE HOSPITAL HAS ALSO ADOPTED THE MOST IMPOVERISHED, LARGEST AND MOST DIVERSE SCHOOL IN THE LOCAL SCHOOL DISTRICT TO HELP EDUCATE STUDENTS, PARENTS AND TEACHERS IN PREVENTION. IN THAT EFFORT, THE HOSPITAL HOSTS AT THE SCHOOL HEALTH AND EDUCATION FAIRS; PARTICIPATES IN CLASSROOM TEACHING AND HEALTH DEMONSTRATIONS; AND PARTICIPATES IN CAREERS FAIRS AT THE SCHOOL. DUE TO HAND-WASHING EDUCATION ALONE, THE SCHOOLS ABSENTEE RATES HAVE DECLINED DRAMATICALLY. FOR STUDENTS TO LEARN, THEY MUST BE IN SCHOOL; AND FOR SCHOOLS TO RECEIVE STATE FUNDING, THEY MUST MAINTAIN THEIR ATTENDANCE.
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 TELEPHARMACY 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.
PART VI, LINE 7, REPORTS FILED WITH STATES	CA

Schedule H (Form 990) 2019

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number
94-1044474

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) CALIFORNIA HEALTH FOUNDATION & TRUST 1215 K ST STE 800 SACRAMENTO,CA95814	94-1498697	501(C)(3)	746,651				HOSPITAL QA FEE PROGRAM PLEDGES

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	THROUGH THE USE OF TEMPORARILY RESTRICTED ACCOUNTS, WE TRACK AND MONITOR THE INCOMING RECEIPTS FROM GRANTS AND THE UTILIZATION OF GRANT FUNDS. EACH GRANT IS TRACKED SEPARATELY. SHOULD THE GRANTOR AGENCY REQUIRE SPECIFIC REPORTS, WE COMPLY WITH THEIR REPORTING REQUIREMENTS. THE GRANTS WE MONITOR ARE SPECIFIC TO THE GRANTOR'S NEEDS AND REQUESTS.

Schedule I (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1REINER SCOTT DIRECTOR/CHAIR	(i) (ii)	0 ------------- 1,184,750	0 ------------- 324,119	0 ------------- 473,935	0 ------------- 16,356	0 ------------- 37,529	0 ------------- 2,036,689	0 ------------- 406,467
2WING BILL DIR/VICE CHAIR/ASST. SEC.	(i) (ii)	0 ------------- 953,512	0 ------------- 273,121	0 ------------- 233,611	0 ------------- 16,356	0 ------------- 36,337	0 ------------- 1,512,937	0 ------------- 172,851
3WOLCOTT DANIEL PRESIDENT	(i) (ii)	0 ------------- 382,233	0 ------------- 119,036	0 ------------- 81,732	0 ------------- 16,356	0 ------------- 46,401	0 ------------- 645,758	0 ------------- 0
4ZIEGELE PAUL CFO & VP	(i) (ii)	0 ------------- 236,625	0 ------------- 27,789	0 ------------- 31,721	0 ------------- 16,356	0 ------------- 37,448	0 ------------- 349,939	0 ------------- 0
5JOBE MEREDITH VP OPERATIONS	(i) (ii)	0 ------------- 395,752	0 ------------- 98,614	0 ------------- 159,873	0 ------------- 16,356	0 ------------- 25,957	0 ------------- 696,552	0 ------------- 60,017
6WAGNER JACK ASST SECRETARY	(i) (ii)	0 ------------- 755,988	0 ------------- 221,735	0 ------------- 92,680	0 ------------- 11,160	0 ------------- 25,957	0 ------------- 1,107,520	0 ------------- 0
7WHITNEY JASON TREASURER	(i) (ii)	0 ------------- 189,822	0 ------------- 30,482	0 ------------- 28,137	0 ------------- 13,858	0 ------------- 42,526	0 ------------- 304,825	0 ------------- 0
8MORENO DEBBE CNO	(i) (ii)	0 ------------- 214,069	0 ------------- 47,393	0 ------------- 31,182	0 ------------- 16,356	0 ------------- 31,065	0 ------------- 340,065	0 ------------- 18,488
9FERCH WAYNE PRESIDENT CCR	(i) (ii)	0 ------------- 642,426	0 ------------- 183,984	0 ------------- 130,776	0 ------------- 16,408	0 ------------- 28,657	0 ------------- 1,002,251	0 ------------- 104,580
10LARSEN DAVID FINANCE OFFICER CCR	(i) (ii)	0 ------------- 372,364	0 ------------- 73,887	0 ------------- 101,785	0 ------------- 16,421	0 ------------- 39,563	0 ------------- 604,020	0 ------------- 32,524
11BROWN MARY RN SUPERVISOR/NURSING ADMIN	(i) (ii)	189,510 ------------- 0	0 ------------- 0	0 ------------- 0	9,661 ------------- 0	11,937 ------------- 0	211,108 ------------- 0	0 ------------- 0
12BECK ATWATER SANDRA DIRECTOR HOSPITAL PHARMACY	(i) (ii)	188,397 ------------- 0	0 ------------- 0	504 ------------- 0	9,698 ------------- 0	14,586 ------------- 0	213,185 ------------- 0	0 ------------- 0
13BRAUER CORY LEE RN CHARGE/SURGERY	(i) (ii)	183,341 ------------- 0	0 ------------- 0	0 ------------- 0	7,659 ------------- 0	11,960 ------------- 0	202,960 ------------- 0	0 ------------- 0
14SCHNEIDER PAMELA EXECUTIVE DIRECTOR-O/P SVCS	(i) (ii)	153,897 ------------- 0	17,552 ------------- 0	9,780 ------------- 0	8,737 ------------- 0	12,240 ------------- 0	202,206 ------------- 0	0 ------------- 0
15LINDSEY MIKE R DIRECTOR OF DIAGNOSTIC IMAGING	(i) (ii)	108,043 ------------- 0	0 ------------- 0	71,936 ------------- 0	8,958 ------------- 0	8,415 ------------- 0	197,352 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 1A	ANY ITEMS CHECKED ON THIS LINE ARE REPORTED AS TAXABLE INCOME TO THE EMPLOYEE, EXCEPT FIRST CLASS OR CHARTER TRAVEL, WHICH IS ONLY APPROVED FOR BUSINESS PURPOSES ON AN EXCEPTION BASIS.
PART I, LINE 4B	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. THIS GOAL IS BELOW THE MARKET MEDIAN FOR EXECUTIVE RETIREMENT PLANS IN THE NOT-FOR-PROFIT HEALTH CARE INDUSTRY. REINER, SCOTT $406,467 WING, BILL $172,851 JOBE, MEREDITH $60,017 MORENO, DEBBE $ 18,488 FERCH, WAYNE $104,580 LARSEN, DAVID $32,524 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.
SCHEDULE J PART II AND FORM 990, PART VII, SECTION A, LINE 1A	THE DIRECTORS SERVE ON THE BOARD WITHOUT COMPENSATION. AMOUNTS REPORTED GENERALLY ARE FOR TAXABLE BENEFITS. FURTHER EXPLANATION FOR THOSE DIRECTORS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN THEIR PROFESSIONAL CAPACITY IS DISCUSSED FOR EACH INDIVIDUAL AS APPLICABLE. IN RECOGNITION OF THE TIME COMMITMENT DIRECTORS MAKE TO SERVE ON THE ADVENTIST HEALTH BOARDS AND COMMITTEES, DIRECTORS RECEIVE COMPENSATION WHEN THEIR EMPLOYMENT AGREEMENTS WITH THEIR EMPLOYERS ALLOW SUCH PAYMENTS. FOR THOSE WHOSE EMPLOYERS DO NOT ALLOW ACCEPTING COMPENSATION FOR BOARD SERVICE, THE FUNDS ARE DIRECTLY DISTRIBUTED TO CHARITABLE ORGANIZATIONS AS MANDATED BY THEIR EMPLOYMENT AGREEMENTS. IN ADDITION, AMOUNTS PAID FOR TAXABLE BENEFITS ARE ALSO REPORTED. FURTHER EXPLANATION FOR THOSE DIRECTORS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN THEIR PROFESSIONAL CAPACITY IS DISCUSSED BELOW. WESLEY RIPPEY, MD IS THE MEDICAL OFFICER (MO) FOR PORTLAND ADVENTIST MEDICAL CENTER. THE HOSPITAL PAID DR. RIPPEY $60,500 FOR HIS MO SERVICES. ADDITIONALLY, DR. RIPPEY PROVIDES VASCULAR STUDY INTERPRETATIONS AND ON CALL COVERAGE FOR PATIENTS OF THE HOSPITAL. THE HOSPITAL PAID $40,100 FOR THESE PROFESSIONAL SERVICES. THESE SERVICES WERE PROVIDED UNDER CONTRACTS APPROVED BY THE BOARD COMPLIANCE COMMITTEE.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) P GILL OBSTETRICS AND GYNECOLOGY	>35% OWNED PARTNERSHIP BY PARAMPAL GILL, FORMER BOARD MEMBER	316,174	PHYSICIAN PROFESSIONAL SERVICE-OB CLINIC, PHYSICIAN RECUITMENT		No
(2) P GILL OBSTETRICS AND GYNECOLOGY	>35% OWNED PARTNERSHIP BY PARAMPAL GILL, FORMER BOARD MEMBER	150,975	PHYSICIAN PROFESSIONAL SERVICE-EMERGENCY ROOM CALL		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Return Reference	Explanation
PAGE 1, BOX J	WEBSITE: HTTPS://WWW.ADVENTISTHEALTH.ORG/LODI-MEMORIAL/
FORM 990, PART VI, SECTION A, LINE 4	THE ARTICLES OF INCORPORATION WERE AMENDED AND RESTATED IN THEIR ENTIRETY. THE CORPORATION BECAME A NONPROFIT RELIGIOUS CORPORATION TO PROMOTE THE WHOLENESS OF HUMANITY PHYSICALLY, SPIRITUALLY, AND MENTALLY, IN A MANNER CONSISTENT WITH THE SEVENTH-DAY ADVENTIST CHURCH'S PRACTICES AND TEACHINGS. THE CORPORATION WILL BE AN AFFILIATE OF ADVENTIST HEALTH SYSTEM/WEST (ADVENTIST HEALTH) AND WILL MANAGE AND MAINTAIN AN ACUTE CARE HOSPITAL IN HARMONY WITH THE ADMINISTRATIVE GUIDELINES AND RELIGIOUS OBJECTIVES OF ADVENTIST HEALTH. OTHER ACTIVITIES IN SUPPORT OF THE HOSPITAL MAY BE CARRIED ON IN FURTHERANCE OF PROVIDING SERVICES THAT WILL MEET THE HEALTHCARE NEEDS IDENTIFIED IN THE COMMUNITY.
FORM 990, PART VI, SECTION A, LINE 6	THE HOSPITAL IS ORGANIZED AS A NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION. THE SOLE CORPORATE MEMBER IS ADVENTIST HEALTH SYSTEM/WEST, A CALIFORNIA NOT-FOR-PROFIT RELIGIOUS CORPORATION. THE HOSPITAL OPERATES AS AN AFFILIATE OF ADVENTIST HEALTH SYSTEM/WEST. FORM 990, PART VI, SECTION A, LINE 7A: THE HOSPITAL BYLAWS DEFINE ITS BOARD OF DIRECTORS TO BE THE SAME INDIVIDUALS WHO ARE MEMBERS OF THE ADVENTIST HEALTH SYSTEM/WEST BOARD OF DIRECTORS. ADVENTIST HEALTH SYSTEM/WEST, A CALIFORNIA NOT-FOR-PROFIT RELIGIOUS CORPORATION, IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE CORPORATE MEMBER, ADVENTIST HEALTH SYSTEM/WEST, MUST APPROVE ALL CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11B	THE COMPLETED FORM 990 IS SHARED WITH MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS BY ELECTRONIC COMMUNICATION FOR THEIR REVIEW PRIOR TO FILING. A SPECIAL BOARD MEETING IS SCHEDULED TO ANSWER QUESTIONS AND RECEIVE INPUT FROM THE BOARD AFTER THEIR REVIEW BUT 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 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 CEO IMMEDIATELY. THE CORPORATE INTERNAL AUDIT STAFF REVIEW THESE QUESTIONNAIRES AND DISCLOSURES EACH YEAR DURING THE AUDIT PROCESS.
FORM 990, PART VI, SECTION B, LINE 15	THE HOSPITAL BOARD OF DIRECTORS HAS ESTABLISHED A HUMAN PERFORMANCE 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 ANNUALLY TO REVIEW COMPARABILITY DATA FROM OUTSIDE CONSULTANTS; RECOMMENDS ANY ADJUSTMENTS TO CURRENT EXECUTIVE COMPENSATION, INCLUDING SALARY RANGES FOR HOSPITAL CEOS AND CFOS, THAT WOULD BE INDICATED BY THE DATA; EVALUATES EXECUTIVE PERFORMANCE AGAINST ANNUAL GOALS; RECOMMENDS APPROPRIATE INCENTIVE AWARDS TO THE BOARD FOR APPROVAL; FOLLOWS A DILIGENT PROCESS THAT MEETS REGULATORY REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS; RECORDS COMMITTEE DELIBERATIONS AND DECISIONS IN TIMELY MINUTES;SELECTS, ENGAGES AND SUPERVISES ANY CONSULTANT HIRED TO ADVISE AND PROVIDE COMPARABILITY DATA. THE BOARD-APPROVED EXECUTIVE COMPENSATION PHILOSOPHY SPECIFIES THAT SALARY RANGES WILL BE ESTABLISHED FOR EXECUTIVES WITH MIDPOINTS SET AT THE MEDIAN OF THE PEER GROUP AND HAVING A 50 PERCENT SPREAD (ABOUT 20% ABOVE AND BELOW MIDPOINT) FROM MINIMUM TO MAXIMUM. THE SYSTEM CEO AND SR VICE PRESIDENTS (EXECUTIVE CABINET) HAVE A MAXIMUM POTENTIAL INCENTIVE OF 30 PERCENT OF BASE SALARY. (THIS INCENTIVE POTENTIAL IS LESS THAN THE INDUSTRY NORM.) OTHER EXECUTIVES HAVE A MAXIMUM POTENTIAL INCENTIVE OF 25 PERCENT OF BASE SALARY.
FORM 990, PART VI, SECTION C, LINE 19	AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC	BANKS, DAVID - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. CHERRY, ROBERT - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. DAVIS, ANDREW - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. FREEDMAN, JOHN - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. GABRIEL, MELODY - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. HEINRICH, KERRY - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. INNOCENT, LARRY - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. PEDERSEN, JAMES - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. REINER, RICHARD - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. RIPPEY, WESLEY - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. SALAZAR, VELINO - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. REINER, SCOTT - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. WING, BILL - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. JOBE, MEREDITH - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. WAGNER, JACK - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. FERCH, WAYNE - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661. LARSEN, DAVID - 2100 DOUGLAS BLVD, ROSEVILLE, CA 95661.
PART VII, SECTION A, LINE 1A	LODI MEMORIAL HOSPITAL OPERATES COMMUNITY CLINICS AS DEFINED BY THE CALIFORNIA HEALTH AND SAFETY CODE SECTION 1204(A). LODI MEMORIAL HOSPITAL ALSO OPERATES HOSPITAL BASED CLINICS AND RURAL HEALTH CLINICS. THE HOSPITAL ENTERS INTO PROVIDER AGREEMENTS WITH AN IPA THOUGH ADVENTIST HEALTH PHYSICIAN NETWORK (AHPN) FOR THE PROFESSIONAL SERVICES PROVIDED IN ALL CLINICS TO THE UNINSURED AND UNDER-INSURED POPULATIONS IN THE COMMUNITY.
FORM 990, PART IX, LINE 11G	PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 20,894,628. MANAGEMENT AND GENERAL EXPENSES 242,921. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,137,549. OTHER MEDICAL PRO FEES: PROGRAM SERVICE EXPENSES 885,815. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 878. TOTAL EXPENSES 886,693. CONSULTING FEES: PROGRAM SERVICE EXPENSES 442,872. MANAGEMENT AND GENERAL EXPENSES 698,705. FUNDRAISING EXPENSES 4,800. TOTAL EXPENSES 1,146,377. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 882. OTHER NON MEDICAL PROFESSIOAL FEES: PROGRAM SERVICE EXPENSES 500. MANAGEMENT AND GENERAL EXPENSES 20,043. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,543. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,527,575. MANAGEMENT AND GENERAL EXPENSES 10,125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,537,700. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,538,754. MANAGEMENT AND GENERAL EXPENSES 22,252,111. FUNDRAISING EXPENSES 392. TOTAL EXPENSES 31,791,257.
FORM 990, PART XI, LINE 9:	BOOK TO TAX K-1 DIFFERENT 139,322. TRANSFER OF CASH/EQUITY TO RELATED ORGANIZATIONS -7,700,000.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

LODI MEMORIAL HOSPITAL ASSOCIATION INC

Employer identification number

94-1044474

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ADVENTIST HEALTH CLEARLAKE HOSPITAL INC 15630 18TH AVE CLEARLAKE,CA95422 68-0395149	HOSPITAL	CA	501(C)(3)	LINE 3	ADVENTIST HEALTH SYSTEM WEST		No
(2)CASTLE MEDICAL CENTER 640 ULUKAHIKI ST KAILUA,HI96734 99-0107330	HOSPITAL	HI	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(3)FEATHER RIVER HOSPITAL 5974 PENTZ RD PARADISE,CA95969 94-1101228	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(4)GLENDALE ADVENTIST MEDICAL CENTER 1509 WILSON TER GLENDALE,CA91206 95-1816017	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(5)HANFORD COMMUNITY HOSPITAL 115 MALL DR HANFORD,CA93230 94-0535360	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(6)NORTHWEST MED FND OF TILLAMOOK 1000 THIRD ST TILLAMOOK,OR97141 93-0622075	HOSPITAL	OR	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(7)PARADISE VALLEY HOSPITAL 2100 DOUGLAS BLVD ROSEVILLE,CA95661 95-1816034	DISCONTINUED OPERATIONS	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(8)PORTLAND ADVENTIST MEDICAL CENTER 10123 SE MARKET ST PORTLAND,OR97216 93-0429015	HOSPITAL	OR	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(9)ST HELENA HOSPITAL 10 WOODLAND RD ST HELENA,CA94574 94-1279779	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(10)SIMI VALLEY HOSPITAL & HEALTH CARE SERV 2975 N SYCAMORE DR SIMI VALLEY,CA93065 95-6064971	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(11)SONORA COMMUNITY HOSPITAL 1000 GREENLEY RD SONORA,CA95370 94-1415069	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(12)UKIAH ADVENTIST HOSPITAL 275 HOSPITAL DR UKIAH,CA95482 94-1639901	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(13)WALLA WALLA GENERAL HOSPITAL 1025 S SECOND AVE WALLA WALLA,WA99362 91-0617726	HOSPITAL	WA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(14)WHITE MEMORIAL MEDICAL CENTER 1720 CESAR E CHAVEZ AVE LOS ANGELES,CA90033 95-2282647	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(15)WILLITS HOSPITAL INC 1 MARCELA DRIVE WILLITS,CA95490 68-0108919	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(16)ADVENTIST HEALTH PHYSICIANS NETWORK 2100 DOUGLAS BLVD ROSEVILLE,CA95661 68-0357690	MEDICAL FOUNDATION	CA	501(C)(3)	LINE 12B, II	ADVENTIST HEALTH SYSTEM WEST		No
(17)ADV HLTH SO CALIFORNIA MED FND 2100 DOUGLAS BLVD ROSEVILLE,CA95661 95-4424391	DISCONTINUED OPERATIONS	CA	501(C)(3)	LINE 12C, III-FI	ADVENTIST HEALTH SYSTEM WEST		No
(18)SAN JOAQUIN COMMUNITY HOSPITAL 2615 CHESTER AVENUE BAKERSFIELD,CA93301 95-2294234	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(19)REEDLEY COMMUNITY HOSPITAL 372 W CYPRESS AVE REEDLEY,CA93654 45-3220509	HOSPITAL	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(20)WESTERN HEALTH RESOURCES 2100 DOUGLAS BLVD ROSEVILLE,CA95661 95-3867863	HOME CARE	CA	501(C)(3)	LINE 1	ADVENTIST HEALTH SYSTEM WEST		No
(21)ADVENTIST HEALTH SYSTEM WEST 2100 DOUGLAS BLVD ROSEVILLE,CA95661 95-3484589	INTEGRATED HEALTH SYSTEM	CA	501(C)(3)	LINE 1	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC (AIC) 1001 S FAIRMONT AVE LODI,CA95240 94-3407786	DIAGNOSTIC IMAGING / MRI OUTPATIENT TREATMENT CENTER	CA	LODI MEMORIAL HOSPITAL ASSOCIATION INC	RELATED	-106,338	401,674		No			No	51.000 %
(2) ARTEL LLC (DBA LODI OUTPATIENT SURGERY CENTER) 521 S HAM LANE LODI,CA95240 26-3513966	AMBULATORY SURGICAL CENTERS	CA	LODI MEMORIAL HOSPITAL ASSOCIATION INC	RELATED	-32,984	1,625,109		No			No	78.150 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) VITAL ENTERPRISES DBA MEMORIAL HOME MED-EQUIP 1115 S FAIRMONT AVE SUITE 1 LODI,CA95240 68-0021729	DURABLE MEDICAL EQUIPMENT COMPANY	CA	LODI MEMORIAL HOSPITAL ASSOCIATION INC	C	52,036	310,686	100.000 %	Yes
(2) LODI REGIONAL HEALTH SYSTEMS INC 975 S FAIRMONT AVE LODI,CA95240 68-0398894	PHYSICIAN MANAGEMENT AND MEDICAL OFFICE BUILDING DEVELOPMENT & MANAGEMENT	CA	LODI MEMORIAL HOSPITAL ASSOCIATION INC	C	901,146	19,154,514	100.000 %	Yes
(3) DELTA RADIOLOGY INC 975 S FAIRMONT AVE LODI,CA95240 94-1715690	RADIOLOGY SERVICES	CA	LODI REGIONAL HEALTH SYSTEMS INC	C	1,994,717	758,966	100.000 %	Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) LODI REGIONAL HEALTH SYSTEMS INC	O	295,488	FMV
(2) LODI REGIONAL HEALTH SYSTEMS INC	K	116,172	FMV
(3) LODI REGIONAL HEALTH SYSTEMS INC	D	2,745,934	OUTSTANDING LOAN BALANCE
(4) LODI REGIONAL HEALTH SYSTEMS INC	P	176,772	FMV
(5) VITAL ENTERPRISES	A	5,184	FMV

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: LIVING GOD'S LOVE BY INSPIRING HEALTH, WHOLENESS AND HOPE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,630
6	Total number of volunteers (estimate if necessary) .............	6	112
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	30,289
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-36,561

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	215,942	206,241
9	Program service revenue (Part VIII, line 2g) .........	231,546,547	227,609,207
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	681,473	603,790
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	225,087	157,821
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	232,669,049	228,577,059
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	75,833	778,146
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	109,753,743	99,058,359
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 160,724
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	140,211,372	126,663,260
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	250,040,948	226,499,765
19	Revenue less expenses. Subtract line 18 from line 12.......	-17,371,899	2,077,294
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	233,497,008	226,199,997
21	Total liabilities (Part X, line 26).............	158,334,613	156,520,986
22	Net assets or fund balances. Subtract line 21 from line 20.....	75,162,395	69,679,011

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 191,563,556 including grants of $ 778,146 ) (Revenue $ 227,554,207 )
	LODI MEMORIAL HOSPITAL IS A NON-PROFIT, ACUTE CARE HOSPITAL WITH HOSPITAL BASED AND COMMUNIY CLINICS PROVIDING HIGH QUALITY SERVICES THAT PROMOTE HEALTH AND REHABILITATION, PREVENT DISEASE, AND TREAT AND CARE FOR THE SICK AND INJURED. HOSPITAL STAFF, MEDICAL STAFF AND THE GOVERNING BOARD ARE DEDICATED TO TREATING ALL PATIENTS AND VISITORS AS INDIVIDUALS WITH EQUAL DIGNITY, RESPECT AND QUALITY OF CARE.LODI MEMORIAL HOSPITAL TREATS AND PROVIDES CARE TO ITS PATIENTS THROUGH INPATIENT AND OUTPATIENT SERVICES. INPATIENTS RECEIVE CARE THROUGH MEDICAL-SURGICAL, PERI-OPERATIVE, PERI-NATAL, PEDIATRIC, INTENSIVE CARE, AND ACUTE-PHYSICAL REHABILITATION SERVICES.OUTPATIENT CARE INCLUDES 24-HOUR EMERGENCY, DIAGNOSTIC SERVICES, SURGERY, REHABILITATION AND EDUCATION.LODI MEMORIAL HOSPITAL IDENTIFIES THE HEALTH-CARE AND HEALTH MAINTENANCE NEEDS AND PREFERENCES OF THE COMMUNITY IT SERVES. DIAGNOSTIC, REHABILITATIVE, EDUCATIONAL, TREATMENT AND PREVENTATIVE SERVICES ARE DEVELOPED AS APPROPRIATE FOR A HOSPITAL OF THIS SIZE AND ROLE.LODI MEMORIAL HOSPITAL, CONSISTENT WITH ITS NON-PROFIT STATUS, DEVELOPS FINANCIAL RESOURCES TO ADEQUATELY SUPPORT HEALTH MAINTENANCE AND PATIENT-CARE SERVICES; CHARITY CARE FOR THOSE UNABLE TO PAY, WORKING CAPITAL NEEDS; AND CAPITAL REQUIREMENTS OF PLANT, EQUIPMENT AND EVOLVING TECHNOLOGY. EVERY EFFORT IS MADE TO KEEP COSTS AFFORDABLE FOR PATIENTS WHILE CONTINUOUSLY STRIVING TO IMPROVE THE QUALITY OF SERVICE.ADVENTIST HEALTH LODI MEMORIAL (AHLM) PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY.ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF ADVENTIST HEALTH LODI MEMORIAL, 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 WILL BE CONSIDERED WHEN INDIVIDUALS WHO NEED HEALTH CARE CANNOT PAY: - PROVIDING FREE CARE AND/OR SUBSIDIZED CARE - PROVIDING CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST - PROVIDING HEALTH/WELLNESS ACTIVITIES AND COMMUNITY EDUCATION PROGRAMSNOT ONLY DOES ADVENTIST HEALTH LODI MEMORIAL 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.AHLM 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 2017 WAS $24,207,884.THE FOLLOWING INPATIENT SERVICES THAT WERE PROVIDED TO ALL OUR PATIENTS. THESE SERVICES INCLUDED: - 1,091 BABIES DELIVERED - 2,119 SURGERIES PERFORMED - 25,248 DIAGNOSTIC IMAGING PROCEDURES PERFORMED - 264,370 LABORATORY TESTS - 34,958 PATIENT DAYS THE FOLLOWING OUTPATIENT SERVICES THAT WERE PROVIDED TO ALL OUR PATIENTS. THESE SERVICES INCLUDED: - 50,460 EMERGENCY DEPARTMENT VISITS - 2,845 OUTPATIENT SURGERIES PERFORMED - 59,437 RADIOLOGY PROCEDURES PERFORMED - 284,577 LABORATORY TESTS - 136,349 MEDICAL CLINIC VISITSAHLM RECOGNIZES IT HAS AN OBLIGATION TO PROVIDE HUMAN SERVICES ABOVE AND BEYOND ITS ROLE AS A HEALING FACILITY. THE FOLLOWING COMMUNITY BENEFITS DEMONSTRATE THE TANGIBLE WAYS IN WHICH THE ORGANIZATION IS FULFILLING ITS MISSION. THE TOTAL UNREIMBURSED COST OF THESE COMMUNITY BENEFITS IN 2017 WAS $2,647,621.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.IN 2017, THE TEAM AT ADVENTIST HEALTH LODI MEMORIAL EMBARKED ON A JOURNEY TO CREATE OPPORTUNITIES DESIGNED SPECIFICALLY FOR THE HISPANIC COMMUNITY, FOCUSED ON LIFESTYLE CHANGES THAT CAN REVERSE THE DIABETES: NUTRITION AND ACTIVITY. JILL BORTH, RN AND NURSE MANAGER FOR CARE MANAGEMENT, BEGAN AN INTENTIONAL OUTREACH EFFORT TO ADDRESS THIS SEGMENT INCLUDING: - DIABETES AMONG FRIENDS * IN 2017, ADVENTIST HEALTH LODI MEMORIAL STARTED A NEW PROGRAM CALLED DIABETES AMONG FRIENDS OFFERED IN BOTH ENGLISH AND SPANISH. AND IN ADDITION TO HOLDING CLASSES AT THE HOSPITAL, THE PROGRAMS ARE HELD AT THE LODI SEVENTH-DAY ADVENTIST SPANISH CHURCH AND AT THE LODI LIBRARY, MEETING PARTICIPANTS CLOSER TO WHERE THEY LIVE AND WORK. THE PROGRAM COVERS DIABETES EDUCATION INCLUDING MEDICATIONS, NUTRITION AND ACTIVITY AND INCLUDES A TRAIN-THE-TRAINER PROGRAM, WHICH IS DESIGNED TO TRAIN STUDENTS TO BECOME TEACHERS. - HISPANIC BUSINESS FAIR * NEARLY 100 HISPANIC BUSINESS LEADERS AND EMPLOYEES PARTICIPATED IN HEALTH SCREENINGS AND RECEIVED HEALTH EDUCATION AND MATERIALS AT THE HISPANIC BUSINESS FAIR, HELD IN LODI IN JULY. - EL CONCILIO SPONSORSHIP * LODI MEMORIAL'S SUPPORT OF ACTIVITIES AND SERVICES TO HELP THE HISPANIC COMMUNITY WAS FURTHERED IN 2017 BY PARTNERING WITH EL CONCILIO, A NONPROFIT ORGANIZATION FOCUSED ON SUPPORT OF THE HISPANIC COMMUNITY THROUGH INTENTIONAL PROGRAMS FOR FAMILY HEALTH AND WELL-BEING. ADVENTIST HEALTH LODI MEMORIAL PROVIDED A SPONSORSHIP AT THEIR 2017 ANNUAL GALA IN NOVEMBER. - SPORTS PHYSICALS * ENDORSING AN ACTIVE LIFESTYLE BEGINS WITH OUR YOUTH, ADVENTIST HEALTH LODI MEMORIAL PHYSICIANS AND EMPLOYEES DEMONSTRATED THAT COMMITMENT THROUGH CONDUCTING SPORTS PHYSICALS AT THREE AREAS SCHOOLS IN 2017, SCREENING NEARLY 500 STUDENTS FOR ATHLETIC PROGRAMS AT JIM ELLIOT CHRISTIAN HIGH SCHOOL, TOKAY HIGH SCHOOL AND LODI HIGH SCHOOL - FIT LIFE IMPACT PROGRAM (FLIP) * ONE OF THE GREATEST CHALLENGES THAT THE LODI COMMUNITY FACES TODAY IS THE HIGH PERCENTAGES OF OBESITY AND TYPE 2 DIABETES. ADVENTIST HEALTH LODI MEMORIAL HAS MADE STRIDES IN THE COMMUNITY WITH PROGRAMS DESIGNED AROUND HELPING PEOPLE ACCESS MORE FRESH FRUITS AND VEGETABLES AND OFFERING FREE, SO IT WAS A NATURAL NEXT STEP TO PARTNER WITH LODI UNIFIED SCHOOL DISTRICT'S AFTER-SCHOOL PROGRAM TO REACH SCHOOL-AGED CHILDREN (4TH AND 5TH GRADE) AND THEIR FAMILIES TO HELP BEND THE OBESITY CURVE. * LODI MEMORIAL LEADERSHIP AND WELLNESS TEAM MEMBERS WORKED WITH LODI UNIFIED SCHOOL DISTRICT IN 2017 TO CREATE THE NEW PROGRAM THAT LAUNCHES IN 2018. FLIP WILL TAKE PLACE IN FOUR SCHOOLS, TWICE PER WEEK DURING THE SPRING AND FALL TERMS. AROUND 400 STUDENTS WILL PARTICIPATE, AND THE PROGRAM WILL FEATURE NUTRITIONAL EDUCATION, KID-FRIENDLY COOKING CLASSES AND FUN FITNESS ACTIVITIES TAUGHT BY PROFESSIONAL FITNESS COACHES. AN ADDITIONAL ELEMENT OF THE PROGRAMMING WILL INTRODUCE CHILDREN TO CAREER OPPORTUNITIES AVAILABLE TO THEM IF THEY REMAIN IN SCHOOL. OUR FLIP COMMUNITY PARTNERS ARE THE LODI UNIFIED SCHOOL DISTRICT AND THE G.O.T. KIDS FOUNDATION.WEBSITES FOR OUR COMMUNITY BENEFIT INFORMATION: HTTPS://WWW.ADVENTISTHEALTH.ORG/DOCUMENTS/LODIMEMORIAL/COMMUNITY-BENEFIT/2017-18_CHP-ANNUAL-REPORT_LODIMEMORIAL.PDFHTTPS://WWW.ADVENTISTHEALTH.ORG/DOCUMENTS/LODIMEMORIAL/COMMUNITY-BENEFIT/FINAL_2016_CHNA_LMH.PDF

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses191,563,556

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)				(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) JOBE MEREDITH........................................................................ VP OPERATIONS	0.00 .......................50.00	X			0	654,239	42,313
(19) WAGNER JACK........................................................................ ASST SECRETARY	0.00 .......................50.00	X			0	1,070,403	37,117
(20) WHITNEY JASON........................................................................ TREASURER	50.00 .......................0.00		X		0	248,441	56,384
(21) MORENO DEBBE........................................................................ CNO	50.00 .......................0.00		X		0	292,644	47,421
(22) FERCH WAYNE........................................................................ PRESIDENT CCR	0.00 .......................50.00		X		0	957,186	45,065
(23) LARSEN DAVID........................................................................ FINANCE OFFICER CCR	0.00 .......................50.00		X		0	548,036	55,984
(24) BROWN MARY........................................................................ RN SUPERVISOR/NURSING ADMIN	49.70 .......................0.00			X	189,510	0	21,598
(25) BECK ATWATER SANDRA........................................................................ DIRECTOR HOSPITAL PHARMACY	45.00 .......................0.00			X	188,901	0	24,284
(26) BRAUER CORY LEE........................................................................ RN CHARGE/SURGERY	43.60 .......................0.00			X	183,341	0	19,619
(27) SCHNEIDER PAMELA........................................................................ EXECUTIVE DIRECTOR-O/P SVCS	45.00 .......................0.00			X	181,229	0	20,977
(28) LINDSEY MIKE R........................................................................ DIRECTOR OF DIAGNOSTIC IMAGING	45.00 .......................0.00			X	179,979	0	17,373

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	922,960	8,296,684	611,274

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	63,500

f	All other contributions, gifts, grants, and similar amounts not included above		1f	142,741

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		206,241

		Business Code
2a	PATIENT SVC REVENUE	621400	225,436,432	225,436,432
b	CAPITATION FEES	621990	2,473,580	2,473,580
c	LOSS FROM ARTEL LLC	621400	-32,984	-32,984
d	LOSS FROM ADVANCED IMAGING CENTER	621400	-106,338	-106,338
e	LOSS FROM AHPN CLINICS	621400	-2,285,002	-2,285,002
f	All other program service revenue.		2,123,519	2,123,519
g	Total. Add lines 2a–2f .....		227,609,207

3 Investment income (including dividends, interest, and othersimilar amounts) ......			603,289			603,289
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		180,421	6a
b	Less: rental expenses		156,205	6b
c	Rental income or (loss)		24,216	6c
d	Net rental income or (loss).......			24,216		-32,272	56,488
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	505		7a
b	Less: cost or other basis and sales expenses	4		7b
c	Gain or (loss)	501		7c
d	Net gain or (loss).........			501			501
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MANAGEMENT FEES		541610	62,561		62,561
b
c
d	All other revenue ....			71,044			71,044
e	Total. Add lines 11a–11d ......			133,605
12	Total revenue. See instructions.....			228,577,059	227,609,207	30,289	731,322

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	778,146	778,146
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	82,460,395	79,026,094	3,319,093	115,208
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,700,446	3,561,280	139,166
9	Other employee benefits .......	6,830,407	6,255,861	552,792	21,754
10	Payroll taxes ...........	6,067,111	5,682,684	375,943	8,484
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	419,785		419,785
c	Accounting ...........	16,518		16,518
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	57,521,001	34,290,144	23,224,787	6,070
12	Advertising and promotion ....	376,875	11,501	362,734	2,640
13	Office expenses .......	1,920,135	1,770,021	149,065	1,049
14	Information technology ......	4,107,544	4,107,544
15	Royalties ..
16	Occupancy ...........	5,733,473	3,247,203	2,482,726	3,544
17	Travel ............	265,533	205,736	59,571	226
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	108,005	88,372	18,839	794
20	Interest ...........	2,028,480		2,028,480
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	10,992,969	10,598,154	394,815
23	Insurance ...	268,255	268,255
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PATIENT CARE SUPPLIES	24,642,035	24,554,172	87,823	40
b	HOSP MEDI-CAL QLTY ASSU	16,711,344	16,711,344
c	ABANDONMENT OF CONSTRUC	782,802		782,802
d
e	All other expenses	768,506	407,045	360,546	915
25	Total functional expenses. Add lines 1 through 24e	226,499,765	191,563,556	34,775,485	160,724
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			237,066	1	91,814
2	Savings and temporary cash investments .........			21,357,581	2	35,331,479
3	Pledges and grants receivable, net ......			974,714	3	734,218
4	Accounts receivable, net .............			49,640,461	4	40,096,132
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			176,025	7	128,634
8	Inventories for sale or use ............			3,713,633	8	4,258,006
9	Prepaid expenses and deferred charges ......			1,377,919	9	877,087
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	252,721,058
b	Less: accumulated depreciation	10b	120,015,732	143,241,621	10c	132,705,326
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			11,349,737	13	11,852,437
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,428,251	15	124,864
16	Total assets. Add lines 1 through 15 (must equal line 33)...			233,497,008	16	226,199,997

17	Accounts payable and accrued expenses .....	24,464,570	17	18,209,945
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	133,870,043	25	138,311,041
26	Total liabilities. Add lines 17 through 25..	158,334,613	26	156,520,986

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	75,162,395	32	69,679,011
33	Total liabilities and net assets/fund balances ........	233,497,008	33	226,199,997