TY 2023 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Heinrich Kerry...................................................................... Dir/Chair/CEO	0.00 ................. 50.50	X	X				0	3,302,428	57,395
(2) Hofheins Todd...................................................................... Dir/Vice Chair/COO	0.00 ................. 50.50	X	X				0	2,272,592	76,141
(3) Beaman John...................................................................... CFO/Assistant Secretary	0.00 ................. 50.50		X				0	1,680,553	73,355
(4) Stevens Eric - President...................................................................... Northern CA/HI State Network	5.00 ................. 45.50					X	0	1,526,293	59,552
(5) Jahn Andrew - Former...................................................................... Care Division President thru 02/22	0.00 ................. 50.00					X	0	1,465,906	103,785
(6) Nahapetian Arby - Former Care...................................................................... Division Medical Off thru 02/22	0.00 ................. 50.00					X	0	1,482,294	69,613
(7) Wells Jason...................................................................... Former President thru 12/20	0.00 ................. 50.00					X	0	1,470,582	37,177
(8) Wing Bill - Former...................................................................... Dir/Asst Secr/Vice Chair thru 01/22	0.00 ................. 0.00					X	0	1,438,460	40,073
(9) Charpentier Paul...................................................................... Physician	40.00 ................. 0.00				X		1,351,494	0	51,436
(10) Jobe Meredith...................................................................... Secretary	0.00 ................. 50.50		X				0	959,488	59,410
(11) Howe Judson - President AHHM...................................................................... Pres, North Coast Network thru 03/22	8.30 ................. 41.70		X				0	808,895	28,997
(12) Tetz Warren - Former...................................................................... Treas/Asst Secr thru 12/22	0.00 ................. 0.00					X	0	560,025	58,835
(13) Eberhart Gregory...................................................................... Area Medical Officer	12.50 ................. 37.50			X			0	582,946	27,959
(14) Spenst Brett - Former Care...................................................................... Division Finance Officer thru 02/22	0.00 ................. 50.00					X	0	520,625	45,847
(15) Mock Jeffrey...................................................................... Treasurer/Asst Secr as of 09/23	10.00 ................. 40.50		X				0	470,391	67,797
(16) Shepardson Dean - Treasurer...................................................................... Asst Secr from 03/23 thru 09/23	12.50 ................. 37.50		X				0	461,843	55,761
(17) Assadian Hoda...................................................................... Operations Executive	16.70 ................. 33.30			X			0	460,925	52,377

(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)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Givens Linda........................................................................ Patient Care Executive/Administrator	50.00 .......................0.00		X			0	402,990	67,969
(19) D'Anis Matthew........................................................................ Director, Pharmacy	40.00 .......................0.00			X		285,786	0	80,285
(20) Radell Raymond........................................................................ Certified RN Anesthetist	40.00 .......................0.00			X		288,209	0	34,581
(21) Niderost Gregory........................................................................ Certified RN Anesthetist	40.00 .......................0.00			X		278,661	0	43,629
(22) Buckingham Amy........................................................................ Associate Patient Care Executive	50.00 .......................0.00		X			0	257,621	63,465
(23) Ramirez Johann - Admin........................................................................ Director, Business Dev & Strategy	40.00 .......................0.00			X		262,252	0	58,563
(24) Byrnes John - Former........................................................................ Medical Officer, NCR thru 02/20	0.00 .......................0.00				X	0	263,659	34,955
(25) Parker Bessant - Former........................................................................ Area Medical Officer thru 03/22	0.00 .......................0.00				X	0	211,890	52,366
(26) Freedman John........................................................................ Director	0.00 .......................4.00	X				0	26,770	0
(27) Cherry Robert........................................................................ Director	0.00 .......................4.00	X				0	26,611	0
(28) Davis Andrew........................................................................ Director	0.00 .......................4.00	X				0	26,611	0
(29) Innocent Larry........................................................................ Director	0.00 .......................4.00	X				0	26,611	0
(30) Newton Bradford........................................................................ Director	0.00 .......................4.00	X				0	26,611	0
(31) Reiner Richard........................................................................ Director	0.00 .......................4.00	X				0	26,611	0
(32) Salazar Velino........................................................................ Director	0.00 .......................4.00	X				0	26,611	0
(33) Banks David........................................................................ Director	0.00 .......................4.00	X				0	26,181	0
(34) Woodson Marc........................................................................ Director	0.00 .......................4.00	X				0	21,611	0
(35) Wagner Jack........................................................................ Director	0.00 .......................4.00	X				0	16,180	0
(36) Fehr Joy........................................................................ Director	0.00 .......................4.00	X				0	430	0
(37) Ocampo Lucy........................................................................ Director thru 08/23	0.00 .......................4.00	X				0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
Pacific Redwood Medical Group Inc 242 Hospital Drive Suite B Ukiah,CA95482	Medical services	2,049,206
Galen Inpatient Physicians Inc 2100 Powell St Ste 400 Emeryville,CA94608	Medical services	1,244,736
RMG Medical Imaging Consultants PO Box 86348 Los Angeles,CA90086	Medical services	1,096,505
Aya Healthcare Inc 5930 Cornerstone Court West San Diego,CA92121	Contract labor services	690,596
Anesthesia Services LLC 617 Park Boulevard Ukiah,CA94582	Medical services	643,720
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 20

- TIN:

SCHEDULE A
(Form 990)

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Part I

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

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

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

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

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

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

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

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

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

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

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

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

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

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

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

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

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

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

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2023

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

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

First 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

Public support percentage for 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2022. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2023. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

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

Schedule A (Form 990) 2023

Page 3

Part III

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 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

Public support percentage for 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3 % support tests—2022. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

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

Schedule A (Form 990) 2023

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

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

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

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

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

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

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

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

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

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer 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).

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

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

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

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

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

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

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

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

10a

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

10a

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

10b

Schedule A (Form 990) 2023

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on 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

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.

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

By reason of the relationship described in 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.

Section E. Type III Functionally-Integrated Supporting Organizations

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

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

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

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

Activities Test. Answer lines 2a and 2b below.

Yes

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

Did the activities described on 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.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

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

Schedule A (Form 990) 2023

Page 6

Part V

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

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

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

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

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

Schedule A (Form 990) 2023

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 2023 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-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2023

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990) (2023)

Schedule B (Form 990) (2023) Page 2

Name of organization Willits Hospital Inc

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)

Schedule B (Form 990) (2023)

Page 3

Name of organization Willits Hospital Inc		Employer identification number 68-0108919

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) (2023)

Schedule B (Form 990) (2023)

Page 4


Name of organization Willits Hospital Inc			Employer identification number 68-0108919
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

right arrow

Complete if the organization is described below. 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

2022

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

Willits Hospital Inc

Employer identification number

68-0108919

Part I-A

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

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

Political campaign activity expenditures. See instructions .................................................................... right arrow

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

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

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990) 2022

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 right arrow

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

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

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2019	(b) 2020	(c) 2021	(d) 2022	(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) 2022

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

8,061

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

8,061

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
Part II-B, Line 1:	The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to NL Short Public Affairs were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare.

Schedule C (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after July 25, 2006, and not on a historic structure listed in the National Register ...	2d

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

Number of states where property subject to conservation easement is located right arrow

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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

Revenue included on Form 990, Part VIII, line 1 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

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

Yes No

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

Part V

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

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

1a	Beginning of year balance ....	548,550	520,110	504,186	497,890	457,504
b	Contributions ...	119,735	750,204	713,261	134,937	371,562
c	Net investment earnings, gains, and losses		-1,374	1,706
d	Grants or scholarships ...					303,063
e	Other expenditures for facilities and programs ...	156,161	720,390	699,043	128,641	28,113
f	Administrative expenses ....
g	End of year balance ......	512,124	548,550	520,110	504,186	497,890

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

Board designated or quasi-endowment right arrow

0 %

Permanent endowment right arrow

0 %

Term endowment right arrow

100.000 %

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

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

Yes

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

3a(i)

Yes

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

3a(ii)

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

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

Part VI

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

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

1a	Land .....
b	Buildings ....	60,728,633	26,907,442	33,821,191
c	Leasehold improvements	1,894,784	1,318,528	576,256
d	Equipment ....	23,528,855	19,523,230	4,005,625
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				38,403,072

Schedule D (Form 990) 2022

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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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 third-party payors				11,585,217
(2)Right-of-use assets				9,501,772
(3)Receivables from related organizations				1,276,736
(4)Other receivables				57,644
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				22,421,369

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
Payables to related organizations	31,613,998
Lease liabilities	8,447,425
Payables to third-party payors	4,417,512






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	44,478,935
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) 2022

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

Part V, Line 4:

Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended.

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, 2023 and 2022, no such assets or liabilities were recorded. The System currently files Form 990 (Informational Return of Organizations Exempt From Income Taxes) and Form 990-T (Exempt Organization Business Income Tax Return) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2020 in major tax jurisdictions.

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	324,341		324,341	0.350 %
b	Medicaid (from Worksheet 3, column a) . . . . .	21,685,180	14,244,952	7,440,228	8.120 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	22,009,521	14,244,952	7,764,569	8.470 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	527,134	9,600	517,534	0.560 %
f	Health professions education (from Worksheet 5) . . .	52,663		52,663	0.060 %
g	Subsidized health services (from Worksheet 6) . . . .	11,281,466	8,191,498	3,089,968	3.370 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	11,861,263	8,201,098	3,660,165	3.990 %
k	Total. Add lines 7d and 7j .	33,870,784	22,446,050	11,424,734	12.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing			381,324		381,324	0.420 %
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development			156,640		156,640	0.170 %
9	Other
10	Total			537,964		537,964	0.590 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

411,379

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

126,720

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

Section B. Medicare

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

33,600,837

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

32,759,736

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

841,101

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2023

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Willits Hospital Inc DBA Adventist Health Howard Memorial 1 Marcela Dr Willits,CA95490 www.adventisthealth.org/howard-memoria 110000013	X	X	X	X

Schedule H (Form 990) 2023

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Willits Hospital Inc DBA Adventist Hea
Name of hospital facility or letter of facility reporting group

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 22

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

Yes

6 a

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

Yes

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

Yes

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

Yes

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

Hospital facility’s website (list url): See Sch H Part VI - Needs Assessment

Other website (list url): See Sch H Part VI - Needs Assessment

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

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

Yes

If "Yes" (list url): See Sch H Part VI - Needs Assessment

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2023

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Willits Hospital Inc DBA Adventist Hea
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

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

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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

Yes

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

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

Sch H Part VI-Patient Educ

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

Sch H Part VI-Patient Educ

A plain language summary of the FAP was widely available on a website (list url):
Sch H Part VI-Patient Educ

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

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

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

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

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

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

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 6

Part VFacility Information (continued)

Billing and Collections

	Willits Hospital Inc DBA Adventist Hea
Name of hospital facility or letter of facility reporting group

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

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

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

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

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

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2023

Page 7

Part VFacility Information (continued)

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

	Willits Hospital Inc DBA Adventist Hea
Name of hospital facility or letter of facility reporting group

Yes

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

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

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

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

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2023

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Willits Hospital, Inc. DBA Adventist Health Howard	Part V, Section B, Line 5: The 2022 Community Health Needs Assessment for Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) was developed using four separate sources of primary and secondary data. This mixed methods approach is considered a preferred practice for needs assessments because it allows for the greatest understanding of community needs from the broadest range of perspectives. Primary data refers to data collected and analyzed specifically for this project, while secondary data refers to data compiled and analyzed by external groups and utilized here. Qualitative primary data collection involved focus group interviews with local service providers and service recipients and individual key informant interviews with local leaders. These were conducted in-person and virtually. Direct quotes were taken from a transcription of key informant interviews and are intended to be 100% accurate but could not be verified in all situations. This information was collected by the Adventist Health Community Well-Being team and evaluation consultants from the Center for Behavioral Health Integration. Secondary data was amassed and analyzed across 45 different data sets by the University of Missouri Extension Center for Applied Research and Engagement Systems (CARES). Finally, survey data sets of registered voters in the community were collected and analyzed by UC Berkeley Institute of Governmental Studies (IGS). In total, nine focus groups were conducted with 40 participants, and seven key informant interviews were held. Survey data was gathered from the North Coast region (region name defined by survey administrator, UC Berkeley IGS).The CHNA Steering Committee identified vulnerable populations and worked with local organizations to coordinate focus groups and key informant interviews to ensure that minority populations - the voices of those with chronic disease, low incomes, and the underserved - were heard. In total, nine focus groups were conducted with 40 participants, and seven key informant interviews were held. Civic government & leadership, community-based organizations focusing on early education, education, low-income, medically underserved, minority populations, older adults, provider, substance use, students, workforce representatives, and unhoused populations were represented in the primary data collection.
Willits Hospital, Inc. DBA Adventist Health Howard	Part V, Section B, Line 6a: Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial Hospital (AHHM) and Adventist Health Mendocino Coast (AHMC) worked together to produce the 2022 CHNA.
Willits Hospital, Inc. DBA Adventist Health Howard	Part V, Section B, Line 6b: Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) collaborated with Building Bridges, Head Start, Housing Action Team, Mendocino Area Parks Association, Mendocino County Department of Public Health, Mendocino County Office of Education, Mendocino County Probation Department, Mendocino County Farm Bureau, Mendonoma Health Alliance, Rural Communities Housing Development Corporation, and Willits Senior Center.
Willits Hospital, Inc. DBA Adventist Health Howard	Part V, Section B, Line 11: Tax year 2023 was Year One of the Implementation Strategy for the 2022 Community Health Needs Assessment (CHNA). Programs and activities provided to the community were in response to the priority health needs identified in the 2022 CHNA. Our 2022 CHNA identified three areas of significant need: Access to Care; Financial Stability and Health Risk Behaviors. Priority Need One: Access to Care - Barriers.Goal is to provide medical services to community members with no transportation. Strategy is to provide medical services to the homeless population through street medicine. FY 2023 Community Impact Activities and Outcomes:Throughout 2023, Adventist Health Street Medicine Program, a collaborative effort of the Adventist Health COMPASS Street Medicine Team and the Adventist Health Family Medicine Residency Street Medicine Active Resident Training (SMART) Track Program, provided and coordinated vital services for people experiencing homelessness (PEH) within Mendocino County. Through collaboration with community partners (Redwood Community Service's Building Bridges Homeless Resource Center, Redwood Gospel Mission's Center for Hope, and the Ukiah Community Food Bank), medical care was provided at over 100 Street Medicine clinics during 2023. Over 400 individuals received care totaling more than 1,000 encounters. The COMPASS Street Medicine team is a multidisciplinary care team with a registered nurse, care coordinator, social worker, physician, nurse practitioner, and licensed therapist. The SMART Track program trains family medicine physicians to competently and compassionately work within a team to provide health care services (including but not limited to MAT, Hepatitis C treatment, and place-based care) to homeless individuals. Three physician residents and multiple resident faculty physicians participated in the program in 2023.The Street Medicine Program also took a new collaborative step forward in 2023 when Mendocino Community Health Clinics' (MCHC) care management staff began integrating into existing clinics. This collaboration has helped improve the quality of care provided via the Street Medicine clinics for patients already established at MCHC for primary care and expanded the primary care access options for person experiencing homelessness (PEH) in Mendocino County.Further amplifying their impact on Street Medicine access in Mendocino County, the COMPASS Team spearheaded the planning for the inaugural Mendocino County Street Medicine Collaborative meeting to be held in February of 2024. This landmark event will convene a diverse group of partner agencies, including MCHC, MCHC's Ryan White Program, MCHC's Community Care Program, MCHC's Medication-Assisted Treatment (MAT) Program, Consolidated Tribal Health Project Outreach, Mendocino Coast Clinic's Street Medicine Program, Mendocino Coast Hospitality Center's Street Medicine Project, AHUV's Family Medicine Residency, Adventist Health's Substance Use Navigation (SUN) program, and Mendocino County AIDS/Viral Hepatitis Network. The goal of this effort is to improve the health and well- being of Mendocino County's PEH via expanded access to physical, mental and social health services through increased community collaboration.After a mid-year needs assessment, the COMPASS Street Medicine team reevaluated its resources and identified better locations to increase the number of PEH being served. This included expanding the amount of time and resources dedicated to outreach to homeless encampments.Priority Need One: Access to Care - Insurance.Goal is to verify/re-verify MediCal eligibility for vulnerable populations.Strategy is to provide education and outreach to medical providers (Registrars, Community Health Workers, Substance Use Navigators) to identify those medically eligible patients and help enroll or re-enroll them in available benefits and direct them to ongoing services.FY 2023 Community Impact Activities and Outcomes:During 2023, AHUV, AHHM and AHMC collaborated with multiple community agencies and organizations to mitigate the potential disruption in healthcare access for Medi-Cal members during the unwinding of the Pandemic Era Medicaid Continuous Coverage Requirement. The restart of Medicaid (Medi-Cal) renewals necessitated a proactive approach to ensure smooth access to healthcare services for individuals with lapsed Medi-Cal coverage needing assistance with the renewal process, as well as those needing assistance applying for other coverage if found to be ineligible for Medi-Cal.A multi-faceted strategy was implemented. A marketing campaign was launched across multiple media platforms, both internally for Adventist Health associates as well as a public media campaign which included social media blasts and educational materials in the form of banners, posters, flyers, and handouts posted and made available in the three hospitals and many ambulatory care clinics run by AHMC. Front-line Adventist Health associates working in patient registration, scheduling and insurance verification were provided training to help navigate patients toward Medi-Cal renewal or to Covered California for other coverage options. Adventist Health collaborated with its revenue cycle management partner to expand the population scope for its insurance navigation program. When appropriate, Adventist Health associates collaborated with other agencies to provide navigation support to patients at high risk of losing their Medi-Cal coverage for procedural reasons (change in address, homelessness, disability, language barrier, etc).Additional programs/activities not included in the 2023 Community Health Implementation Strategy that promote access to care that were provided by AHUV, AHHM, and AHMC included physician recruitment efforts.Almost 77% of the population of Mendocino County live in an area affected by a shortage of primary care providers. This shortage contributes to access to care and health status issues within the community. In an effort to combat a shortage of providers, AHUV, AHHM, and AHMC has strived to recruit and retain primary care, dental and mental health professionals. In 2023, AHUV onboarded four primary care advanced practice providers; two primary care physicians; one ophthalmologist; one advanced practice provider specializing in hematology/oncology and one advanced practice provider specializing in psychiatry. AHMC onboarded two primary care advanced practice providers; two advanced practice providers of which one is an orthopedic specialty and the other is a psychologist. AHHM onboarded one primary care advanced practice provider: one advanced practice provider in orthopedics and two general surgeons. In addition, the Incubate Program which is a collaborative effort between the three Hospitals and the community was commenced in 2023. Its goals extended beyond immediate support for physicians to create a long-term vision of a sustainable healthcare environment in Ukiah Valley. Key factors identified during the quarterly summits included the need to foster collaboration between various stakeholders, including healthcare providers and public health organizations; a focus on diversity, equity, and inclusion; and the priority of physician wellness by ensuring they have the support they need to thrive in their community as well as in their work.Priority Need Two: Financial Stability.Goal is to identify vulnerable, unstably housed community members and connect with Community Health Workers for Support services through CalAIM funding.Strategy is to utilize the COMPASS Street Medicine team identify unstably housed clients and connect them with services within the county that afford financial assistance.FY 2023 Community Impact Activities and Outcomes:With more than a dozen contracted CalAIM provider organizations in Mendocino County, AHUV, AHHM, and AHMC identified the need for increased navigation support for people experiencing homelessness (PEH) who are desperately in need of the services provided through CalAIM. The COMPASS team provided care coordination to PEH accessing services across multiple healthcare providers; including Adventist Health Hospitals, primary care and specialty clinics, Mendocino Community Health Clinics, Consolidated Tribal Health Project, Round Valley Health Center, and Mendocino Coast Clinics.The COMPASS team participates in multiple monthly meetings with other community agencies and organizations where the delivery of services is coordinated and planned, including the Mendocino County Homeless Service Continuum of Care (a collaborative of over 31 agencies throughout Mendocino County), the Mendocino County CalAIM Collaborative, and Mendocino County Adult Protective Services.
Part V, Section B, Line 11, continuation:	In 2023, the COMPASS team provided ongoing care management services to 320 people experiencing homelessness. Of those served, 57% were medically complex with a severe mental health diagnosis and 81% were medically complex with substance use disorder. The population served had a 36% reduction in hospitalizations, 64% reduction in emergency room visits, and a 27% increase in primary care visits.In 2023, the COMPASS team received and provided specialized palliative care and advanced care planning training for marginalized populations. COMPASS provided these trainings to multiple organizations serving PEH, including Hospitality House Homeless Shelter, Consolidated Tribal Health Project, Redwood Community Services' Building Bridges Homeless Resource Center, Mendocino County Adult Protective Services, and Mendocino Community Health Clinic and their Ryan White Program. The COMPASS team also formed the Mendocino County Hospice and Palliative Care Collaborative, which brought together multiple hospice and palliative care providers to discuss care collaboration instead of competition. VyncaCare, Hospice of Ukiah, Madrone Care Network, and RCMS Community Healthcare all attended these quarterly meetings in 2023.Further amplifying their impact, the COMPASS team spearheaded the inaugural Mendocino County Street Medicine Collaborative meeting to be held in February of 2024. This landmark event will convene a diverse group of partner agencies, including Mendocino Community Health Clinic, the MCHC Ryan White Program, MCHC Community Care, MCHC Medication-Assisted Treatment (MAT) Program, Consolidated Tribal Health Project Outreach, Mendocino Coast Clinics Street Medicine Program, Mendocino Coast Hospitality Center's Street Medicine Project, Adventist Health Ukiah Valley Family Medicine Residency, Adventist Health COMPASS Street Medicine and Substance Use Navigation (SUN) program, and Mendocino County AIDS/Viral Hepatitis Network. This collaborative effort will be dedicated to improving the health and well-being of Mendocino County's PEH through community collaboration.All three Adventist Health Hospitals work with the COPE Health Scholar program to provide educational opportunities for individuals interested in making a difference in health care by working together to advance their careers through firsthand experience in clinical and administrative health care settings to become an integral part of the care delivery team. Cope Scholars assist with basic care for patients alongside nurses, physicians and other members of the care delivery team, and have opportunities to learn the "business" of health care, preparing them for a health care career and helping earn volunteer hours for medical school, nursing school, and other graduate programs while positioning students well for entry-level positions in healthcare.Priority Need Three: Health Risk Behaviors - Diet.Goal is to reduce the obesity rate among teens and adults through targeted food and diet education.Strategy is to improve health food and beverage access.FY 2023 Community Impact and Activities: Working closely with the Blue Zones Project Mendocino County team, the City of Ukiah Update Plan included the implementation of three food policy initiatives: 1. Adopted Healthy food and beverage standards and wellness policies at all city facilities. 2. Adopted institutional wellness policies that reduce and/or eliminate sugar-sweetened beverages in out-of-school programs, as well as parks and recreation sites and programs. 3. Adopted policy to incentivize landowners to allow community-based agriculture on their nonproductive property. In addition, work was done in 2023 to plan and host the reinstitution of the North Coast Farmers' Convergence, an annual gathering of producers and consumers to strengthen long-term capacity and collaboration across food systems-focused organizations and initiatives.Priority Need Three: Health Risk Behaviors - Illicit Drugs.Goal is to increase access to treatment in a community with high substance use and overdose rates.Strategy is to create policies and spaces for the treatment of substance use disorders and reduce harm to people who use substances.FY 2023 Community Impact and Activities: In 2023, AHUV, AHHM, and AHMC continued the CA Bridge model of care for addiction treatment, the Substance Use Navigator provides brief screening and intervention for people with substance use and behavioral health needs in the emergency department, inpatient setting and community members in need. The SUN team provided navigation 1,282 times, which resulted in 385 referrals to treatment: 137 into MAT treatment, 77 to Behavioral Health services, and 171 to residential treatment. SUN navigators also participate in Mendocino County Jail discharge planning and meet weekly to coordinate reentry directly to MAT and residential treatment services.All three Adventist Health Hospitals in Mendocino County participate in the SafeRx Mendocino program and the Naloxone Distribution Project. Mendocino County's SafeRx program tackles the opioid crisis through a two-pronged approach: prescriber education and harm reduction. For medical professionals, SafeRx offers training on safe opioid prescribing practices, encouraging the use of the CURES 2.0 prescription monitoring database to prevent overprescribing. The program also focuses on patient education, providing resources to help people understand their opioid prescriptions and navigate conversations with their doctors. Additionally, SafeRx works on harm reduction by facilitating access to naloxone (Narcan), a medication that can reverse opioid overdoses. Through these efforts, Mendocino County's SafeRx program aims to prevent opioid misuse and addiction while equipping the community to respond to potential overdoses. In 2021, Mendocino County had the highest fatal overdose rate of any county in California, at 54.7 per 100,000 residents. Data through the third quarter of 2023 shows that rate had dropped to 44.0 per 100,000 residents.Priority Need Three: Health Risk Behaviors - Tobacco Use.Strategy One: Decrease youth tobacco use and availability of cigarettes, e-cigarettes, and all flavored tobacco products.Strategy Two: Create systems and supports that target tobacco use prevention and cessation.FY 2023 Community Impact and Activities:AHUV, AHHM, and AHMC and the Blue Zones Project worked closely with the City of Ukiah to adopt policies pertaining tobacco use in Mendocino County. One policy was to provide a smoke-free multi-unit housing policy to include individual units, balconies, patios, and common indoor and outdoor areas and the adoption of outdoor policies that eliminate secondhand smoke and aerosol exposure including dining areas, entryways, public events, recreation areas, service areas, sidewalks, and outdoor worksites. The City of Ukiah adopted a Tobacco Retail License (TRL) that includes ending the sale of flavored tobacco products including fruit, candy, mint, and menthol flavors and eliminate possession, use and purchase (PUP) penalties.The City of Willits adopted a Tobacco Retail License (TRL) that includes ending the sale of flavored tobacco products including fruit, candy, mint, and menthol flavors and eliminate possession, use and purchase (PUP) penalties. Significant needs not met:No hospital can address all the health needs identified in its community. AHUV, AHHM and AHMC are committed to serving the community by adhering to its mission, and using its skills, expertise and resources to provide a range of community benefit programs. Areas of significant health needs that will not be directly addressed at this time include housing, mental health, food security, environment & infrastructure, inclusion & equity, COVID, education, community vitality and community safety. While these health needs are not addressed directly, they will likely benefit from the collective efforts of our community partnerships.
Part V, Section B, Line 13h:	Patients who do not meet the income criteria, may be eligible for financial assistance based on essential living expenses and resources. The following two (2) qualifications must both apply:1. Essential living expenses: Exceed fifty percent (50%) of the household income; and2. Resources: The patient's excess medical expenses (the amount that allowable medical expenses are greater than 50% of annual household income) must be greater than available qualifying assets.

Schedule H (Form 990) 2023

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address		Type of Facility (describe)
1	1 - Adventist Health Howard Memorial - RHC 3 Marcela Drive Suite C Willits,CA95490	RHC
2	2 - Adventist Health Howard Memorial - OP 3 Marcela Drive Suite D Willits,CA95490	O/P physical therapy
3	3 - Adventist Health Howard Memorial - Retai 3 Marcela Drive Suite B Willits,CA95490	Retail pharmacy
4
5
6
7
8
9
10

Schedule H (Form 990) 2023

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference	Explanation
Part I, Line 7:	The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (provision for bad debts + other revenue + interest income)/gross patient chargesThe Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government.
Part II, Community Building Activities:	The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020, Adventist Health acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be able to gain ground in shifting the balance from healthcare treating people once they are ill to transformative well-being changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint. In 2022, these projects were active and growing. In 2023, we saw tremendous growth in several of our markets promoting walking moais, worksite wellness, Blue Zones Project school pledges to create an environment that instills healthy lifestyle choices for our children and Blue Zones Project restaurant pledges to provide healthy options. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease.
Part III, Line 2:	Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2.
Part III, Line 3:	The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.
Part III, Line 4:	The Adventist Health audited combined financial statements do not contain a footnote describing bad debt expense.
Part III, Line 8:	The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals. For further information, please refer to Schedule H, Part III, Section B.
Part III, Line 9b:	When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income, and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest
Part VI, Line 2:	Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) promote access to their 2022 Community Health Needs Assessment (CHNA), the 2023 Community Health Implementation Strategy (CHIS) approved in fiscal year 2023, and the Year One Update, FY 2023 for the Community Health Implementation Strategy by posting their reports on the Hospital's website at:https://www.adventisthealth.org/howard-memorial/about-us/community-benefit/The two most recent Community Health Needs Assessments, the two most recent Implementation Strategy reports and the 2021, 2022 and 2023 Community Health Plan Updates are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, Adventist Health supports local partners to augment our own efforts, and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of our region. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community.In addition to the CHNA, the Hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level. Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact.
Part VI, Line 3:	The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at: https://www.adventisthealth.org/patient-resources/bill-pay/financial-assistance/ The documents are available in multiple languages. The link to the Hospital's Self-Pay Billing and Collection Policy is posted at:https://www.adventisthealth.org/documents/system/13863-self-pay-billing-and-collection-policy.pdfAt the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The Hospital also provides a brochure during the registration process that explains the Hospital's billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance.
Part VI, Line 4:	From spectacular ocean views, redwood forests, and picturesque towns, the CHNA service area for Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM) and Adventist Health Mendocino Coast (AHMC) is a breathtaking community with a total population of 116,095. Throughout the County people enjoy activities such as the Mendocino Art Center, Theatre Company, and music and film festivals. The median household income is $56,401. The largest segment of the population (37.2%) is made up of residents aged over age 55. The community is known as a location focused on the well-being of its residents with support in the built environment, grocery stores and access to care while also implementing a Blue Zones Project. Among this population, 59.95% of an individual's income is spent on housing and transportation, while 20.66% of children live in poverty and 6.67% of students are unhoused, compared to the state average of 4.25% and national average of 2.77%. 15.9% of the population smoke tobacco, which is a higher rate than in California (11.5%). The teen birth rate is 21.4 per 1,000 females, which is greater than the state's teen birth rate of 15.6 and the national rate of 19.3. The percentage of infants with low birth weight is significantly greater, with Mendocino's rate at 15.1% compared to the state at 6.9%.The AHUV, AHHM, and AHMC CHNA market has a total population of 116,095 (based on the 2020 Decennial Census). The largest city in the service area is Ukiah, with a population of 16,075. The service area is comprised of the following zip codes: 95415, 95463, 95410, 95445, 95460, 95428, 95488, 95449, 95437, 95425, 95453, 95589, 95427, 95456, 95469, 95459, 95468, 95432, 95490, 95429, 95417, 95482, 95587, 95466, 95470, 95494, 95420, 95454, 95585. 62.33% of the population owns their home and 37.67% of the population rent their home. Total Population by age groups: Age 0-4: 5.8%, Age 5-17:14.9%, Age 18-24: 7.4%, Age 25-34: 11.1%, Age 35-44: 11.7%, Age 45-54: 11.9%, Age 55-64: 14.6%, Age 65+: 22.6%.
Part VI, Line 5:	Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "Triple Aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low-income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders.As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy.Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy - even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population, 2. Factors that cause the present outcomes distribution, and3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to:1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors,2. Improve care quality and patient safety, and3. Advance care coordination across the health care continuum.We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community.
Part VI, Line 6:	The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as tele-pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals.
Part VI, Line 7, Reports Filed With States	CA
Part VI: Other Information:	Adventist Health Ukiah Valley (AHUV), Adventist Health Howard Memorial (AHHM), and Adventist Mendocino Coast (AHMC) are proud sponsors of Blue Zones. From May through December 2021, the Blue Zones Project Mendocino County (BZPMC) team assessed Mendocino County's readiness to undertake the community well-being transformation initiative where the healthy option becomes the easy option through permanent changes in environment, policy, and social networks. The Blue Zones Project team conducted a comprehensive analysis of the current state of well-being and met with local leaders and stakeholders across all sectors to learn about the strengths, challenges, and opportunities for improving well-being in Mendocino County and summarized their findings in the Blue Zones Project Discovery Report. The findings in that report were coupled with expert-led discovery meetings in the policy areas of built environment, tobacco, and food policy to inform the Blueprint for Blue Zones Project implementation in Mendocino County. Here is a summary of progress outcomes for 2023 for the three main pillars of engagement of people, places, and policy. PEOPLEIn 2023 over 3,600 unique individuals 15 years or older participated in Blue Zones Project (BZP) activities. Those activities are as follows: - 1,582 individuals completed the RealAge Test, our Community Wellbeing Survey. The local team advocated for paper surveys to reach community members with no access to internet/email. Because of this, we were able to reach a more diverse population than we did in our baseline year when we didn't have the option of paper surveys.- 14% of people engaged have participated in multiple BZP activities.- The Engagement Committee has broad representation geographically and demographically including inland and Coastal representation consisting of Indigenous, Latino, older adults, parent, and people with disabilities. - Partnerships with Tribal, Latino and the Recovery communities to include participation in purpose moais at Brush Meadows housing complex for migrant farm workers; Zumba Muevete port u Salud; Annual Dia del Nino and Hispanic Heritage events; Spirit Walkers (recovery group) walking moais and purpose workshops; Round Valley Earth Day Celebration; Redwood Valley Little River Band of Pomo Indians Spirit run; Pinoleville Pomo Nation BZP story speech; and attending walking moais, a health fair and the Gathering of Native Americans with the Coyote Valley Band of Pomo Indians. - Partnership with Mendocino Community College (MCC) to include participation at the Dia de Los Muertos; Latino student retreat; cooking demonstrations with MCC CalFresh food distribution program in partnership with Mendocino County CalFresh Healthy Living Program; MCC walking moais (inland and Coast); Native American Heritage Celebration; and the Healthy Body/Healthy Mind educational series.- Facilitated the second largest Purpose Workshop with 180 staff members for all North Coast Opportunities (NCO) employees in partnership with Blue Zones Project Lake County. - Alternative Education High School Engagement with: Big Picture Ukiah Blue Zones Story Speech, Big Picture Fort Bragg cooking demonstrations series, Sanhedrin High School Willits purpose workshop, and Willits High School Community Learning Center (adults with disabilities).- Signature Blue Zones Project events in 2023 included attendance at: Blue Zones story speeches with 6,140 individuals; 11 walking moais with 120 individuals; six purpose workshops with 78 individuals; 28 cooking demonstration/classes with 90 individuals; five volunteer events with 186 individuals and 25 people downloading the Sharecare digital platform. PLACESSchools: Dana Gray Elementary School and Big Picture Alternative High School in Fort Bragg Unified School District achieved BZP Approval status in 2023 and one is in progress for approval early in 2024.Brookside Elementary School and Sanhedrin Alternative High School in Willits Unified School District achieved BZP Approval status in 2023 and one is in progress for approval early in 2024. The BZPMC team is working to set up a planning meeting to create an implementation plan for 2024 in the Ukiah Unified School District.Restaurants: Brickhouse Coffee in Willits, Cafe One in Fort Bragg and Roots Cafe AHHM all achieved Blue Zones Approval status in 2023. Three more are registered, actively engaged in the pledge process, and nearing approval in early 2024.Grocery Stores: Harvest Market in Fort Bragg became Blue Zones approved in October 2023, and the team is actively seeking engagement from two additional grocery stores.Worksites: North Coast Opportunities became Blue Zones Approved in July 2023. Six additional employers are actively working through the pledge process with four approvals expected in early 2024.POLICY Built Environment: Worked with the City of Ukiah General Plan Update to include three built environment policy Initiatives: 1. Active Transportation Plan, 2. Great Redwood Trail connectivity and expansion, and 3. Complete Streets Policy Also, the City of Ukiah requested technical assistance from the BZPMC team in the form of conceptual design for the Perkins and Gobbi Gateway Project, a project that focuses on safety for all modes of transportation and placemaking elements.Capacity Building: Hosted three Complete Streets Workshops for the City of Fort Bragg, the City of Willits, and Mendocino County; joined the Technical Advisory Committee for Mendocino Council of Governments' (MCOG) Mobility Solutions Feasibility Study to define challenges and find solutions for unincorporated Mendocino County communities with no access to public transportation; and worked with the City of Ukiah Clara Avenue Construction Project for a remodel of existing throughfares to include bicycle and pedestrian infrastructure for Complete Streets implementation.

Schedule H (Form 990) 2023

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

2023

Open to Public
Inspection

Name of the organization
Willits Hospital Inc

Employer identification number
68-0108919

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) CA Health Fund & Trust 1215 K Street Suite 800 Sacramento,CA95814	94-1498697	501(c)(3)	34,115	0			General Support

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2023

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:	Annual assistance is provided with no reporting required by recipient.

Schedule I (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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? ....

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2023

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, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Heinrich Kerry Dir/Chair/CEO	(i) (ii)	0 ------------- 2,017,000	0 ------------- 1,208,880	0 ------------- 76,548	0 ------------- 13,296	0 ------------- 44,099	0 ------------- 3,359,823	0 ------------- 0
2Hofheins Todd Dir/Vice Chair/COO	(i) (ii)	0 ------------- 1,389,462	0 ------------- 735,265	0 ------------- 147,865	0 ------------- 13,296	0 ------------- 62,845	0 ------------- 2,348,733	0 ------------- 0
3Beaman John CFO/Assistant Secretary	(i) (ii)	0 ------------- 1,091,769	0 ------------- 569,149	0 ------------- 19,635	0 ------------- 13,296	0 ------------- 60,059	0 ------------- 1,753,908	0 ------------- 0
4Stevens Eric - President Northern CA/HI State Network	(i) (ii)	0 ------------- 1,045,616	0 ------------- 319,995	0 ------------- 160,682	0 ------------- 13,296	0 ------------- 46,256	0 ------------- 1,585,845	0 ------------- 0
5Jahn Andrew - Former Care Division President thru 02/22	(i) (ii)	0 ------------- 1,044,420	0 ------------- 406,990	0 ------------- 14,496	0 ------------- 53,160	0 ------------- 50,625	0 ------------- 1,569,691	0 ------------- 0
6Nahapetian Arby - Former Care Division Medical Off thru 02/22	(i) (ii)	0 ------------- 967,385	0 ------------- 329,621	0 ------------- 185,288	0 ------------- 13,296	0 ------------- 56,317	0 ------------- 1,551,907	0 ------------- 0
7Wells Jason Former President thru 12/20	(i) (ii)	0 ------------- 892,808	0 ------------- 337,640	0 ------------- 240,134	0 ------------- 13,296	0 ------------- 23,881	0 ------------- 1,507,759	0 ------------- 0
8Wing Bill - Former Dir/Asst Secr/Vice Chair thru 01/22	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 1,438,460	0 ------------- 13,296	0 ------------- 26,777	0 ------------- 1,478,533	0 ------------- 0
9Charpentier Paul Physician	(i) (ii)	1,332,294 ------------- 0	19,200 ------------- 0	0 ------------- 0	12,672 ------------- 0	38,764 ------------- 0	1,402,930 ------------- 0	0 ------------- 0
10Jobe Meredith Secretary	(i) (ii)	0 ------------- 660,525	0 ------------- 168,715	0 ------------- 130,248	0 ------------- 13,296	0 ------------- 46,114	0 ------------- 1,018,898	0 ------------- 0
11Howe Judson - President AHHM Pres, North Coast Network thru 03/22	(i) (ii)	0 ------------- 538,154	0 ------------- 186,337	0 ------------- 84,404	0 ------------- 13,296	0 ------------- 15,701	0 ------------- 837,892	0 ------------- 0
12Tetz Warren - Former Treas/Asst Secr thru 12/22	(i) (ii)	0 ------------- 17,731	0 ------------- 125,629	0 ------------- 416,665	0 ------------- 13,296	0 ------------- 45,539	0 ------------- 618,860	0 ------------- 0
13Eberhart Gregory Area Medical Officer	(i) (ii)	0 ------------- 516,674	0 ------------- 19,931	0 ------------- 46,341	0 ------------- 13,296	0 ------------- 14,663	0 ------------- 610,905	0 ------------- 0
14Spenst Brett - Former Care Division Finance Officer thru 02/22	(i) (ii)	0 ------------- 259,692	0 ------------- 250,809	0 ------------- 10,124	0 ------------- 13,296	0 ------------- 32,551	0 ------------- 566,472	0 ------------- 0
15Mock Jeffrey Treasurer/Asst Secr as of 09/23	(i) (ii)	0 ------------- 344,451	0 ------------- 53,131	0 ------------- 72,809	0 ------------- 13,296	0 ------------- 54,501	0 ------------- 538,188	0 ------------- 0
16Shepardson Dean - Treasurer Asst Secr from 03/23 thru 09/23	(i) (ii)	0 ------------- 307,500	0 ------------- 25,000	0 ------------- 129,343	0 ------------- 13,296	0 ------------- 42,465	0 ------------- 517,604	0 ------------- 0
17Assadian Hoda Operations Executive	(i) (ii)	0 ------------- 329,595	0 ------------- 101,331	0 ------------- 29,999	0 ------------- 13,296	0 ------------- 39,081	0 ------------- 513,302	0 ------------- 0
18Givens Linda Patient Care Executive/Administrator	(i) (ii)	0 ------------- 305,709	0 ------------- 60,305	0 ------------- 36,976	0 ------------- 13,296	0 ------------- 54,673	0 ------------- 470,959	0 ------------- 0
19D'Anis Matthew Director, Pharmacy	(i) (ii)	239,925 ------------- 0	23,159 ------------- 0	22,702 ------------- 0	10,344 ------------- 0	69,941 ------------- 0	366,071 ------------- 0	0 ------------- 0
20Radell Raymond Certified RN Anesthetist	(i) (ii)	281,540 ------------- 0	6,669 ------------- 0	0 ------------- 0	11,163 ------------- 0	23,418 ------------- 0	322,790 ------------- 0	0 ------------- 0
21Niderost Gregory Certified RN Anesthetist	(i) (ii)	271,949 ------------- 0	6,712 ------------- 0	0 ------------- 0	7,931 ------------- 0	35,698 ------------- 0	322,290 ------------- 0	0 ------------- 0
22Buckingham Amy Associate Patient Care Executive	(i) (ii)	0 ------------- 229,280	0 ------------- 27,036	0 ------------- 1,305	0 ------------- 13,296	0 ------------- 50,169	0 ------------- 321,086	0 ------------- 0
23Ramirez Johann - Admin Director, Business Dev & Strategy	(i) (ii)	91,778 ------------- 0	30,600 ------------- 0	139,874 ------------- 0	8,699 ------------- 0	49,864 ------------- 0	320,815 ------------- 0	0 ------------- 0
24Byrnes John - Former Medical Officer, NCR thru 02/20	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 263,659	0 ------------- 13,183	0 ------------- 21,772	0 ------------- 298,614	0 ------------- 0
25Parker Bessant - Former Area Medical Officer thru 03/22	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 211,890	0 ------------- 10,594	0 ------------- 41,772	0 ------------- 264,256	0 ------------- 0

Schedule J (Form 990) 2023

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, Lines 4a-b

Severance payments are made based upon agreements between certain qualifying employees and Adventist Health System/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Byrnes, John - severance payment - $262,731 Parker, Bessant - severance payment - $212,500 Ramirez, Johann - severance payment - $112,232 Tetz, Warren - severance payment - $416,673 Wing, Bill - severance payment - $1,440,800 Select executives agreed to participate in CAP-EX in place of a traditional insurance SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life insurance participants are John Beaman, Kerry Heinrich, Todd Hofheins, Andrew Jahn, Brett Spenst, Jack Wagner, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2023

Schedule J (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Return Reference	Explanation
Form 990, Part III, Line 4a:	Willits Hospital Inc., DBA Adventist Health Howard Memorial (AHHM), provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although, reimbursement for services rendered is critical to the operation and stability of AHHM, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following coverage will be considered when individuals who need health care cannot afford to pay: - Free care and/or subsidized care - Care to persons covered by governmental programs at/or below cost - Health/wellness activities and community education programs Not only does AHHM provide low-cost care to individuals covered by government programs, and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHHM recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2023 was $7,764,569. The following Inpatient services were provided to all our patients: - 589 surgeries performed - 6,101 patient days The following Outpatient services were provided to all our patients: - 14,574 emergency department visits - 958 outpatient surgeries performed - 33,677 outpatient visits - 20,277 clinic visits AHHM recognizes it has an obligation to provide human services above and beyond its role as a healing facility. Schedule H provides more details on the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2023 was $3,660,165. Adventist Health's mission statement of living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry, as represented by the life of Jesus Christ, and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs, and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ A conversation with Judson Howe By Karen Rifkin for The Ukiah Daily Journal reported May 5, 2023: According to the Soil Test Report, commissioned by Adventist Health last December, to determine the viability of the community to recruit and sustain primary care doctors, "...Ukiah is home to 19,000 residents... known for its beautiful views, great climate, recreational activities, and wineries. Despite these attributes, AHUV struggles with provider recruitment and retention national report revealed that nearly one in five health care workers have left their jobs during the COVID-19 pandemic, citing environmental strains related to the pandemic, poor pay, and burnout as primary reasons." Judson Howe is the President of Adventist Health's North Coast Network that includes six facilities operating in burnout and loss of purpose which is causing us to question why we make the sacrifices we make every day; and it's especially challenging under these circumstances to find and recruit physicians. With the needs being greater than what physicians can provide, creating human suffering that cannot be solved or cured, he is seeking solutions for breaking out of this cycle, a situation not unique to Mendocino County but of national import. According to an article from the Press Democrat dated March 6, 2021, Lake County had the highest rate of fatal overdoses statewide in 2019 with more than 60 deaths per 100,000 people, more than triple the statewide average rate of 19.6. Mendocino County came second on the list with an overdose death rate of just over 40 fatalities per 100,000, followed by San Francisco County. Howe adds to these statistics: the county is burdened with severe impairments in the social determinants of health; adverse childhood experiences four times the national norm; alcohol use two times the national norm; and severe mental illness that is worsening. He estimates there are 50 primary care providers in the county with a need for 25 more and he is looking for a way for the hospital and community to come together to break out of this impasse and develop a viable method of recruiting and retaining physicians, to support, appreciate and acknowledge what they do and to build capacity for them to preserve themselves for tomorrow. The Soil Test Report identifies that some of the biggest challenges are stability of physician workforce, call/practice coverage, mental health, spousal satisfaction and specialist availability. Corporate medicine is identified as a problem. "We're seeing a loss of empathy and kindness in the medical space; at AHUV we often fail to put a human face to our business," he says. The report points out the importance of doctors having access to specialists, allowing them to practice full spectrum medicine - the way doctors practiced in an earlier era, with a broader spectrum of practice as opposed to hyper-specialization. "The idea that health care is a relationship between the patient and the provider and to build that continuity within the same visit are what full spectrum residencies are going for. We're a full spectrum program, cradle to the grave." But that is not their present reality. "It can take weeks or months to see a doctor and there are not enough. Our current health inequities are massive to the point where senior citizens cannot get in to see a provider." Howe is currently working with Benjamin Anderson, formerly the CEO of Kearney County Hospital in rural, western Kansas, who developed a successful model for medical provider recruitment. Anderson says they developed a culture that allowed them to recruit medical staff - everything from a sustainable on-call structure to building a sense of trust between medical providers and administration. He says by way of providing support, he and his wife babysat a physician's two-year-old daughter; and that most important is communicating that they care about their team members and their families. Howe says, "Everyone needs to stop competing and create access for health care together - not just Adventist Health but Mendocino Community Health Clinic and other stakeholders and providers, as well. We need to be willing to be accessible and humble, to create a safe vulnerable space so we can have a conversation about the collective health needs of the community. "Recruiting on wine, Redwoods and the coast is not sufficient; we have to recruit differently to missional providers, those who realize there's a problem and want to be a part of the solution; we need to initiate a community-led approach to health care with community resources augmenting the physician. That's what we're doing with the Incubate Program." The Incubate Program is a county-wide, collaborative task force sponsored by Mendocino County Health Clinic; Adventist Health; Ukiah Valley Residency Program; North Coast Opportunities; and the Mendocino County Public Health Department to cultivate a supportive training environment for full-scope family medicine in Ukiah, connecting provider and community well-being. Its volunteer members meet twice a quarter with the intention of uniting diverse stakeholders and constructing a supportive environment for physician residents and their families. Their goals include summarizing the current state of workforce challenges, implementing collaborative solutions and developing multi-year strategies. "We need to have housing - viable, sticky neighborhoods where physicians can stay, help connect them to our community, appreciate them and...we need to support local medicine. Every time a patient leaves the community, it takes away a local job. "I want to gather people who want to be part of the conversation, who want to be part of the solution."
Form 990, Part VI, Section A, line 4	The Hospital's Articles of Incorporation were amended for the following: 1. Article III was updated to allow for the Board of Directors of the Hospital to have sole authority to amend or repeal the Articles of Incorporation, subject to the additional approval of the Board of Directors of Adventist Health System/West. The Hospital has no members within the meaning of Section 5056 of the California Corporations Code. The Hospital's Bylaws were amended for the following: 1. Article 2 was removed and the Hospital has no members. All sections relating to the membership were removed. 2. Article 5 was revised to indicate that only directors may serve as the chair of the Board and that the vice chair of the Board is designated by the Chief Executive Officer of Adventist Health System/West.
Form 990, Part VI, Section A, line 7a	The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors.
Form 990, Part VI, Section A, line 7b	The Board of Directors of the Hospital shall have sole authority to amend or repeal the Articles of Incorporation, subject to the additional approval of the Board of Directors of Adventist Health System/West. The Hospital does not have any Members.
Form 990, Part VI, Section B, line 11b	This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the Corporate Finance Officer and Market Financial Officer, and shared by electronic communication with the Corporation's Board of Directors prior to filing.
Form 990, Part VI, Section B, line 12c	During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital corporate officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the market president or the System General Counsel immediately. The System General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The System General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System General Counsel retains the COIs for all individuals. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board.
Form 990, Part VI, Section B, line 15	The Hospital's Board of Directors has established a Human Resources Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets at least annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, 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 executives, with midpoints aligned with the 60th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum.
Form 990, Part VI, Section C, line 19	The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency.
Form 990, Part VII:	Board compensation is for Adventist Health System/West Board of Directors only - not hospital Board of Directors.
Form 990, Part IX, line 11g	Physician professional fees: Program service expenses 8,479,629. Management and general expenses 61,652. Fundraising expenses 0. Total expenses 8,541,281. All other purchased services: Program service expenses 3,311,873. Management and general expenses 250,365. Fundraising expenses 0. Total expenses 3,562,238. Contract labor: Program service expenses 3,149,061. Management and general expenses 27,759. Fundraising expenses 0. Total expenses 3,176,820. Other medical professional fees: Program service expenses 584,970. Management and general expenses 0. Fundraising expenses 0. Total expenses 584,970. Purchased medical services: Program service expenses 403,723. Management and general expenses 1,794. Fundraising expenses 0. Total expenses 405,517. Consulting and other management fees: Program service expenses 134,727. Management and general expenses 255,880. Fundraising expenses 0. Total expenses 390,607. Repairs and maintenance: Program service expenses 1,244,737. Management and general expenses 5,416. Fundraising expenses 0. Total expenses 1,250,153. Other professional fees non-medical: Program service expenses 5,014. Management and general expenses 49,468. Fundraising expenses 0. Total expenses 54,482.
Form 990, Part XI, Line 8:	Prior period adjustments were a result of cash balance correction and clean up books due to prior period activities including debt service, capital expenditures, and other items.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

Willits Hospital Inc

Employer identification number

68-0108919

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake,CA95422 68-0395149	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(2)Adventist Health Delano 1401 Garces Hwy Delano,CA93215 77-0258013	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(3)Adventist Health Foundation 1 Adventist Health Way Roseville,CA95661 68-0002188	Charitable foundation	CA	501(c)(3)	Line 7	Adventist Health SystemWest		No
(4)Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi,CA93561 81-2240617	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(5)Adventist Health Mendocino Coast 700 River Drive Fort Bragg,CA95437 84-5174585	Hospital	CA	501(c)(3)	Line 3	Stone Point Health		No
(6)Adventist Health Physicians Network 1 Adventist Health Way Roseville,CA95661 68-0357690	Medical foundation	CA	501(c)(3)	Line 12b, II	Adventist Health SystemWest		No
(7)Adventist Health SystemWest 1 Adventist Health Way Roseville,CA95661 95-3484589	Integrated health system	CA	501(c)(3)	Line 10	N/A		No
(8)Adventist Health Tulare 869 North Cherry Street Tulare,CA93274 83-2351753	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(9)Castle Medical Center 640 Ulukahiki Street Kailua,HI96734 99-0107330	Hospital	HI	501(c)(3)	Line 3	Adventist Health SystemWest		No
(10)Feather River Hospital 1 Adventist Health Way Roseville,CA95661 94-1101228	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(11)Glendale Adventist Medical Center 1509 Wilson Terrace Glendale,CA91206 95-1816017	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(12)Hanford Community Hospital 115 Mall Drive Hanford,CA93230 94-0535360	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(13)Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi,CA95240 94-1044474	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(14)Mid-Columbia Medical Center 1700 E 19th Street The Dalles,OR97058 93-0386936	Hospital	OR	501(c)(3)	Line 3	Stone Point Health		No
(15)Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook,OR97141 93-0622075	Hospital	OR	501(c)(3)	Line 3	Adventist Health SystemWest		No
(16)Paradise Valley Hospital 1 Adventist Health Way Roseville,CA95661 95-1816034	Discontinued Operations	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(17)Portland Adventist Medical Center 10123 SE Market Street Portland,OR97216 93-0429015	Hospital	OR	501(c)(3)	Line 3	Adventist Health SystemWest		No
(18)Reedley Community Hospital 372 Cypress Avenue Reedley,CA93654 45-3220509	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(19)Rideout Memorial Hospital 726 Fourth Street Marysville,CA95901 94-1387866	Acute care hospital	CA	501(c)(3)	Line 3	Stone Point Health		No
(20)St Helena Hospital 10 Woodland Road St Helena,CA94574 94-1279779	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(21)San Joaquin Community Hospital 2615 Chester Avenue Bakersfield,CA93301 95-2294234	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(22)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		No
(23)Sonora Community Hospital 1000 Greenley Road Sonora,CA95370 94-1415069	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(24)Stone Point Health 1 Adventist Health Way Roseville,CA95661 82-3763347	Supporting organization	CA	501(c)(3)	Line 12b, II	Adventist Health SystemWest		No
(25)Ukiah Adventist Hospital 275 Hospital Drive Ukiah,CA95482 94-1639901	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(26)United Com-Serve 726 Fourth Street Marysville,CA95901 94-3015356	Skilled nursing/assisted living/home health	CA	501(c)(3)	Line 12b, II	Stone Point Health		No
(27)Walla Walla General Hospital 1 Adventist Health Way Roseville,CA95661 91-0617726	Hospital - closed July 2017	WA	501(c)(3)	Line 3	Adventist Health SystemWest		No
(28)Western Health Resources 1 Adventist Health Way Roseville,CA95661 95-3867863	Home care	CA	501(c)(3)	Line 10	Adventist Health SystemWest		No
(29)White Memorial Medical Center 1720 E Cesar E Chavez Avenue Los Angeles,CA90033 95-2282647	Hospital	CA	501(c)(3)	Line 3	Adventist Health SystemWest		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) Blue Legacy Ventures LLC 1010 NE 2nd Avenue Miami,FL33132 87-1254649	Real property rental	FL	N/A				No			No
(2) Blue Zones LLC 200 Southdale Center Edina,MN55435 27-1603327	Education	MN	N/A				No			No
(3) PAR LLC DBA CherryWood Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas,OR97015 93-1262371	Senior housing	OR	N/A				No			No
(4) PVHR LLC DBA Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas,OR97015 26-0622555	Senior housing	OR	N/A				No			No
(5) PVHR2 LLC DBA Parkview Memory Care at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas,OR97015 47-3300170	Senior housing	OR	N/A				No			No
(6) WWGHR LLC DBA Wheatland Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas,OR97015 81-0591221	Senior housing	OR	N/A				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) AdHealth Limited PO Box HM 2062 Hamilton HM HX BD	Pure captive insurance	BD	N/A	C					No
(2) Adventist Health Plan Inc 1 Adventist Health Way Roseville,CA95661 46-3833261	Health insurance	CA	N/A	C					No
(3) South Coast Medical Center 1 Adventist Health Way Roseville,CA95661 95-2037291	Wind down after sale of hospital	CA	N/A	C					No
(4) Thrive Productions Inc 200 Southdale Center Edina,MN55435 45-3369049	Production company	MN	N/A	C					No

Schedule R (Form 990) 2023

Page 3

Part V

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Schedule R (Form 990) 2023

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2023

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) 2023

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	918,685	130,644
9	Program service revenue (Part VIII, line 2g) .........	87,493,806	95,152,282
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,965,854	1,373,676
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	92,378,345	96,656,602
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	97,433	59,186
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)	36,632,870	40,007,941
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	52,848,599	51,544,216
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	89,578,902	91,611,343
19	Revenue less expenses. Subtract line 18 from line 12.......	2,799,443	5,045,259
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	123,933,006	134,193,908
21	Total liabilities (Part X, line 26).............	50,834,882	52,630,760
22	Net assets or fund balances. Subtract line 21 from line 20.....	73,098,124	81,563,148

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 74,387,132 including grants of $ 59,186 ) (Revenue $ 95,152,282 )
	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 expenses74,387,132

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	2,466,402	20,851,244	1,401,323

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	13,011

f	All other contributions, gifts, grants, and similar amounts not included above		1f	117,633

g	Noncash contributions included in lines 1a - 1f:$		1g	15,000

h Total. Add lines 1a-1f.......		130,644

1	Briefly describe the organization’s mission or most significant activities: Living God's love by inspiring health, wholeness and hope.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	410
6	Total number of volunteers (estimate if necessary) .............	6	28
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Business Code
2a	Patient service revenue	621110	89,716,855	89,716,855
b	Premium revenue	621110	3,685,913	3,685,913
c	340B Pharmacy revenue	456110	687,586	687,586
d	Dietary/cafeteria revenue	722514	469,540	469,540
e	Revenue/subsidy from related orgs	621400	348,586	348,586
f	All other program service revenue.		243,802	243,802
g	Total. Add lines 2a–2f .....		95,152,282

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,373,676			1,373,676
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a
b	Less: rental expenses	6b
c	Rental income or (loss)	6c
d	Net rental income or (loss).......
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a
b	Less: cost or other basis and sales expenses	7b
c	Gain or (loss)	7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..

Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			96,656,602	95,152,282	0	1,373,676

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	59,186	59,186
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	31,966,126	27,019,881	4,946,245
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,151,597	966,418	185,179
9	Other employee benefits .......	4,741,512	4,075,448	666,064
10	Payroll taxes ...........	2,148,706	1,826,766	321,940
11	Fees for services (non-employees):
a	Management ......	7,776,044		7,776,044
b	Legal .........	286,199		286,199
c	Accounting ...........
d	Lobbying ...........	8,061	8,061
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)	17,966,068	17,313,734	652,334
12	Advertising and promotion ....	18,239		18,239
13	Office expenses .......	393,257	253,038	140,219
14	Information technology ......	2,484,177	529,751	1,954,426
15	Royalties ..
16	Occupancy ...........	2,510,933	2,506,037	4,896
17	Travel ............	156,904	101,389	55,515
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	25,717	22,444	3,273
20	Interest ...........	943,433	943,433
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,548,210	4,543,282	4,928
23	Insurance ...	737,711	737,711
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	11,662,008	11,623,088	38,920
b	Quality assurance fees	139,874	139,874
c	Rental/leases costs equ	116,502	116,502
d
e	All other expenses	1,770,879	1,601,089	169,790
25	Total functional expenses. Add lines 1 through 24e	91,611,343	74,387,132	17,224,211	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,960	1	5,545
2	Savings and temporary cash investments .........			50,831,699	2	60,094,043
3	Pledges and grants receivable, net ......			159,379	3	181,613
4	Accounts receivable, net .............			12,847,228	4	11,372,335
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 .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,137,864	8	1,624,922
9	Prepaid expenses and deferred charges ......			68,019	9	91,009
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,152,272
b	Less: accumulated depreciation	10b	47,749,200	40,973,137	10c	38,403,072
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			17,912,720	15	22,421,369
16	Total assets. Add lines 1 through 15 (must equal line 33)...			123,933,006	16	134,193,908

17	Accounts payable and accrued expenses .....	7,061,753	17	8,117,338
18	Grants payable ...		18
19	Deferred revenue .........	0	19	34,487
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	43,773,129	25	44,478,935
26	Total liabilities. Add lines 17 through 25..	50,834,882	26	52,630,760

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	72,549,574	27	81,051,024
28	Net assets with donor restrictions ...........	548,550	28	512,124
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	73,098,124	32	81,563,148
33	Total liabilities and net assets/fund balances ........	123,933,006	33	134,193,908