NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK (EIN 93-0622075)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-10
- IRS object ID
- 202103149349307470
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-10T17:47:34-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 W March Ln Ste 200 | AddressLine1Txt |
| City | Stockton | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 952192367 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930622075 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northwest Medical Foundation Tillamook | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Third Street | AddressLine1Txt |
| City | Tillamook | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97141 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Micah Smith | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 9164060000 | PhoneNum |
| Signature | 2021-10-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Micah | PersonFirstNm |
| Person Last | Smith | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tracy S Paglia | PreparerPersonNm |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | PhoneNum |
| Preparation | 2021-10-25 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adventist Health Tillamook | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Eric Swanson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Third Street | AddressLine1Txt |
| City | Tillamook | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97141 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $100,489,282 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 1071 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.adventisthealth.org/tillamook/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | Living God's love by inspiring health, wholeness and hope. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 662 | TotalEmployeeCnt |
| Total Volunteers | 74 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $283,663 | PYContributionsGrantsAmt |
| CY Contributions Grants | $484,076 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $93,519,298 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $98,435,134 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,794,429 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,569,552 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$679 | CYOtherRevenueAmt |
| PY Total Revenue | $95,597,390 | PYTotalRevenueAmt |
| CY Total Revenue | $100,488,083 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $261 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,677,450 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $44,336,424 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $193,570 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $45,816,947 | PYOtherExpensesAmt |
| CY Other Expenses | $49,140,085 | CYOtherExpensesAmt |
| PY Total Expenses | $91,494,658 | PYTotalExpensesAmt |
| CY Total Expenses | $93,476,509 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,102,732 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,011,574 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $75,433,844 | TotalAssetsBOYAmt |
| Total Assets EOY | $95,488,229 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,229,792 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,272,603 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $59,204,052 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $66,215,626 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Living God's love by inspiring health, wholeness and hope. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $71,973,992 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $98,435,134 | RevenueAmt |
| Desc | See Schedule O | Desc |
| Total Program Service Expenses | $71,973,992 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 662 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Todd Hofheins CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9164060000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 619135 | AddressLine1Txt |
| City | Roseville | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95661 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||
| Dir/Chair | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $2,358,378 | $54,819 | |||
| Wing Bill | ||||||||||
| Dir/Asst Secr/Vice Chair | 0.00 | 50.00 | Yes (X) | Yes (X) | $0 | $1,760,327 | $59,054 | |||
| Jahn Andrew | ||||||||||
| President, Care Division | 2.00 | 48.00 | $0 | $1,365,841 | $59,307 | Yes (X) | ||||
| Newmyer Joyce | ||||||||||
| President, PNR | 12.50 | 37.50 | $0 | $933,247 | $62,067 | Yes (X) | ||||
| Nahapetian Arby - Care | ||||||||||
| Division Chief Medical Officer | 2.00 | 48.00 | $0 | $868,206 | $54,711 | Yes (X) | ||||
| Reppert Joseph | ||||||||||
| Former CFO/Asst Secr thru 08/19 | 0.00 | 0.00 | $0 | $813,425 | $41,111 | Yes (X) | ||||
| LaFleur Brett | ||||||||||
| Physician | 50.00 | 0.00 | $784,058 | $0 | $43,713 | Yes (X) | ||||
| Jobe Meredith | ||||||||||
| Secretary | 0.00 | 50.00 | Yes (X) | $0 | $769,985 | $43,868 | ||||
| Welch Donald | ||||||||||
| Finance Officer, PNR | 12.50 | 37.50 | $0 | $597,456 | $53,834 | Yes (X) | ||||
| Butler David | ||||||||||
| President thru 08/19 | 0.00 | 50.00 | $0 | $550,904 | $59,307 | Yes (X) | ||||
| Kaba David | ||||||||||
| Physician | 50.00 | 0.00 | $491,109 | $0 | $49,015 | Yes (X) | ||||
| Hofheins Todd | ||||||||||
| CFO as of 08/20 | 0.00 | 50.00 | Yes (X) | $0 | $469,107 | $13,281 | ||||
| Mitchell Brandon | ||||||||||
| Physician | 50.00 | 0.00 | $354,891 | $0 | $54,048 | Yes (X) | ||||
| Leach Judy | ||||||||||
| Strategy & Comm Exec, PNR | 0.00 | 50.00 | $0 | $358,886 | $39,489 | Yes (X) | ||||
| Halferty Michael | ||||||||||
| Physician | 50.00 | 0.00 | $342,005 | $0 | $54,120 | Yes (X) | ||||
| Thompson Albert | ||||||||||
| Physician | 50.00 | 0.00 | $360,324 | $0 | $28,080 | Yes (X) | ||||
| Swanson Eric | ||||||||||
| President | 50.00 | 0.00 | Yes (X) | $0 | $327,157 | $26,442 | ||||
| Voshell Shane | ||||||||||
| Reg HR Dir, PNR | 0.00 | 50.00 | $0 | $271,024 | $58,224 | Yes (X) | ||||
| Smith Micah | ||||||||||
| Treas/Asst Secr | 50.00 | 0.00 | Yes (X) | $0 | $256,052 | $54,536 | ||||
| Saxon Kathleen | ||||||||||
| PT Care Executive | 0.00 | 50.00 | $0 | $262,289 | $40,709 | Yes (X) | ||||
| Wagner Jack | ||||||||||
| Former Asst Secr thru 03/18 | 0.00 | 0.00 | $0 | $269,387 | $13,558 | Yes (X) | ||||
| Seufert Regina | ||||||||||
| Physician/Clinic Svcs Exec | 0.00 | 50.00 | $0 | $243,589 | $26,437 | Yes (X) | ||||
| Lee Adam | ||||||||||
| Dir Marketing & Comm, PNR | 0.00 | 50.00 | $0 | $197,098 | $39,016 | Yes (X) | ||||
| Freedman John | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $27,216 | $0 | ||||
| Davis Andrew | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,971 | $0 | ||||
| Reiner Richard | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,764 | $0 | ||||
| Cherry Robert | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $26,160 | $0 | ||||
| Innocent Larry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $25,608 | $0 | ||||
| Graham Ricardo | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $23,359 | $0 | ||||
| Heinrich Kerry | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,608 | $0 | ||||
| Woodson Marc | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,608 | $0 | ||||
| Ocampo Lucy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $20,358 | $0 | ||||
| Banks David | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $15,441 | $0 | ||||
| Salazar Velino | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $6,651 | $0 | ||||
| Fehr Joy | ||||||||||
| Director | 0.00 | 4.00 | Yes (X) | $0 | $108 | $0 | ||||
| Philip Celeste | ||||||||||
| Director thru 04/20 | 0.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,332,387 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $12,912,210 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,028,746 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 80 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Tillamook Emergency Services Inc | |||||
| 1000 Third Street | Tillamook | OR | 97141 | Physician Services | $2,381,872 |
| Comphealth Inc | |||||
| PO Box 972651 | Dallas | TX | 75397 | Physician Services | $1,321,344 |
| Bivens Medical Corporation | |||||
| 20105 Geisendorfer Rd | Applegate | CA | 95703 | Physician Services | $1,299,089 |
| Staff Care Inc | |||||
| PO Box 281923 | Atlanta | GA | 30384 | Physician Services | $823,627 |
| Rural Physicians Group Pannu PLLC | |||||
| 10624 S Eastern Ave Ste A-263 | Henderson | NV | 89052 | Physician Services | $722,193 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $10,000 | RelatedOrganizationsAmt |
| All Other Contributions | $474,076 | AllOtherContributionsAmt |
| Total Contributions | $484,076 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 900099 | $89,311,448 | $89,311,448 |
| CAREs Act funding | 900099 | $6,984,471 | $6,984,471 |
| Rental income | 531120 | $53,792 | $53,792 |
| Dietary services | 722210 | $47,364 | $47,364 |
| Management fees | 900099 | $36,472 | $36,472 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,001,587 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,001,587 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $98,435,134 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,569,245 | TotalRevenueColumnAmt |
| Exclusion | $1,569,245 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $307 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $307 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $307 | TotalRevenueColumnAmt |
| Exclusion | $307 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $520 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,199 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$679 | TotalRevenueColumnAmt |
| Exclusion | -$679 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $100,488,083 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $98,435,134 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,568,873 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,737 | TotalAmt |
| Program Services | $31,737 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,282,916 | TotalAmt |
| Program Services | $31,189,367 | ProgramServicesAmt |
| Management And General | $2,961,981 | ManagementAndGeneralAmt |
| Fundraising | $131,568 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,373,430 | TotalAmt |
| Program Services | $1,316,845 | ProgramServicesAmt |
| Management And General | $51,518 | ManagementAndGeneralAmt |
| Fundraising | $5,067 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,392,075 | TotalAmt |
| Program Services | $5,952,657 | ProgramServicesAmt |
| Management And General | $395,074 | ManagementAndGeneralAmt |
| Fundraising | $44,344 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,256,266 | TotalAmt |
| Program Services | $2,032,521 | ProgramServicesAmt |
| Management And General | $213,050 | ManagementAndGeneralAmt |
| Fundraising | $10,695 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,741,093 | TotalAmt |
| Program Services | $340,245 | ProgramServicesAmt |
| Management And General | $8,400,848 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,062 | TotalAmt |
| Management And General | $74,062 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,209 | TotalAmt |
| Program Services | $5,209 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,848,737 | TotalAmt |
| Program Services | $10,803,474 | ProgramServicesAmt |
| Management And General | $5,045,263 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,280 | TotalAmt |
| Management And General | $3,280 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $879,482 | TotalAmt |
| Program Services | $567,322 | ProgramServicesAmt |
| Management And General | $311,745 | ManagementAndGeneralAmt |
| Fundraising | $415 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,322,702 | TotalAmt |
| Program Services | $494,937 | ProgramServicesAmt |
| Management And General | $2,827,765 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,063,154 | TotalAmt |
| Program Services | $1,799,757 | ProgramServicesAmt |
| Management And General | $263,397 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,327 | TotalAmt |
| Program Services | $151,493 | ProgramServicesAmt |
| Management And General | $86,853 | ManagementAndGeneralAmt |
| Fundraising | $981 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,301 | TotalAmt |
| Program Services | $125,676 | ProgramServicesAmt |
| Management And General | $1,130 | ManagementAndGeneralAmt |
| Fundraising | $495 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,894 | TotalAmt |
| Program Services | $101,894 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,206,743 | TotalAmt |
| Program Services | $2,192,907 | ProgramServicesAmt |
| Management And General | $13,836 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600,425 | TotalAmt |
| Program Services | $600,425 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|---|
| Patient care supplies | $10,431,563 | $10,431,558 | $5 | |
| Quality assurance fee | $3,770,893 | $3,770,893 | ||
| Rental/leases costs, eq | $66,128 | $65,075 | $1,053 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $658,092 | TotalAmt |
| Management And General | $658,092 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,476,509 | TotalAmt |
| Program Services | $71,973,992 | ProgramServicesAmt |
| Management And General | $21,308,947 | ManagementAndGeneralAmt |
| Fundraising | $193,570 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,899,003 | BOYAmt |
| EOY | $61,883,155 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,101 | BOYAmt |
| EOY | $384 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,895,719 | BOYAmt |
| EOY | $12,798,550 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,166,764 | BOYAmt |
| EOY | $1,236,966 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,797 | BOYAmt |
| EOY | $148,879 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $53,743,598 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $40,245,742 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,015,700 | BOYAmt |
| EOY | $13,497,856 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,263,760 | BOYAmt |
| EOY | $5,922,439 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,433,844 | BOYAmt |
| EOY | $95,488,229 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,311,195 | BOYAmt |
| EOY | $6,902,161 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,710 | BOYAmt |
| EOY | $130,977 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,895,887 | BOYAmt |
| EOY | $22,239,465 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,229,792 | BOYAmt |
| EOY | $29,272,603 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,052,862 | BOYAmt |
| EOY | $65,966,728 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,190 | BOYAmt |
| EOY | $248,898 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,204,052 | BOYAmt |
| EOY | $66,215,626 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,433,844 | BOYAmt |
| EOY | $95,488,229 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $7,011,574 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,209 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,209 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1, Lobbying Activities: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $151,190 | BeginningYearBalanceAmt |
| Contributions | $358,438 | ContributionsAmt |
| Other Expenditures | $260,729 | OtherExpendituresAmt |
| End Year Balance | $248,899 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $123,746 | BeginningYearBalanceAmt |
| Contributions | $258,531 | ContributionsAmt |
| Grants Or Scholarships | $67,558 | GrantsOrScholarshipsAmt |
| Other Expenditures | $163,529 | OtherExpendituresAmt |
| End Year Balance | $151,190 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $63,235 | BeginningYearBalanceAmt |
| Contributions | $121,979 | ContributionsAmt |
| Grants Or Scholarships | $17,988 | GrantsOrScholarshipsAmt |
| Other Expenditures | $43,480 | OtherExpendituresAmt |
| End Year Balance | $123,746 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $41,331 | BeginningYearBalanceAmt |
| Contributions | $96,447 | ContributionsAmt |
| Grants Or Scholarships | $19,446 | GrantsOrScholarshipsAmt |
| Other Expenditures | $55,097 | OtherExpendituresAmt |
| End Year Balance | $63,235 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $697,451 | BeginningYearBalanceAmt |
| Contributions | $101,947 | ContributionsAmt |
| Other Expenditures | $758,067 | OtherExpendituresAmt |
| End Year Balance | $41,331 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.04020 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.95980 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,056,181 | OtherCostOrOtherBasisAmt |
| Book Value | $1,056,181 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,718,364 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,392,069 | DepreciationAmt |
| Book Value | $7,326,295 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,967,747 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,444,988 | DepreciationAmt |
| Book Value | $522,759 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,001,306 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,408,685 | DepreciationAmt |
| Book Value | $4,592,621 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,497,856 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivables from third-party payors | $5,087,457 |
| Other receivables | $671,194 |
| Receivables from related organizations | $144,557 |
| Other assets | $19,231 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,922,439 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Payables to third-party payors | $7,908,690 |
| Other liabilities | $8,211,103 |
| Payables to related organizations | $6,119,672 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $22,239,465 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2020 and 2019, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2016 in major tax jurisdictions. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,190,539 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,190,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02340 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,519,927 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,652,028 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,710,466 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,652,028 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,190,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02340 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $877,923 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $622,479 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $255,444 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $378,896 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $378,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $163,396 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $177 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $163,219 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,256 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,256 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,449,471 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $622,656 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $826,815 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,159,937 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $23,274,684 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,017,354 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03220 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,469 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,469 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,570 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,570 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,039 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,039 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,083,501 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $395,257 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $27,681,234 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $27,397,541 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $283,693 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northwest Med Found Tillamook | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Third Street | AddressLine1Txt |
| City | Tillamook | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97141 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | adventisthealth.org/Tillamook | WebsiteAddressTxt |
| State License | 14-1177 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northwest Med Found Tillamook | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Sch H Part VI - Needs Assesment | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Sch H Part VI - Needs Assesment | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Sch H Part VI - Needs Assesment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | Sch H Part VI-Patient Educ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | Sch H Part VI-Patient Educ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | Sch H Part VI-Patient Educ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Northwest Med Found Tillamook | Part V, Section B, Line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data. 3. Qualitative data gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews.From April 22, 2019 to June 12, 2019, focus groups, key informant interviews and surveys were administered. Approximately 131 people were surveyed to obtain input from the community in the form of three focus groups (with a total of 26 focus group participants), 17 key informant interviews and 81 people responded to the online survey.Key informant interviews were comprised of community leaders representing a broad range of organizations such as school districts, non-profits, and community resource centers. Among the key informants were Project and School Resources Coordinators, Executive Directors, CEO's, College Presidents, School Superintendents of agencies that provide a wide range of services to the residents in Tillamook County.Individuals who participated in the survey shared similarities with people who participated in the key informant interviews and focus groups. Majority of the survey respondents lived in Tillamook County (97%), and only 2% reported living outside the county boundaries. There were participants from various Tillamook County zip codes including 97101, 97107, 97112, 97118, 97122, 97130, 97131, 97134, 97135, 97136, 97141, 97143, 97147, 97367, 97370, which represent many cities across the county. Secondary data sources included publicly available state and nationally recognized data sources. Data on key health indicators, morbidity, mortality, and various social determinants of health were collected from the Annie E. Casey Foundation Kids County Data Center, CARES Engagement Network, Feed America, Map the Meal Gap, National Income Low Housing Coalition, Regional Health Assessment & Regional Health Improvement Plan 2019, Robert Wood Johnson Foundation, County Health Rankings and Roadmaps, 2019 and various other state and federal databases. The quantitative data includes County specific data, and if available, data disaggregated to primary service area has been provided. When feasible, health metrics have been further compared to benchmarks, such as Healthy People 2021 objectives and State estimates. |
| Northwest Med Found Tillamook | Part V, Section B, Line 6a: None, AHTM is the only hospital in the County of Tillamook. |
| Northwest Med Found Tillamook | Part V, Section B, Line 6b: Tillamook Regional Medical Center partnered with the following organizations in conducting our 2019 CHNA: Rinehart Clinic & Pharmacy, Tillamook County Community Health Centers, Tillamook Counseling Center. |
| Northwest Med Found 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. Our 2019 CHNA identified four areas of significant need: Housing and Homelessness, Mental Health, Access to Health Care, and 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 wellbeing 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 - Adventist Health Tillamook (AHTM) was able to secure a spot on the Tillamook County Housing Commission. AHTM's involvement in the commission's effort will largely center on increasing public understanding of housing as a social determinate of health and how collaborative problem-solving can improve community livability, economic viability and individual health and well-being. Activity 1.2 - Referrals for Housing Assistance - Due to COVID-19 this program was supported through grant funds that were provided through our Adventist Health system office. Additional Activities - AHTM partnered with the local Tillamook Seventh Day Adventist Church and contributed $28,964 for meal ingredients and supplies. AHTM also help serve 104 individuals at the annual Homeless Connect and provided health assessments, necessities, and service referrals. 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 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. Within the Opioid Use Response grant, AHTM will be starting year three. This is a collaborative effort to increase provider and community education around opioid use/overuse/overdose, as well as prevention and treatment for opioid and substance use disorders. Collaborative accomplishments include, 52 medical and behavioral health providers attend Grand Rounds for O.U.D. Substance use disorder stigma training for providers and staff. Additionally, 27 Naloxone kits provided to Tillamook County Law enforcement agencies. Additional Activities include our Grief Support Group. AHTM was able to lead a no-cost in-person, and later virtual grief support class for 31 individuals during 2020. 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, Activity 1.2 - Connect Oregon Network (UniteUs), & Activity 1.3 - Screening for early childhood development delays. Although some 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 requirements. Within 2020, the Health Insurance Enrollment Program - AHTM assisted 1,798 people in accessing health insurance through the Oregon Health Plan (Medicaid) in 2020. The Free/Discounted Prescription Drugs Program - AHTM provided more than 306 individuals in need with $138,759 worth of medications. The Telehealth program - Despite challenges due to COVID-19, through gifts and grants, AHTM fully funded a specialty unit for $13,000 which will be used for dermatology telehealth services. The Community-Based Care Program - AHTM Care Coordinators began providing care in non-traditional settings, including in people's home and at community meal sites. Grant funding allowed AHTM to secure an outreach vehicle. Of the 7,620 lives touched during 2020, 276 were home or street visits. The Closed Loop Referral Program - AHTM collaborated with Tillamook County Partners to engage with and attract UniteUs to provide a web-based, closed-loop referral platform for connecting clinical care with community services that address social determinants of health. Early Childhood Development Screening Program - Currently only two providers are actively screening and referring children for development needs. AHTM led the annual collaborative Early Childhood Screening Fair - which served a total of 52 preschoolers and resulted in 97 referrals. Our Children and Youth Program - AHTM provided 60 annual adolescent exams/sport physicals at no charge to area youth. Although due to COVID, AHTM's athletic trainer provided assessments and treatment for 9,506 student athlete encounters during 2020, through a no-cost program partnership with Tillamook School District 9. Education Program - Within 2020, AHTM proctored/mentored a total of 795 students for future careers in medicine, radiology, physical therapy, nursing, and other healthcare occupations. 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, Activity 1.2 - Screening for pre-diabetes, Activity 1.3 - Lifestyle Medicine, & Activity 1.4 - Develop comprehensive Medication Assisted Treatment (MAT) Program. Although some 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 requirements. Within the Opioid Addiction Treatment/MAT program- In an effort to treat the chronic condition of opioid addiction, AHTM began implementation of a Medication Assisted Therapy Program, training 19 medical providers. This also included getting providers X-Waiver trained, so they can prescribe buprenorphine. Reducing Readmission Program - In collaboration with the Northwest Senior & Disability Services, AHTM, Home Health & Hospice, Columbia Pacific CCO and other partners. This program is designed to reduce readmissions through self-management and in-home support and facilitates wrap-around care to reduce stress and improve outcomes for patients and their families. During 2020, this program served 120 individuals. Lifestyle Medicine Program - This program focuses on using lifestyle habits to treat and prevent medical conditions and issues. Two cohorts (17 patients total) convened prior to the onset of COVID-19. Due to COVID, the program was placed on hold for the remainder of 2020. This program will be relaunched in 2021. Chronic Disease & Self-Management Education Program - A total of 56 individuals participated in free programming offered by AHTM. Due to COVID, this program was shut down and will relaunch in 2021. Access to Nutrition/Food Security Program - This program include funds that were covered by grants. Formal community benefit expenses include the Community Well-Being directors time to securing the grant, processing, and coordinating program requirements. Tillamook County Wellness Coalition - As an active member of the coalition AHTM is constantly working to improve the lives of those who live within the community. Due to COVID, program activities were reduced. However, activities will resume once it is safe to do so. |
| Part V, Section B, Line 11, continuation: | Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health Tillamook is committed to serving the community be 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. Adventist Health Tillamook 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 11 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 2 - AHTM Bayshore Medical Lincoln City | ||||
| 1105 SE Jetty Avenue Suite C | Lincoln City | OR | 97367 | Rural health clinic |
| 3 - AHTM Bayshore Medical Pacific City | ||||
| 38505 Brooten Road Suite A | Pacific City | OR | 97135 | Rural health clinic |
| 4 - AHTM Medical Group Estacada | ||||
| 200 SE Highway 224 | Estacada | OR | 97023 | Rural health clinic |
| 5 - AHTM Manzanita Primary & Specialty Care | ||||
| 10445 Neahkahnie Creek Road | Manzanita | CA | 97130 | Rural health clinic |
| 6 - AHTM Hoodland | ||||
| 24461 E Welches Road | Welches | OR | 97067 | Rural health clinic |
| 7 - Adventist Health Tillamook Medical Group | ||||
| 1100 Third Street | Tillamook | OR | 97141 | Rural health clinic |
| 8 - AHTM Vernonia | ||||
| 1005 Cougar Street | Vernonia | OR | 97064 | Rural health clinic |
| 9 - AHTM Bayocean | ||||
| 1011 Third Street | Tillamook | OR | 97141 | Rural health clinic |
| 10 - Adventist Health Sheridan Medical Office | ||||
| 222 SE Jefferson Street | Sheridan | OR | 97378 | Rural health clinic |
| 11 - AHTM Medical Group Banks | ||||
| 12350 NW Main Suite 112 | Banks | OR | 97106 | Rural health clinic |
| 12 - Adventist Health Occupational Medicine | ||||
| 980 Third Street Suite 100 | Tillamook | OR | 97141 | Occupational medicine |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 that 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 completed the acquisition of Blue Zones as the first step toward reaching this goal. By partnering with Blue Zones, we are 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. 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 evolving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, 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.Reconciliation of Medicare Revenue from the Hospital's Medicare Cost Report to GL*Medicare Cost Report Revenue 27,681,234 Prior Year Settlements 852,298 Cost Report Reimbursable Bad Debts 176,279 Estimates and Accrual Variances (54,161)Other 82,327 Total Medicare Revenue 28,737,977 *Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. |
| 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 2019 CHNA, the 2021 Community Health Plan (CHP) Update for fiscal year 2020, and the 2020 Implementation Strategy adopted in 2020 are posted on the hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/The two most recent Community Health Needs Assessment, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, Northwest Medical Foundation of Tillamook supports local partners to augment our own efforts, and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of our region. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community. |
| Part VI, Line 3: | The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at:https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-Policy.pdf. These 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: | Northwest Medical Foundation of Tillamook's service area is all of Tillamook County for a total population of 22,248 which contains three geographic areas: Nehalem (North), Tillamook (Central), and Cloverdale (South). In addition to serving patients at the hospital, patients are also served at the five rural health clinics in our network. The largest age group is comprised of persons aged 55-64 years, with a median age of 51.1. The population is primarily composed of individuals who identify as White (89%) and the smallest group is composed of individuals who identify as Pacific Islander (0.3%). 11.2% of the population is of Hispanic origin. English is the dominant language spoken in the service area. The median income for all households is $54,713 and average household size of 2.3. 35% of Tillamook county have graduated from high school with 42% having some college. Tillamook has an unemployment rate of 3.4% as compared to the state of Oregon at 3.3%. Tillamook County has the highest percentage of person's living in poverty (22.9% total population and 15.5% of children) in comparison to the state (19% and 14.9%, respectively). In 2017, The Oregon Health Authority published county figures for homeless population and homeless K-12 students. Within the homeless population, Tillamook County had higher total homeless population (8.7 per 1,000) and K-12 enrolled students (80.9 per 1,000) as compared to the state (3.4 and 39.0, respectively).Across each provider indicator (dental, mental health, and primary care), Tillamook County recorded lower proportions of providers to population for dental (44.9) mental health providers (247.3) and primary care providers (68.9) than the state. Tillamook County has the largest proportion of persons who are uninsured (9.3%) and percentages of persons covered through the Medicaid program (27.2%) as compared to the state estimates (8.8% and 23.8%, respectively). |
| 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 |
| Part VI: Other Information | In 2020, Adventist Health as a system took the following actions in response to the needs created or exacerbated by COVID-19: Adventist Health as a system directed "Community Strength Fund grants" to each hospital to support community partners' immediate response to COVID-19; Adventist Health as a system directed "Community Integration Catalyst" funds to each hospital to support internal new or expanded community well-being programming and innovation as an immediate response to COVID-19; began offering more virtual health care visits to keep community members safe and healthy; developed an online symptom tracker to help community members determine if they may have COVID-19 or some other flu type illness and what steps to take; partnered with MaskUp, a collaboration of 100 leading health systems representing thousands of hospitals across the U.S. joining to create messages for the betterment of the communities they serve.Locally, Adventist Health Tillamook (AHTM) took these additional actions: Formally organized an Incident Command Team in response to COVID-19. Provided coordination, staffing and facilities for a remote COVID testing site. Market President conducts daily COVID-related status reports, including case counts, local and regional response capacity. Hospital leadership participated in weekly community COVID strategic planning and public outreach, including weekly radio broadcasts. Market Philanthropy facilitated COVID grant allocations to community-based partners from Adventist Health and regional funding sources. Weekly, and sometimes daily, meeting with Tillamook County vaccine collaborative to plan, coordinate and execute vaccination distribution throughout Tillamook County. This included serving specific populations, including in-home vaccination distribution for medically fragile, home-bound individuals. As a result of those efforts, Tillamook County had the second highest rate in the state of vaccinations for this population. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reiner Scott | ||||||||||||||
| Dir/Chair | $0 | $1,631,895 | $0 | $352,059 | $0 | $374,424 | $0 | $17,042 | $0 | $37,777 | $0 | $2,413,197 | $0 | $349,200 |
| Wing Bill | ||||||||||||||
| Dir/Asst Secr/Vice Chair | $0 | $1,458,328 | $0 | $279,883 | $0 | $22,116 | $0 | $17,042 | $0 | $42,012 | $0 | $1,819,381 | $0 | $0 |
| Jahn Andrew | ||||||||||||||
| President, Care Division | $0 | $992,796 | $0 | $210,574 | $0 | $162,471 | $0 | $17,042 | $0 | $42,265 | $0 | $1,425,148 | $0 | $0 |
| Newmyer Joyce | ||||||||||||||
| President, PNR | $0 | $757,634 | $0 | $155,648 | $0 | $19,965 | $0 | $17,042 | $0 | $45,025 | $0 | $995,314 | $0 | $0 |
| Nahapetian Arby - Care | ||||||||||||||
| Division Chief Medical Officer | $0 | $648,088 | $0 | $107,260 | $0 | $112,858 | $0 | $12,449 | $0 | $42,262 | $0 | $922,917 | $0 | $0 |
| Reppert Joseph | ||||||||||||||
| Former CFO/Asst Secr thru 08/19 | $0 | $2,779 | $0 | $0 | $0 | $810,646 | $0 | $0 | $0 | $41,111 | $0 | $854,536 | $0 | $0 |
| LaFleur Brett | ||||||||||||||
| Physician | $784,058 | $0 | $0 | $0 | $0 | $0 | $17,042 | $0 | $26,671 | $0 | $827,771 | $0 | $0 | $0 |
| Jobe Meredith | ||||||||||||||
| Secretary | $0 | $575,127 | $0 | $81,637 | $0 | $113,221 | $0 | $13,010 | $0 | $30,858 | $0 | $813,853 | $0 | $0 |
| Welch Donald | ||||||||||||||
| Finance Officer, PNR | $0 | $437,746 | $0 | $79,504 | $0 | $80,206 | $0 | $17,042 | $0 | $36,792 | $0 | $651,290 | $0 | $0 |
| Butler David | ||||||||||||||
| President thru 08/19 | $0 | $415,385 | $0 | $71,168 | $0 | $64,351 | $0 | $17,042 | $0 | $42,265 | $0 | $610,211 | $0 | $0 |
| Kaba David | ||||||||||||||
| Physician | $491,109 | $0 | $0 | $0 | $0 | $0 | $17,042 | $0 | $31,973 | $0 | $540,124 | $0 | $0 | $0 |
| Hofheins Todd | ||||||||||||||
| CFO as of 08/20 | $0 | $297,756 | $0 | $66 | $0 | $171,285 | $0 | $0 | $0 | $13,281 | $0 | $482,388 | $0 | $0 |
| Mitchell Brandon | ||||||||||||||
| Physician | $353,751 | $0 | $0 | $0 | $1,140 | $0 | $16,959 | $0 | $37,089 | $0 | $408,939 | $0 | $0 | $0 |
| Leach Judy | ||||||||||||||
| Strategy & Comm Exec, PNR | $0 | $289,448 | $0 | $34,453 | $0 | $34,985 | $0 | $17,042 | $0 | $22,447 | $0 | $398,375 | $0 | $0 |
| Halferty Michael | ||||||||||||||
| Physician | $342,005 | $0 | $0 | $0 | $0 | $0 | $17,042 | $0 | $37,078 | $0 | $396,125 | $0 | $0 | $0 |
| Thompson Albert | ||||||||||||||
| Physician | $360,324 | $0 | $0 | $0 | $0 | $0 | $15,369 | $0 | $12,711 | $0 | $388,404 | $0 | $0 | $0 |
| Swanson Eric | ||||||||||||||
| President | $0 | $275,481 | $0 | $9,765 | $0 | $41,911 | $0 | $11,723 | $0 | $14,719 | $0 | $353,599 | $0 | $0 |
| Voshell Shane | ||||||||||||||
| Reg HR Dir, PNR | $0 | $216,133 | $0 | $32,844 | $0 | $22,047 | $0 | $14,269 | $0 | $43,955 | $0 | $329,248 | $0 | $0 |
| Smith Micah | ||||||||||||||
| Treas/Asst Secr | $0 | $214,833 | $0 | $18,594 | $0 | $22,625 | $0 | $12,610 | $0 | $41,926 | $0 | $310,588 | $0 | $0 |
| Saxon Kathleen | ||||||||||||||
| PT Care Executive | $0 | $213,502 | $0 | $19,146 | $0 | $29,641 | $0 | $12,756 | $0 | $27,953 | $0 | $302,998 | $0 | $0 |
| Wagner Jack | ||||||||||||||
| Former Asst Secr thru 03/18 | $0 | $0 | $0 | $0 | $0 | $269,387 | $0 | $0 | $0 | $13,558 | $0 | $282,945 | $0 | $0 |
| Seufert Regina | ||||||||||||||
| Physician/Clinic Svcs Exec | $0 | $201,542 | $0 | $17,994 | $0 | $24,053 | $0 | $11,872 | $0 | $14,565 | $0 | $270,026 | $0 | $0 |
| Lee Adam | ||||||||||||||
| Dir Marketing & Comm, PNR | $0 | $168,272 | $0 | $13,154 | $0 | $15,672 | $0 | $6,981 | $0 | $32,035 | $0 | $236,114 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Lines 4a-b | FormAndLineReferenceDesc |
| Explanation | Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Reppert, Joseph - severance payment - $809,806 Wagner, Jack - severance payment - $269,387 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 participants are Joyce Newmyer, Scott Reiner, Jack Wagner, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for non-vested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Reiner, Scott - $349,200 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Charles Saxon | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of Key EE, K. Saxon | RelationshipDescriptionTxt |
| Transaction | $31,737 | TransactionAmt |
| Transaction | Employment | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a: | Northwest Medical Foundation Tillamook dba Tillamook Regional Medical Center (AHTM) provides quality medical health care 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 will be considered when individuals who need health care cannot afford to pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing 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 2020 was $2,190,539. The following Inpatient services were provided to all our patients. These services included: - 179 Babies delivered - 308 Surgeries performed - 3,780 Patient days The following Outpatient services were provided to all our patients. These services included: - 8,539 Emergency department visits - 690 Outpatient Surgeries performed - 80,739 Outpatient visits - 88,691 Clinic visits AHTM recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2020 was $826,815. 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 System Controller and Market Finance Officer, and shared by electronic communication with the Hospital'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 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 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. Copies for the officers and key employees' COIs are kept in their personnel files. 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 Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital Presidents and Finance Officers, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital Presidents and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital President has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital (incentive potential is industry norm). Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. |
| Form 990, Part VI, Section C, line 19 | The 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: | In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported. |
| Form 990, Part IX, line 11g | Physician professional fees: Program service expenses 7,545,036. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,545,036. Consulting and other management fees: Program service expenses 542. Management and general expenses 252,070. Fundraising expenses 0. Total expenses 252,612. Repairs and maintenance: Program service expenses 123,194. Management and general expenses 3,447. Fundraising expenses 0. Total expenses 126,641. All other purchased services: Program service expenses 2,453,373. Management and general expenses 1,646,387. Fundraising expenses 0. Total expenses 4,099,760. Other professional nonmedical fees: Program service expenses 51,658. Management and general expenses 7,792. Fundraising expenses 0. Total expenses 59,450. Contract Labor: Program service expenses 321,040. Management and general expenses 0. Fundraising expenses 0. Total expenses 321,040. Other professional medical fees: Program service expenses 0. Management and general expenses 869. Fundraising expenses 0. Total expenses 869. Purchased medical services: Program service expenses 308,631. Management and general expenses 0. Fundraising expenses 0. Total expenses 308,631. Cerner management fees: Program service expenses 0. Management and general expenses 3,134,698. Fundraising expenses 0. Total expenses 3,134,698. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 680357690 | Medical foundation | CA | 501(c)(3) | Line 12b, II | Adventist Health SystemWest | 0 | |
| Adventist Health SystemWest | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 953484589 | Integrated health system | CA | 501(c)(3) | Line 10 | 0 | N/A | |
| 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 | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 941101228 | Hospital | CA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Fremont-Rideout Health Group | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 942917251 | Acute care hospital | CA | 501(c)(3) | Line 12b, II | Stone Point Health | 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 | |||||||||||
| PO Box 619135 | 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 | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 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 | |||||||||||
| PO Box 619135 | 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 | |||||||||||
| 989 Plumas Street | Yuba City | CA | 95991 | 943015356 | Skilled nursing/assisted living/home health | CA | 501(c)(3) | Line 12b, II | Stone Point Health | 0 | |
| Walla Walla General Hospital | |||||||||||
| PO Box 619135 | Roseville | CA | 95661 | 910617726 | Hospital - closed July 2017 | WA | 501(c)(3) | Line 3 | Adventist Health SystemWest | 0 | |
| Western Health Resources | |||||||||||
| PO Box 619135 | 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 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| Blue Zones LLC | |||||||||
| 323 N Washington Avenue 2nd Floor | Minneapolis | MN | 55401 | 271603327 | Education | MN | N/A | 0 | 0 |
| PVHR LLC dba Paradise Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 260622555 | Real property rental | OR | N/A | 0 | 0 |
| PVHR2 LLC dba Parkview at Paradise Village | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 473300170 | Real property rental | OR | N/A | 0 | 0 |
| WWGHR LLC | |||||||||
| 8440 SE Sunnybrook Blvd Suite 100 | Clackmas | OR | 97015 | 810591221 | Rental | OR | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AdHealth Limited | ||||||||||||||
| PO Box HM 2062 | Hamilton | BD | HM HX | Pure captive insurance | BD | N/A | C | 0 | ||||||
| Adventist Health Plan Inc | ||||||||||||||
| Health insurance | N/A | C | 0 | 1 Adventist Health Way | Roseville | CA | 95661 | 463833261 | CA | |||||
| South Coast Medical Center | ||||||||||||||
| Wind down after sale of hospital | N/A | C | 0 | PO Box 619135 | Roseville | CA | 95661 | 952037297 | CA | |||||
| Thrive Productions Inc | ||||||||||||||
| Production company | N/A | C | 0 | 323 N Washington Avenue | Minneapolis | CA | 55401 | 453369049 | MN | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |