2022-11-03T11:27:06-05:00 2021-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2021-01-01 813021580 FOUNDATION HEALTH LLC FOUN 9074585550 1650 COWLES STREET FAIRBANKS AK 99701 GARY RODERICK CFO 9074585550 2022-11-01 1 GARY RODERICK 999009999 MEGAN R RYAN P00737884 4254544919 2022-10-31 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z GARY RODERICK 1650 COWLES STREET FAIRBANKS AK 99701 342008799 0 X WWW.FOUNDATIONHEALTH.ORG X LLC 2016 AK COMPASSIONATE HEALTH CARE FOR EVERY CHAPTER IN YOUR LIFE STORY. 13 10 2368 62 1533586 573001 31356025 11812343 283651697 327281776 58083 50517 3064430 2782172 318130235 341926808 0 100000 0 0 184808272 195378893 0 0 0 133430554 143969277 318238826 339448170 -108591 2478638 117689591 109912718 38644495 27928413 79045096 81984305 A LIFETIME OF EXCELLENT CARE PROVIDED BY YOUR COMMUNITY HEALTH CARE TEAM. 0 0 276762450 100000 327295279 FOUNDATION HEALTH LLC OWNS AND OPERATES FAIRBANKS MEMORIAL HOSPITAL (HOSPITAL), DENALI CENTER (HOME), AND TANANA VALLEY CLINIC (CLINIC). THE HOSPITAL IS A GENERAL ACUTE, SOLE COMMUNITY, 152 BED FACILITY. THE HOSPITAL SERVES PATIENTS FROM FAIRBANKS AND THROUGHOUT THE INTERIOR OF ALASKA PROVIDING INPATIENT CARE, EMERGENCY CARE AND A BROAD ARRAY OFOUTPATIENT MEDICAL SERVICES. THE HOME IS A 90 BED SKILLED NURSING CARE HOME THAT PROVIDES POST ACUTE CARE FOR SHORT TERM PATIENTS, AS WELL AS LONG TERM CARE FOR OTHER PATIENTS. THE CLINIC IS A MULTI-SPECIALTY CLINIC THAT OFFERS 15 MEDICAL SPECIALITIES AND OPERATES A WALK-IN CLINIC WITH AFTER HOURS SERVICES. THE HOSPITAL SERVED 49,160 PATIENTS IN 2021, INCLUDING 1,079 BABIES DELIVERED. THE HOME SERVED 195 INDIVIDUALS AND THE CLINIC PROVIDED ACCESS TO CARE FOR 42,716 PEOPLE. 276762450 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 49 0 1 2368 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X GARY RODERICK CFO 9074583310 1650 COWLES STREET FAIRBANKS AK 99701 ZACH WERLE BOARD MEMBER/PHYSICIAN 40.00 0.40 X 511353 0 43942 LAURA BRUNNER BOARD MEMBER/PHYSICIAN 40.00 0.50 X 525375 0 15744 MARK SIMON BOARD MEMBER 0.40 0.60 X 2696 0 0 JEFF COOK BOARD PRESIDENT 3.60 3.60 X X 0 0 0 JOE FAULHABER VICE PRESIDENT 2.20 1.80 X X 0 0 0 SCOTT BELL TREASURER 1.10 0.90 X X 0 0 0 WILLIAM VIVLAMORE SECRETARY 0.70 1.10 X X 0 0 0 CHERYL KILGORE BOARD MEMBER 0.50 0.70 X 0 0 0 GALEN JOHNSON BOARD MEMBER 0.50 1.00 X 0 0 0 KAREN PERDUE BOARD MEMBER 1.00 0.60 X 0 0 0 MARGARET SODEN BOARD MEMBER 1.10 0.80 X 0 0 0 RICHARD HATTAN BOARD MEMBER 1.10 0.70 X 0 0 0 STEVE FRANK BOARD MEMBER 0.70 0.90 X 0 0 0 ANGELIQUE RAMIREZ CHIEF MEDICAL OFFICER 40.00 0.00 X 414601 0 36759 SHELLEY EBENAL EXECUTIVE DIRECTOR FHP CEO 40.00 0.00 X 364106 0 41823 ELIZABETH WOODYARD CHIEF CLINICAL SERVICES 40.00 0.00 X 340715 0 30189 GARY RODERICK CHIEF FINANCIAL OFFICER 40.00 0.00 X 314643 0 35952 CLINT BROOKS CHIEF OPERT OFFICER SHARED SERV 40.00 0.00 X 333469 0 11290 JENNIFER N WELCH CHIEF HR OFFICER 40.00 0.00 X 206215 0 34797 TERRI KISS CHIEF QUALITY OFFICER 40.00 0.00 X 95354 0 3626 SARAH MARTIN CHIEF NURSING OFFICER 40.00 0.00 X 227191 0 37183 ROBIN FOWLER LEGAL COUNSEL AND COMPLIANCE 40.00 0.00 X 189618 0 27312 ROY ROEHL IT SENIOR DIRECTOR 40.00 0.00 X 164703 0 38095 JENNIFER HOUSE FIN & REV SENIOR DIRECTOR 40.00 0.00 X 180291 0 19898 AMY LUCKE QUALITY SENIOR DIRECTOR 40.00 0.00 X 169766 0 27759 JOSEPH O'CONNOR FIN & REV SENIOR DIRECTOR 40.00 0.00 X 159481 0 30988 ROMEL C WRENN PHYSICIAN 40.00 0.00 X 1290738 0 34003 LEE M PIERSON PHYSICIAN 40.00 0.00 X 1080527 0 33857 WILLIAM QUIRK PHYSICIAN 40.00 0.00 X 792412 0 34728 MILAN BAJMOCZI PHYSICIAN 40.00 0.00 X 774577 0 31153 BRUCE M FOOTIT PHYSICIAN SUPERVISOR 40.00 0.00 X 752657 0 31439 8890488 0 600537 254 0 1 0 CROSS COUNTRY STAFFING INC LA LOCKBOX FILE 50941 LOS ANGELES CA 90074 MEDICAL STAFFING 8831786 HURON CONSULTING SERVICES LLC 550 W VAN BUREN STREET CHICAGO IL 60607 BUSINESS CONSULTING COMPANY 4368705 MAYO COLLABORATIVE SVCS INC PO BOX 9146 MINNEAPOLIS MN 55480 REFERENCE LAB SERVICES & CONSULTING SERV 1650407 HEALTH CAROUSEL LLC 3805 EDWARDS RD STE 700 CINCINNATI OH 45209 MEDICAL STAFFING 1108157 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 30384 PHYSICIAN FEES 586336 28 11812343 11812343 OUTPATIENT REVENUE 622110 146836342 145345357 1490985 INPATIENT REVENUE 621110 100880492 100880492 CLINIC 621111 49395318 49395318 NURSING HOME 623110 20170734 20170734 PHARMACY 446110 5251231 5211110 40121 4747659 4747659 327281776 42347 42347 459619 0 459619 459619 459619 8170 0 8170 8170 8170 132712 81991 50721 50721 CAFETERIA/MEALS 722514 1404839 1404839 DAY CARE CENTER 624410 479034 479034 SERVICE INCOME 900099 206326 206326 181633 13503 2480 165650 2271832 341926808 325764173 1533586 2816706 100000 100000 4928889 3144478 1784411 163172922 135562135 27610787 3253781 2655133 598648 14651287 11369619 3281668 9372014 7781993 1590021 351114 351114 141665 20000 121665 65250 65250 23481364 12686781 10794583 126184 123803 2381 1808850 6728 1802122 13415295 11174829 2240466 47059097 38412732 8646365 263258 226480 36778 12637 10912 1725 242547 188067 54480 1939634 1433369 506265 MEDICAL SUPPLIES 24457285 24312964 144321 PHARMACEUTICAL SUPPLIES 14083686 13546689 536997 NON MEDICAL SUPPLIES 7207304 6469548 737756 REPAIRS AND MAINT. 3319599 3317609 1990 5994508 4218581 1775927 339448170 276762450 62685720 0 34307684 29440194 8680776 8681309 61797158 57378136 8654178 9614013 2945103 3248721 1304692 1550345 117689591 109912718 27462001 23337520 10159370 3359786 1023124 1231107 38644495 27928413 X 79045096 81984305 79045096 81984305 117689591 109912718 X 2478638 460571 X 0 1 X 1 1 0 X 0 0 0 0 0 0 1 65250 0 1 23667 88917 0 PART II-B, LINE 1: LINE 1G: FOUNDATION HEALTH (FH) ENGAGED AN INDEPENDENT CONTRACTOR TO PROVIDE GOVERNMENT RELATIONS AND LOBBYING CONSULTING SERVICES. THE CONTRACTOR WORKED WITH THE ALASKA STATE LEGISLATURE AND GOVERNMENT ON COMPLEX ISSUES RELATED TO FH'S CHARITABLE MISSION IN 2021. IN 2021 FH PAID $65,250 FOR THESE SERVICES. LINE 1I: ALASKA STATE HOSPITAL AND NURSING HOME ASSOCIATION USE 7% OF ALL DUES PAID TO THEM FOR SPECIFIC LOBBYING EXPENSES. 0 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1231107 1231107 342008265 0 342008265 -81457 -81457 341926808 339529627 81457 81457 339448170 0 339448170 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 534. COST OF GOODS SOLD -81,991. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTEREST INCOME -534. COST OF GOOD SOLD 81,991. 1 1 X 1 X 1 X 1 1 0 0 472848 472848 0.00140 77822793 54292527 23530266 0.06930 78295641 54292527 24003114 0.07070 159832 159832 0.00050 485518 485518 0.00140 42084372 32637942 9446430 0.02780 267632 267632 0.00080 42997354 32637942 10359412 0.03050 121292995 86930469 34362526 0.10120 4304 4304 0.00000 24300 24300 0.00010 28604 28604 0.00010 1 2539622 66230969 55247241 10983728 X 1 1 1 1 FAIRBANKS MEMORIAL HOSPITAL 1650 COWLES STREET FAIRBANKS AK 99701 HTTPS://WWW.FOUNDATIONHEALTH.ORG GACH-004 X X X FAIRBANKS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE PART V, SECTION C X 1 20 1 SEE PART V, SECTION C 0 1 X 100.000000000000 350.000000000000 X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY BENEFIT STEERING COMMITTEE (CBSC) GUIDED ALL ASPECTS OF THE CHNA PROCESS INCLUDING OVERSIGHT OF THE ASSESSMENT DATA AND PROCESS, PRIORITIZING IDENTIFIED HEALTH NEEDS, AND DEVELOPMENT OF IMPLEMENTATION STRATEGIES AND REPORTING. THE CBSC SERVED AS OVERSIGHT TO A BROADER COMMUNITY ADVISORY COMMITTEE (CAC) COMPRISED OF KEY INFORMANTS AMONG COMMUNITY ENTITIES SUCH AS PUBLIC HEALTH, GOVERNMENT (SEVERAL STATE, LOCAL, TRIBAL, AND REGIONAL), EDUCATION, AND SOCIAL SERVICES INCLUDING REPRESENTATION OF THE UNDERSERVED, MARGINALIZED, UNINSURED, AND MINORITY POPULATIONS. THERE WERE NO PUBLIC COMMENTS RECEIVED (VIA THE ORGANIZATION WEBSITE LINK) FOR THE 2016 CHNA AND IMPLEMENTATION REPORTS.SUMMARY INPUT FROM THE COMMMUNITY: A PHASED PROCESS OVER A FOUR MONTH PERIOD IN FALL 2019 WITH OVERSIGHT FROM AN INTERNAL STEERING COMMITTEE AND INCLUDED THE COMMUNITY ADVISORY COUNCIL. THE PHASED PROCESS INCLUDED ANALYSIS OF DETERMINANTS OF HEALTH DATA AND COMMUNITY HEALTH ASSESSMENT SURVEYS, PRIORITIZATION, HEALTH IMPROVEMENT PLANNING, AND IMPLEMENTATION PLANNING. THE RESULTING CHNA AND CHIP REPORTS WERE REVIEWED AND APPROVED FOUNDATION HEALTH LLC (81-3021580) BY THE ORGANIZATIONS GOVERNING BOARD. THE COMMUNITY ADVISORY COUNCIL INCLUDED KEY INFORMANTS FROM THE FOLLOWING ORGANIZATIONS WITH (*) INDICATING ORGANIZATIONS WHOSE FOCUS IS LARGELY MEDICALLY UNDERSERVED, LOW INCOME, MINORITY POPULATIONS - *FAIRBANKS NATIVE ASSOCIATION, *FAIRBANKS COMMUNITY MENTAL HEALTH, *ALASKA DIVISION OF PUBLIC HEALTH, US ARMY MEDICAL DEPARTMENT, *LOVE INC OF THE TANANA VALLEY, *INTERIOR COMMUNITY HEALTH CENTER, *LITERACY COUNCIL OF ALASKA, *ALASKA HEALTH FAIR, *UNITED WAY OF THE TANANA VALLEY, CITY OF FAIRBANKS, FAIRBANKS NORTH STAR BOROUGH SCHOOL DISTRICT, *INTERIOR CENTER FOR NON-VIOLENT LIVING, *NORTH STAR COUNCIL ON AGING, *FAIRBANKS NORTH STAR BOROUGH. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: 1) MENTAL HEALTH -(RECOGNIZING THE COMORBIDITY OF SUBSTANCE USE) REDUCTION OF WAIT TIME FOR OUTPATIENT ACCESS, PARTNER TO IMPLIMENT CRISIS NOW MODEL INCLUDING MOBILE CRISIS TEAM AND PEER SUPPORT SYSTEMS, PARTNER TO SUPPORT YOUTH AND ADOLESCENT LOCAL PLACEMENT, ADJUST TO MEDICAID 1115 WAIVER CHANGING GAPS, PARTNER FOR HOUSING AND WORKFORCE SHORTAGES, HELP COORDINATE LOCAL PLANNING AND SERVICES.2) SENIOR CARE - IMPROVE PUBLIC AND LEADER UNDERSTANDING OF ISSUES, INCREASE ACCESSIBILITY FOR MENTAL AND PHYSICAL FITNESS, AID NAVIGATION, ADDRESS MEDICAID ELIGIBILITY WAIT TIME, PARTNER FOR HOUSING SOLUTIONS, COMMUNITY BASED SERVICE ACCESS, ADDRESS WORKFORCE SHORTAGES, COORDINATE PLANNING.3) ACES/TRAUMA - IMPROVE COMMUNITY UNDERSTANDING OF TRAUMA INFORMED CARE, EXPAND PREVENTION AND RESILIENCY PROGRAMS, CREATE COLLABORATIVE GROUP. 4) HEALTHY BEHAVIORS - IMPROVE UNDERSTANDING OF RECOMMENDATIONS FOR WELLNESS CHECKS, MOVEMENT, NUTRITION, AND IMMUNIZATION. ADDRESS VACCINE HESITANCY ISSUES. ADDRESS EQUITABLE ACCESS TO COMMUNITY BASED SUPPORTS FOR HEALTH. INCREASE SCREENING FOR 2030 HEALTHY ALASKAN INDICATORS, IMPROVE VACCINATION RATES, UPDATE RESOURCE GUIDES, JOINT PLANNING AMONG SERVICES.EACH OF THESE FOUR FOCUS AREAS HAS AN ONGOING COMMUNITY WORK GROUP TEAM ESTABLISHED AND THE ORGANIZATION SUPPORTS THE FACILITATION OF ONGOING COLLABORATIONS. NEEDS ASSESSED BUT NOT ADDRESSED (OR ADDRESSED AS SUBSETS OF THE MAJOR FOUR): POVERTY, AIR/WATER QUALITY, PRENATAL CARE RATES, PREVENTABLE INJURIES, DENTAL, TRANSPORTATION, MOBILITY, BURNOUT, SUBSPECIALTY ACCESS, REMOTE LOCATIONS, VISITING NURSES, AND INTELLECTUAL DEVELOPMENTAL DISABILITIES. THE IDENTIFIED NEEDS WHICH ARE NOT SPECIFICALLY ADDRESSED WERE NOT ENTIRELY EXCLUDED, MANY ARE WITHIN THE CONTEXT OF THE FOCUS AREAS; THEY DID NOT HOWEVER RISE TO THE PRIORITIZATION LEVELS DESCRIBED IN 3.E. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: THE ORGANIZATION USES A FIXED DOLLAR HOUSEHOLD INCOME AMOUNT TO IDENTIFY PATIENTS ELIGIBLE FOR DISCOUNTED CARE. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: COVERAGE THROUGH OTHER PROGRAMS OR INSURANCE MUST BE EXHAUSTED OR DENIED. FAMILY SIZE. PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE PRIORITIZED AS A RESULT OF IDENTIFYING COMMUNITY HEALTH NEEDS THROUGHT THE CHNA PROCESS. THE ANALYSE PROCESS INCLUDED AN EVALUATION OF EACH IDENTIFIED HEALTH NEED RELATIVE TO FACTORS INCLUDING SERIOUSNESS OF THE ISSUE, SIZE OF THE ISSUE, CLEAR DISPARTIES OR INEQUITIES, LOCAL NEED BEING WORSE THAN NATIONAL RATES, AND ABILITY TO IMPACT. THE RESULTING PRIORITIZED NEEDS INCLUDE MENTAL HEALTH, SENIOR CARE/AGING, ADVERSE CHILDHOOD EXPERIENCES (ACES) AND TRAUMA AND THEIR IMPACT ON HEALTH AT EVERY AGE, AND PHYSICAL HEALTH AND OVERALL HEALTHY BEHAVIORS IMPACTING CHRONIC CONDITIONS. PART V, SECTION B, LINE 7A: HTTPS://WWW.FOUNDATIONHEALTH.ORG/OUR_COMMUNITY/COMMUNITY_HEALTH/COMMUNITY_NEEDS/CHNA PART V, SECTION B, LINE 10A: HTTPS://WWW.FOUNDATIONHEALTH.ORG/OUR_COMMUNITY/COMMUNITY_HEALTH/COMMUNITY_NEEDS/CHIP PART V, SECTION B, LINE 16: WEBSITE APPLICABLE FOR LINES 16A, 16B, 16C:HTTPS://WWW.FOUNDATIONHEALTH.ORG/PATIENTS_AND_VISITORS/BILL_PAY/FINANCIAL_ASSISTANCE 2 1 - TANANA VALLEY CLINIC LLC 1001 NOBLE STREET FAIRBANKS AK 99701 MULTI SPECIALTY CLINIC 2 - DENALI CENTER 1510 19TH AVENUE FAIRBANKS AK 99701 SKILLED NURSING FACILITY PART I, LINE 3C: THE ORGANIZATION USES A FIXED DOLLAR HOUSEHOLD INCOME AMOUNT TO IDENTIFY PATIENTS ELIGIBLE FOR DISCOUNTED CARE. PART I, LINE 7: THE ORGANIZATION USED THE COST TO CHARGE RATIO FROM WORKSHEET 2 TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINE 7. PART I, LINE 7G: FOUNDATION HEALTH OPERATES TANANA VALLEY CLINIC WHICH IS A MULTI-SPECIALTY CLINIC OFFERING FAMILY PRACTICE, PEDIATRIC, OB-GYN SERVICES AMONG OTHERS. THE CLINIC ACCEPTS ALL GOVERNMENT PAYERS INCLUDING MEDICARE AND MEDICAID WITH NO LIMITATIONS. THE CLINIC ALSO PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO QUALIFY. PART II: COMMUNITY BUILDING ACTIVITIES PROVIDE COALITION LEADERSHIP AND PARTICIPATION IN ESTABLISHED COMMUNITY COALITIONS FOR HOMELESSNESS, SUBSTANCE USE, BEHAVIORAL HEALTH CARE, AND PUBLIC HEALTH SERVICES SERVING THE INTERIOR OF ALASKA. PROMOTE COMMUNITY HEALTH VIA REPRESENTATION IN COMMUNITY COALITIONS FOR WELLNESS (SUICIDE PREVENTION), FAIRBANKS NORTH STAR BOROUGH SENIOR CITIZENS ADVISORY COMMISSION, AGENET (SENIORS) AND ALASKA COMMISSION ON AGING (SENIORS). PROVIDE SPACE AND EMPLOYMENT COACHING SUPPORT SERVICES FOR WORKFORCE DEVELOPMENT AMONG PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (SEARCH PROGRAM) AND FOR STUDENTS IN PROGRAMS TO INTRODUCE HEALTH RELATED OCCUPATIONS. PART III, LINE 2: CONTRACTUAL (CT) AND BAD DEBT (BD) ALLOWANCES FOR HOSPITAL ACCOUNTS RECEIVABLE (A/R) BALANCES ARE CALCULATED EACH MONTH BY COMPARING TARGET ADJUSTMENTS TO OBSERVED ADJUSTMENTS; THE DIFFERENCE BETWEEN TARGET ADJUSTMENTS AND OBSERVED ADJUSTMENTS IS BOOKED AS AN ALLOWANCE. TARGET ADJUSTMENTS ARE FOUND BY APPLYING TARGET PERCENTAGES TO THE GROSS CHARGES THAT RESULTED IN CURRENT A/R BALANCES. TARGET PERCENTAGES ARE DERIVED FROM HISTORICAL ADJUSTMENT DATA, ON CLOSED ACCOUNTS, IN A LOOKBACK PERIOD CONTAINING 12 MONTHS. THE CT LOOKBACK PERIOD IS THE 12 MONTH PERIOD ENDING 3 MONTHS PRIOR TO THE CURRENT PERIOD. THE BD LOOKBACK PERIOD IS THE 12 MONTH PERIOD ENDING 15 MONTHS PRIOR TO THE CURRENT PERIOD. TARGET ADJUSTMENT PERCENTAGES ARE UPDATED EACH MONTH AND CALCULATED FOR ACCOUNT PORTFOLIOS BASED ON INPATIENT/OUTPATIENT DESIGNATION AND FINANCIAL CLASS. ACTUAL COLLECTIONS ON PRIOR PERIOD A/R BALANCES ARE REVIEWED TO ENSURE THE ALLOWANCE METHODOLOGY IS APPROPRIATE AND RELIABLY ESTIMATES A/R COLLECTABILITY. PART III, LINE 4: SEE AUDITED FINANCIAL STATEMENTS, PAGE 11 FOR DISCUSSION REGARDING THE ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 6 IS FROM THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS THAT WE BELIEVE MAY QUALIFY FOR FINANCIAL ASSISTANCE ARE TOLD ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND GIVEN AN APPLICATION (IF WANTED) DURING THE ADMISSIONS PROCESS. IF THE PATIENT APPLIES AND QUALIFIES, THE BALANCE IS WRITTEN OFF IN PART OR IN FULL. IF THE ACCOUNT IN NOT WRITTEN OFF ENTIRELY, THE REDUCED BALANCE IS TREATED IN THE SAME MANNER AS ACCOUNTS FOR PATIENTS WITHOUT INSURANCE, WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. THE COLLECTION POLICY INCLUDES 8 PATIENT STATEMENTS AND 2 REMINDER LETTERS SENT TO THE PATIENT. PAYMENT PLANS ARE MADE AVAILABLE; ATTEMPTS ARE MADE TO VERIFY PHYSICAL ADDRESSES OF PATIENTS; AND EFFORTS USED TO DETERMINE IF THE PATIENT MAY BE MEDICAID ELIGIBLE. OUR BILLING STAFF ATTEMPTS TO CONTACT AS MANY PATIENTS AS POSSIBLE. PART VI, LINE 2: THE ORGANIZATION CONTINUOUSLY SEEKS AND RESPONDS TO COMMMUNITY INPUT REGARDING HEALTH CARE NEEDS. A LINK FOR COMMUNITY FEEDBACK IS ON THE ORGANIZATION WEBSITE AND IS DELIVERED TO THE DIRECTOR OF COMMUNICATIONS. THE COMMUNICATIONS DIRECTOR IS ACCOUNTABLE FOR ADDRESSING THE FEEDBACK AND REFERRING COMMUNITY NEED INPUT TO THE DIRECTOR, INTERNAL AND EXTERNAL AFFAIRS. THE TRAUMA TEAM OF THE EMERGENCY SERVICES AND THE CANCER TREATMENT PROGRAM CONDUCT FORMAL ANNUAL COMMUNITY NEEDS ASSESSMENTS ACCORDING TO ACCREDITATION STANDARDS. THE OUTCOME OF THEIR NEEDS ASSESSMENTS IS EVALUATED BY THE EXECUTIVE LEADERSHIP AND IS MERGED WITH ONGOING INPUT FOR THE NEXT CHNA. THE ADMINISTRATIVE TEAM OF THE HOSPITAL MAINTAINS FORMAL AND INFORMAL RELATIONSHIPS WITH GOVERNMENT, BUSINESS, PROVIDER, AND HEALTH SYSTEM CONSUMER GROUPS AND ROUTINELY ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AS REPRESENTED BY INPUT FROM THESE ENTITIES. PART VI, LINE 3: REGISTRATION STAFF OFFERS FINANCIAL ASSISTANCE INFORMATION AT THE TIME OF REGISTRATION FOR PATIENTS LACKING INSURANCE COVERAGE. MONTHLY BILLING STATEMENTS INCLUDE A PHONE NUMBER TO CALL FOR INFORMATION ON FINANCIAL ASSISTANCE AND POSSIBLE ELIGIBILITY FOR OTHER PROGRAMS. INPATIENTS WITH NO INSURANCE ARE CONTACTED BY OUR INPATIENT FINANCIAL SERVICES REPRESENTATIVE FOR MEDICAID SCREENING. WE ALSO CONTRACT WITH A THIRD PARTY VENDOR TO CONDUCT OUTREACH TO DISCHARGED PATIENTS WITH SELF PAY BILLS TO ASSIST THEM TO APPLY TO OTHER PROGRAMS SUCH AS MEDICAID. MEDICARE FINANCIAL ASSISTANCE BROCHURES ARE AVAILABLE IN THE EMERGENCY DEPARTMENT AND OTHER REGISTRATION AREAS. INFORMATION REGARDING OUR FINANCIAL ASSISTANCE PROGRAM IS PUBLISHED ON OUR WEBSITE. PART VI, LINE 4: FAIRBANKS MEMORIAL HOSPITAL IS THE SOLE COMMUNITY PROVIDER AND THE ONLY STATE LICENSED HOSPITAL IN ITS PRIMARY AND SECONDARY SERVICE AREAS.- THE PRIMARY AREA INCLUDES THE 7,400 SQUARE MILE FAIRBANKS NORTH STAR BOROUGH (FNSB) POPULATION 98,455 - THE SECONDARY AREA IS APPROXIMATELY 127,000 SQUARE MILES OF WHAT IS REFERRED TO AS INTERIOR OR NORTHERN ALASKA - WITH VERY FEW OF THE COMMUNITIES IN THIS AREA ACCESSIBLE BY ROAD.- OVERALL, THE HOSPITAL'S SERVICE POPULATION IS ESTIMATED TO BE A POPULATION OF APPROXIMATELY 132,000 WITH 89 PERCENT OF THE HOSPITAL BUSINESS SERVING THE PRIMARY AREA; FAIRBANKS NORTH STAR BOROUGH.- THE NEXT CLOSEST HOSPITAL IS 350 MILES SOUTH OF FAIRBANKS.THOSE WHO ARE NOT SERVED BY THIS HOSPITAL ARE POTENTIALLY RECEIVING SERVICES FROM TANANA CHIEFS CONFERENCE - CHIEF ANDREW ISAAC HEALTH CENTER (AN INDIAN HEALTH SERVICE), BASSETT ARMY COMMUNITY HOSPITAL (FOR MILITARY BENEFICIARIES), AND AN AMBULATORY SURGERY CENTER. PER U.S. CENSUS BUREAU, THE FAIRBANKS NORTH STAR BOROUGH POPULATION IS 75% WHITE, 8% ALASKA NATIVE/AMERICAN INDIAN, 5% BLACK, AND SMALLER PERCENTAGES ARE ASIAN, HISPANIC, AND TWO OR MORE RACIAL DESCENTS. OF 5% FOREIGN-BORN POPULATION, 45% ASIAN, 22% EUROPE,16% LATIN AMERICA, 12% NORTH AMERICA, 4% AFRICA, 2% OCEANIA. THE MEDIAN AGE IS 31.5 YEARS WITH LARGEST AGE GROUP BEING 20-29 YEARS OLD (20%) AND ALL AGE GROUPS UNDER 40 EXCEED U.S. AVERAGE AND 10% ARE 65 AND OLDER.MEDIAN HOUSEHOLD INCOME IS $76,464, PER CAPITA INCOME $38,031. MEDIAN HOUSE VALUE $240,300 AND 59% OF HOUSING IS OWNER OCCUPIED. OF ALL PERSONS, 6.6% PERSONS ARE BELOW THE POVERTY LINE WITH SENIORS (65 AND OLDER) AT 5%, CHILDREN 8%. VETERANS COMPRISE 16% OF THE POPULATION. NO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS ARE PRESENT IN THE FNSB. PART VI, LINE 5: FAIRBANKS MEMORIAL HOSPITAL IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF VOLUNTEER COMMUNITY REPRESENTATIVES. THE BOARD ESTABLISHES THE ORGANIZATIONS PRIORITIES, ENSURES OPERATIONS ARE CONSISTENT WITH THE NON-PROFIT PURPOSE AND MISSION, AND REINVESTS IN NEW EQUIPMENT AND TECHNOLOGY, NEW OR EXPANDED PATIENT SERVICES, AND MAINTAINS EXISTING ASSETS TO MEET COMMUNITY NEED AND LONG TERM HEALTH. FMH UTILIZES AN OPEN MEDICAL STAFF MODEL; THE HOSPITAL AND CLINIC ALSO EMPLOY AND CONTRACT WITH PROVIDERS TO ENSURE EFFICIENT, EVIDENCE-BASED, AND HIGH QUALITY CLINICAL CARE WITHIN AN INTEGRATED SYSTEM ALONG THE FULL CONTINUUM OF CARE. THE HOSPITAL FUNCTIONS IN A BOROUGH AND CITY GOVERNMENT STRUCTURE THAT DOES NOT INCLUDE A PUBLIC HEALTH INFRASTRUCTURE OUTSIDE THE STATE SYSTEM RESOURCES; THEREFOR, FOR ALL PUBLIC HEALTH INITIATIVES AND EMERGENCIES, THE HOSPITAL FUNCTIONS AS CRITICAL PUBLIC HEALTH FACILIATOR, PLANNER, AND PROVIDER. THE HOSPITAL ALSO FUNCTIONS IN COLLABORATION WITH ALASKA TRIBAL HEALTH PROVIDERS AND ARMY-AIRFORCE HEALTH PROVIDERS, ALL OF WHICH PARTNER FOR EMERGENCY PREPAREDNESS. PART VI, LINE 6: FOUNDATION HEALTH LLC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7: ALASKA DOES NOT REQUIRE FILING OF A COMMUNITY BENEFIT REPORT. 1 UNIVERSITY OF ALASKA 3211 PROVIDENCE DRIVE ANCHORAGE AK 995088030 926000147 GOVERNMENT 100000 0 SCHOOL OF NURSING EXPANSION 1 0 PART I, LINE 2: FOUNDATION HEALTH MAINTAIN RECORDS SHOWING GRANT RECEIPTS AND GRANT EXPENDITURES. THE GRANT MANAGERS MAINTAIN INFORMATION REGARDING HOW EXPENSES WERE SPENT. THE GRANT ACCOUNTANT CONFIRMS WITH GRANT MANAGERS WHETHER OR NOT THEY HAVE PROOF OF ELIGIBILITY AND SELECTION CRITERIA. GRANT FUNDS ARE OVERSEEN BY THE GRANT MANAGERS. EXPENSES ARE PROCESSED THROUGH ACCOUNTS PAYABLE AND CODED TO EACH GRANT ACTIVITY CODE. ACCOUNTING COMPLETES INVOICES TO GRANT ADMINISTRATORS AND RECONCILES MONEY SPENT TO MONEY INVOICED. WHEN ACCOUNTING CREATES THE INVOICE, THE GRANT MANAGERS REVIEW AND APPROVE THE INVOICES PRIOR TO SENDING THE INVOICE TO THE GRANT ADMINISTRATOR. X X X 0 0 0 1 0 1 0 0 0 ROMEL C WRENN PHYSICIAN 830832 0 454344 0 5562 0 11600 0 22403 0 1324741 0 0 0 LEE M PIERSON PHYSICIAN 677038 0 373084 0 30405 0 11600 0 22257 0 1114384 0 0 0 WILLIAM QUIRK PHYSICIAN 789736 0 0 0 2676 0 3188 0 31540 0 827140 0 0 0 MILAN BAJMOCZI PHYSICIAN 651502 0 119370 0 3705 0 0 0 31153 0 805730 0 0 0 BRUCE M FOOTIT PHYSICIAN SUPERVISOR 514344 0 233461 0 4852 0 11600 0 19839 0 784096 0 0 0 ZACH WERLE BOARD MEMBER/PHYSICIAN 257253 0 222984 0 31116 0 11596 0 32346 0 555295 0 0 0 LAURA BRUNNER BOARD MEMBER/PHYSICIAN 378593 0 124000 0 22782 0 11403 0 4341 0 541119 0 0 0 ANGELIQUE RAMIREZ CHIEF MEDICAL OFFICER 381933 0 25000 0 7668 0 1896 0 34863 0 451360 0 0 0 SHELLEY EBENAL EXECUTIVE DIRECTOR FHP CEO 308620 0 48376 0 7110 0 11600 0 30223 0 405929 0 0 0 ELIZABETH WOODYARD CHIEF CLINICAL SERVICES 293829 0 44764 0 2122 0 8719 0 21470 0 370904 0 0 0 GARY RODERICK CHIEF FINANCIAL OFFICER 267079 0 42073 0 5491 0 8199 0 27753 0 350595 0 0 0 CLINT BROOKS CHIEF OPERT OFFICER SHARED SERV 285518 0 43003 0 4948 0 10638 0 652 0 344759 0 0 0 SARAH MARTIN CHIEF NURSING OFFICER 188260 0 30922 0 8009 0 8174 0 29009 0 264374 0 0 0 JENNIFER N WELCH CHIEF HR OFFICER 165983 0 27812 0 12420 0 5420 0 29377 0 241012 0 0 0 ROBIN FOWLER LEGAL COUNSEL AND COMPLIANCE 189215 0 0 0 403 0 7512 0 19800 0 216930 0 0 0 ROY ROEHL IT SENIOR DIRECTOR 156979 0 2062 0 5662 0 6989 0 31106 0 202798 0 0 0 JENNIFER HOUSE FIN & REV SENIOR DIRECTOR 180127 0 0 0 164 0 5420 0 14478 0 200189 0 0 0 AMY LUCKE QUALITY SENIOR DIRECTOR 168223 0 0 0 1543 0 7013 0 20746 0 197525 0 0 0 JOSEPH O'CONNOR FIN & REV SENIOR DIRECTOR 158581 0 72 0 828 0 0 0 30988 0 190469 0 0 0 PART I, LINE 5 PHYSICIANS RECEIVE PRODUCTION PAY IN ADDITION TO THEIR BASE COMPENSATION. A SET SPECIFIC RATE OF PAY IS PAID PER WORK RELATIVE VALUE UNIT PERFORMED OVER AN AGGREGATE THRESHOLD. PART I, LINE 6 THE EXECUTIVE PERFORMANCE INCENTIVE (EPI) IS AN INCENTIVE PAY PLAN DESIGNED TO REWARD AND RECOGNIZE EXECUTIVES FOR ORGANIZATION PERFORMANCE. THE AMOUNT OF THE ACTUAL AWARD IS DETERMINED AS A PERCENTAGE OF BASE PAY AND THE LEVEL OF PERFORMANCE ACHIEVED AGAINST FHP'S OPERATING PRIORITIES. EACH ELIGIBLE EXECUTIVE IS ELIGIBLE FOR A 15% TARGET / 20% MAXIMUM AWARD AS A PERCENTAGE OF BASE SALARY. IF ORGANIZATION PERFORMANCE FALLS ABOVE THE TARGET BUT BELOW THE MAXIMUM, THEN THE AWARD WOULD BE PRORATED TO BE PAID AS THE PERCENTAGE BETWEEN THE TARGET AND MAXIMUM RATE BASED ON THE GOAL RESULT. RESULTS ABOVE THE MAXIMUM WOULD BE PAID AT THE MAXIMUM PERCENTAGE. FORM 990, PART I, LINE 6: THE TOTAL HOURS VOLUNTEERS SERVED WAS 2,317 HOURS IN 5 DEPARTMENTS. VOUNTEERS WERE USED IN "POP-UP" COVID CLINICS, SCREENING VISITORS AT POINTS OF ENTRY, CLERICAL SUPPORT, VOLUNTEER DOG VISITS BOOSTING MORAL FOR PATIENTS AND STAFF, AND PAITIENT BESIDE COMFORT AND COMPANIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 FOUNDATION HEALTH'S SOLE MEMBER IS GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A FOUNDATION HEALTH'S SOLE MEMBER, GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION, APPOINTS 5 OF FOUNDATION HEALTH'S BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE APPROVAL BY THE ORGANIZATION'S SOLE MEMBER: 1) SALE OF ALL OR SUBSTANTIALLY ALL ASSETS OF THE COMPANY; 2) SUBSTANTIALLY CHANGING THE NATURE OR SCOPE OF THE BUSINESS OF THE COMPANY; 3) THE PARTICIPATION IN PARTNERSHIP AGREEMENTS, JOINT VENTURES, OR OTHER ASSOCIATIONS OF ANY KIND WITH ANY PERSON OR PERSONS; 4) EQUIPMENT PURCHASES EXCEEDING $5,000 AND EXCEEDING THE APPROVED OPERATING BUDGET; 5) ENTERING INTO GUARANTIES; INCURRING LIABILITIES; BORROWING MONEY, ISSUING NOTES, BONDS, AND OTHER OBLIGATIONS; OR SECURING ANY COMPANY OBLIGATION BY MORTGAGE OR PLEDGE OR ANY COMPANY PROPERTY OR INCOME; AND 6) LENDING MONEY, INVESTMENT OR REINVESTMENT OF THE COMPANY'S FUNDS, OR RECEIPT AND HOLDING OF PROPERTY AS SECURITY FOR REPAYMENT, INCLUDING, WITHOUT LIMITATION, LOANING MONEY TO, AND OTHERWISE HELPING THE MEMBER, ANY OFFICERS, EMPLOYEES, OR AGENTS. FORM 990, PART VI, SECTION B, LINE 11B A FULL COPY OF THE FORM 990 WILL BE EMAILED TO THE BOARD FOR THEIR REVIEW PRIOR TO SUBMISSION. ANY QUESTIONS WILL BE RESOLVED PRIOR TO OBTAINING THE SIGNATURE OF THE CFO. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, OFFICERS AND THE QUALITY AND COMPLIANCE COMMITTEE MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST THAT MAY GIVE RISE TO A CONFLICT OF INTEREST PROMPTLY TO THE QUALITY AND COMPLIANCE COMMITTEE BOARD. THE COMMITTEE MUST THEN CONSIDER THE DISCLOSED INTEREST AND EITHER AUTHORIZE THE CONTINUATION OF THE POTENTIAL FINANCIAL INTEREST AND ANY RELATED TRANSACTION WITH APPROPRIATE PROTECTIONS, OR DISAPPROVE OF IT. OTHER FH EMPLOYEES MUST GO THROUGH A SIMILAR PROCESS OF DISCLOSURE TO THEIR RESPECTIVE SUPERVISOR AND TO THE QUALITY AND COMPLIANCE COMMITTEE. ALL BOARD MEMBERS, MEMBERS OF LOCAL BOARDS OF OWNED FACILITIES, OFFICERS OF FHP, ADMINISTRATORS, EMPLOYED PHYSICIANS, AND OTHER EMPLOYEES AND INDIVIDUALS DESIGNATED BY THEIR SUPERVISORS OR BY THE CHIEF COMPLIANCE OFFICER MUST COMPLETE AN ANNUAL SURVEY THAT IS DISTRIBUTED UNDER THE SUPERVISION OF THE CHIEF COMPLIANCE BOARD. THE SURVEY INCLUDES A QUESTIONNAIRE THAT IS DESIGNED TO IDENTIFY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, AS WELL AS OTHER TRANSACTION AND RELATIONSHIPS REQUIRED TO BE DISCLOSED IN THE FORM 990 AND SCHEDULE L. FORM 990, PART VI, SECTION B, LINE 15 FOUNDATION HEALTH PARTNERS USES A PAY RATE CALCULATOR IN ORDER TO DETERMINE COMPENSATION. THE FHP COMPENSATION BOARD APPROVES THE FHP PAY RATE CALCULATOR (PRC) GUIDELINES WHICH IS USED EVERY TIME AN OFFER OR PAY CHANGE IS MADE FOR AN EMPLOYEE. ANY OFFER OUTSIDE OF THE RECOMMENDED RANGE WILL REQUIRE AN APPROVAL. OFFER APPROVALS GO TO THE COMPENSATION AND BENEFITS TEAM, WHICH WILL THEN DECIDE WHAT TYPE OF APPROVAL IS ULTIMATELY REQUIRED. UNDER THE FHP PHILOSOPHY, AN EXCEPTION COMMITTEE WILL BE CREATED TO REVIEW REQUESTED EXCEPTIONS THAT ARE OTHERWISE CONTRARY TO FHP'S COMPENSATION PHILOSOPHY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ASSET TRANSFER FROM RELATED PARTY 460,571. DENALI CENTER LLC 1510 19TH AVENUE FAIRBANKS AK 99701 300945293 COMPREHENSIVE SHORT AND LONG TERM CARE CENTER AK 19313048 2122785 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL HOSPITAL LLC 1650 COWLES STREET FAIRBANKS AK 99701 320499956 HOSPITAL/HEALTHCARE SERVICES AK 262688674 107336603 FOUNDATION HEALTH LLC TANANA VALLEY CLINIC LLC 1001 NOBLE STREET FAIRBANKS AK 99701 611797882 PRIMARY CARE SERVICES AK 18253772 6140369 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL CARDIOLOGY CENTER LLC 1650 COWLES ST FAIRBANKS AK 99701 364841105 CARDIOLOGY CLINIC AK 37008716 330648 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL HOME MEDICAL EQUIPMENT LLC 19 COLLEGE RD STE D FAIRBANKS AK 99701 371830937 HOME MEDICAL EQUIPMENT RENTALS AND SALES AK 1277298 122682 FOUNDATION HEALTH LLC GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION PO BOX 71396 FAIRBANKS AK 71396 920035784 OWN/LEASE HOSPITAL RELATED MEDICAL FACILITIES AK 501(C)(3) LINE 7 N/A 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0