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

OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
Northwest Medical Foundation Tillamook
 
Employer identification number

93-0622075
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?
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 Medical Center Tehachapi
1100 Magellan Drive

Tehachapi,CA93561
81-2240617 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(3)Adventist Health Physicians Network
PO Box 619135

Roseville,CA95661
68-0357690 		Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest
 
 
No
(4)Adventist Health SystemWest
PO Box 619135

Roseville,CA95661
95-3484589 		Integrated health system CA 501(c)(3) Line 10 N/A
 
No
(5)Castle Medical Center
640 Ulukahiki Street

Kailua,HI96734
99-0107330 		Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(6)Feather River Hospital
PO Box 619135

Roseville,CA95661
94-1101228 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(7)Fremont-Rideout Health Group
989 Plumas Street

Yuba City,CA95991
94-2917251 		Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health
 
 
No
(8)Glendale Adventist Medical Center
1509 Wilson Terrace

Glendale,CA91206
95-1816017 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(9)Hanford Community Hospital
115 Mall Drive

Hanford,CA93230
94-0535360 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(10)Lodi Memorial Hospital Association Inc
975 S Fairmont Avenue

Lodi,CA95240
94-1044474 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(11)Paradise Valley Hospital
PO Box 619135

Roseville,CA95661
95-1816034 		Discontinued operations CA 501(c)(3) Line 1 Adventist Health SystemWest
 
 
No
(12)Portland Adventist Medical Center
10123 SE Market Street

Portland,OR97216
93-0429015 		Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(13)Reedley Community Hospital
372 Cypress Avenue

Reedley,CA93654
45-3220509 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(14)Rideout Memorial Hospital
989 Plumas Street

Yuba City,CA95991
94-1387866 		Acute care hospital CA 501(c)(3) Line 3 Fremont-Rideout Health Group
 
 
No
(15)St Helena Hospital
10 Woodland Road

St Helena,CA94574
94-1279779 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(16)San Joaquin Community Hospital
2615 Chester Avenue

Bakersfield,CA93301
95-2294234 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(17)Simi Valley Hospital & Health Care Services
2975 N Sycamore Drive

Simi Valley,CA93065
95-6064971 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(18)Sonora Community Hospital
1000 Greenley Road

Sonora,CA95370
94-1415069 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(19)Stone Point Health
PO Box 619135

Roseville,CA95661
82-3763347 		Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest
 
 
No
(20)Ukiah Adventist Hospital
275 Hospital Drive

Ukiah,CA95482
94-1639901 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(21)United Com-Serve
989 Plumas Street

Yuba City,CA95991
94-3015356 		Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Fremont-Rideout Health Group
 
 
No
(22)Walla Walla General Hospital
PO Box 619135

Roseville,CA95661
91-0617726 		Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(23)Western Health Resources
PO Box 619135

Roseville,CA95661
95-3867863 		Home care CA 501(c)(3) Line 10 Adventist Health SystemWest
 
 
No
(24)White Memorial Medical Center
1720 Cesar E Chavez Avenue

Los Angeles,CA90033
95-2282647 		Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest
 
 
No
(25)Willits Hospital Inc
1 Marcela Drive

Willits,CA95490
68-0108919 		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) 2018
Page 2
Schedule R (Form 990) 2018
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) South Coast Medical Center

PO Box 619135
Roseville,CA95661
95-2037291 		Wind down after sale of hospital CA N/A
 C         No












Schedule R (Form 990) 2018
Page 3
Schedule R (Form 990) 2018
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2018
Page 4
Schedule R (Form 990) 2018
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Page 5
Schedule R (Form 990) 2018
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) 2018

Additional Data


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