Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
A For the 2020 calendar year, or tax year beginning 01-01-2020 , and ending 12-31-2020
BCheck if applicable:
CName of organization
Adventist Health SystemWest
 
 
Doing business as
Adventist Health
 
Number and street (or P.O. box if mail is not delivered to street address)
1 Adventist Health Way
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Roseville, CA95661
D Employer identification number

95-3484589
E Telephone number

G Gross receipts $ 768,259,201
F Name and address of principal officer:
Scott Reiner
1 Adventist Health Way
Roseville,CA95661
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.adventisthealth.org/
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet1071
K Form of organization:  
L Year of formation: 1980
M State of legal domicile: CA
Part I
Summary
Activities & Governance 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 MediumBullet
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 12
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ...... 5 4,715
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 113,566
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 2,325,317
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 795,492 656,685
9 Program service revenue (Part VIII, line 2g) ......... 344,940,537 594,258,703
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 13,808,361 5,929,276
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 15,364,321 57,591,236
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 374,908,711 658,435,900
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 4,770,896 3,181,946
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) 260,843,076 389,662,256
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,444,704    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 258,399,416 347,228,956
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 524,013,388 740,073,158
19 Revenue less expenses. Subtract line 18 from line 12....... -149,104,677 -81,637,258
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 2,329,560,827 3,118,796,040
21 Total liabilities (Part X, line 26)............. 2,597,540,161 3,317,448,358
22 Net assets or fund balances. Subtract line 21 from line 20..... -267,979,334 -198,652,318
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2020)
Form 990 (2020)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: Living God's love by inspiring health, wholeness and hope.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 228,881,608 including grants of $ 3,181,946 ) (Revenue $ 594,258,703 )
See Schedule O
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 expensesMediumBullet228,881,608
Form 990 (2020)
Form 990 (2020)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I .... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part IIClick to see attachment...........
26
Yes
 
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part IIIClick to see attachment.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................Click to see attachment
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
2,923
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
4,715
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
Form 990 (2020)
Form 990 (2020)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
14
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletTodd Hofheins CFOPO Box 619135   Roseville,CA95661 (916) 406-0000
Form 990 (2020)
Form 990 (2020)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Larsen David......................................................................
Senior Finance Officer
 50.00
.................
0.00 		      X     3,202,560 0 614,651
(2) Reiner Scott......................................................................
CEO
 50.00
.................
0.00 		X   X       2,358,378 0 54,819
(3) Wing Bill - DirAsst SecCFO......................................................................
to 08/20/President as of 08/20
 50.00
.................
0.00 		X   X       1,760,327 0 59,054
(4) Jahn Andrew......................................................................
President, Care Division
 50.00
.................
0.00 		      X     1,365,841 0 59,307
(5) Ferch Wayne......................................................................
President, CCR
 50.00
.................
0.00 		      X     1,298,607 0 49,186
(6) El-Asmar Hoda......................................................................
Chief Clinical Officer thru 10/20
 50.00
.................
0.00 		      X     1,247,499 0 39,498
(7) Eller Jeff......................................................................
President, NCR thru 06/20
 50.00
.................
0.00 		      X     1,154,747 0 49,411
(8) Olson JoAline - Former Chief......................................................................
Human Perf Officer, AHRS thru 08/19
 0.00
.................
0.00 		          X 1,051,211 0 30,421
(9) Beaman John......................................................................
Chief Business Officer
 50.00
.................
0.00 		      X     963,104 0 45,033
(10) Ashlock Mark - Ambulatory......................................................................
Post-Acute President thru 06/20
 50.00
.................
0.00 		      X     963,056 0 44,174
(11) Newmyer Joyce......................................................................
President, PNR
 50.00
.................
0.00 		      X     933,247 0 62,067
(12) Nahapetian Arby......................................................................
Care Division Chief Medical Officer
 50.00
.................
0.00 		      X     868,206 0 54,711
(13) Kofl Andrea......................................................................
President, AHHF
 50.00
.................
0.00 		        X   842,089 0 49,411
(14) Raffoul John......................................................................
FO, SCR/President
 50.00
.................
0.00 		        X   817,586 0 49,411
(15) Reppert Joseph......................................................................
Former CFO/Asst Secr thru 08/19
 0.00
.................
0.00 		          X 813,425 0 41,111
(16) Issai Alice......................................................................
President, AHGL
 50.00
.................
0.00 		      X     814,454 0 29,312
(17) Rawson Richard......................................................................
President, AHRO
 50.00
.................
0.00 		      X     798,315 0 29,537
Form 990 (2020)
Form 990 (2020)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Briggs Sharlet........................................................................
President, AHBD thru 08/20
 50.00
.......................0.00 		      X     775,419 0 46,197
(19) Jobe Meredith........................................................................
Secretary
 50.00
.......................0.00 		    X       769,985 0 43,868
(20) Byrnes John........................................................................
Medical Officer, NCR
 50.00
.......................0.00 		      X     766,859 0 46,424
(21) Long Collier........................................................................
Business Development Executive
 50.00
.......................0.00 		      X     769,706 0 41,198
(22) Brass Steven........................................................................
Medical Officer
 50.00
.......................0.00 		        X   762,403 0 35,825
(23) Chen Steven........................................................................
Finance Officer, CCR
 50.00
.......................0.00 		        X   719,712 0 59,174
(24) Wells Jason........................................................................
Chief Consumer & Innovation Officer
 50.00
.......................0.00 		      X     712,445 0 59,307
(25) Wolcott Daniel........................................................................
President, AHLM
 50.00
.......................0.00 		      X     695,987 0 59,307
(26) Beehler Robert........................................................................
Mkt Dev, M&A Exec
 50.00
.......................0.00 		      X     702,064 0 46,579
(27) Bancarz Gloria........................................................................
System Chief Quality Officer
 50.00
.......................0.00 		      X     702,620 0 32,013
(28) Fink Matthew........................................................................
Chief Information Officer
 50.00
.......................0.00 		        X   671,197 0 59,152
(29) Liebowitz Jacalyn........................................................................
System Chief Nursing Officer
 50.00
.......................0.00 		      X     679,163 0 44,488
(30) Raethel Kathryn........................................................................
President, AHCS
 50.00
.......................0.00 		      X     678,307 0 44,499
(31) Conklin Jeffrey - Former Payer........................................................................
Strategy Exec thru 07/19
 0.00
.......................0.00 		          X 551,575 0 41,343
(32) Hofheins Todd........................................................................
CFO as of 08/20
 50.00
.......................0.00 		    X       469,107 0 13,281
(33) Church Lowell........................................................................
Former VP Material Mgmt thru 03/19
 0.00
.......................0.00 		          X 350,078 0 31,378
(34) Wagner Jack........................................................................
Former CFO/Asst Secr thru 03/18
 0.00
.......................0.00 		          X 269,387 0 13,558
(35) Knittel Monty........................................................................
Former President, AHFR thru 09/18
 0.00
.......................0.00 		          X 123,451 0 8,068
(36) Zachary Beth........................................................................
Former President, SCR thru 01/18
 0.00
.......................0.00 		          X 110,666 0 11,291
(37) Freedman John........................................................................
Director/Vice Chair
 4.00
.......................0.00 		X   X       27,216 0 0
(38) Davis Andrew........................................................................
Director
 4.00
.......................0.00 		X           26,971 0 0
(39) Reiner Richard........................................................................
Director
 4.00
.......................0.00 		X           26,764 0 0
(40) Cherry Robert........................................................................
Director
 4.00
.......................0.00 		X           26,160 0 0
(41) Innocent Larry........................................................................
Director
 4.00
.......................0.00 		X           25,608 0 0
(42) Graham Ricardo........................................................................
Director/Chair
 4.00
.......................0.00 		X   X       23,359 0 0
(43) Heinrich Kerry........................................................................
Director
 4.00
.......................0.00 		X           20,608 0 0
(44) Woodson Marc........................................................................
Director
 4.00
.......................0.00 		X           20,608 0 0
(45) Ocampo Lucy........................................................................
Director
 4.00
.......................0.00 		X           20,358 0 0
(46) Banks David........................................................................
Director
 4.00
.......................0.00 		X           15,441 0 0
(47) Salazar Velino........................................................................
Director
 4.00
.......................0.00 		X           6,651 0 0
(48) Fehr Joy........................................................................
Director
 4.00
.......................0.00 		X           108 0 0
(49) Philip Celeste........................................................................
Director thru 04/20
 4.00
.......................0.00 		X           0 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 32,772,635 0 2,098,064
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet749
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Cerner Corporation

2800 Rockcreek Parkway
Kansas City,MO64117 		IT Solutions Management 6,484,100
Huron Consulting Services LLC

3005 Momentum Place
Chicago,IL60689 		Operations Managment 4,828,061
Swinerton Builders

15 Business Park Way Suite 101
Sacramento,CA95828 		Construction 3,987,964
Latham and Watkins LLP

PO Box 894256
Los Angeles,CA90189 		Legal Services 2,360,625
Robert Half International Inc

PO Box 743295
Los Angeles,CA90074 		Contract Labor 2,250,120
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet159
Form 990 (2020)
Form 990 (2020)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f 656,685
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 656,685
Program Service RevenueAmt Business Code
2a Management fees 900099 573,266,585 569,128,300 4,138,285  
b Other program service rev 900099 20,992,118 20,992,118    
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 594,258,703
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 4,321,057     4,321,057
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   26,664 6a
b Less: rental expenses   0 6b
c Rental income or (loss)   26,664 6c
d Net rental income or (loss).......MediumBullet 26,664     26,664
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 8,000 111,357,583 7a
b Less: cost or other basis and sales expenses 0 109,757,364 7b
c Gain or (loss) 8,000 1,600,219 7c
d Net gain or (loss).........MediumBullet 1,608,219     1,608,219
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..MediumBullet      
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..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a 76,593
b Less: cost of goods sold .. 10b 65,937
c Net income or (loss) from sales of inventory..MediumBullet 10,656     10,656
Business Code Miscellaneous Revenue
11a Vendor rebates 900099 34,865,675     34,865,675
b Health plan liability adj 900099 19,823,387     19,823,387
c Partnership income 523900 -4,024,719   -4,024,719  
d All other revenue .... 6,889,573     6,889,573
e Total. Add lines 11a–11d ...... MediumBullet 57,553,916
12 Total revenue. See instructions.....MediumBullet 658,435,900 590,120,418 113,566 67,545,231
Form 990 (2020)
Form 990 (2020)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 3,181,946 3,181,946
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 ........... 27,357,782   27,357,782  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 3,697,040 1,331,709 2,365,331  
7 Other salaries and wages........ 290,524,249 78,903,319 211,548,405 72,525
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 9,190,099 5,266,654 3,921,425 2,020
9 Other employee benefits ....... 39,863,931 9,128,764 30,723,437 11,730
10 Payroll taxes ........... 19,029,155 5,253,553 13,769,590 6,012
11 Fees for services (non-employees):        
a Management ...... 104,093 5,813 98,280  
b Legal ......... 9,980,390   9,980,390  
c Accounting ........... 4,304,571   4,304,571  
d Lobbying ........... 625,075 625,075    
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) 206,923,507 56,743,054 149,179,192 1,001,261
12 Advertising and promotion .... 14,502,838   14,502,838  
13 Office expenses ....... 9,299,059 1,454,471 7,759,464 85,124
14 Information technology ...... 34,808,002 23,288,493 11,253,477 266,032
15 Royalties ..        
16 Occupancy ........... 7,181,000 4,527,170 2,653,830  
17 Travel ............ 2,295,751 918,983 1,376,768  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 118,019 43,273 74,746  
20 Interest ........... 24,355,173 24,355,173    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 11,989,851 5,913,732 6,076,119  
23 Insurance ... 345,410 334,241 11,169  
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 3,233,771 3,233,771    
b Income taxes 1,670,452 1,669,866 586  
c Rental/lease costs equi 403,277 197,231 206,046  
d
e All other expenses 15,088,717 2,505,317 12,583,400  
25 Total functional expenses. Add lines 1 through 24e 740,073,158 228,881,608 509,746,846 1,444,704
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2020)
Form 990 (2020)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1  
2 Savings and temporary cash investments ......... 284,018,550 2 109,284,618
3 Pledges and grants receivable, net ...... 27,871 3 97,245
4 Accounts receivable, net ............. 17,058 4 726
5 Loans and other receivables from 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 .......
54,227,593 5 54,208,997
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 ........... 6,812,192 7 5,870,461
8 Inventories for sale or use ............   8  
9 Prepaid expenses and deferred charges ...... 42,824,285 9 47,575,339
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 531,877,096
b Less: accumulated depreciation 10b 222,879,921 330,467,992 10c 308,997,175
11 Investments—publicly traded securities . 1,532,854,443 11 2,199,558,333
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .. 11,609,673 13 143,935,557
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 66,701,170 15 249,267,589
16 Total assets. Add lines 1 through 15 (must equal line 33)... 2,329,560,827 16 3,118,796,040
Liabilities 17 Accounts payable and accrued expenses ..... 219,704,780 17 261,367,830
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 2,141,149,922 20 2,043,611,693
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 .. 0 23 59,997,108
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 236,685,459 25 952,471,727
26 Total liabilities. Add lines 17 through 25.. 2,597,540,161 26 3,317,448,358
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... -270,248,542 27 -199,886,561
28 Net assets with donor restrictions ........... 2,269,208 28 1,234,243
Organizations that do not follow FASB ASC 958, check here MediumBullet 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 ........... -267,979,334 32 -198,652,318
33 Total liabilities and net assets/fund balances ........ 2,329,560,827 33 3,118,796,040
Form 990 (2020)
Form 990 (2020)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
658,435,900
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
740,073,158
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-81,637,258
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
-267,979,334
5
Net unrealized gains (losses) on investments ...............
5
147,374,807
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
3,589,467
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
-198,652,318
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2020)
Form 990 (2020)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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
2020
Open to Public
Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
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.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 50,000 96,561 7,311,552 795,492 656,685 8,910,290
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 289,039,507 263,827,180 241,640,379 339,571,640 590,120,418 1,724,199,124
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 5 289,089,507 263,923,741 248,951,931 340,367,132 590,777,103 1,733,109,414
7a Amounts included on lines 1, 2, and 3 received from disqualified persons 6,349,290 4,259,278 6,178,041 8,120,494 14,691,141 39,598,244
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.           0
c Add lines 7a and 7b.. 6,349,290 4,259,278 6,178,041 8,120,494 14,691,141 39,598,244
8 Public support. (Subtract line 7c from line 6.) 1,693,511,170
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
9 Amounts from line 6... 289,089,507 263,923,741 248,951,931 340,367,132 590,777,103 1,733,109,414
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 57,028,162 8,329,768 2,629,457 5,992,756 4,347,721 78,327,864
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 57,028,162 8,329,768 2,629,457 5,992,756 4,347,721 78,327,864
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. 272,887 517,858 573,287     1,364,032
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. 1,997,795   660,599 15,292,368 61,655,228 79,605,990
13 Total support. (Add lines 9, 10c, 11, and 12.).. 348,388,351 272,771,367 252,815,274 361,652,256 656,780,052 1,892,407,300
14
Section C. Computation of Public Support Percentage
15
15
89.490 %
16
16
89.210 %
Section D. Computation of Investment Income Percentage
17
17
4.140 %
18
18
7.860 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in 11a above?
11b
 
 
c
A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described in line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 0.015 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 0.035 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  
7
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2020 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2020 		(iii)
Distributable
Amount for 2020
1 Distributable amount for 2020 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 2020:
a From 2015.......  
b From 2016.......  
c From 2017.......  
d From 2018.......  
e From 2019.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2020 distributable amount  
i Carryover from 2015 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2020 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2020 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2020, 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 2020. 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 2021. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2016.....  
b Excess from 2017.....  
c Excess from 2018.....  
d Excess from 2019.....  
e Excess from 2020.....  
Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020
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, Part III, Line 12, Explanation of Other Income: Gain on debt refinancing Miscellaneous revenue Settlement proceeds
Schedule A (Form 990 or 990-EZ) 2020


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... 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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
Name of organization
Adventist Health SystemWest
  		Employer identification number
95-3484589
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
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 3
Name of organization
Adventist Health SystemWest
  		Employer identification number

95-3484589
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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 4
Name of organization
Adventist Health SystemWest
  		Employer identification number

95-3484589
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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2020)
Additional Data


Software ID:  
Software Version:  
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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
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
Adventist Health SystemWest
 
Employer identification number

95-3484589
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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) 2020

Schedule C (Form 990 or 990-EZ) 2020
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ...................................................................................................................

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) 2017 (b) 2018 (c) 2019 (d) 2020 (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) 2020


Schedule C (Form 990 or 990-EZ) 2020
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
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
625,075
j
Total. Add lines 1c through 1i ....................................................................................................
625,075
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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: Adventist Health engages lobbyists and belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare.
Schedule C (Form 990 or 990EZ) 2020


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
2020
Open to Public Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2020

Schedule D (Form 990) 2020
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 .... 3,418,916 3,006,309 1,146,338 1,131,235 1,114,944
b Contributions ... 656,685 795,400 7,277,972 96,561 50,000
c Net investment earnings, gains, and losses   3,399,636 -3,327,136 18,082 21,830
d Grants or scholarships ...       94,541 55,539
e Other expenditures for facilities
and programs ... 		1,691,650 3,782,429 2,090,865 4,999  
f Administrative expenses ....          
g End of year balance ...... 2,383,951 3,418,916 3,006,309 1,146,338 1,131,235
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet48.230 %
b
Permanent endowment SchDMd Bullet0 %
c
Term endowment SchDMd Bullet51.770 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .......................
3a(i)
 
No
(ii) Related organizations .......................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....   43,387,821 43,387,821
b Buildings ....   117,404,821 5,429,050 111,975,771
c Leasehold improvements   3,482,330 609,276 2,873,054
d Equipment ....   367,602,124 216,841,595 150,760,529
e Other .....        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 308,997,175
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 3
Part VII
Investments - Other 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.)Small Bullet  
Part VIII
Investments - Program 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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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
(1)Receivables from related organizations 229,016,819
(2)Other receivables 15,135,291
(3)Other assets 5,115,479
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 249,267,589
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  
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 952,471,727
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) 2020

Schedule D (Form 990) 2020
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: A $1M board-designated fund was established to honor a former AH president. The earnings are used to provide funding for paying college student interns and graduate student residents as they participate in tracks such as accounting/finance, human resources, communications and management with the goal of introducing the participants to career options in the integrated health care field. Individuals who participate in the program frequently become employed within the AH system upon completion of their academic studies.
Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2020 and 2019, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2016 in major tax jurisdictions.
Schedule D (Form 990) 2020


Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region		 (f) Total expenditures
for and investments
in the region
Central America and the Caribbean 0 0 Program services Administration, legal and accounting fees 57,500
Central America and the Caribbean 0 0 Program services Reinsurance fees 1,273,750
Central America and the Caribbean 0 0 Investments in region N/A 97,000,962
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .... 0 0 98,332,212
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 98,332,212
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of noncash
assistance 		(h) Description
of noncash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
 
3 Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
noncash
assistance 		(g) Description
of noncash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2020
Schedule F (Form 990) 2020
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
Part I, line 3: Accrual method
Part III Accounting Method:  
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2020
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
2020
Open to Public
Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number
95-3484589
Part I
General Information on Grants and Assistance
1
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? ........................
2
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) Adventist Health Clearlake Hospital Inc
15630 18th Avenue
Clearlake,CA95422 		68-0395149 501(c)(3) 10,000       General support
(2) Adventist Health Delano
1401 Garces Highway
Delano,CA93215 		77-0258013 501(c)(3) 10,000       Employee Emergency Fund
(3) Adventist Health Medical Center Tehachapi
1100 Magellan Drive
Tehachapi,CA93561 		81-2240617 501(c)(3) 10,000       Imaging Pavilion
(4) American Red Cross
1565 Exposition Blvd
Sacramento,CA95815 		53-0196605 501(c)(3) 10,000       Community Integration
(5) Blanche Memillan
41-902 Oluolu Street
Waimanalo,HI96795 		82-2039190 501(c)(3) 10,000       Rapid Response - COVID-19
(6) California Farmworker Foundation
800 10th Avenue
Delano,CA93215 		81-3960575 501(c)(3) 10,000       Rapid Response - COVID-19
(7) Carmichael SDA Church
4600 Winding Way
Sacramento,CA95841 		94-1576849 501(c)(3) 15,000       Community Integration
(8) Castle Medical Center
640 Ulukahiki Street
Kailua,HI96734 		99-0107330 501(c)(3) 10,000       ER equipment update
(9) CityServe Network
7001 Auburn Street
Bakersfield,CA93306 		82-4490879 501(c)(3) 10,000       Rapid Response - COVID-19
(10) Community Action Resource Enterprises (CARE) Inc
2310 1st St Suite 2
Tillamook,OR97141 		93-1062448 501(c)(3) 10,000       Rapid Response - COVID-19
(11) Conejo Valley Senior Concerns
401 Hodencamp Road
Thousand Oaks,CA91360 		95-2992927 501(c)(3) 10,000       Rapid Response - COVID-19
(12) Cornerstone Community Alcohol & Drug Recovery Systems Inc
PO Box 1124
Hanford,CA92322 		77-0259210 501(c)(3) 10,000       Rapid Response - COVID-19
(13) Delano Community Alliance
1842 Norwalk Street
Delano,CA93215 		82-1310319 501(c)(3) 10,000       Rapid Response - COVID-19
(14) End Homelessness California
463 Hartford Ave 308
Los Angeles,CA90017 		81-4962168 501(c)(3) 10,000       Rapid Response - COVID-19
(15) Food Roots
PO Box 1275
Tillamook,CA97141 		20-5371832 501(c)(3) 20,000       Rapid Response - COVID-19
(16) Ford Street Project
139 Ford Street
Ukiah,CA95482 		94-2767559 501(c)(3) 10,000       Rapid Response - COVID-19
(17) Fremont Rideout Foundation
414 G Street
Marysville,CA95901 		23-7366330 501(c)(3) 20,000       Annual Sponsorship
(18) Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale,CA91206 		95-1816017 501(c)(3) 10,000       NICU Cooling blanket
(19) Habilitat Inc
PO Box 801
Kaneohi,HI96744 		99-0146306 501(c)(3) 10,000       Rapid Response - COVID-19
(20) Hanford Community Hospital
115 Mall Drive
Hanford,CA93230 		94-0535360 501(c)(3) 10,000       Employee Emergency Fund
(21) Highlands Senior Service Center
PO Box 180
Clearlake,CA95422 		68-0010987 501(c)(3) 10,000       Rapid Response - COVID-19
(22) Interfaith Community Social Services
18500 Striker Ct
Sonora,CA95370 		77-0207244 501(c)(3) 10,000       Rapid Response - COVID-19
(23) Kings Gospel Mission
126 W 7th St
Hanford,CA92320 		77-0259210 501(c)(3) 10,000       Annual Sponsorship
(24) LCF - Lodi Parks and Recreation Fund
955 University Ave Suite A
Sacramento,CA95825 		94-2891517 501(c)(3) 10,000       Rapid Response - COVID-19
(25) Lighthouse Rescue Mission
PO Box 1453
Tulare,CA93275 		03-0551530 501(c)(3) 10,000       Rapid Response - COVID-19
(26) Lodi Memorial Hospital Foundation
845 S Fairmont Ave Ste 3
Lodi,CA95240 		94-2719880 501(c)(3) 10,000       Annual Sponsorship 400.99
(27) Mentis
709 Franklin Street
Napa,CA94559 		94-1236934 501(c)(3) 10,000       Rapid Response - COVID-19
(28) Northwest Medical Foundation of Tillamook
1000 Third Street
Tillamook,OR97141 		93-0622075 501(c)(3) 10,000       Childrens Health, ambulance, Faith in Action
(29) Paradise Adventist Church
2500 Floral Ave Ste 30
Chico,CA95973 		94-1702441 501(c)(3) 50,000       Fire Fund
(30) Paradise Seventh Day Adventist Church
PO Box 1266
Paradise,CA95967 		94-1702441 501(c)(3) 20,000       Rapid Response - COVID-19
(31) Paradise Stronger
PO Box 3991
Chico,CA95927 		84-4195690 501(c)(3) 8,220       Fire Fund
(32) Portland Adventist Community Services
11020 NE Halsey St
Portland,CA97220 		35-2468744 501(c)(3) 10,000       Rapid Response - COVID-19
(33) Portland Adventist Medical Center
10123 SE Market Street
Portland,OR97216 		93-0429015 501(c)(3) 10,000       Cancer care services
(34) RaisingHOPE Inc
1107 Whitecliff Rd
Thousand Oaks,CA91360 		47-1788053 501(c)(3) 16,000       Rapid Response - COVID-19
(35) Reedley Community Hospital
372 Cypress Avenue
Reedley,CA93654 		45-3220509 501(c)(3) 10,000       Employee Emergency Fund
(36) Resiliency Village
PO Box 523
Soulsbyville,CA95372 		61-1946540 501(c)(3) 10,000       Rapid Response - COVID-19
(37) Roseville Area Chamber Of Commerce
650 Douglas Blvd
Roseville,CA95678 		94-1079379 501(c)(6) 7,900       Annual Sponsorship
(38) Sacramento Region Community Foundation
955 University Ave Suite A
Sacramento,CA95825 		94-2891517 501(c)(3) 10,000       Annual Sponsorship
(39) San Joaquin Community Hospital
2615 Chester Avenue
Bakersfield,CA93301 		95-2294234 501(c)(3) 10,000       Event underwriting, breast cancer center
(40) Simi Valley Hospital Foundation
2975 N Sycamore Drive
Simi Valley,CA93065 		91-2135595 501(c)(3) 10,000       Advance Care Expansion, Cath Lab
(41) Sonora Community Hospital
1000 Greenley Road
Sonora,CA95370 		94-1415069 501(c)(3) 10,000       Hospice, Cancer, Birth Center
(42) St Helena Hospital Foundation
10 Woodland Road
St Helena,CA94574 		20-1384250 501(c)(3) 80,000       Rapid Response - Wildfire
(43) Tamara Tadman
3461 Walnut Ave No 13
Carmichael,CA95608 		501(c)(3) 6,000       Annual Sponsorship
(44) The Weingart East Los Angeles YMCA
625 S New Hampshire Ave
Los Angeles,CA90005 		95-1644052 501(c)(3) 20,000       Rapid Response - COVID-19
(45) Tillamook County Community Action Resource Enterprises Inc
2310 1st St Suite 2
Tillamook,OR97141 		93-1062448 501(c)(3) 10,000       Annual Sponsorship
(46) Tulare Hospital Foundation
906 N Cherry St
Tulare,CA93274 		77-0166566 501(c)(3) 10,000       Annual Sponsorship 400.99
(47) Ukiah Adventist Hospital
275 Hospital Drive
Ukiah,CA95482 		94-1639901 501(c)(3) 10,000       New MRI
(48) UpValley Family Centers of Napa County
1440 Spring Street
St Helena,CA94574 		80-0023012 501(c)(3) 10,000       Rapid Response - COVID-19
(49) Weingart East Los Angeles YMCA
2900 Whittier Blvd
Los Angeles,CA90023 		95-1644052 501(c)(3) 20,000       Annual Sponsorship
(50) White Memorial Medical Center Charitable Foundation
1720 Cesar E Chavez Avenue
Los Angeles,CA90033 		95-3760201 501(c)(3) 10,000       Healthcare Workforce Development
(51) Willits Daily Bread Inc
PO Box 1826
Willits,CA95490 		68-0411538 501(c)(3) 10,000       Rapid Response - COVID-19
(52) Yuba Sutter Food Bank
760 Stafford Way
Yuba City,CA95991 		94-2909773 501(c)(3) 10,000       Rapid Response - COVID-19
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
51
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020

Schedule I (Form 990) 2020
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: Funding provided to other organizations is provided to recipients with the understanding that the funds are being used only for the designated purposes. No monitoring is conducted by AH.
Schedule I (Form 990) 2020



Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .....
1b
Yes
 
2
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? ....
2
Yes
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
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
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Larsen David
Senior Finance Officer 		(i)

(ii)		 595,439
-------------
0 		106,067
-------------
0 		2,501,054
-------------
0 		576,851
-------------
0 		37,800
-------------
0 		3,817,211
-------------
0 		2,400,418
-------------
0
2Reiner Scott
CEO 		(i)

(ii)		 1,631,895
-------------
0 		352,059
-------------
0 		374,424
-------------
0 		17,042
-------------
0 		37,777
-------------
0 		2,413,197
-------------
0 		349,200
-------------
0
3Wing Bill - DirAsst SecCFO
to 08/20/President as of 08/20 		(i)

(ii)		 1,458,328
-------------
0 		279,883
-------------
0 		22,116
-------------
0 		17,042
-------------
0 		42,012
-------------
0 		1,819,381
-------------
0 		0
-------------
0
4Jahn Andrew
President, Care Division 		(i)

(ii)		 992,796
-------------
0 		210,574
-------------
0 		162,471
-------------
0 		17,042
-------------
0 		42,265
-------------
0 		1,425,148
-------------
0 		0
-------------
0
5Ferch Wayne
President, CCR 		(i)

(ii)		 1,018,284
-------------
0 		250,697
-------------
0 		29,626
-------------
0 		17,042
-------------
0 		32,144
-------------
0 		1,347,793
-------------
0 		0
-------------
0
6El-Asmar Hoda
Chief Clinical Officer thru 10/20 		(i)

(ii)		 719,268
-------------
0 		163,690
-------------
0 		364,541
-------------
0 		17,042
-------------
0 		22,456
-------------
0 		1,286,997
-------------
0 		0
-------------
0
7Eller Jeff
President, NCR thru 06/20 		(i)

(ii)		 926,131
-------------
0 		197,976
-------------
0 		30,640
-------------
0 		17,042
-------------
0 		32,369
-------------
0 		1,204,158
-------------
0 		0
-------------
0
8Olson JoAline - Former Chief
Human Perf Officer, AHRS thru 08/19 		(i)

(ii)		 4,836
-------------
0 		102,043
-------------
0 		944,332
-------------
0 		0
-------------
0 		30,421
-------------
0 		1,081,632
-------------
0 		212,518
-------------
0
9Beaman John
Chief Business Officer 		(i)

(ii)		 815,598
-------------
0 		130,585
-------------
0 		16,921
-------------
0 		0
-------------
0 		45,033
-------------
0 		1,008,137
-------------
0 		0
-------------
0
10Ashlock Mark - Ambulatory
Post-Acute President thru 06/20 		(i)

(ii)		 720,972
-------------
0 		153,655
-------------
0 		88,429
-------------
0 		14,637
-------------
0 		29,537
-------------
0 		1,007,230
-------------
0 		0
-------------
0
11Newmyer Joyce
President, PNR 		(i)

(ii)		 757,634
-------------
0 		155,648
-------------
0 		19,965
-------------
0 		17,042
-------------
0 		45,025
-------------
0 		995,314
-------------
0 		0
-------------
0
12Nahapetian Arby
Care Division Chief Medical Officer 		(i)

(ii)		 648,088
-------------
0 		107,260
-------------
0 		112,858
-------------
0 		12,449
-------------
0 		42,262
-------------
0 		922,917
-------------
0 		0
-------------
0
13Kofl Andrea
President, AHHF 		(i)

(ii)		 587,803
-------------
0 		128,954
-------------
0 		125,332
-------------
0 		17,042
-------------
0 		32,369
-------------
0 		891,500
-------------
0 		0
-------------
0
14Raffoul John
FO, SCR/President 		(i)

(ii)		 606,284
-------------
0 		81,799
-------------
0 		129,503
-------------
0 		17,042
-------------
0 		32,369
-------------
0 		866,997
-------------
0 		0
-------------
0
15Reppert Joseph
Former CFO/Asst Secr thru 08/19 		(i)

(ii)		 2,779
-------------
0 		0
-------------
0 		810,646
-------------
0 		0
-------------
0 		41,111
-------------
0 		854,536
-------------
0 		0
-------------
0
16Issai Alice
President, AHGL 		(i)

(ii)		 616,370
-------------
0 		91,597
-------------
0 		106,487
-------------
0 		0
-------------
0 		29,312
-------------
0 		843,766
-------------
0 		0
-------------
0
17Rawson Richard
President, AHRO 		(i)

(ii)		 585,738
-------------
0 		115,611
-------------
0 		96,966
-------------
0 		0
-------------
0 		29,537
-------------
0 		827,852
-------------
0 		0
-------------
0
18Briggs Sharlet
President, AHBD thru 08/20 		(i)

(ii)		 395,851
-------------
0 		98,542
-------------
0 		281,026
-------------
0 		17,042
-------------
0 		29,155
-------------
0 		821,616
-------------
0 		0
-------------
0
19Jobe Meredith
Secretary 		(i)

(ii)		 575,127
-------------
0 		81,637
-------------
0 		113,221
-------------
0 		13,010
-------------
0 		30,858
-------------
0 		813,853
-------------
0 		0
-------------
0
20Byrnes John
Medical Officer, NCR 		(i)

(ii)		 578,510
-------------
0 		98,480
-------------
0 		89,869
-------------
0 		17,042
-------------
0 		29,382
-------------
0 		813,283
-------------
0 		0
-------------
0
21Long Collier
Business Development Executive 		(i)

(ii)		 587,019
-------------
0 		80,611
-------------
0 		102,076
-------------
0 		15,674
-------------
0 		25,524
-------------
0 		810,904
-------------
0 		0
-------------
0
22Brass Steven
Medical Officer 		(i)

(ii)		 600,167
-------------
0 		53,904
-------------
0 		108,332
-------------
0 		14,533
-------------
0 		21,292
-------------
0 		798,228
-------------
0 		0
-------------
0
23Chen Steven
Finance Officer, CCR 		(i)

(ii)		 533,654
-------------
0 		104,566
-------------
0 		81,492
-------------
0 		17,042
-------------
0 		42,132
-------------
0 		778,886
-------------
0 		0
-------------
0
24Wells Jason
Chief Consumer & Innovation Officer 		(i)

(ii)		 524,002
-------------
0 		80,171
-------------
0 		108,272
-------------
0 		17,042
-------------
0 		42,265
-------------
0 		771,752
-------------
0 		0
-------------
0
25Wolcott Daniel
President, AHLM 		(i)

(ii)		 510,921
-------------
0 		98,950
-------------
0 		86,116
-------------
0 		17,042
-------------
0 		42,265
-------------
0 		755,294
-------------
0 		0
-------------
0
26Beehler Robert
Mkt Dev, M&A Exec 		(i)

(ii)		 510,207
-------------
0 		76,256
-------------
0 		115,601
-------------
0 		17,042
-------------
0 		29,537
-------------
0 		748,643
-------------
0 		0
-------------
0
27Bancarz Gloria
System Chief Quality Officer 		(i)

(ii)		 509,793
-------------
0 		86,481
-------------
0 		106,346
-------------
0 		17,042
-------------
0 		14,971
-------------
0 		734,633
-------------
0 		0
-------------
0
28Fink Matthew
Chief Information Officer 		(i)

(ii)		 507,077
-------------
0 		84,499
-------------
0 		79,621
-------------
0 		17,042
-------------
0 		42,110
-------------
0 		730,349
-------------
0 		0
-------------
0
29Liebowitz Jacalyn
System Chief Nursing Officer 		(i)

(ii)		 467,077
-------------
0 		55,070
-------------
0 		157,016
-------------
0 		5,700
-------------
0 		38,788
-------------
0 		723,651
-------------
0 		0
-------------
0
30Raethel Kathryn
President, AHCS 		(i)

(ii)		 492,087
-------------
0 		66,191
-------------
0 		120,029
-------------
0 		17,042
-------------
0 		27,457
-------------
0 		722,806
-------------
0 		0
-------------
0
31Conklin Jeffrey - Former Payer
Strategy Exec thru 07/19 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		551,575
-------------
0 		0
-------------
0 		41,343
-------------
0 		592,918
-------------
0 		0
-------------
0
32Hofheins Todd
CFO as of 08/20 		(i)

(ii)		 297,756
-------------
0 		66
-------------
0 		171,285
-------------
0 		0
-------------
0 		13,281
-------------
0 		482,388
-------------
0 		0
-------------
0
33Church Lowell
Former VP Material Mgmt thru 03/19 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		350,078
-------------
0 		0
-------------
0 		31,378
-------------
0 		381,456
-------------
0 		0
-------------
0
34Wagner Jack
Former CFO/Asst Secr thru 03/18 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		269,387
-------------
0 		0
-------------
0 		13,558
-------------
0 		282,945
-------------
0 		0
-------------
0
35Knittel Monty
Former President, AHFR thru 09/18 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		123,451
-------------
0 		0
-------------
0 		8,068
-------------
0 		131,519
-------------
0 		0
-------------
0
36Zachary Beth
Former President, SCR thru 01/18 		(i)

(ii)		 0
-------------
0 		0
-------------
0 		110,666
-------------
0 		0
-------------
0 		11,291
-------------
0 		121,957
-------------
0 		4,831
-------------
0
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
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 Tax indemnification and gross-up payments - received by 11 directors All items checked on this line are reported as taxable income to the employee or director receiving the benefit.
Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Ashlock, Mark - severance payment - $ 57,658 Briggs, Sharlet - severance payment - $189,316 Church, Lowell - severance payment - $349,054 Conklin, Jeffrey - severance payment - $551,575 El-Asmar, Hoda - severance payment - $197,829 Knittel, Monty - severance payment - $123,451 Olson, Joaline - severance payment - $722,636 Reppert, Joseph - severance payment - $809,806 Wagner, Jack - severance payment - $269,387 Zachary, Beth - severance payment - $110,666 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Larsen, David - funding - $559,809 Larsen, David - distribution - $2,400,418 Olson, JoAline - distribution - $212,518 Select executives agreed to participate in CAP-EX in place of a traditional SERP. See Schedule L, Part V, for a broader description. Split-Dollar life insurance participants are Mark Ashlock, John Beaman, Jeffrey Eller, Alan Ferch, Joyce Newmyer, JoAline Olson, Scott Reiner, Jack Wagner, Bill Wing, and Beth Zachary. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Reiner, Scott - $349,200 Zachary, Beth - $4,831
Schedule J (Form 990) 2020

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number
95-3484589
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A CSCDA Series A 2007
  		68-0164610 1307957C5 05-08-2007 57,500,000 See Part VI   X   X   X
B CHFFA Series B 2009
  		52-1643828 13033LBC0 05-20-2009 30,000,000 See Part VI   X   X   X
C CHFFA Series C 2011
  		52-1643828 000000000 06-09-2011 130,000,000 See Part VI   X   X   X
D CHFFA Series A 2013
  		52-1643828 13033LS65 02-14-2013 208,420,907 See Part VI   X   X   X
CHFFA Series A 2013
  		52-1643828 13033LS57 02-14-2013 100,741,934 See Part VI   X   X   X
CSCDA Series A 2015
  		68-0164610 13080SJL9 06-30-2015 157,990,834 See Part VI   X   X   X
CSCDA Series A 2015
  		68-0164610 13080SJM7 06-30-2015 42,422,999 See Part VI   X   X   X
CHFFA Series A 2016
  		52-1643828 13032UGL6 09-08-2016 309,720,490 See Part VI   X   X   X
CSCDA Series A 2018
  		68-0164610 13080SWK6 09-27-2018 272,074,615 See Part VI   X   X   X
HFA Multnomah 2019
  		93-1266280 62551PCX3 11-13-2019 60,886,489 See Part VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 21,440,000 14,118,000 45,540,000 43,510,000
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 57,500,000 30,000,000 130,000,000 208,420,907
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 643,910 216,916 478,200 979,977
8 Credit enhancement from proceeds ............. 1,409,177      
9 Working capital expenditures from proceeds ............. 4,480,297 9,150 2,576  
10 Capital expenditures from proceeds ............. 50,966,616 29,783,084 129,521,800  
11 Other spent proceeds ............. 27,000,000 156,488,239   207,440,930
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2010 2009 2015 2016
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2019, a current refunding issue)? ........ 		  X   X   X X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2019, an advance refunding issue)? ........ 		  X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X X  
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 % 0 % 0.020 %
6 Total of lines 4 and 5 ............. 0 % 0 % 0 % 0.020 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ... X     X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........   X   X   X   X
c No rebate due? ......... X   X   X   X  
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X     X   X
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Date Rebate Computation Performed Issuer Name: CHFFA Series B 2009 Date the Rebate Computation was Performed: 06/17/2019 Issuer Name: CHFFA Series C 2011 Date the Rebate Computation was Performed: 07/25/2016 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020
Part I, Columns (A-D) Issuer's Name: CSCDA - California Statewide Communities Development Authority CHFFA - California Health Facilities Financing Authority HFA - The Hospital Facilities Authority of Multnomah County, Oregon
Part I, Entity 1, Column (f), Line A: Construct, equip and remodel the following health care facilities: Feather River Hospital, Paradise, CA Hanford Community Hospital, Hanford, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA
Part I, Entity 1, Column (f), Line B: Acquire, construct and equip the following health care facilities: Adventist Health Clearlake Hospital Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA
Part I, Entity 1, Column (f), Line C: Refinance a bank loan used to construct, equip the following health care facilities: Adventist Health Clearlake Hospital, Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA
Part I, Entity 1, Column (f), Line D: Refund outstanding balance of the following bond issues: 1991 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 23, 1991 1991 California Health Facilities Financing Authority (AHS/West Series B) bonds issued September 25, 1991 1991 City of Glendale (AHS/West Series A) bonds issued July 23, 1991
Part I, Entity 2, Column (f), Line A: Acquire, construct, and equip the following health care facilities: Central Valley General Hospital, Hanford, CA Feather River Hospital Paradise, CA Willits Hospital, Inc, Willits, CA Hanford Community Hospital, Hanford, CA San Joaquin Community Hospital, Bakersfield, CA Ukiah Valley Hospital, Ukiah, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA
Part I, Entity 2, Column (f), Line B: Refund outstanding balance of the following bond issue: 2005 California Statewide Communities Development Authority (AHS/West Series A) bonds issued on October 18, 2005
Part I, Entity 2, Column (f), Line C: Acquire, construct, and equip the following health care facilities: Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA
Part I, Entity 2, Column (f), Line D: Refund outstanding balance of the following bond issues: 2002 California Health Facilities Financing Authority (AHS/West Series A) bonds issued March 20, 2002 2002 California Health Facilities Financing Authority (AHS/West Series B) bonds issued March 2002 2003 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 1, 2003
Part I, Entity 3, Column (f), Line A: Finance the new headquarters facility for the Corporation located in Roseville, CA and refinance the following bond issues: City of Marysville, CA Rideout Series 2011 Bonds acquired in the affiliation with The Fremont-Rideout Health Group and Rideout Memorial Hospital effective April 1, 2018
Part I, Entity 3, Column (f), Line B: Refund the outstanding balance of the following bond issue: 2009 HFA - The Hospital Facilities Authority of Multnomah County, Oregon (AHS/West Series A) issued September 30, 2009
Part II, Entity 1, Line 11, Column D: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.
Part II, Entity 2, Line 11, Columns B & D: The other spent proceeds are the refunding proceeds no longer in escrow.
Part II, Entity 3, Line 11, Column A: The other spent proceeds are the proceeds used to pay off the taxable line of credit which was used to finance initial costs of the project.
Part II, Entity 3, Line 11, Column B: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.
Schedule K (Form 990) 2020

Additional Data


Software ID:  
Software Version:  


Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number
95-3484589
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A CSCDA Series A 2007
  		68-0164610 1307957C5 05-08-2007 57,500,000 See Part VI   X   X   X
B CHFFA Series B 2009
  		52-1643828 13033LBC0 05-20-2009 30,000,000 See Part VI   X   X   X
C CHFFA Series C 2011
  		52-1643828 000000000 06-09-2011 130,000,000 See Part VI   X   X   X
D CHFFA Series A 2013
  		52-1643828 13033LS65 02-14-2013 208,420,907 See Part VI   X   X   X
CHFFA Series A 2013
  		52-1643828 13033LS57 02-14-2013 100,741,934 See Part VI   X   X   X
CSCDA Series A 2015
  		68-0164610 13080SJL9 06-30-2015 157,990,834 See Part VI   X   X   X
CSCDA Series A 2015
  		68-0164610 13080SJM7 06-30-2015 42,422,999 See Part VI   X   X   X
CHFFA Series A 2016
  		52-1643828 13032UGL6 09-08-2016 309,720,490 See Part VI   X   X   X
CSCDA Series A 2018
  		68-0164610 13080SWK6 09-27-2018 272,074,615 See Part VI   X   X   X
HFA Multnomah 2019
  		93-1266280 62551PCX3 11-13-2019 60,886,489 See Part VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 21,440,000 14,118,000 45,540,000 43,510,000
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 57,500,000 30,000,000 130,000,000 208,420,907
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 643,910 216,916 478,200 979,977
8 Credit enhancement from proceeds ............. 1,409,177      
9 Working capital expenditures from proceeds ............. 4,480,297 9,150 2,576  
10 Capital expenditures from proceeds ............. 50,966,616 29,783,084 129,521,800  
11 Other spent proceeds ............. 27,000,000 156,488,239   207,440,930
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2010 2009 2015 2016
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2019, a current refunding issue)? ........ 		  X   X   X X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2019, an advance refunding issue)? ........ 		  X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X X  
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 % 0 % 0.020 %
6 Total of lines 4 and 5 ............. 0 % 0 % 0 % 0.020 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ... X     X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........   X   X   X   X
c No rebate due? ......... X   X   X   X  
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X     X   X
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Date Rebate Computation Performed Issuer Name: CHFFA Series B 2009 Date the Rebate Computation was Performed: 06/17/2019 Issuer Name: CHFFA Series C 2011 Date the Rebate Computation was Performed: 07/25/2016 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020
Part I, Columns (A-D) Issuer's Name: CSCDA - California Statewide Communities Development Authority CHFFA - California Health Facilities Financing Authority HFA - The Hospital Facilities Authority of Multnomah County, Oregon
Part I, Entity 1, Column (f), Line A: Construct, equip and remodel the following health care facilities: Feather River Hospital, Paradise, CA Hanford Community Hospital, Hanford, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA
Part I, Entity 1, Column (f), Line B: Acquire, construct and equip the following health care facilities: Adventist Health Clearlake Hospital Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA
Part I, Entity 1, Column (f), Line C: Refinance a bank loan used to construct, equip the following health care facilities: Adventist Health Clearlake Hospital, Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA
Part I, Entity 1, Column (f), Line D: Refund outstanding balance of the following bond issues: 1991 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 23, 1991 1991 California Health Facilities Financing Authority (AHS/West Series B) bonds issued September 25, 1991 1991 City of Glendale (AHS/West Series A) bonds issued July 23, 1991
Part I, Entity 2, Column (f), Line A: Acquire, construct, and equip the following health care facilities: Central Valley General Hospital, Hanford, CA Feather River Hospital Paradise, CA Willits Hospital, Inc, Willits, CA Hanford Community Hospital, Hanford, CA San Joaquin Community Hospital, Bakersfield, CA Ukiah Valley Hospital, Ukiah, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA
Part I, Entity 2, Column (f), Line B: Refund outstanding balance of the following bond issue: 2005 California Statewide Communities Development Authority (AHS/West Series A) bonds issued on October 18, 2005
Part I, Entity 2, Column (f), Line C: Acquire, construct, and equip the following health care facilities: Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA
Part I, Entity 2, Column (f), Line D: Refund outstanding balance of the following bond issues: 2002 California Health Facilities Financing Authority (AHS/West Series A) bonds issued March 20, 2002 2002 California Health Facilities Financing Authority (AHS/West Series B) bonds issued March 2002 2003 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 1, 2003
Part I, Entity 3, Column (f), Line A: Finance the new headquarters facility for the Corporation located in Roseville, CA and refinance the following bond issues: City of Marysville, CA Rideout Series 2011 Bonds acquired in the affiliation with The Fremont-Rideout Health Group and Rideout Memorial Hospital effective April 1, 2018
Part I, Entity 3, Column (f), Line B: Refund the outstanding balance of the following bond issue: 2009 HFA - The Hospital Facilities Authority of Multnomah County, Oregon (AHS/West Series A) issued September 30, 2009
Part II, Entity 1, Line 11, Column D: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.
Part II, Entity 2, Line 11, Columns B & D: The other spent proceeds are the refunding proceeds no longer in escrow.
Part II, Entity 3, Line 11, Column A: The other spent proceeds are the proceeds used to pay off the taxable line of credit which was used to finance initial costs of the project.
Part II, Entity 3, Line 11, Column B: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.
Schedule K (Form 990) 2020

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number
95-3484589
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A CSCDA Series A 2007
  		68-0164610 1307957C5 05-08-2007 57,500,000 See Part VI   X   X   X
B CHFFA Series B 2009
  		52-1643828 13033LBC0 05-20-2009 30,000,000 See Part VI   X   X   X
C CHFFA Series C 2011
  		52-1643828 000000000 06-09-2011 130,000,000 See Part VI   X   X   X
D CHFFA Series A 2013
  		52-1643828 13033LS65 02-14-2013 208,420,907 See Part VI   X   X   X
CHFFA Series A 2013
  		52-1643828 13033LS57 02-14-2013 100,741,934 See Part VI   X   X   X
CSCDA Series A 2015
  		68-0164610 13080SJL9 06-30-2015 157,990,834 See Part VI   X   X   X
CSCDA Series A 2015
  		68-0164610 13080SJM7 06-30-2015 42,422,999 See Part VI   X   X   X
CHFFA Series A 2016
  		52-1643828 13032UGL6 09-08-2016 309,720,490 See Part VI   X   X   X
CSCDA Series A 2018
  		68-0164610 13080SWK6 09-27-2018 272,074,615 See Part VI   X   X   X
HFA Multnomah 2019
  		93-1266280 62551PCX3 11-13-2019 60,886,489 See Part VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 21,440,000 14,118,000 45,540,000 43,510,000
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 57,500,000 30,000,000 130,000,000 208,420,907
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 643,910 216,916 478,200 979,977
8 Credit enhancement from proceeds ............. 1,409,177      
9 Working capital expenditures from proceeds ............. 4,480,297 9,150 2,576  
10 Capital expenditures from proceeds ............. 50,966,616 29,783,084 129,521,800  
11 Other spent proceeds ............. 27,000,000 156,488,239   207,440,930
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2010 2009 2015 2016
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2019, a current refunding issue)? ........ 		  X   X   X X  
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2019, an advance refunding issue)? ........ 		  X   X   X   X
16 Has the final allocation of proceeds been made? .......... X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X X  
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 % 0 % 0.020 %
6 Total of lines 4 and 5 ............. 0 % 0 % 0 % 0.020 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ... X     X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........   X   X   X   X
c No rebate due? ......... X   X   X   X  
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X X     X   X
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Date Rebate Computation Performed Issuer Name: CHFFA Series B 2009 Date the Rebate Computation was Performed: 06/17/2019 Issuer Name: CHFFA Series C 2011 Date the Rebate Computation was Performed: 07/25/2016 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CHFFA Series A 2013 Date the Rebate Computation was Performed: 04/06/2018 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020 Issuer Name: CSCDA Series A 2015 Date the Rebate Computation was Performed: 07/20/2020
Part I, Columns (A-D) Issuer's Name: CSCDA - California Statewide Communities Development Authority CHFFA - California Health Facilities Financing Authority HFA - The Hospital Facilities Authority of Multnomah County, Oregon
Part I, Entity 1, Column (f), Line A: Construct, equip and remodel the following health care facilities: Feather River Hospital, Paradise, CA Hanford Community Hospital, Hanford, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA
Part I, Entity 1, Column (f), Line B: Acquire, construct and equip the following health care facilities: Adventist Health Clearlake Hospital Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA
Part I, Entity 1, Column (f), Line C: Refinance a bank loan used to construct, equip the following health care facilities: Adventist Health Clearlake Hospital, Inc., Clearlake, CA Feather River Hospital, Paradise, CA Glendale Adventist Medical Center, Glendale, CA St. Helena Hospital, St. Helena, CA Simi Valley Hospital and Health Care Services, Simi Valley, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA
Part I, Entity 1, Column (f), Line D: Refund outstanding balance of the following bond issues: 1991 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 23, 1991 1991 California Health Facilities Financing Authority (AHS/West Series B) bonds issued September 25, 1991 1991 City of Glendale (AHS/West Series A) bonds issued July 23, 1991
Part I, Entity 2, Column (f), Line A: Acquire, construct, and equip the following health care facilities: Central Valley General Hospital, Hanford, CA Feather River Hospital Paradise, CA Willits Hospital, Inc, Willits, CA Hanford Community Hospital, Hanford, CA San Joaquin Community Hospital, Bakersfield, CA Ukiah Valley Hospital, Ukiah, CA Acquire and install a clinical information system: Adventist Health System/West, Roseville, CA
Part I, Entity 2, Column (f), Line B: Refund outstanding balance of the following bond issue: 2005 California Statewide Communities Development Authority (AHS/West Series A) bonds issued on October 18, 2005
Part I, Entity 2, Column (f), Line C: Acquire, construct, and equip the following health care facilities: Hanford Community Hospital, Hanford, CA St. Helena Hospital, St. Helena, CA
Part I, Entity 2, Column (f), Line D: Refund outstanding balance of the following bond issues: 2002 California Health Facilities Financing Authority (AHS/West Series A) bonds issued March 20, 2002 2002 California Health Facilities Financing Authority (AHS/West Series B) bonds issued March 2002 2003 California Health Facilities Financing Authority (AHS/West Series A) bonds issued July 1, 2003
Part I, Entity 3, Column (f), Line A: Finance the new headquarters facility for the Corporation located in Roseville, CA and refinance the following bond issues: City of Marysville, CA Rideout Series 2011 Bonds acquired in the affiliation with The Fremont-Rideout Health Group and Rideout Memorial Hospital effective April 1, 2018
Part I, Entity 3, Column (f), Line B: Refund the outstanding balance of the following bond issue: 2009 HFA - The Hospital Facilities Authority of Multnomah County, Oregon (AHS/West Series A) issued September 30, 2009
Part II, Entity 1, Line 11, Column D: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.
Part II, Entity 2, Line 11, Columns B & D: The other spent proceeds are the refunding proceeds no longer in escrow.
Part II, Entity 3, Line 11, Column A: The other spent proceeds are the proceeds used to pay off the taxable line of credit which was used to finance initial costs of the project.
Part II, Entity 3, Line 11, Column B: The other spent proceeds are the refunding proceeds of the issue that are no longer in escrow.
Schedule K (Form 990) 2020

Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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.
MediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
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 (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
(1) Ashlock M Key employee Supplemental retirement CASD   X 3,724,014 3,742,915   No Yes   Yes  
(2) El-Asmar H Key employee Relocation   X 150,000 143,850   No Yes   Yes  
(3) Beaman J Key employee Relocation   X 125,000 298,150   No Yes   Yes  
(4) Beaman J Key employee Supplemental retirement CASD   X 2,358,349 2,370,319   No Yes   Yes  
(5) Beehler R Key employee Relocation   X 100,000 78,100   No Yes   Yes  
(6) Byrnes J Key employee Relocation   X 200,000 196,200   No Yes   Yes  
(7) Chen S Highest compensated employee Relocation   X 100,000 148,650   No Yes   Yes  
(8) Eller J Key employee Supplemental retirement CASD   X 7,956,827 7,997,210   No Yes   Yes  
(9) Ferch W Key employee Supplemental retirement CASD   X 6,584,597 6,618,016   No Yes   Yes  
(10) Fink M Highest compensated employee Relocation   X 100,000 94,350   No Yes   Yes  
(11) Jahn A Key employee Relocation   X 400,000 395,600   No Yes   Yes  
(12) Jobe M Officer Relocation   X 100,000 82,000   No Yes   Yes  
(13) Larsen D Key employee Relocation   X 150,000 148,050   No Yes   Yes  
(14) Liebowitz J Key employee Relocation   X 150,000 149,000   No Yes   Yes  
(15) Newmyer J Key employee Relocation   X 150,000 135,600   No Yes   Yes  
(16) Newmyer J Key employee Supplemental retirement CASD   X 4,475,347 4,498,061   No Yes   Yes  
(17) Olson J Highest compensated employee Relocation   X 200,000 52,500   No Yes   Yes  
(18) Olson J Highest compensated employee Supplemental retirement CASD   X 1,862,254 1,871,706   No Yes   Yes  
(19) Raethel K Key employee Relocation   X 61,050 6,050   No Yes   Yes  
(20) Rawson R Key employee Relocation   X 100,000 96,000   No Yes   Yes  
(21) Reiner S Officer Supplemental retirement CASD   X 8,683,504 8,727,576   No Yes   Yes  
(22) Wagner J Former officer Supplemental retirement CASD   X 6,671,634 6,705,495   No Yes   Yes  
(23) Wing B Officer Relocation   X 200,000 189,200   No Yes   Yes  
(24) Wing B Officer Supplemental retirement CASD   X 7,191,107 7,227,604   No Yes   Yes  
(25) Wolcott D Key employee Relocation   X 200,000 200,000   No Yes   Yes  
(26) Zachary B Former key employee Supplemental retirement CASD   X 2,026,510 2,036,795   No Yes   Yes  
Total ...............Small Bullet $ 54,208,997
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) 2020
Schedule L (Form 990 or 990-EZ) 2020
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?
Yes No
(1) Beehler Matthew Family member of Key EE, B. Beehler 312,565 Employment   No
(2) Bancarz Michelle Family member of Key EE, G. Bancarz 133,738 Employment   No
(3) Bancarz Theodore Family member of Key EE, G. Bancarz 110,481 Employment   No
(4) Eller Eric Family member of Key EE, J. Eller 67,487 Employment   No
(5) Ferch Josiah Family member of Key EE, W. Ferch 73,707 Employment   No
(6) PVHR LLC
  		Greater than 35% owned by former Director, M. Gabriel and family members   Interest   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Part II, Supplemental Retirement Benefits: The organization provides supplemental retirement benefits through an alternative funding arrangement the IRS calls "collateral assignment split dollar" (CASD). Although the IRS requires reporting in the loan section of Schedule L, CASD is not an actual loan - no funds are transferred to the executive. Rather, the "loan" treatment applies because after the executive has received retirement benefits, the organization recovers all outlays plus interest.The recovery right is a key advantage of CASD for the organization. Rather than paying retirement benefits to the executive that would never be recovered, under CASD the organization recovers not only its outlays, but also consideration for the time value of money.CASD works as follows. The organization deposits funds into a cash value life insurance policy on the executive's life. During life, to the extent the executive fulfills service and vesting requirements, the executive can borrow against values in the policy to supplement retirement income. Policy performance is closely monitored. If policy performance lags, the executive's borrowing rights are reduced to protect the organization's recovery rights.At the executive's death, the policy death proceeds are first used to repay the organization its deposits plus compounded interest (at the IRS long-term applicable federal rate). The executive's beneficiary then receives any projected retirement borrowing the executive did not access during life. Any remaining death proceeds were available to be paid to the executive's beneficiary. However, the executives made a gift of the excess proceeds, estimated to total $98 million, to the organization to provide additional funding for the organization's charitable activities.Gift of excess proceeds (estimated):Mark Ashlock: $7,108,295: John Beaman: $7,387,524; Jeffrey Eller: $15,637,403; Alan Ferch: $9,908,434; Joyce Newmyer: $6,815,816; JoAline Olson: $2,507,864; Scott Reiner: $17,423,228; Jack Wagner: $14,494,934; Bill Wing: $14,236,602; Beth Zachary: $3,197,524.
Part IV, Page 1, Line 1: Melody Gabriel, an AH director, and her husband are owners and officers of businesses that engage in joint ventures with AH and member hospitals. Other family members with ownership and officer positions in these businesses include her parents, her brother and his wife, and trusts established on behalf of her children. The ventures are organized as LLCs. At the end of 2020, PVHR, LLC had an outstanding balance of $1,673,320 secured and unsecured market rate interest bearing loans. This LLC is 50% controlled by another LLC of which Ms. Gabriel and her family have a controlling interest. Interest is accrued on these loans, principal and interest at the end of 2020 was $237,991. Principal and interest payments are being made monthly. Total interest paid during 2020 was $44,039.
Schedule L (Form 990 or 990-EZ) 2020


Additional Data


Software ID:  
Software Version:  




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
2020
Open to Public
Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
Return Reference Explanation
Form 990, Part III, Line 4a: Adventist Health is a faith-based, nonprofit integrated health system serving more than 80 communities on the West Coast and Hawaii. Founded on Seventh-day Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care agencies, hospice agencies and joint-venture retirement centers in both rural and urban communities. Our compassionate and talented team of 35,000 includes associates, medical staff physicians, allied health professionals and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope. Together, we are transforming the American healthcare experience with an innovative, yet timeless, whole-person focus on physical, mental, spiritual and social healing. Mission-driven The healthcare industry continues to experience significant changes. From high and rising costs to regulatory initiatives, these issues are causing hospitals and health systems to re-think who they are and how they want to deliver care. At Adventist Health, we are thriving and growing in the face of this transition by building on our legacy and reestablishing ourselves as the leader in physical, mental, spiritual and social health. We remain committed to "living God's love by inspiring health, wholeness and hope." Our mission represents the heart of our people. It expresses that we know the love of God and consistently reflect that love in our actions, relationships and work. Mission is the reason our organization exists. Community Health Development Adventist Health's commitment to improve well-being not only grew out of our mission to live God's love, but also from the needs we see in communities across our system of 23 hospitals. While diseases of despair continue to escalate along with healthcare costs, we are presented with the opportunity to bring whole person care, philanthropy, public heath, human services, government, community members, and business owners together to change the well-being of people, places, and policies. A key step towards well-being transformation is the formation of the Well-Being Division, an entity within Adventist Health established in 2020 after its acquisition of Blue Zones, a pioneer in taking a systemic and environmental approach to improving the health of entire cities and communities. Moving toward our vision to see a time when well-being is accessible to everyone, the Well-Being Division works with Blue Zones to design, leverage and demonstrate evidence-informed solutions that measurably and sustainably improve individual, organizational and community well-being. This work starts with our 35,000 associates, who have access to a wide variety of well-being resources from a Blue Zones at Adventist Health well-being app to free online counseling and chaplaincy services. Adventist Health locations also have access to Blue Zones Campus Certification, which invests in creating safe environments that foster well-being and longevity. In early 2021, the Well-Being Division launched four Blue Zones Campus Certifications and four Blue Zones Projects with a goal to roll-out both initiatives across Adventist Health's entire footprint. Over the next three years, every community with an Adventist Health hospital will begin working towards a Blue Zones Project, an achievement that transforms health and well-being everywhere people live, work and play. Outside of Blue Zones specific initiatives, the Well-Being Division has delivered the following to our community members and partner organizations: - 7,976,162 pounds of food to our California communities, - 10,863 showers to our homeless populations - 2.68 million personal protected equipment - $470,000 of household goods and furnishings to fire victims These intentionally targeted and strategically aligned initiatives not only alleviate a significant equity gap in our communities but have also proven to produce lasting, transformative change. Adventist Health has developed a substantiated capacity for vulnerable population community well-being solutions designed for replication further establishing our commitment to ensuring an equity lens through access to well-being for all. Population Health Population health is a whole-person, outcomes-based approach that works to improve the health of entire communities. It requires collaboration among researchers, providers, public health entities and policy makers. Population health aligns with Adventist Health's philosophy of care and, as overall health declines in North America, provides unprecedented opportunities. Adventist Health believes that improving the health status of entire populations begins at home In 2020, Adventist Health moved to one plans but still offered wellness-focused programs and tools, including a wellness website, fitness activities, nutrition guidance, smoking cessation workshops and more. As a safety transition due to the pandemic, members able to complete a free at-home biometric screening and those with high-risk conditions were able to take part in a free care management program that provides support and education. In 2020, 155 members completed a biometric screening. Whole-person health involves mind, body and spirit. The health plans empowers employees, their families and, by extension, the larger community to take an active role in managing their health so they may live vibrant and productive lives. Care Transformation Care Transformation in Adventist Health reflects our promise to deliver top decile safety and quality performance and top quartile in clinical operations. The transformation focuses on initiatives such as Clinical Leadership Development, High Reliability Organization, Patient Experience, Care Redesign, Population Health and Clinical Workforce. All these efforts focus on effectively blending people, processes and technology, and include consistent design, delivery and evaluation of care performance. Our caregivers are working hard every day to achieve the clinical goals and continue to spread our mission. Patient Safety & Quality Adventist Health focuses not only on patient safety and quality patient care, but also provides a quality work environment for its associates. Maintaining a culture of teamwork and safety among clinicians and staff is foundational to Care Transformation. For the past nine years, Adventist Health has participated in the Culture of Safety survey, which provides insight into focused areas where actions can be taken to improve the safety and teamwork climate in clinical departments. Adventist Health hospitals received quality and safety awards from The Joint Commission, The LeapFrog Group, Healthgrades, CMS and Malcolm Baldrige. Physician Alignment Adventist Health operates 379 medical offices across the West Coast and Hawaii. These ambulatory care centers include Rural Health Clinics (RHC), hospital-based outpatient clinics (HBOC), employed physician models in Oregon and Hawaii, medical foundation in California and community health clinics. These medical offices offer primary care and more than 50 different specialties in medical offices large and small. We have more than 500 primary care providers and about 700 specialists providing services ranging from Addiction Medicine to Wound Care, Audiology to Vascular Surgery. Adventist Health also provides much-needed dental care in 10 of our rural communities. The providers in these medical offices are committed to providing best practice, quality-driven care with excellent health outcomes and exceptional patient experience. In each of the past four years we have provided more than 2 million patient visits in 2020 many of those visits shifted to virtual care to safely continue delivering care in the midst of the COVID-19 pandemic. Patient satisfaction scores skyrocketed as the communities we serve recognized how our physicians and associates were working diligently to get them the medical care they needed. The excellent experience our physicians and Advanced Practice Providers offer patients results in a patient satisfaction Star Rating of 4.7 out of 5 stars.
Form 990, Part III, Line 4a (continued): Rural Health Clinic (RHC) As an extension of our mission, high quality services are provided to rural communities where access to care is often significantly more challenging than urban areas. We have 70 rural health clinics (RHCs) providing healthcare to underserved populations throughout Northern and Central California, Hawaii and Oregon. Our system of rural health continues to be the largest network of clinics in the state of California (more than 10 percent of the RHCs in the state are part of Adventist Health). Our RHC network also is one of the largest in the country, representing almost one percent of the nation's RHCs. Adventist Health provides oversight services for all our RHCs to include financial monitoring, program audits, operational support, professional development, advocacy and education regarding new regulations. Thanks to the RHCs, many of these rural communities' most disenfranchised have access to primary care, dentistry, women's and children's services and health education. Specialty care services are also available at many RHC locations, including 24 behavioral health programs. Home Care Services Adventist Health /Home Care offers advanced, high quality health care in an at-home setting by operating 14 home health agencies and nine hospices. In 2020, care, compassion and high-quality services were provided with 204,587 home health visits and 78,641 hospice days. Many of the agencies provide specialized programs and treatment plans, such as wound care, CHF and, diabetes management. Our home health mission is to help patient's recover, regain independence and become as self-sufficient as possible in the comfort of their home. Our hospice mission is to provide whole-person care that envelopes the body, comforts the mind and nurtures the spirit. We are most proud of the following accomplishments in 2020: 1. Implemented Cardinal Health at-Home to provide patient direct supplies 2. Implemented Forcura to create efficiencies for physician orders and intake 3. Received regulatory change of ownership approval for Lodi Home Health to move under Western Health Resources 4. Expanded the Yuba City, CA service area to include the Feather River population 5. Migrated all contracts to Conga to create system standardization 6. Prepared for mandatory Electronic Visit Verification in Hawaii for an anticipated go-live of 8/1/2021 7. Started HCHB optimization Developing a Virtual Care Network The Adventist Health Virtual Care Network allows health care professionals to evaluate, diagnose and treat patients using telecommunications technology. Virtual Care is the umbrella term for the group of services and functions that include telemedicine, telepharmacy, teleICU, teleradiology, and telepathology, but which also includes and can support regional health information sharing, patient education and provider networking. Virtual Care provides patients with access to high-quality, affordable specialty care when and where they need it, aiding in rapid diagnosis, treatment and improved patient outcomes. This collaboration supports Adventist Health's mission of bringing high-quality health and healing to the communities it serves, and is consistent with the organization's focus on innovation, strategic growth and population health. Virtual Care services continued to grow in 2019 and took a huge leap in 2020 with the onset of the COVID-19 pandemic. Our clinics implemented virtual visits using Microsoft Teams as a means to safely continue caring for patients with primary care or chronic health needs. Our traditional telehealth visits combined with Teams visits totaled 45,791 in April and 36,295 in May. Inpatient virtual care continues to serve hundreds of patients. Thirteen hospitals use telehealth stroke services, seven hospitals use pediatric services, five sites use infectious disease services and ten sites use emergency psychiatry assessment services. Under an initiative with Blue Shield of California, funds from a USDA grant and hospital investment, telehealth equipment was provided for medical specialty outpatient care and deployed to 28 sites in California and Oregon including three non-Adventist Health sites. We are also positioned to grow in 2020 with six more sites being added, including in Hawaii. We continue to offer store and forward services for dermatology and diabetic retinopathy screenings, as well as peer-to-peer e-consults. A direct-to-Consumer service we offer to Adventist Health employees, Adventist Health OnDemand, was expanded to consumers as well and communicated to our markets as an additional health care resource available amidst the pandemic. Adventist Health is a preferred provider for Virtual Care with the California Department of Corrections and Rehabilitation, serving multiple prison locations through the Virtual Care Care Coordination Center. Strategic Planning Our ten-year strategy represents a bold vision that is fully aligned with the calling of our mission. This diversified, growth-oriented 2030 strategy is based on building an organization that will bring "affordable consumer health and well-being within reach" for everyone we serve. Within 10 years, we will grow to reach more than 10 million individuals each year within our own footprint and another 50 million across the nation with health and well-being solutions. To support this work and bring our 2030 strategy to life, we have organized into three divisions: Care Division, Health Division and Well-being Division. These divisions will work together to meet the needs of our consumers and exceed expectations physically, virtually or digitally. We will provide better care at a lower cost by focusing on efficiencies in delivery operations and creating value-based care models accountable for the health of defined populations. And we will develop new businesses that bring health and well-being solutions within reach in the communities we serve.
Form 990, Part VI, Section A, line 6 Individuals who represent the Seventh-day Adventist Church and lay people who are in good standing with the Seventh-day Adventist Church serve as members of Adventist Health System/West (the Organization") including the following: (a) the president, treasurer, and one other representative from both the offices of the Pacific Union and the North Pacific Union; (b) one representative from each of the local conferences of the Church in which affiliated health care facilities are located; (c) two representatives selected from among the colleges and universities affiliated with the Church and located in the Pacific Union or North Pacific Union; (d) the CEO of the Organization, plus three additional representatives of the management of the Organization; (e) three representatives selected from the presidents of the hospitals affiliated with the Organization; (f) three healthcare leaders; (g) up to 16 lay representatives who do not belong to any of the other categories set forth but who otherwise meet the qualifications for membership. Annually, the members meet for the purpose of conducting the business of the membership. Actions are taken as required to enable Adventist Health System/West to continue operating in concert with its Articles and Bylaws.
Form 990, Part VI, Section A, line 7a The Organization's Board of Directors consists of the following: (a) The president of the Pacific Union and North Pacific Union of the Seventh-day Adventist Church; (b) two presidents selected from among the local conferences of the Church in which are located affiliated health care institutions; (c) The CEO of the Organization; (d) the president of the Organization, if there is no president, such other persons as the membership shall appoint; (e) two professional health care providers who are practicing or serving in healthcare leadership; and (f) seven lay representatives as elected by the membership.
Form 990, Part VI, Section A, line 7b Amendments to the Organization's Bylaws require approval by the membership.
Form 990, Part VI, Section B, line 11b This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Organization's Board of Directors prior to filing.
Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, corporate officers, key employees, and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the CEO immediately. The statements for the AHSW Board of Directors are reviewed by the EY auditor as part of the annual financial statement audit. All conflicts are reviewed by the System General Counsel. For potential conflicts, the System General Counsel will determine and present all relevant facts to the governing body for decision. After addressing any questions asked by the governing body, the person with a declared conflict must leave the meeting during the discussion of the matter that involves a conflict and during any vote on the matter.
Form 990, Part VI, Section B, line 15 The Organization's Board of Directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital Presidents and Finance Officers, 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 hospital Presidents and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital President has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital (incentive potential is industry norm). Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary.
Form 990, Part VI, Section C, line 19 The Organization does not make its governing documents publicly available beyond required filings of Articles of Incorporation with the Secretary of State. The Organization does not make its Conflict of Interest Policy available to the public.
Form 990, Part VII: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported.
Form 990, Part IX, line 11g Physician professional fees: Program service expenses 82,600. Management and general expenses 1,088,182. Fundraising expenses 0. Total expenses 1,170,782. Other medical professional fees: Program service expenses 0. Management and general expenses 545,415. Fundraising expenses 0. Total expenses 545,415. Consulting and other management fees: Program service expenses 3,701,023. Management and general expenses 29,123,364. Fundraising expenses 957,378. Total expenses 33,781,765. Other professional fees non-medical: Program service expenses 550. Management and general expenses 5,654,694. Fundraising expenses 0. Total expenses 5,655,244. Contract labor: Program service expenses 1,180,818. Management and general expenses 8,798,021. Fundraising expenses 0. Total expenses 9,978,839. Repairs & Maintenance: Program service expenses 34,745,988. Management and general expenses 134,912. Fundraising expenses 0. Total expenses 34,880,900. Purchased medical services: Program service expenses 448,841. Management and general expenses 721,401. Fundraising expenses 0. Total expenses 1,170,242. Other purchased services: Program service expenses 16,583,234. Management and general expenses 103,113,203. Fundraising expenses 43,883. Total expenses 119,740,320.
Form 990, Part XI, line 9: BlueZones acquisition adjustment -435,252. Partnership loss reported on Sch K-1 4,024,719.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
Adventist Health SystemWest
 
Employer identification number

95-3484589
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
(1) Incentive Acute Care Network LLC
PO Box 619135
Roseville,CA95661
 Acute care network CA 0 0 Adventist Health SystemWest
 
(2) Incentive Health LLC
PO Box 619135
Roseville,CA95661
 MSO CA 471,080 4,360,717 Adventist Health SystemWest
 








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?
Yes No
(1)Adventist Health Clearlake Hospital Inc
15630 18th Avenue

Clearlake,CA95422
68-0395149 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(2)Adventist Health Delano
1401 Garces Highway

Delano,CA93215
77-0258013 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(3)Adventist Health Medical Center Tehachapi
1100 Magellan Drive

Tehachapi,CA93561
81-2240617 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(4)Adventist Health Mendocino Coast
700 River Drive

Fort Bragg,CA95437
84-5174585 		Hospital CA 501(c)(3) Line 3 Stone Point Health
 
Yes
 
(5)Adventist Health Physicians Network
PO Box 619135

Roseville,CA95661
68-0357690 		Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest
 
Yes
 
(6)Adventist Health Tulare
869 North Cherry Street

Tulare,CA93274
83-2351753 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(7)Castle Medical Center
640 Ulukahiki Street

Kailua,HI96734
99-0107330 		Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(8)Feather River Hospital
PO Box 619135

Roseville,CA95661
94-1101228 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(9)Fremont-Rideout Health Group
989 Plumas Street

Yuba City,CA95991
94-2917251 		Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health
 
Yes
 
(10)Glendale Adventist Medical Center
1509 Wilson Terrace

Glendale,CA91206
95-1816017 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(11)Hanford Community Hospital
115 Mall Drive

Hanford,CA93230
94-0535360 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(12)Lodi Memorial Hospital Association Inc
975 S Fairmont Avenue

Lodi,CA95240
94-1044474 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(13)Northwest Medical Foundation of Tillamook
1000 Third Street

Tillamook,OR97141
93-0622075 		Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(14)Paradise Valley Hospital
PO Box 619135

Roseville,CA95661
95-1816034 		Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest
 
Yes
 
(15)Portland Adventist Medical Center
10123 SE Market Street

Portland,OR97216
93-0429015 		Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(16)Reedley Community Hospital
372 Cypress Avenue

Reedley,CA93654
45-3220509 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(17)Rideout Memorial Hospital
989 Plumas Street

Yuba City,CA95991
94-1387866 		Acute care hospital CA 501(c)(3) Line 3 Stone Point Health
 
Yes
 
(18)San Joaquin Community Hospital
2615 Chester Avenue

Bakersfield,CA93301
95-2294234 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(19)Simi Valley Hospital and Health Care Services
2975 N Sycamore Drive

Simi Valley,CA93065
95-6064971 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(20)Sonora Community Hospital
1000 Greenley Road

Sonora,CA95370
94-1415069 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(21)St Helena Hospital
10 Woodland Road

St Helena,CA94574
94-1279779 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(22)Stone Point Health
PO Box 619135

Roseville,CA95661
82-3763347 		Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest
 
Yes
 
(23)Ukiah Adventist Hospital
275 Hospital Drive

Ukiah,CA95482
94-1639901 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(24)United Com-Serve
989 Plumas Street

Yuba City,CA95991
94-3015356 		Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health
 
Yes
 
(25)Walla Walla General Hospital
PO Box 619135

Roseville,CA95661
91-0617726 		Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(26)Western Health Resources
PO Box 619135

Roseville,CA95661
95-3867863 		Home care CA 501(c)(3) Line 10 Adventist Health SystemWest
 
Yes
 
(27)White Memorial Medical Center
1720 Cesar E Chavez Avenue

Los Angeles,CA90033
95-2282647 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
(28)Willits Hospital Inc
1 Marcela Drive

Willits,CA95490
68-0108919 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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
Yes No Yes No
(1) Blue Zones LLC

323 N Washington Avenue 2nd Floor
Minneapolis,MN55401
27-1603327 		Education MN Adventist Health SystemWest
  		Unrelated 1,776,845 7,727,528   No -5,555,454 Yes   100.000 %
(2) PVHR LLC dba Paradise Village

8440 SE Sunnybrook Blvd Suite 100
Clackmas,OR97015
26-0622555 		Real property rental OR Adventist Health SystemWest
  		Unrelated 151,388 17,366,645   No 151,356 Yes   50.000 %
(3) PVHR2 LLC dba Parkview at Paradise Village

8440 SE Sunnybrook Blvd Suite 100
Clackmas,OR97015
47-3300170 		Real property rental OR Adventist Health SystemWest
  		Unrelated -121,349 3,690,666   No -121,349 Yes   50.000 %
(4) WWGHR LLC

8440 SE Sunnybrook Blvd Suite 100
Clackmas,OR97015
81-0591221 		Rental OR Adventist Health SystemWest
  		Unrelated -497,278 4,325,030   No -497,558 Yes   50.000 %






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?
Yes No
(1) AdHealth Limited

PO Box HM 2062
Hamilton   HM HX
BD
Pure captive insurance BD Adventist Health SystemWest
  		C 526,319 1,705,393 50.000 %   No
(2) Adventist Health Plan Inc

1 Adventist Health Way
Roseville,CA95661
46-3833261 		Health insurance CA Adventist Health SystemWest
  		C 33,254,537 6,995,662 100.000 % Yes  
(3) South Coast Medical Center

PO Box 619135
Roseville,CA95661
95-2037291 		Wind down after sale of hospital CA Adventist Health SystemWest
  		C     100.000 % Yes  
(4) Thrive Productions Inc

323 N Washington Avenue
Minneapolis,MN55401
45-3369049 		Production company MN Adventist Health SystemWest
  		C 273,567 12,137 100.000 % Yes  






Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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) Adventist Health Clearlake Hospital Inc

 L 17,537,429 FMV
(2) Adventist Health Medical Center Tehachapi

 L 5,241,349 FMV
(3) Adventist Health Physicians Network

 L 14,552,939 FMV
(4) Castle Medical Center

 L 20,722,656 FMV
(5) Glendale Adventist Medical Center

 L 57,478,182 FMV
(6) Hanford Community Hospital

 L 42,765,902 FMV
(7) Lodi Memorial Hospital Association Inc

 L 30,126,621 FMV
(8) Northwest Medical Foundation of Tillamook

 L 11,515,897 FMV
(9) Portland Adventist Medical Center

 L 35,230,876 FMV
(10) Reedley Community Hospital

 L 23,899,035 FMV
(11) Rideout Memorial Hospital

 L 54,794,348 FMV
(12) San Joaquin Community Hospital

 L 54,183,805 FMV
(13) Simi Valley Hospital and Health Care Services

 L 20,460,874 FMV
(14) Sonora Community Hospital

 L 32,559,671 FMV
(15) St Helena Hospital

 L 25,094,376 FMV
(16) Ukiah Adventist Hospital

 L 24,997,598 FMV
(17) Western Health Resources

 L 2,541,289 FMV
(18) White Memorial Medical Center

 L 54,846,796 FMV
(19) Willits Hospital Inc

 L 9,846,208 FMV
(20) Adventist Health Clearlake Hospital Inc

 O 773,828 FMV
(21) Adventist Health Delano

 O 763,057 FMV
(22) Adventist Health Medical Center Tehachapi

 O 590,517 FMV
(23) Adventist Health Mendocino Coast

 O 325,860 FMV
(24) Adventist Health Tulare

 O 177,870 FMV
(25) Castle Medical Center

 O 1,291,529 FMV
(26) Feather River Hospital

 O 61,764 FMV
(27) Glendale Adventist Medical Center

 O 2,667,966 FMV
(28) Hanford Community Hospital

 O 1,897,365 FMV
(29) Lodi Memorial Hospital Association Inc

 O 1,861,248 FMV
(30) Northwest Medical Foundation of Tillamook

 O 617,690 FMV
(31) Portland Adventist Medical Center

 O 1,373,320 FMV
(32) Rideout Memorial Hospital

 O 2,331,023 FMV
(33) San Joaquin Community Hospital

 O 2,315,319 FMV
(34) Simi Valley Hospital and Health Care Services

 O 1,731,039 FMV
(35) Sonora Community Hospital

 O 1,399,501 FMV
(36) St Helena Hospital

 O 1,457,140 FMV
(37) Ukiah Adventist Hospital

 O 802,743 FMV
(38) White Memorial Medical Center

 O 2,960,826 FMV
(39) Willits Hospital Inc

 O 763,199 FMV
(40) Adventist Health Delano

 Q 243,073 FMV
(41) Adventist Health Mendocino Coast

 Q 176,107 FMV
(42) Adventist Health Ukiah Valley

 Q 85,883 FMV
(43) Castle Medical Center

 Q 51,476 FMV
(44) Glendale Adventist Medical Center

 Q 81,350 FMV
(45) Hanford Community Hospital

 Q 87,702 FMV
(46) Lodi Memorial Hospital Association Inc

 Q 57,311 FMV
(47) San Joaquin Community Hospital

 Q 55,851 FMV
(48) Simi Valley Hospital and Health Care Services

 Q 54,427 FMV
(49) Sonora Community Hospital

 Q 130,455 FMV
(50) Adhealth Limited

 R 1,273,750 Cash transfer amount
(51) Adventist Health Medical Center Tehachapi

 R 16,920,105 Cash transfer amount
(52) Adventist Health Physicians Network

 R 11,420,845 Cash transfer amount
(53) Castle Medical Center

 R 16,087,689 Cash transfer amount
(54) Hanford Community Hospital

 R 47,714,622 Cash transfer amount
(55) Northwest Medical Foundation of Tillamook

 R 10,675,399 Cash transfer amount
(56) Portland Adventist Medical Center

 R 12,984,570 Cash transfer amount
(57) Reedley Community Hospital

 R 23,516,677 Cash transfer amount
(58) San Joaquin Community Hospital

 R 13,393,216 Cash transfer amount
(59) Simi Valley Hospital and Health Care Services

 R 1,305,132 Cash transfer amount
(60) Sonora Community Hospital

 R 25,107,956 Cash transfer amount
(61) Ukiah Adventist Hospital

 R 10,052,018 Cash transfer amount
(62) Walla Walla General Hospital

 R 301,770 Cash transfer amount
(63) White Memorial Medical Center

 R 155,647,057 Cash transfer amount
(64) Willits Hospital Inc

 R 3,377,609 Cash transfer amount
(65) Adventist Health Clearlake Hospital Inc

 S 2,831,038 Cash transfer amount
(66) Adventist Health Tulare

 S 32,717,189 Cash transfer amount
(67) Feather River Hospital

 S 18,880,382 Cash transfer amount
(68) Fremont-Rideout Health Group

 S 11,670,649 Cash transfer amount
(69) Glendale Adventist Medical Center

 S 10,780,495 Cash transfer amount
(70) Lodi Memorial Hospital Association Inc

 S 50,043,904 Cash transfer amount
(71) Rideout Memorial Hospital

 S 45,133,709 Cash transfer amount
(72) South Coast Medical Center

 S 601,992 Cash transfer amount
(73) St Helena Hospital

 S 6,214,337 Cash transfer amount
(74) United Com-Serve

 S 55,771,404 Cash transfer amount
(75) Western Health Resources

 S 11,429,423 Cash transfer amount
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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) 2020

Additional Data


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