2023-11-01T12:45:44-05:00 2022-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2022-01-01 930622075 Northwest Medical Foundation Tillamook NORT 9164060000 1000 Third Street Tillamook OR 97141 Micah Smith Treasurer 5038424444 2023-10-25 1 Micah Smith 999009999 1 Tracy S Paglia P00366884 2099556100 2023-10-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Adventist Health Tillamook Eric Swanson 1000 Third Street Tillamook OR 97141 113814719 0 1071 X www.adventisthealth.org/tillamook/ X 1973 OR Living God's love by inspiring health, wholeness and hope. 13 11 503 22 0 0 1707320 1953039 98490095 108297333 2324577 3207998 0 0 102521992 113458370 36377 3055 0 0 41681764 44505184 0 0 2791 51535306 58898587 93253447 103406826 9268545 10051544 90626617 84103995 27226888 20510816 63399729 63593179 X Living God's love by inspiring health, wholeness and hope. 0 0 81681533 3055 108297333 See Schedule O 81681533 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 503 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X John Beaman CFO 9164060000 1 Adventist Health Way Roseville CA 95661 X Wing Bill Dir/Asst Secr/Vice Chair thru 01/22 0.00 50.00 X X 0 2511347 56319 Heinrich Kerry Dir/Chair/CEO as of 01/22 0.00 50.00 X X 0 2131443 75065 Hofheins Todd Dir/Vice Chair/COO as of 01/22 0.00 50.00 X X 0 1971652 72279 Jahn Andrew Care Division President thru 02/22 0.00 50.00 X 0 1409539 74100 Beaman John CFO/Asst Secretary as of 01/22 0.00 50.00 X 0 1361096 58476 Nahapetian Arby - Care Division Medical Officer thru 02/22 0.00 50.00 X 0 1334111 68537 Stevens Eric - Care Division Operations Executive thru 02/22 0.00 50.00 X 0 1315314 62845 Spenst Brett - Care Division Finance Officer thru 02/22 0.00 50.00 X 0 1322824 36101 Reiner Scott Former Dir/Chair/CEO thru 12/21 0.00 0.00 X 0 1222073 36652 Newmyer Joyce President, OR State Network 15.00 35.00 X 0 1076247 59339 Jobe Meredith Secretary 0.00 50.00 X 0 930036 39184 Rippey Wesley - Former Reg Medical Officer, PNR thru 02/20 0.00 50.00 X 0 780034 39936 LaFleur Brett Physician 40.00 0.00 X 771855 0 40625 Butler David Former President thru 08/19 0.00 50.00 X 0 663483 70562 Welch Donald - Former Treas Finance Officer, PNR thru 02/20 0.00 50.00 X 0 670417 44648 Kaba David Physician 40.00 0.00 X 503468 0 44771 Leach Judy - Former Strategy & Comm Exec, PNR thru 02/20 0.00 50.00 X 0 474203 57486 Swanson Eric President 50.00 0.00 X 0 471757 47020 Echelberger Amy Physician 40.00 0.00 X 356015 0 65356 Lee Adam - Former Dir Marketing & Comm, PNR thru 02/20 0.00 50.00 X 0 322432 86733 Welch Paul Medical Officer 40.00 0.00 X 346903 0 61160 Gerken Brittany Physician 40.00 0.00 X 344170 0 60818 Smith Micah Treas/Asst Secretary 50.00 0.00 X 0 316319 52486 Voshell Shane - Former Reg HR Dir, PNR thru 02/20 0.00 50.00 X 0 287390 56928 Seufert Regina Physician/Clinic Svcs Exec 0.00 50.00 X 0 283632 58678 Saxon Kathleen Interim Patient Care Executive 50.00 0.00 X 0 217485 55572 Thompson Heather - Patient Care Executive as of 04/22 0.00 50.00 X 0 228068 40146 Freedman John Director 0.00 4.00 X 0 26858 0 Woodson Marc Director 0.00 4.00 X 0 26728 0 Banks David Director 0.00 4.00 X 0 26478 0 Cherry Robert Director 0.00 4.00 X 0 26478 0 Davis Andrew Director 0.00 4.00 X 0 26478 0 Innocent Larry Director 0.00 4.00 X 0 26478 0 Reiner Richard Director 0.00 4.00 X 0 26478 0 Newton Bradford Director 0.00 4.00 X 0 25180 0 Salazar Velino Director 0.00 4.00 X 0 21478 0 Fehr Joy Director 0.00 4.00 X 0 430 0 Ocampo Lucy Director 0.00 4.00 X 0 430 0 2322411 21534396 1521822 115 1 1 0 Tillamook Emergency Services Inc 1000 Third Street Tillamook OR 97141 Physician services 2839474 Oxford Anesthesia Management LLC PO Box 69355 Baltimore MD 21264 Professional fees 2028608 Aya Healthcare Inc 5930 Cornerstone Court W San Diego CA 92121 Contract labor 1771246 Bivens Medical Corporation 20105 Geisendorfer Applegate CA 95703 Physician services 1436047 Comphealth Inc PO Box 972651 Dallas TX 75397 Physician services 1379959 26 1599619 353420 1953039 Patient service revenue 621110 106692543 106692543 340B Pharmacy revenue 456110 696733 696733 Dietary services 722210 220707 220707 CARES Act funding 621110 157757 157757 Related rental income 531120 91319 91319 438274 438274 108297333 3564347 3564347 356349 -356349 -356349 -356349 113458370 108297333 0 3207998 X 3055 3055 35271336 30865402 4404142 1792 911996 778395 133542 59 5997701 5405979 590783 939 2324151 2049415 274736 10701317 10701317 20281 20281 3984 3984 3799 3799 19935096 19133468 801628 175435 175435 869953 663605 206348 3056174 416716 2639458 2031057 1554862 476195 347004 256197 90807 21672 9417 12255 197004 197004 2145831 1614430 531401 1312793 1303961 8832 Patient care supplies 12320385 12204960 115424 1 Quality assurance fee 5070442 5070442 Rental/leases costs, eq 100493 100296 197 585867 50130 535737 103406826 81681533 21722502 2791 61959607 54694444 56873 112348 12111836 15649532 1627683 1686331 48064 26591 50123378 40880480 12501397 9242898 2321157 2691851 90626617 84103995 6857418 7237759 1292183 417820 19077287 12855237 27226888 20510816 X 63136929 63369710 262800 223469 63399729 63593179 90626617 84103995 X 10051544 -4425094 -5433000 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3799 3799 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations - such as the Oregon Association of Hospital and Health Systems - for which a portion of the membership dues is used for lobbying activities. 272800 1952471 -9864 1981938 233469 248899 1582574 13649 1572322 272800 151190 358438 260729 248899 123746 258531 67558 163529 151190 63235 121979 17988 43480 123746 0.00000 0.00000 1.00000 0 0 1056181 1056181 29240224 24092201 5148023 2137162 1581765 555397 17689811 15206514 2483297 9242898 Payables to related organizations 10819368 Other liabilities 1430859 Payables to third-party payors 605010 12855237 X Part V, Line 4: Board-designated, temporary and permanently restricted 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, 2022 and 2021, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2019 in major tax jurisdictions. 1 1 X 1 X 1 X 1 1 1 0 1 1 880617 880617 0.00850 880617 880617 0.00850 209585 209585 0.00200 58172 58172 0.00060 23061201 17928825 5132376 0.04960 90523 90523 0.00090 23419481 17928825 5490656 0.05310 24300098 17928825 6371273 0.06160 10844 10844 0.00010 1935 1935 0.00000 2178 2178 0.00000 14957 14957 0.00010 1 1451450 323400 32257744 31822367 435377 X 1 1 1 1 Adventist Health Tillamook 1000 Third Street Tillamook OR 97141 adventisthealth.org/Tillamook 14-1177 X X X X Adventist Health Tillamook 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 22 1 See Sch H Part VI - Needs Assesment 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Adventist Health Tillamook Part V, Section B, Line 5: The 2022 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.Community-based organizations focusing on education, higher education, low-income, medically underserved, minority populations, food insecure, providers and student populations participated in five focus groups with 81 participants and 13 individual interviews ensuring rich primary data. Represented race/ethnicities included Hispanic, Multi-race and White.The 2022 Community Health Needs Assessment 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) Survey data was gathered from the Central Valley region (region name defined by survey administrator, UC Berkeley IGS). Adventist Health Tillamook Part V, Section B, Line 6b: Organizations that participated in the 2022 CHNA included: Tillamook County Community Health Centers (TCCHC), Tillamook Family Counseling Center, Rinehart Clinic, Columbia Pacific CCO (serving the Oregon Health Plan), Consejo Hispano, Northwest Senior & Disability Services (a local intergovernmental agency), Oregon Food Bank, Oregon State University Extension Service, Pelican Brewing Company, Tides of Change, Tillamook Chamber of Commerce, Tillamook County, Tillamook County Family YMCA, Tillamook County Office of Education, Tillamook County Transportation District, Tillamook Bay Community College, Tillamook Seventh Day Adventist Church and West Business Development Center. Adventist Health Tillamook Part V, Section B, Line 11: The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible, while ensuring the health and safety of those participating. Additionally, Adventist Health took the following actions to support COVID-19 efforts: 1. Hospital COVID-19 vaccines for employees, families, children, and friends.2. Mobile vaccine efforts in rural areas with no access to healthcare.3. Partnered with large employer groups to bring vaccines to their workforce.Locally, Adventist Health Tillamook (AHTM) took these additional actions:1. On-going monitoring of needs and actions by the COVID-19 Incident Command Team.2. Offered walk-in COVID-19 testing and vaccination sites.3. Market President conducted daily COVID-related status reports, including case counts, local and regional response capacity.4. Hospital leadership participated in community COVID-19 strategic planning, response and public outreach, including weekly radio broadcasts.5. On-going collaboration among Tillamook County vaccine partners to plan, coordinate and execute vaccination distribution throughout Tillamook County.Tax year 2022 was year three of the Implementation Strategy for the 2019 CHNA. All programs and activities provided to the community were in response to the priority health needs identified in the 2019 CHNA. Our 2019 CHNA identified four areas of significant need: Housing and Homelessness, Mental Health, Access to Health Care, Prevention and Management of Chronic Disease.Priority Need 1 - Housing & Homelessness - The goal is to partner across sectors to reduce the impact that housing insecurity has on health and well-being for all individuals in Tillamook County.Strategy 1 - Partner to support community action programs, and community-based organizations that provide shelter/transitional housing supports in the region.Activity 1.1 - Housing Commission Appointment - In 2022, the Housing Commission established and began distributing funds from Short Term Rental Operator fees, to help offset costs for workforce housing development. Funds were distributed to six developers to further development of a total of 87 new housing units. In addition, members of the Housing Commission presented public testimony in favor of a multi-family housing development that came under public appeal. After testimony from members of the Housing Commission, including the large employer representative from AHTM, the City Council voted in favor of the development, bringing 46 new affordable apartments to the city proper. Work continues on creating a developable lands inventory. Additionally, Brownfields grant funding was awarded in 2022, with up to six assessment sites, targeting housing development. Finally, the Housing Commission was instrumental in getting an ordinance passed to permit Accessory Dwelling Units (ADUs) in incorporated communities of Tillamook County. The AHTM Well-Being Director continues to serve as an active member of the Housing Commission. Activity 1.2 - Referrals for Housing Assistance - In partnership with CARE, Inc., during 2022, 16 households were provided transitional housing assistance, affecting a total of 21 individuals. Through state funded rental assistance programs, 33 households were served, totaling 88 people. Priority Need 2 - Mental Health - The goal is to allow access to and capacity for any individual seeking mental health services.Strategy 1 - Increase access to mental and behavioral health and treatment for substance use disorders through new services, education, and partnerships.Activity 1.1 - Increase education and trainings related to SUD and/or OUD through O.U.R Tillamook.Activity 1.2 - Develop a comprehensive Medication Assisted Treatment (MAT) program - Although most of the program activities and services are covered under grants, our community benefit expenses include our Community Well-Being directors time in securing these grants and coordinating program development. AHTM accomplishments include: 1. Five O.U.R. Tillamook partners received $2.2 Million from Measure 110 to create a Behavioral Health Resource Network (BHRN) for Tillamook County. 2. Distributed 16 additional naloxboxes to local businesses and organizations. 3. Distributed free naloxone at the Tillamook County Fair adding 200 more kits out in the community. 4. Hosted Hazelden Betty Ford Foundation to provide five SUD/OUD training events. Almost 100 professionals in healthcare and supportive services attended. Part V, Section B, Line 11, continuation: Priority Need 3 - Access to Health Care - The goal is to eliminate barriers to primary care, including geographic and transportation inconveniences, lack of knowledge, and lack of insurance coverage.Strategy 1 - Increase access to primary care through programs that seek to address barriers by engaging in the community.Activity 1.1 - Explore and create a mobile integrated health care team - Provided 977 documented mobile healthcare services in 2022. Mobile visits include pharmacy deliveries, home and street well-checks, senior center visits, community outreach events (e.g. Homeless Connect), adolescent sports physicals, and flu/vaccine clinics.Activity 1.2 - Connect Oregon Network (UniteUs) - three initial referrals. Pivot to integration of Unite Us into EHR (Cerner) to facilitate workflows.Activity 1.3 - Screening for early childhood development delays. Not actively pursued due to staff capacity issues. Priority Need 4 - Prevention and Management of Chronic Diseases - The goal is to decrease chronic disease prevalence through focus on reducing chronic disease risk factors.Strategy 1 - Provide follow up care to high-risk individuals and partner to increase lifestyle management program targeted to those with chronic disease.Activity 1.1 - Follow up process for critically ill and discharged patients - 56 emergency room visits in 2022 (17.6% reduction over prior year)Activity 1.2 - Screening for pre-diabetes - four closed loop referrals.Activity 1.3 - Lifestyle Medicine, & Activity - Program suspended due to COVID-19.Priority needs not addressed:No hospital can address all the health needs identified in its community. AHTM is 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. Significant health needs that are not included in the 2020 Community Health Plan update include addressing physical environment, safety, and access to parks and recreation. We are currently partnered with the Tillamook YMCA which provides free services to community members, including offering programing to seniors age 60 and over and people with disabilities at no charge. The Oregon Coast Visitors Association and Tillamook Coast Visitors Association have had results facilitating investment in outdoor recreation facilities that promote activities such as hiking, biking, kayaking, boating and camping, among others. AHTM will continue to partner with Tillamook County Wellness to provide collaboration to increase safe access to physical built environments, including coordination and promotion of detailed, interactive recreational maps. 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. 10 1 - AHTM Medical Plaza 1100 Third Street Tillamook OR 97141 Rural health clinic 2 - AHTM Women's and Family Health 1011 Third Street Tillamook OR 97141 Rural health clinic 3 - AHTM Bayshore Medical Lincoln City 1105 SE Jetty Avenue Suite C Lincoln City OR 97367 Rural health clinic 4 - AHTM Manzanita Primary & Specialty Care 10445 Neahkahnie Creek Road Manzanita CA 97130 Rural health clinic 5 - AHTM Medical Group Estacada 103 SW Hwy 224 Suite B Estacada OR 97023 Rural health clinic 6 - AHTM Hoodland 24461 E Welches Road Welches OR 97067 Rural health clinic 7 - AHTM Bayshore Medical Pacific City 38505 Brooten Road Suite A Pacific City OR 97135 Rural health clinic 8 - AHTM Vernonia 1005 Cougar Street Vernonia OR 97064 Rural health clinic 9 - AHTM Occupational Medicine 980 Third Street Suite 100 Tillamook OR 97141 Occupational medicine 10 - AHTM Sheridan Office 222 SE Jefferson Street Sheridan OR 97378 Rural health clinic 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 audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:(Total expenses - (Provision for bad debts + Other revenue + Interest income)) / Gross patient charges 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, and as we entered 2022 these projects have been active. 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. These activities are not included elsewhere on Schedule H. 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 system-wide 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: The Hospital's 2022 Community Health Needs Assessment (CHNA), the 2023 Community Health Implementation Strategy (CHIS) approved in fiscal year 2023, and the 2022 Community Health Plan (CHP) updated for fiscal year 2022 are posted on the Hospital's website at: https://www.adventisthealth.org/tillamook/about-us/community-benefit/The two most recent CHNAs, the two most recent CHIS reports and the 2020, 2021 and 2022 CHP Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The 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, our hospitals support 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 the regions we serve. 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. 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 AH_Financial_Assistance_Policy_2022.pdf (adventisthealth.org):1. https://www.adventisthealth.org/patient-resources/bill-pay/financial-assistance/ 2. https://www.adventisthealth.org/documents/financial-assistance/13863-Self-Pay-Billing-and-Collection-Policy.pdfThese documents are available in multiple languages.At 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 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: Tillamook County is nestled in the fertile Oregon Coast Range and recognized for its plentiful region of dairy farms. Tillamook, or "Land of Many Waters," is comprised of 75 miles of coastline, four bays, nine rivers, and is home to the Tillamook Cheese Factory - attracting many tourists. Tillamook City, the largest city in the county, has a population of 4,971 with a majority age group of older adults (65+) making up 25.3% of the population. The total population of the area included in this needs assessment is 27,216 people. The Tillamook County Fair, summer parades, rodeos, and unity of the community contribute to the smalltown rural feel of this community. Residents are 89.4% non-Hispanic, 10.6% Hispanic and have a median household income of $55,214 of which 62.83% is spent on housing and transportation. Among this population, 15.96% of children live in poverty and 4.81% of students are unhoused, compared to the state average of 3.99% and national average of 2.77%. The following zip codes represent Tillamook County's primary service area (PSA), accounting for 75% of hospital discharges. Additionally, we took a collaborative approach and expanded our PSA by inviting Steering Committee Members to include zip codes of those they serve. The Tillamook County CHNA has a total population of 27,216 (based on the Decennial Census). The largest city in the service area is Tillamook with a population of 4,971. The service area is comprised of the following zip codes: 97107, 97118, 97131, 97136, 97108, 97147, 97122, 97149, 97134, 97130, 97135, 97141, 97112. 69.82% of the population own their home and 30.18% are renters.The availability of primary care providers is extremely limited in Tillamook County, with 70.07 primary care providers per 100,000 population as compared with 130.37 in Oregon and 104.44 in the United States. A shortage of mental health providers as compared to Oregon is also seen, with 169.11 mental health care providers per 100,000 people in Tillamook County compared to 312.16 in Oregon. The number of intensive care unit hospital beds is also limited, with 14.95 beds per 100,000 people as compared to 20 in Oregon and 28.05 in the United States. Only 26% of the population lives within half a mile of public transportation. This is less than half of the rate of Oregon as a whole, which creates a substantial barrier for many. Sixteen percent of children under 18 years of age are living in poverty, as compared to 15% in Oregon. When examining poverty levels by race though the numbers tell a very different story, the rates are especially staggering for children who are Native American or Alaska Natives (87.9%) and Native Hawaiian or Pacific Islanders (80.6%). These groups are undoubtedly experiencing significantly greater health disparities than the overall population. The average household income and the median household income are both lower in Tillamook ($55,214) than in Oregon ($65,667) and the US ($64,994). Affordability and housing costs, by calculating the percentage of household income needed for housing and transportation costs comes up to a high rate of 62.8% as compared to 54.4% in Oregon and 54.3% nationally. 100% of Black residents in the area rent their homes, as compared to 29% of whites, 48% of Asians, 49% of Native Americans or Alaska Natives, and 46% of multi-race persons. 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 are 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; and 3. 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, and 3. 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 telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States OR X X X X 1 1 0 0 0 0 0 0 0 Wing Bill Dir/Asst Secr/Vice Chair thru 01/22 0 263334 0 662638 0 1585375 0 12220 0 44099 0 2567666 0 0 Heinrich Kerry Dir/Chair/CEO as of 01/22 0 1817710 0 76 0 313657 0 12220 0 62845 0 2206508 0 0 Hofheins Todd Dir/Vice Chair/COO as of 01/22 0 1358421 0 376216 0 237015 0 12220 0 60059 0 2043931 0 0 Jahn Andrew Care Division President thru 02/22 0 1047840 0 349414 0 12285 0 12220 0 61880 0 1483639 0 0 Beaman John CFO/Asst Secretary as of 01/22 0 1047636 0 298600 0 14860 0 12220 0 46256 0 1419572 0 0 Nahapetian Arby - Care Division Medical Officer thru 02/22 0 927049 0 234212 0 172850 0 12220 0 56317 0 1402648 0 0 Stevens Eric - Care Division Operations Executive thru 02/22 0 896507 0 250602 0 168205 0 12220 0 50625 0 1378159 0 0 Spenst Brett - Care Division Finance Officer thru 02/22 0 817612 0 416845 0 88367 0 12220 0 23881 0 1358925 0 0 Reiner Scott Former Dir/Chair/CEO thru 12/21 0 348458 0 870709 0 2906 0 12220 0 24432 0 1258725 0 0 Newmyer Joyce President, OR State Network 0 774426 0 262849 0 38972 0 12220 0 47119 0 1135586 0 0 Jobe Meredith Secretary 0 639741 0 154687 0 135608 0 12220 0 26964 0 969220 0 0 Rippey Wesley - Former Reg Medical Officer, PNR thru 02/20 0 527416 0 153245 0 99373 0 12220 0 27716 0 819970 0 0 LaFleur Brett Physician 771855 0 0 0 0 0 12220 0 28405 0 812480 0 0 0 Butler David Former President thru 08/19 0 222193 0 102825 0 338465 0 12220 0 58342 0 734045 0 0 Welch Donald - Former Treas Finance Officer, PNR thru 02/20 0 435619 0 154115 0 80683 0 12220 0 32428 0 715065 0 0 Kaba David Physician 503468 0 0 0 0 0 12220 0 32551 0 548239 0 0 0 Leach Judy - Former Strategy & Comm Exec, PNR thru 02/20 0 348505 0 85586 0 40112 0 12220 0 45266 0 531689 0 0 Swanson Eric President 0 343654 0 78993 0 49110 0 12220 0 34800 0 518777 0 0 Echelberger Amy Physician 356015 0 0 0 0 0 10680 0 54676 0 421371 0 0 0 Lee Adam - Former Dir Marketing & Comm, PNR thru 02/20 0 245847 0 50972 0 25613 0 9673 0 77060 0 409165 0 0 Welch Paul Medical Officer 346903 0 0 0 0 0 10407 0 50753 0 408063 0 0 0 Gerken Brittany Physician 344170 0 0 0 0 0 10325 0 50493 0 404988 0 0 0 Smith Micah Treas/Asst Secretary 0 244633 0 46792 0 24894 0 9490 0 42996 0 368805 0 0 Voshell Shane - Former Reg HR Dir, PNR thru 02/20 0 209514 0 56469 0 21407 0 8622 0 48306 0 344318 0 0 Seufert Regina Physician/Clinic Svcs Exec 0 217306 0 41630 0 24696 0 8509 0 50169 0 342310 0 0 Saxon Kathleen Interim Patient Care Executive 0 143859 0 44962 0 28664 0 6525 0 49047 0 273057 0 0 Thompson Heather - Patient Care Executive as of 04/22 0 177526 0 6650 0 43892 0 6842 0 33304 0 268214 0 0 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. Butler, David - severance payment - $255,471 Wing, Bill - severance payment - $1,584,880 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, Joyce Newmyer, Scott Reiner, Brett Spenst, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an of their corporate provided benefits. The balance is set aside for forfeiture and is at risk to the creditors of Adventist Health. Payouts substantial risks of forfeiture have lapsed. The plan was frozen for new amount equivalent to 41 percent of their base compensation, less the value nonvested deferred compensation that is subject to substantial risk of occur according to the participants' payment elections after all non-vested contributions in 2016. Jahn, Andrew - participant, no activity in 2022 Newmyer, Joyce - participant, no activity 2022 Form 990, Part III, Line 4a: Northwest Medical Foundation Tillamook, dba Adventist Health Tillamook (AHTM), 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 AHTM, 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 AHTM 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. AHTM 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 2022 was $880,617. The following Inpatient services were provided to all our patients: - 86 babies delivered - 271 surgeries performed - 3,969 patient days The following Outpatient services were provided to all our patients: - 10,270 emergency department visits - 784 outpatient surgeries performed - 82,089 outpatient visits - 87,572 clinic visits AHTM 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 2022 was $5,490,656. 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/ Form 990, Part VI, Section A, line 6 The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The Hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Section A, line 7a The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. Form 990, Part VI, Section A, line 7b The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11b 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 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 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 50th 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, Section A: 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 10,809,094. Management and general expenses 0. Fundraising expenses 0. Total expenses 10,809,094. Consulting and other management fees: Program service expenses 46,454. Management and general expenses 0. Fundraising expenses 0. Total expenses 46,454. Repairs and maintenance: Program service expenses 124,356. Management and general expenses 130,411. Fundraising expenses 0. Total expenses 254,767. All other purchased services: Program service expenses 3,312,448. Management and general expenses 659,282. Fundraising expenses 0. Total expenses 3,971,730. Other professional nonmedical fees: Program service expenses 4,958. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,958. Contract Labor: Program service expenses 4,533,252. Management and general expenses 11,935. Fundraising expenses 0. Total expenses 4,545,187. Other professional medical fees: Program service expenses 729. Management and general expenses 0. Fundraising expenses 0. Total expenses 729. Purchased medical services: Program service expenses 302,177. Management and general expenses 0. Fundraising expenses 0. Total expenses 302,177. 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. Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 845174585 Hospital CA 501(c)(3) Line 3 Stone Point Health 0 Adventist Health Physicians Network 1 Adventist Health Way Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Adventist Health SystemWest 1 Adventist Health Way Roseville CA 95661 953484589 Integrated health system CA 501(c)(3) Line 10 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital 1 Adventist Health Way Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Lodi Memorial Hospital Association Inc 975 S Fairmont Avenue Lodi CA 95240 941044474 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Paradise Valley Hospital 1 Adventist Health Way Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Rideout Memorial Hospital 726 Fourth Street Marysville CA 95901 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 0 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital and Health Care Services 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Stone Point Health 1 Adventist Health Way Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 United Com-Serve 726 Fourth Street Marysville CA 95901 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health 0 Walla Walla General Hospital 1 Adventist Health Way Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 0 Western Health Resources 1 Adventist Health Way Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 0 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Blue Legacy Ventures LLC 1010 NE 2nd Avenue Miami FL 33132 871254649 Real property rental FL N/A 0 0 Blue Zones LLC 200 Southdale Center Edina MN 55435 271603327 Education MN N/A 0 0 PAR LLC dba CherryWood Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 931262371 Senior housing OR N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Senior housing OR N/A 0 0 PVHR2 LLC dba Parkview Memory Care at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Senior housing OR N/A 0 0 WWGHR LLC dba Wheatland Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Senior housing OR N/A 0 0 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center 1 Adventist Health Way Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 200 Southdale Center Edina MN 55435 453369049 Production company MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1