2020-11-12T18:35:43-06:00 2019-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2019-01-01 930622075 Northwest Medical Foundation Tillamook NORT 9164060000 1000 Third Street Tillamook OR 97141 Micah Smith Treasurer 9164060000 2020-10-29 1 Tracy S Paglia P00366884 2099556100 2020-10-29 172.9.161.112 2020-10-29 18:34:10 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2019 2021-01-29 14:40:06Z Tillamook Regional Medical Cente Eric Swanson 1000 Third Street Tillamook OR 97141 95597390 0 1071 X www.adventisthealth.org/tillamook/ X 1973 OR Living God's love by inspiring health, wholeness and hope. 14 12 682 80 0 0 180140 283663 87209174 93519298 869624 1794429 0 0 88258938 95597390 68833 261 0 0 43348351 45677450 0 0 163583 41678838 45816947 85096022 91494658 3162916 4102732 65583470 75433844 10482150 16229792 55101320 59204052 X Living God's love by inspiring health, wholeness and hope. 0 0 73759290 261 93519298 See Schedule O 73759290 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 682 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X Jay Lipps VP System Controller 9164061092 PO Box 619135 Roseville CA 95661 Reiner Scott Dir/Chair 0.00 50.00 X X 0 1995696 53734 Wing Bill Dir/Asst Secretary/CFO 0.00 50.00 X X 0 1572254 46583 Reppert Joseph CFO/Asst Secr thru 08/2019 0.00 50.00 X 0 1209069 57565 Newmyer Joyce President, PNR 12.50 37.50 X 0 871962 53734 Wagner Jack Former Asst Secr 0.00 0.00 X 0 778475 29189 Jobe Meredith Secretary 0.00 50.00 X 0 730385 45909 LaFleur Brett Physician 50.00 0.00 X 627317 0 31278 Welch Donald Finance Officer, PNR 12.50 37.50 X 0 596433 53734 Kaba David Physician 50.00 0.00 X 503174 0 44304 Butler David President thru 08/2019 50.00 0.00 X 0 487381 58696 Naidoo Abendra Physician 50.00 0.00 X 457772 0 41413 Mitchell Brandon Physician 50.00 0.00 X 393854 0 53698 Leach Judy Strategy & Comm Exec, PNR 0.00 50.00 X 0 360654 38929 Thompson Albert Physician 50.00 0.00 X 354125 0 28674 Voshell Shane Reg HR Dir, PNR 0.00 50.00 X 0 264030 56205 Saxon Kathleen PT Care Executive 0.00 50.00 X 0 279415 25869 Smith Micah Treas/Asst Secr 50.00 0.00 X 0 248647 53561 Seufert Regina Physician/Clinic Svcs Exec 0.00 50.00 X 0 238100 21649 Swanson Eric President as of 09/2019 50.00 0.00 X 0 184701 13532 Reiner Richard Director 0.00 4.00 X 0 28588 0 Davis Andrew Director 0.00 4.00 X 0 28246 0 Cherry Robert Director 0.00 4.00 X 0 26315 0 Heinrich Kerry Director 0.00 4.00 X 0 20102 0 Innocent Larry Director 0.00 4.00 X 0 18852 0 Woodson Marc Director 0.00 4.00 X 0 15000 0 Graham Ricardo Director 0.00 4.00 X 0 8848 0 Banks David Director 0.00 4.00 X 0 6382 0 Freedman John Director 0.00 4.00 X 0 2367 0 Salazar Velino Director 0.00 4.00 X 0 553 0 Ocampo Lucy Director 0.00 4.00 X 0 0 0 Philip Celeste Director 0.00 4.00 X 0 0 0 2336242 9972455 808256 76 1 1 0 Tillamook Emergency Services 1000 Third Street Tillamook OR 97141 Physician Services 2257987 Staff Care Inc PO Box 281923 Atlanta GA 30384 Physician Services 1510021 Bivens Medical Corporation 20105 Geisendorfer Rd Applegate CA 95703 Physician Services 1344182 Favorite Healthcare Staffing Inc 7255 W 98th Terr Overland Park KS 66212 Staffing and Recruiting 877731 Rural Physicians Group Pannu PLLC 10624 S Eastern Ave Ste A-263 Henderson NV 89052 Physician Services 744975 20 10000 273663 283663 Patient service revenue 900099 92815835 92815835 Other revenue 900099 549627 549627 Dietary services 722210 107164 107164 Rental income 531120 46672 46672 93519298 1788391 1788391 6038 0 6038 6038 6038 95597390 93519298 0 1794429 X 261 261 35179356 32846057 2240891 92408 1392877 1325613 64433 2831 6743068 6306718 407808 28542 2362149 2158847 195924 7378 6563039 656304 5906735 1045820 4712 1041108 2736 2736 15610728 11418294 4163384 29050 8458 7188 1270 935852 816887 117146 1819 3463052 691173 2771879 2495252 2186118 309134 421570 273688 146327 1555 84672 56908 27764 85485 85485 1548224 1533521 14703 235573 235573 Patient care supplies 10033638 10002987 30651 Quality assurance fee 3093524 3093524 Rental/leases costs, eq 57294 56696 598 132030 132030 91494658 73759290 17571785 163583 33196667 43899003 0 11101 11746970 10895719 1468058 1166764 120451 181797 51448396 37432696 11852262 14015700 7199062 5263760 65583470 75433844 6216390 7311195 0 22710 4265760 8895887 10482150 16229792 X 54977574 59052862 123746 151190 55101320 59204052 65583470 75433844 4102732 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2736 2736 0 Part II-B, Line 1, Lobbying Activities: 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. 123746 258531 67558 163529 151190 63235 121979 17988 43480 123746 41331 96447 19446 55097 63235 697451 101947 758067 41331 1324795 159334 786678 697451 0.00000 0.00000 1.00000 0 0 1056181 1056181 29381139 21379946 8001193 1985129 1372228 612901 19025947 14680522 4345425 14015700 Receivables from related organizations 2531098 Receivables from third-party payors 2282433 Other receivables 430998 Other assets 19231 5263760 Payables to related organization 6448299 Other liabilities 2436965 Payables to third-party payors 10623 8895887 X Part V, Line 4: Board-designated, temporary and permanently restricted funds are for specified operating and capital projects. The funds are released as project costs are expended. Part X, Line 2: The principal operations of the System is 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, 2019 and 2018, 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 2015 in major tax jurisdictions. 1 1 X 1 X 1 X 1 1 1 0 1 1 2335757 2335757 0.02550 2335757 2335757 0.02550 804265 436401 367864 0.00400 359928 359928 0.00390 241484 241484 0.00260 54838 54838 0.00060 1460515 436401 1024114 0.01110 3796272 436401 3359871 0.03660 1130 1130 0.00000 2601 2601 0.00000 40000 40000 0.00040 43731 43731 0.00040 1 2335757 816323 30513788 30580971 -67183 X 1 1 1 1 Northwest Med Found Tillamook 1000 Third Street Tillamook OR 97141 adventisthealth.org/Tillamook 14-1177 X X X X Northwest Med Found Tillamook 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 19 1 See Sch H Part VI - Needs Assesment 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 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 3 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 2020 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: Our 2016 CHNA identified four areas of significant needs: access to health care, chronic diseases & senior care, behavioral health & substance abuse, and children's health. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation. Priority Need 1 - Access to Health Care main objective: to improve top priority health care access issues through connecting uninsured patients with health insurance and financial assistance resources, recruiting and maintaining adequate numbers and types of healthcare providers, and providing services at the most appropriate level of care with navigation and follow up as needed. 2019 saw the increase in availability and access to health care through a 21.64% increase in urgent care visits totally 20,912 and 98.2% of our patients were able to be assigned a medical home in 2019 which is an increase of 2.2% from 2018. Interventions: 1. Provide uninsured patients with assistance for obtaining health insurance information and/or coverage and access to financial assistance as needed, through clinic care coordinators and financial counselors. Number of community members served - 1,285 / 1,241 (individuals assisted in obtaining health insurance).2. Dental Van: Free mobile dental clinic for those in need of dental services. Number of community members served - 11.3. Doc Talks: Monthly health seminars on various health topics presented by local health care providers. Talks are located at either local library or at the hospital. Healthy snacks are provided, and each talk is recorded by videographer and aired on local access channel and online. Number of community members served - 25,000.4. No cost Vaccination Van for adults and children. Number of community members served - 100.5. No cost prescription drug program. Number of community members served - 172.6. Care Coordination Support Program. Number of community members served - 518.7. Community Paramedic Program: conducts home visits for patients who are identified by our case managers and care coordinators who are at risk for readmission. Home visits consist a needs assessment, physical assessment, medication reconciliation, patient and family education, assistance with transportation and referral to our many community resources. In addition, our Community Paramedic participates in multi-disciplinary teams to help navigate patients and families to the proper resources for care with the goal of allowing the patient to remain at home. Patients can be referred to the program by our providers and community partners. This program tends to fill the gaps that may exist in the patient's continuum of care. Number of community members served - 351.Priority Need 2 - Chronic Diseases & Senior Care - main objective: to meet chronic health prevention needs identified by strengthening access to care, enhancing the continuum of care, supporting care coordination and navigation, and providing community wellness education that supports healthy lifestyle choices. 2019 saw 380 patients enrolled in chronic disease management care plans. There were 20,378 patients visits to specialty clinics in 2019 which is a 28.96% increase from 2018. Interventions: 1. Partner with the Tillamook County Year of Wellness (YOW) to develop a strategy for community coalition to decrease the impact of diabetes on Tillamook County residents. Number of community members served - 25,000.2. Complete Health Improvement Program (CHIP) lifestyle wellness classes offered to community members. Number of community members served - 18.3. Serving up Hope community dinner for those who are homeless and food insecure. Number of community members served - 1,499.4. Sponsorship of early morning warm therapy pool times at Tillamook Family YMCA to enhance physical activity for people with chronic health limitations. Number of community members served - 600.5. Clinic sponsored wellness activities. Number of community members served - 296.Priority Need 3 - Behavioral Health & Substance Abuse - main objective: to improve top priority access points through recruitment, screening, education and community awareness. 100% of ED and Primary Care patients with LCSW visits were screened 2019. There were 2,439 behavioral health patient visits in 2019 which is a 6.13% increase from 2018. Interventions: 1. Provide Wellspring respite care for patients with cognitive impairment who reside in community care settings. Number of community members served - 60.2. Provide comprehensive medical and behavioral health care to inmates lodged in the Tillamook County Jail. Number of community members served - 352.3. Payment of $10,000 on a three-year pledge of $25,000 to help purchase a building to house services for low-income population provided by CARE, Inc., Tillamook County's anti-poverty agency. Number of community members served - 3,000.4. Increase of licensed social workers to all medical offices. Number of community members served - 2,439.Priority Need 4 - Children's Health - main objective: to address top priority children's health needs through early identification of risks, treatment of identified concerns, and education and outreach to parents and children. There were 85 children screened for school readiness in 2019 with 6,760 pediatric patient visits. Interventions: 1. Continue leadership of annual, communitywide School Readiness for Tillamook County Kids (formerly Multi-Modular Preschool Exams) provided at no cost to all Tillamook County children ages 2-6 years that screens 12 areas of health and development. Number of community members served - 85.2. Pediatric Services. Number of community members served - 6,756.3. Certified Athletic Trainer at Tillamook High School providing services to student athletes. Number of community members served - 17,931 contacts with student athletes.Priority Areas Not Addressed:For the 2017-2019 Community Health Plan (implementation strategy), the Hospital has elected to adopt a broad strategy that addresses all the priority needs identified. 12 1 - AH Tillamook Medical Group 980 Third Street Tillamook OR 97141 Outpatient clinic 2 - AH Tillamook Women and Family Facility 1011 Third Street Tillamook OR 97141 Outpatient clinic 3 - Manzanita Primary & Specialty Care 10445 Neahkahnie Creek Road Manzanita CA 97130 Rural health clinic 4 - Bayshore Family Medicine 38505 Brooten Road Suite A Pacific City OR 97135 Rural health clinic 5 - Bayshore Family Medicine 1105 SE Jetty Avenue Suite C Lincoln City OR 97367 Rural health clinic 6 - Adventist Health Banks 1235 NW Main Suite 112 Banks OR 97106 Rural health clinic 7 - Adventist Health TillamookMedical Group 103 SW Highway 224 Suite B Estacada OR 97023 Rural health clinic 8 - Adventist Health TillamookMedical Group 24461 E Welches Road Welches OR 97067 Rural health clinic 9 - Tillamook Medical Plaza 1100 Third Street Tillamook OR 97141 Outpatient clinic 10 - Adventist Health - Vernonia 1005 Cougar Street Tillamook OR 97064 Rural health clinic 11 - Specialty Clinic - Occupational Therapy 980 Third Street Tillamook OR 97141 Outpatient clinic 12 - Adventist Health Medical Group Surgery S 980 Third Street Suite 100 Tillamook OR 97141 Outpatient clinic Part I, Line 7: The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on hospital specific data included in the system-wide audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:(Total expenses - (Provision for bad debts + Other revenue + Interest income)) / Gross patient charges Part II, Community Building Activities: The hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. 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 30,513,788Prior Year Settlements 2,271,813Cost Report Reimbursable Bad Debts 143,087Estimates and Accrual Variances (2,869,676)Other 14,998,169Total Medicare Revenue 45,057,181*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 2020 Community Health Plan (CHP) Update for fiscal year 2019, and the 2020 Implementation Strategy are posted on the hospital's website at:https://www.adventisthealth.org/tillamook/about-us/community-benefit/ The two most recent Community Health Needs Assessments, 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/In addition to the CHNA, our hospital engages in a process of continuous quality improvement, focusing on questions such as: are our interventions making a difference in improving health outcomes; are we providing the appropriate resources in the appropriate locations; and how are we using technology to track our health improvements and provide relevant feedback at the local level? Building a healthy community requires multiple stakeholders working together with a common purpose. With that in mind, our hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. Part VI, Line 3: The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at:https://www.adventisthealth.org/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: Tillamook Regional Medical Center'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 is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population;.2) Factors that cause the present outcomes distribution.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. 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States OR X X X X 1 0 0 0 0 0 0 0 0 Reiner Scott Dir/Chair 0 1510024 0 420315 0 65357 0 16782 0 36952 0 2049430 0 0 Wing Bill Dir/Asst Secretary/CFO 0 1200390 0 318717 0 53147 0 16782 0 29801 0 1618837 0 0 Reppert Joseph CFO/Asst Secr thru 08/2019 0 581409 0 187572 0 440088 0 16782 0 40783 0 1266634 0 0 Newmyer Joyce President, PNR 0 706207 0 125111 0 40644 0 16782 0 36952 0 925696 0 0 Wagner Jack Former Asst Secr 0 0 0 0 0 778475 0 0 0 29189 0 807664 0 0 Jobe Meredith Secretary 0 524870 0 65461 0 140054 0 16782 0 29127 0 776294 0 0 LaFleur Brett Physician 608569 0 18748 0 0 0 11182 0 20096 0 658595 0 0 0 Welch Donald Finance Officer, PNR 0 412260 0 66318 0 117855 0 16782 0 36952 0 650167 0 0 Kaba David Physician 503174 0 0 0 0 0 16782 0 27522 0 547478 0 0 0 Butler David President thru 08/2019 0 385387 0 25060 0 76934 0 16782 0 41914 0 546077 0 0 Naidoo Abendra Physician 457772 0 0 0 0 0 16782 0 24631 0 499185 0 0 0 Mitchell Brandon Physician 362563 0 31291 0 0 0 16731 0 36967 0 447552 0 0 0 Leach Judy Strategy & Comm Exec, PNR 0 256203 0 34051 0 70400 0 16782 0 22147 0 399583 0 0 Thompson Albert Physician 338573 0 14409 0 1143 0 16085 0 12589 0 382799 0 0 0 Voshell Shane Reg HR Dir, PNR 0 198696 0 27119 0 38215 0 14348 0 41857 0 320235 0 0 Saxon Kathleen PT Care Executive 0 195369 0 33675 0 50371 0 11447 0 14422 0 305284 0 0 Smith Micah Treas/Asst Secr 0 189738 0 9339 0 49570 0 12121 0 41440 0 302208 0 0 Seufert Regina Physician/Clinic Svcs Exec 0 183611 0 10144 0 44345 0 11106 0 10543 0 259749 0 0 Swanson Eric President as of 09/2019 0 136574 0 0 0 48127 0 9363 0 4169 0 198233 0 0 Part I, Line 4a 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 - $194,953 Wagner, Jack - severance payment - $778,453 Charles Saxon Family member of Key EE, K. Saxon 122061 Employment 0 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 Northwest Medical foundation Tillamook dba Tillamook Regional Medical Center, 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 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 Northwest Medical Foundation Tillamook DBA Tillamook Regional Medical Center 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 2019 was $2,335,757. The following Inpatient services that were provided to all our patients. These services included: - 177 Babies delivered - 336 Surgeries performed - 4,373 Patient days The following Outpatient services that were provided to all our patients. These services included: - 10,632 Emergency department visits - 732 Outpatient surgeries performed - 85,081 Outpatient visits - 99,703 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 2019 was $1,024,114. 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 4 The organization made changes to Article 8.1, Execution of Legal Documents, which consolidated signature authority. 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 that operates as a public charity. 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 CEO immediately. The Corporate 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 Corporate General Counsel reviews all the disclosures on the board and Corporate employees' COIs. Corporate General Counsel retains the COIs for the board members. 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 Board of Directors has established a Human Performance Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital presidents and finance officers that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital CEO 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 IX, line 11g Physician professional fees: Program service expenses 8,054,147. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,054,147. Consulting and other management fees: Program service expenses 25,185. Management and general expenses 52,373. Fundraising expenses 0. Total expenses 77,558. Repairs and maintenance: Program service expenses 565,067. Management and general expenses 909. Fundraising expenses 0. Total expenses 565,976. All other purchased services: Program service expenses 2,773,895. Management and general expenses 491,948. Fundraising expenses 29,050. Total expenses 3,294,893. Revenue cycle fees: Program service expenses 0. Management and general expenses 3,618,154. Fundraising expenses 0. Total expenses 3,618,154. 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 receive compensation when their employment agreements with their employers allow such payments. For those whose employers do not allow accepting compensation for board service, the funds are directly distributed to charitable organizations as mandated by their employment agreements. In addition, amounts paid for taxable benefits are also reported. 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 PO Box 460 Delano CA 93216 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 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 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital 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 Fremont-Rideout Health Group 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 Fremont-Rideout Health Group 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 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0