2020-08-14T15:01:56-05:00 2019-09-30 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990 2018-10-01 930508781 SKY LAKES MEDICAL CENTER SKYL 5412746311 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 RICHARD RICO VP/CFO 5412746311 2020-08-13 1 WENDY CAMPOS P00448102 5032421447 2020-08-13 76.115.0.27 2020-08-13 18:04:30 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 06B4DE7D56E09CB4E6180B2096A9A38989FE8D6D 2018 2020-11-06 18:47:13Z PAUL STEWART 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 686298756 0 X WWW.SKYLAKES.ORG X 1979 OR SKY LAKES MEDICAL CENTER WILL CONTINUALLY STRIVE TO REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY, AND TO IMPROVE THE HEALTH, SELF- RELIANCE AND WELL-BEING OF THE PEOPLE WE SERVE. WE WILL DEMONSTRATE THAT WE ARE COMPETENT AND CARING IN ALL WE DO. WE SHALL ENDEAVOR TO BE SO SUCCESSFUL IN THIS EFFORT THAT WE WILL BECOME A PREEMINENT HEALTHCARE CENTER. 10 9 1786 301 7315 3313 1693000 1205100 638302623 665035449 1439402 4716967 5441606 8934321 646876631 679891837 265123 249421 0 0 125200047 126408378 0 0 0 503199485 529740868 628664655 656398667 18211976 23493170 379169745 416863008 119660072 130070850 259509673 286792158 X SKY LAKES MEDICAL CENTER WILL CONTINUALLY STRIVE TO REDUCE THE BURDEN OF ILLNESS, INJURY AND DISABILITY, AND TO IMPROVE THE HEALTH, SELF- RELIANCE AND WELL-BEING OF THE PEOPLE WE SERVE. WE WILL DEMONSTRATE THAT WE ARE COMPETENT AND CARING IN ALL WE DO. WE SHALL ENDEAVOR TO BE SO SUCCESSFUL IN THIS EFFORT THAT WE WILL BECOME A PREEMINENT HEALTHCARE CENTER. 0 0 547539221 182398 651211910 PATIENT CARE EXPENSES - ACUTE INPATIENT CARE FOR ADULT AND PEDIATRIC PATIENTS; A LEVEL III TRAUMA EMERGENCY DEPARTMENT; SERVICES RELATED TO CHILD ABUSE, HOME CARE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES; A CANCER TREATMENT CENTER WITH BOTH MEDICAL AND RADIATION ONCOLOGY; AND DIAGNOSTIC TESTING (LABORATORY AND DIAGNOSTIC IMAGING) AVAILABILITY IN SETTINGS AROUND THE COMMUNITY. 19494785 0 0 UNCOMPENSATED CARE - DURING FISCAL YEAR 2019, CHARGES WRITTEN OFF UNDER OUR BROAD-REACHING CHARITY CARE POLICY TOTALED $11,530,369. IN ADDITION TO CHARITY CARE WRITE OFFS, CHARGES WRITTEN OFF AS BAD DEBT TOTALED $7,964,416. AS A PERCENTAGE OF CHARGES, FISCAL YEAR 2019 WRITE OFFS REPRESENT 1.7% (CHARITY CARE) AND 1.2% (BAD DEBT), RESPECTIVELY. 4696773 67023 1988758 EDUCATIONAL SUPPORT - SKY LAKES MEDICAL CENTER COMMITS SIGNIFICANT DOLLARS AND HOURS TO BENEFIT EDUCATIONAL EFFORTS IN AND FOR THE COMMUNITY. AMONG THOSE COMMITMENTS ARE THE FOLLOWING: OREGON HEALTH & SCIENCE UNIVERSITY AFFILIATED FAMILY PRACTICE RESIDENCY PROGRAM AND CLINIC; AN RN I TRAINING PROGRAM TO INCLUDE 6 MONTHS OF ONE-ON-ONE SUPERVISED ORIENTATION TO THE INPATIENT CARE AREAS; AWARDING OF SCHOLARSHIPS TO COMMUNITY MEMBERS AND/OR EMPLOYEES IN HEALTHCARE- RELATED PROGRAMS; A HOSPITAL DEPARTMENT, LEARNING RESOURCES, DEDICATED TO THE EDUCATION OF PHYSICIANS, EMPLOYEES AND COMMUNITY MEMBERS; COMMITMENT TO EMPLOYEES ACTING, EITHER FULL-TIME OR PART-TIME, AS INSTRUCTORS IN ACCREDITED COURSES AT THE HIGH SCHOOL, COMMUNITY COLLEGE OR UNIVERSITY LEVEL; STIPEND PAYMENTS TO STUDENTS PERFORMING WORK AND/OR ON-THE-JOB TRAINING WITHIN THE HOSPITAL SETTING; TUITION REIMBURSEMENTS PAID TO EMPLOYEES ENROLLED IN COLLEGE-LEVEL COURSEWORK; JOINT PARTICIPATION IN A SIMULATION LABORATORY WITH OIT; FREE OR MINIMAL COST COMMUNITY EDUCATIONAL OPPORTUNITIES SUCH AS DIABETES EDUCATION, NUTRITION AND OTHER EDUCATION PROGRAMS IN OR FOR THE SCHOOLS; AND HEALTH FAIRS. 48277580 0 11275279 EXPENSES RELATED TO MEDICAL CENTER SUPPORTING SERVICES SUCH AS ADMINISTRATION, INFORMATION SYSTEMS, FINANCIAL SERVICES, REVENUE CYCLE PROCESSES, HUMAN RESOURCES, ENGINEERING, ENVIRONMENTAL SERVICES, RISK MANAGEMENT, AND SAFETY AND SECURITY. 48277580 0 11275279 620008359 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 217 0 1 1786 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 OR X RICHARD RICO VPCFO 5412746150 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 PAUL STEWART PRESIDENT/CEO/SECRETARY/TREAS 50.00 1.00 X X 829103 0 46134 JOHN BELL CHAIRMAN 3.00 1.00 X X 0 0 0 ROD WENDT VICE CHAIRMAN 1.00 1.00 X X 0 0 0 HEIDI NEEL BIGGS BOARD MEMBER 1.00 1.00 X 0 0 0 CLARK PEDERSON BOARD MEMBER 1.00 3.00 X 0 0 0 JEAN PHILLIPS BOARD MEMBER 1.00 1.00 X 0 0 0 WENDY WARREN MD BOARD MEMBER 1.00 1.00 X 0 0 0 DOUGLAS MCINNIS DVM BOARD MEMBER 1.00 1.00 X 0 0 0 HOLLY MONTJOY MD BOARD MEMBER 1.00 1.00 X 0 0 0 ROBERT JACKMAN MD BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD E RICO VP/CFO 50.00 0.00 X 459262 0 51258 STANTON T SMITH MD MEDICAL PROVIDER 40.00 0.00 X 598734 0 32758 MARC ORLANDO MD MEDICAL PROVIDER 40.00 0.00 X 591393 0 32758 JARED OGAO MD MEDICAL PROVIDER 40.00 0.00 X 583740 0 32758 BRADLEY A KRAMER MD MEDICAL PROVIDER 40.00 0.00 X 582849 0 32758 DAVID CHADBOURNE MD MEDICAL PROVIDER 40.00 0.00 X 537847 0 32758 4182928 0 261182 194 0 1 0 WALSH CONSTRUCTION COOREGON 2905 SW FIRST AVENUE PORTLAND OR 97201 CONSTRUCTION 21903045 KLAMATH ORTHOPEDIC CLINIC 2200 BRYANT WILLIAMS DR KLAMATH FALLS OR 97601 PHYSICIAN PRACTICE 8555378 KLAMATH RADIOLOGY ASSOCIATES 2900 DAGGETT AV KLAMATH FALLS OR 97601 PHYSICIAN PRACTICE 4115190 EDWARD SCOTT HUDSON 4625 NADINE LN FRANKLIN TN 37064 STAFFING SERVICES 2533208 MEDICAL SOLUTIONS 1010 NORTH 102ND ST OMAHA NE 68114 STAFFING SERVICES 2142168 33 1205100 1205100 PATIENT REVENUE 622110 654305753 654305753 OTHER PROGRAM REVENUE 622110 10729696 10729696 665035449 4716967 4716967 623048 679268 -56220 -56220 -56220 13300079 5727651 7572428 7572428 NONOPERATING INCOME 900099 1970300 1970300 PASSTHROUGH INCOME 622110 -552187 -559502 7315 1418113 679891837 664475947 7315 14203475 139065 139065 110356 110356 1495218 1495218 101854205 89940414 11913791 3644161 3103088 541073 12330259 10552157 1778102 7084535 5679376 1405159 1794303 62410 1731893 518068 518068 152372 152372 23832257 23810494 21763 1151271 360831 790440 2117545 1051188 1066357 8871194 1032471 7838723 3679348 2114348 1565000 123620 123620 920785 625748 295037 3310162 3235818 74344 10649788 10620541 29247 1909018 1545578 363440 CONTRACTUAL ALLOWANCE 390911184 390911184 SUPPLIES 37949458 37667663 281795 BAD DEBTS 7964416 7964416 TAXES PAID ON UBI 33000 33000 33853079 29357593 4495486 656398667 620008359 36390308 0 10522782 16024633 13038735 7867442 31182469 28811596 977608 1160671 5362360 5985486 2647174 3560897 239986919 149662597 95630530 90324322 62963378 56978078 83188163 98122949 73656546 108026934 379169745 416863008 35562792 44295858 2374116 2340678 75180639 76825727 6542525 6608587 119660072 130070850 X 259509673 286792158 259509673 286792158 379169745 416863008 X 23493170 3225382 279 563654 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4337398 33078 237779 40455 184 4567616 3795751 189824 561415 209418 174 4337398 16327034 207062 649810 203150 13185005 3795751 14766429 831608 1640023 21511 587712 301803 16327034 15555625 128097 183989 15940 878284 207058 14766429 0.00000 0.00000 1.00000 0 1 1 4178507 4178507 138306785 76133800 62172985 5376354 3752404 1623950 88743912 69356864 19387048 3381361 419529 2961832 90324322 INVESTMENTS IN OTHER COMPANIES 5973530 C LIFE INSURANCE 89205705 F DEFERRED COMP PLAN ASSETS 2943714 F 98122949 ASSETS LIMITED AS TO USE 1635100 OTHER ASSETS 1189518 RISK POOL WITHHOLD RECEIVABLE 7269368 CONSTRUCTION IN PROCESS 47845138 OTHER RECEIVABLES 50087810 108026934 CAPITAL LEASE OBLIGATIONS 4992131 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1616456 6608587 X PART V, LINE 4: ENDOWMENTS ARE HELD BY A RELATED ORGANIZATION, SKY LAKES MEDICAL CENTER FOUNDATION, FOR THE BENEFIT OF SKY LAKES MEDICAL CENTER. PART X, LINE 2: FIN 48 (ASC 740) UNCERTAIN TAX POSITION FOOTNOTE - THE MEDICAL CENTER AND FOUNDATION ARE TAX-EXEMPT ORGANIZATIONS AND ARE NOT SUBJECT TO STATE OR FEDERAL INCOME TAXES, EXCEPT ON UNRELATED BUSINESS INCOME, IN ACCORDANCE WITH SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER AND FOUNDATION HAD NO UNRECOGNIZED TAX BENEFITS AT SEPTEMBER 30, 2019 OR 2018. THE MEDICAL CENTER AND FOUNDATION RECOGNIZE INTEREST ACCRUED AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AS AN ADMINISTRATIVE EXPENSE. DURING THE YEARS ENDED SEPTEMBER 30, 2019 AND 2018, THE MEDICAL CENTER AND FOUNDATION RECOGNIZED NO INTEREST AND PENALTIES. THE MEDICAL CENTER FILES AN EXEMPT ORGANIZATION INFORMATION RETURN AND AN UNRELATED BUSINESS INCOME TAX RETURN IN THE U.S. FEDERAL JURISDICTION AND AN UNRELATED BUSINESS INCOME TAX RETURN WITH THE OREGON DEPARTMENT OF REVENUE. THE FOUNDATION FILES AN EXEMPT ORGANIZATION INFORMATION RETURN IN THE U.S. FEDERAL JURISDICTION. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 4151592 9340 4142252 0.00640 64899368 56450415 8448953 0.01300 69050960 56459755 12591205 0.01940 980066 131588 848478 0.00130 4696773 1988758 2708015 0.00420 23133361 18088421 5044940 0.00780 589235 589235 0.00090 29399435 20208767 9190668 0.01420 98450395 76668522 21781873 0.03360 615916 444283 171633 0.00030 11206 0 11206 0.00000 1349268 0 1349268 0.00210 1976390 444283 1532107 0.00240 0 7964416 1194662 80325142 113260247 -32935105 X 1 1 1 1 SKY LAKES MEDICAL CENTER 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 SKYLAKES.ORG 14-0724 X X X X SKY LAKES MEDICAL CENTER 1 0 0 1 X X X X X X X X X X 18 1 0 0 1 X SKYLAKES.ORG X HEALTHYKLAMATH.ORG X X 1 18 1 SKYLAKES.ORG 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SKYLAKES.ORG X SKYLAKES.ORG X SKYLAKES.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 3J: TO BETTER UNDERSTAND THE HEALTH NEEDS OF THE COMMUNITY IT SERVES, SKY LAKES MEDICAL CENTER WORKED WITH AN ASSORTMENT OF COMMUNITY PARTNERS TO DEVELOP A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMPANION COMMUNITY HEALTH IMPROVEMENT PLAN. TOGETHER, THE DOCUMENTS DESCRIBE AND HELP US UNDERSTAND THE POPULATION'S HEALTH NEEDS AND WAYS TO ADDRESS THOSE NEEDS AS TOGETHER WE WORK TO IMPROVING THE HEALTH OF THE COMMUNITY. THE MAJOR PARTNERS SKY LAKES MEDICAL CENTER, KLAMATH FALLS, ORE., PRIMARILY ENGAGED IN THE NEEDS ASSESSMENT INCLUDE KLAMATH COUNTY (ORE.) PUBLIC HEALTH; KLAMATH HEALTH PARTNERSHIP (AKA KLAMATH OPEN DOOR), WHICH OPERATES FEDERALLY QUALIFIED FAMILY MEDICINE AND DENTAL CLINICS; AND CASCADE HEALTH ALLIANCE, WHICH OVERSEES CARE FOR SOME 18,000 MEDICAID RECIPIENTS IN THE AREA, BASED IN KLAMATH FALLS. THESE AND OTHER COMMUNITY PARTNERS ARE ORGANIZED IN THE HEALTHY KLAMATH COALITION.THE COALITION REPRESENTS THE HELP AND SUPPORT OF LOCAL ORGANIZATIONS, AGENCIES AND BUSINESSES INCLUDING CASCADES EAST FAMILY MEDICINE CENTER, A RURAL RESIDENCY PROGRAM AND CLINIC IN KLAMATH FALLS; OREGON STATE UNIVERSITY'S EXTENSION IN KLAMATH COUNTY; OREGON HEALTH & SCIENCE UNIVERSITY'S NURSING PROGRAM AT OREGON INSTITUTE OF TECHNOLOGY IN KLAMATH FALLS; THE CITY OF KLAMATH FALLS AND KLAMATH COUNTY GOVERNMENTS; LOCAL SCHOOL DISTRICTS; THE LOCAL NEWSPAPER; THE REGION'S LARGEST RADIO STATION; AND OTHERS. SKY LAKES, THE LOCAL PUBLIC HEALTH AGENCY, KLAMATH HEALTH PARNETSHIP, AND CASCADE HEALTH ALLIANCE COMPRISE THE HEALTHY KLAMATH COALITION LEADERSHIP. IT IS THIS COLLABORATION THAT ALSO PROVED INSTRUMENTAL IN BRINGING THE BLUE ZONES PROJECT TO KLAMATH FALLS AND SUSTAINING ITS WORK LOCALLY. DATA COLLECTED IN BEHALF OF THE BLUE ZONES PROJECT HELPED CORROBORATE FINDINGS IN THE NEEDS ASSESSMENT AND VALIDATE STRATEGIES IN THE IMPROVEMENT PLAN. THE BLUE ZONES PROJECT CONTINUES TO COORDINATE THE HEALTH KLAMATH ACTIVITIES.THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FORMALLY ASSESSES AND DOCUMENTS THE HEALTH OF OUR COMMUNITY UTILIZING A COORDINATED AND COLLABORATIVE PROCESS. IT IS THE FIRST STEP TO THE ONGOING PROCESS OF COMMUNITY HEALTH IMPROVEMENT. CONDUCTING THE ASSESSMENT IS A DYNAMIC PROCESS THAT HELPS THE LOCAL HEALTH CARE COMMUNITY AND OTHERS SEEKING TO IMPROVE THE HEALTH OF THEIR COMMUNITY TO IDENTIFY CURRENT HEALTH ISSUES AND ANALYZE TRENDS OF HEALTH OUTCOMES. THE PROCESS ALSO HELPS COMMUNITY PARTNERS GAIN VALUABLE INSIGHT FROM THEIR CONSTITUENCIES ON FACTORS AFFECTING HEALTH AND QUALITY OF LIFE IN THE SERVICE AREA.THE CHNA DOCUMENTS KEY FINDINGS AND RECOGNIZES THERE ARE MYRIAD CAUSES FOR POOR HEALTH; THE PROBLEM IS TOO LARGE FOR ANY ONE ORGANIZATION TO TAKE ON ALONE, FURTHER REINFORCING THE COLLABORATIVE NATURE OF THE HEALTHY KLAMATH COALITION. THE ASSESSMENT RELIES ON SECONDARY DATA AND USED SURVEYS AND FOCUS GROUPS TO GATHER BOTH QUALITATIVE AND QUANTITATIVE DATA. THE INTENT WAS TO HEAR FROM MANY VOICES AND TO STRIVE FOR HARMONY AS WE WORKED TOGETHER TO MAKE CHANGES, SUPPORTED BY DATA THAT WOULD RESULT IN HEALTHIER BEHAVIORS IN THE POPULATION.WE MONITOR OUR PROGRESS USING SOME 150 HEALTHY COMMUNITIES INSTITUTE (HCI) HEALTH AND SOCIO-ECONOMICS INDICATORS AND DISPLAYED ON A PUBLIC WEBSITE, HEALTHYKLAMATH.ORG; THE SITE ALSO LINKS FROM THE MEDICAL CENTER'S SITE, SKYLAKES.ORG. THE INDICATORS ARE CONTINUALLY UPDATED AS NEW DATA ARE COLLECTED.FOR THE MOST PART, PRIMARY DATA WERE NOT COLLECTED FOR THIS CHNA BECAUSE THOSE EFFORTS WOULD GENERALLY DUPLICATE RECENT EFFORTS OF PARTNER ORGANIZATIONS, WHICH COLLECTED MEANINGFUL DATA THROUGH COMMUNITY SURVEYS, FOCUS GROUPS, AND INTERNAL DATA ANALYSIS. RESULTS FROM THOSE REPORTS WERE SYNTHESIZED INTO A COMPREHENSIVE COMMUNITY ASSESSMENT. MANY DATA SOURCES WERE UTILIZED THROUGHOUT THIS ASSESSMENT, BUT CERTAIN KEY REPORTS WERE HEAVILY RELIED UPON BECAUSE OF THEIR RICH QUALITATIVE DATA THAT PROVIDES THE STORIES BEHIND THE NUMBERS. ASSESSMENTS AND RESOURCES CONTAINING PRIMARY DATA INCLUDE:- BLUE ZONES PROJECT-KLAMATH FALLS, ASSESSMENT REPORT. THE BLUE ZONES PROJECT ASSESSMENT TEAM IN 2016 CONDUCTED 16 FOCUS GROUPS WITH MORE THAT 220 PEOPLE AND MET WITH MORE THAN 25 KEY LEADERS AND COMMUNITY GROUPS TO LEARN ABOUT KLAMATH FALLS, ITS HISTORY, ECONOMY, AND PEOPLE. FOCUS GROUPS WERE ORGANIZED BY SECTOR AND INCLUDED SCHOOLS, WORKSITES, COMMUNITY POLICY, RESTAURANTS, GROCERY STORES, AND FAITH-BASED AND CIVIC GROUPS. ADDITIONALLY, A THREE-DAY BUILT ENVIRONMENT AUDIT VIA WALKING, BIKING, AND DRIVING WAS CONDUCTED BY NATIONAL BIKE AND WALKABILITY EXPERTS DAN BURDEN AND SAMANTHA THOMAS. THESE DATA WERE REGULARLY REVIEWED AND CONSIDERED FOR THE CURRENT CHNA, AND ADDRESSING THOSE ISSUES IS PART OF THE CURRENT IMPLEMENTATION PLAN. - GALLUP-HEALTHWAYS WELL-BEING INDEX, KLAMATH FALLS: THIS ASSESSMENT TEAM COLLECTS A SURVEY DATA FROM RESIDENTS IN THE KLAMATH FALLS URBAN GROWTH BOUNDARY TO ANALYZE FIVE ELEMENTS OF WELLBEING: PURPOSE, SOCIAL, FINANCIAL, COMMUNITY, AND PHYSICAL. THE INDEX WAS LAUNCHED LOCALLY FIRST IN 2015 AND REPEATED ANNUALLY. THE CURRENT INDEX WAS CALCULATED THROUGH 765 COMPLETED ADDRESS-BASED SURVEYS ADMINISTERED IN THE SUMMER OF 2018. THOSE DATA INDICATE THE INDEX IN KLAMATH COUNTY INCREASED 2.6 POINTS TO 54.9. THAT'S 3.6 POINTS BELOW THE US VALUE 4.2 POINTS BELOW THE OREGON VALUE. COMMUNITY WELL-BEING CAN BE DEFINED AS LIKING WHERE YOU LIVE, FEELING SAFE AND HAVING PRIDE IN YOUR COMMUNITY.- OREGON INSTITUTE OF TECHNOLOGY (OIT) POPULATION HEALTH MANAGEMENT: STUDENTS IN THE PROGRAM WORKING WITH THE OIT RESEARCH CENTER FIELDED A KLAMATH COMMUNITY SURVEY TO COLLECT CURRENT QUALITATIVE DATA TO BETTER UNDERSTAND LOCAL HEALTH STATUS, HEALTH CONCERNS, BARRIERS TO CARE, AND HEALTH BEHAVIORS. A TOTAL OF 500 SURVEYS WERE COLLECTED FROM AN ASSORTMENT OF EVENTS AND VENUES INCLUDING THE ANNUAL SKY LAKES HEALTH FAIR HELD AT THE KLAMATH COUNTY FAIRGROUNDS NEAR THE POPULATION CENTER OF KLAMATH FALLS, THE LARGEST CITY IN THE COUNTY. PRINCIPAL FINDINGS INDICATED ABOUT A FOURTH OF THE RESPONDENTS REPORTED A HOUSEHOLD INCOME OF LESS THAN $20,000; ABOUT 38 PERCENT HAD EMPLOYER-SPONSERED HEALTH INSURANCE WHILE ANOTHER 38 PERCENT WERE ENROLLED IN A GOVERNMENT-SPONSORED INSURANCE PROGRAM; AND THE TOP THREE RESPONSES TO THE QUESTION "IS THERE ANYTHING YOU FEEL IS KEEPING YOU FROM HAVING BETTER HEALTH?" WERE LACK OF PHYSICAL ACTIVITY, COST, AND CHRONIC ILLNESS. - LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA): USING THE INSTRUMENTS FROM THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS, THE SURVEY ASKED THREE QUESTIONS IN EACH OF THE 11 CATEGORIES SEEKING INFORMATION ON THE 10 ESSENTIAL PUBLIC HEALTH SERVICES AND HEALTH EQUITY. THE MONTH-LONG ELECTRONIC SURVEY RESULTED IN 31 FULLY COMPLETED RESPONSES FROM COMMUNITY PARTNERS REPRESENTING MANY DIFFERENT SECTORS. THE RESULTS IDENTIFIED WHERE PARTNERS CAN STRENGTHEN HOW THEY DELIVER ESSENTIAL PUBLIC HEALTH SERVICES. - COMMUNITY THEMES AND STRENGTHS ASSESSMENT: THIS INSTRUMENT SOUGHT TO IDENTIFY ASSETS IN THE COMMUNITY AND ISSUES THAT ARE IMPORTANT TO PEOPLE LIVING HERE. THE ONE-DAY COMMUNITY FORUM WAS ATTENDED BY 25 PEOPLE WHO EVALUATED "HEALTH BEHAVIORS," "CLINICAL CARE," "PHYSICAL ENVIRONMENT, AND "SOCIAL AND ECONOMIC FACTORS." THESE CATEGORIES ALIGN WITH THE NATIONAL COUNTY HEALTH RANKINGS MODEL. AMONG THE FINDINGS:STRENGTHS INCLUDE:- THE HOSPITAL IS VERY INVOLVED IN THE COMMUNITY, AND HOSTS LARGE-SCALE EVENTS SUCH AS THE COMMUNITY HEALTH FAIR;- THERE ARE NUMEROUS WELLNESS INITIATIVES IN THE COMMUNITY, MANY LAUNCHED AND MAINTAINED BY SKY LAKES, FOCUSED ON DIET AND PHYSICAL ACTIVITY; AND- THE FOCUS ON TRAILS, PARKS, AND BIKE LANES, OFTEN WITH SKY LAKES IN A LEADERSHIP POSITION.WEAKNESSES INCLUDE:- TOBACCO USE;- LOW HEALTH LITERACY;- DISPARITIES BETWEEN POPULATIONS; AND- PUBLIC TRANSPORATIONWHILE THE AREA SERVED BY SKY LAKES AND ITS PARTNERS COVERS MORE THAN 10,000 SQUARE MILES IN FOUR COUNTIES, TWO OF THEM IN NORTHERN CALIFORNIA, THE POPULATION IS CONCENTRATED WITHIN THE KLAMATH FALLS URBAN GROWTH BOUNDARY (UGB). COMMUNITY HEALTH IMPROVEMENT EFFORTS ARE PRIMARILY IMPLEMENTED WITHIN THE UGB TO HAVE THE GREATEST IMPACT ON THE HIGHEST CONCENTRATION OF RESIDENTS.KLAMATH COUNTY'S POPULATION IS APPROXIMATELY 67,650 (2018) WITH KLAMATH FALLS, AT 21,540 PEOPLE, BEING THE LARGEST CITY WITH AN EQUALLY LARGE SUBURBAN POPULATION. THE POPULATION OF THE UGB WAS ESTIMATED AT 43,500 PEOPLE, AND IT'S WIDELY HELD THAT ANOTHER 12,000 PEOPLE ARE SCATTERED IN ENCLAVES AROUND THE UGB.THE REGION IS PREDOMINANTLY WHITE AND NON-HISPANIC, 77.4 PERCENT (2018). THE POPULATION OF PEOPLE IDENTIFYING AS HISPANIC OR LATINO IS STEADILY RISING AT 13.4 PERCENT IN 2018, UP FROM 10 PERCENT IN 2010. THE REGION IS ALSO UNIQUE IN THAT IT HAS A STRONG AMERICAN INDIAN PRESENCE THAT MAKES UP 4.9 PERCENT OF THE POPULATION[SEE LINE 3J OVERFLOW LATER IN PART V] SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 5: THE KLAMATH COUNTY CHNA COORDINATED BY SKY LAKES MEDICAL CENTER IN PARTNERSHIP WITH OTHER ORGANIZATIONS TAKES INTO ACCOUNT AN UNDERSTANDING OF THE ENVIRONMENT WITHIN WHICH WE OPERATE. UNDERSTANDING THE STRENGTHS AND WEAKNESSES OF THE CURRENT LOCAL HEALTHCARE SYSTEM, AS WELL AS SOCIAL, POLITICAL, AND ECONOMIC CONDITIONS, ARE INTEGRAL TO DEVELOPING PRIORITY AREAS OF FOCUS. THE MAJOR PARTNERS WITH SKY LAKES MEDICAL CENTER, KLAMATH FALLS, ORE., INCLUDED KLAMATH COUNTY (ORE.) PUBLIC HEALTH; KLAMATH HEALTH PARTNERSHIP (A.K.A. KLAMATH OPEN DOOR), WHICH OPERATES FEDERALLY QUALIFIED FAMILY MEDICINE AND DENTAL CLINICS; AND CASCADE HEALTH ALLIANCE, WHICH OVERSEES CARE FOR SOME 18,000 MEDICAID RECIPIENTS IN THE AREA, BASED IN KLAMATH FALLS. OTHER COMMUNITY PARTNERS ARE ORGANIZED IN THE HEALTHY KLAMATH COALITION. THE COALITION REPRESENTS THE HELP AND SUPPORT OF LOCAL ORGANIZATIONS AND AGENCIES INCLUDING CASCADES EAST FAMILY MEDICINE CENTER, A RURAL RESIDENCY PROGRAM AND CLINIC IN KLAMATH FALLS; OREGON STATE UNIVERSITY'S EXTENSION IN KLAMATH COUNTY; OREGON HEALTH & SCIENCE UNIVERSITY'S NURSING PROGRAM AT OREGON INSTITUTE OF TECHNOLOGY IN KLAMATH FALLS; THE CITY OF KLAMATH FALLS AND KLAMATH COUNTY GOVERNMENTS; LOCAL SCHOOL DISTRICTS; THE LOCAL NEWSPAPER; THE REGION'S LARGEST RADIO STATION; AND OTHERS. SKY LAKES, THE LOCAL PUBLIC HEALTH AGENCY, KLAMATH HEALTH PARTNERSHIP, AND CASCADE HEALTH ALLIANCE COMPRISE THE HEALTHY KLAMATH COALITION'S LEADERSHIP.IT IS THIS COLLABORATION THAT ALSO PROVED INSTRUMENTAL IN BRINGING THE BLUE ZONES PROJECT TO KLAMATH FALLS. DATA COLLECTED IN BEHALF OF THE BLUE ZONES PROJECT HELPED CORROBORATE FINDINGS IN THE NEEDS ASSESSMENT AND VALIDATE STRATEGIES IN THE IMPROVEMENT PLAN.ASSESSMENTS AND RESOURCES CONTAINING PRIMARY DATA INCLUDE: BLUE ZONES PROJECT-KLAMATH FALLS, ASSESSMENT REPORT. THE BLUE ZONES PROJECT ASSESSMENT TEAM IN 2016 CONDUCTED 16 FOCUS GROUPS WITH MORE THAN 220 PEOPLE AND MET WITH MORE THAN 25 KEY LEADERS AND COMMUNITY GROUPS TO LEARN ABOUT KLAMATH FALLS, ITS HISTORY, ECONOMY, AND PEOPLE. FOCUS GROUPS WERE ORGANIZED BY SECTOR AND INCLUDED SCHOOLS, WORKSITES, COMMUNITY POLICY, RESTAURANTS, GROCERY STORES, AND FAITH-BASED AND CIVIC GROUPS. ADDITIONALLY, A THREE-DAY BUILT ENVIRONMENT AUDIT VIA WALKING, BIKING, AND DRIVING WAS CONDUCTED BY NATIONAL BIKE AND WALKABILITY EXPERTS DAN BURDEN AND SAMANTHA THOMAS. THESE DATA WERE REGULARLY REVIEWED AND CONSIDERED FOR THE CURRENT CHNA, AND ADDRESSING THOSE ISSUES IS PART OF THE CURRENT IMPLEMENTATION PLAN.GALLUP-HEALTHWAYS WELL-BEING INDEX, KLAMATH FALLS: THIS ASSESSMENT TEAM COLLECTS A SURVEY DATA FROM RESIDENTS IN THE KLAMATH FALLS URBAN GROWTH BOUNDARY TO ANALYZE FIVE ELEMENTS OF WELLBEING: PURPOSE, SOCIAL, FINANCIAL, COMMUNITY, AND PHYSICAL. THE INDEX WAS LAUNCHED LOCALLY FIRST IN 2015 AND REPEATED ANNUALLY. THE CURRENT INDEX WAS CALCULATED THROUGH 765 COMPLETED ADDRESS-BASED SURVEYS ADMINISTERED IN THE SUMMER OF 2018. THOSE DATA INDICATE THE INDEX IN KLAMATH COUNTY INCREASED 2.6 POINTS TO 54.9. THAT'S 3.6 POINTS BELOW THE US VALUE 4.2 POINTS BELOW THE OREGON VALUE. COMMUNITY WELL-BEING CAN BE DEFINED AS LIKING WHERE YOU LIVE, FEELING SAFE AND HAVING PRIDE IN YOUR COMMUNITY.OREGON INSTITUTE OF TECHNOLOGY (OIT) POPULATION HEALTH MANAGEMENT: STUDENTS IN THE PROGRAM WORKING WITH THE OIT RESEARCH CENTER FIELDED A KLAMATH COMMUNITY SURVEY TO COLLECT CURRENT QUALITATIVE DATA TO BETTER UNDERSTAND LOCAL HEALTH STATUS, HEALTH CONCERNS, BARRIERS TO CARE, AND HEALTH BEHAVIORS. A TOTAL OF 500 SURVEYS WERE COLLECTED FROM AN ASSORTMENT OF EVENTS AND VENUES INCLUDING THE ANNUAL SKY LAKES COMMUNITY HEALTH FAIR HELD AT THE KLAMATH COUNTY FAIRGROUNDS NEAR THE POPULATION CENTER OF KLAMATH FALLS, THE LARGEST CITY IN THE COUNTY. PRINCIPAL FINDINGS INDICATED ABOUT A FOURTH OF THE RESPONDENTS REPORTED A HOUSEHOLD INCOME OF LESS THAN $20,000; ABOUT 38 PERCENT HAD EMPLOYER-SPONSORED HEALTH INSURANCE WHILE ANOTHER 38 PERCENT WERE ENROLLED IN A GOVERNMENT-SPONSORED INSURANCE PROGRAM; AND THE TOP THREE RESPONSES TO THE QUESTION "IS THERE ANYTHING YOU FEEL IS KEEPING YOU FROM HAVING BETTER HEALTH?" WERE LACK OF PHYSICAL ACTIVITY, COST, AND CHRONIC ILLNESS.LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA): USING THE INSTRUMENT FROM THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS, THE SURVEY ASKED THREE QUESTIONS IN EACH OF 11 CATEGORIES SEEKING INFORMATION ON THE 10 ESSENTIAL PUBLIC HEALTH SERVICES AND HEALTH EQUITY. THE MONTH-LONG ELECTRONIC SURVEY RESULTED IN 31 FULLY COMPLETED RESPONSES FROM COMMUNITY PARTNERS REPRESENTING MANY DIFFERENT SECTORS. THE RESULTS IDENTIFIED WHERE PARTNERS CAN STRENGTHEN HOW THEY DELIVER ESSENTIAL PUBLIC HEALTH SERVICES.COMMUNITY THEMES AND STRENGTHS ASSESSMENT: THIS INSTRUMENT SOUGHT TO IDENTIFY ASSETS IN THE COMMUNITY AND ISSUES THAT ARE IMPORTANT TO PEOPLE LIVING HERE. THE ONE-DAY COMMUNITY FORUM WAS ATTENDED BY 25 PEOPLE WHO EVALUATED "HEALTH BEHAVIORS," "CLINICAL CARE," "PHYSICAL ENVIRONMENT, AND "SOCIAL AND ECONOMIC FACTORS." THESE CATEGORIES ALIGN WITH THE NATIONAL COUNTY HEALTH RANKINGS MODEL. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 7D: PRINTED COPIES AT SKY LAKES MEDICAL CENTER, CASCADES EAST FAMILY MEDICINE CLINIC, KLAMATH COUNTY HEALTH DEPARTMENT, KLAMATH COUNTY LIBRARY'S MAIN BRANCH, AND ON REQUEST. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 11: ACCORDING TO THE FEDERAL CENTERS FOR DISEASE CONTROL (CDC), THE TOP 10 LEADING CAUSES OF DEATH IN THE UNITED STATES ARE HEART DISEASE, CANCER, CHRONIC LOWER RESPIRATORY DISEASES, STROKE, UNINTENTIONAL INJURIES, ALZHEIMER'S DISEASE, DIABETES MELLITUS, PNEUMONIA AND INFLUENZA, KIDNEY DISEASE, AND SUICIDE. SEVEN OF THESE 10 ARE CHRONIC DISEASES THAT PERSIST FOR YEARS, DECREASE QUALITY OF LIFE, AND STRAIN THE HEALTHCARE SYSTEM; TREATING PEOPLE WITH CHRONIC CONDITIONS ACCOUNTS FOR 90 PERCENT OF THE NATION'S HEALTHCARE COSTS. THE TOP FIVE LEADING CAUSES OF DEATH IN KLAMATH COUNTY ARE CANCER, HEART DISEASE, CHRONIC RESPIRATORY DISEASES, ACCIDENTS AND SUICIDE. FURTHER, ALMOST A FOURTH OF ALL DEATHS IN KLAMATH COUNTY ARE TOBACCO-RELATED. SKY LAKES MEDICAL CENTER'S RESPONSE TO CANCER- AND TOBACCO-RELATED DEATHS INCLUDE TRAINING FACILITATORS AND HOSTING FREEDOM FROM SMOKING CLASSES AND MARKETING THE CLASSES ONLINE, IN MASS MEDIA AND IN NEWS CHANNELS. SKY LAKES ALSO PROMOTED REGULAR SCREENING (COLORECTAL AND SKIN CANCER SCREENINGS ARE HIGHLIGHTS OF THE 2019 ANNUAL COMMUNITY HEALTH FAIR ORGANIZED BY SKY LAKES; SOME 2,500 PEOPLE ATTEND THE FREE EVENT AT THE KLAMATH COUNTY FAIRGROUNDS) AND MASS MEDIA AWARENESS CAMPAIGNS. THE HEALTH FAIR AND OTHER COMMUNITY HEALTH IMPROVEMENT AND ADVOCACY PROGRAMS AMOUNT TO A SKY LAKES INVESTMENT OF MORE THAN $90,000 (NET) EACH YEAR.ACCORDING TO THE FINDINGS WITHIN THE CHNA, MORE THAN HALF THE PEOPLE IN KLAMATH COUNTY HAVE ONE OR MORE CHRONIC CONDITIONS, AND MOST PEOPLE HAVE ONE OR MORE RISK FACTORS FOR A CHRONIC CONDITION. RISK FACTORS INCLUDE OBESITY, LACK OF PHYSICAL ACTIVITY, TOBACCO USE, HIGH BLOOD PRESSURE, AND HIGH CHOLESTEROL. SKY LAKES PROVIDES PEOPLE IN THE COMMUNITY IT SERVES APPROXIMATELY $5.5 MILLION (NET) IN SUBSIDIZED HEALTH SERVICES.SKY LAKES IS ADDRESSING OBESITY HEAD ON WITH THE IMPLEMENTATION OF THE SKY LAKES WELLNESS CENTER, WHICH OFFERS NUTRITION, EXERCISE, AND STRESS MANAGEMENT COACHING. MANY PARTNER ORGANIZATIONS INCLUDING OREGON STATE UNIVERSITY'S EXTENSION PROGRAM, OFTEN IN COOPERATION WITH SKY LAKES DEPARTMENTS, ARE IMPLEMENTING INTERVENTIONS TO PREVENT OBESITY BY OFFERING WALKING GROUPS, AFTER-SCHOOL ACTIVITIES, NUTRITION EDUCATION, AND RECREATION OPPORTUNITIES. SKY LAKES DIETITIANS REGULARLY PRESENT AT NO CHARGE TO BUSINESSES AND ORGANIZATIONS IN THE COMMUNITY ADVOCATING FOR BETTER NUTRITION CHOICES. THESE AND RELATED COMMUNITY-BUILDING ACTIVITIES INVOLVING SKY LAKES AMOUNT TO APPROXIMATELY $1.4 MILLION A YEAR (NET).SKY LAKES INVESTED $600,000 OVER THREE YEARS ($200,000 A YEAR THROUGH 2018) TO LEVERAGE $1.2 MILLION MATCHING FUNDING TO BRING THE BLUE ZONES PROJECT TO KLAMATH FALLS. THE CITY IS THE FIRST BLUE ZONES DEMONSTRATION CITY IN THE PACIFIC NORTHWEST. BLUE ZONES EMPLOYS EVIDENCE-BASED WAYS TO HELP PEOPLE LIVE LONGER WHILE LIVING BETTER. BLUE ZONES TAKES A SYSTEMATIC, ENVIRONMENTAL APPROACH TO WELL-BEING, WHICH FOCUSES ON OPTIMIZING POLICY, BUILDING DESIGN, SOCIAL NETWORKS, AND THE BUILT ENVIRONMENT. SKY LAKES IS THE PRINCIPAL SPONSOR OF THE CURRENT BLUE ZONES PROJECT AND EMPLOYS ITS LEADERSHIP STAFF TO HELP ENSURE CONTINUITY AND COORDINATION OF LOCAL PROGRAMS.THE PROJECT'S FULL-TIME STAFF AND AN EXTENSIVE LOCAL VOLUNTEER CADRE ENCOURAGE INCREASED PHYSICAL ACTIVITY, NO TOBACCO, AND HEALTHIER NUTRITION CHOICES AS WELL AS MORE SOCIAL INTERACTIONS TO RELIEVE STRESS. THEY ALSO ADVOCATE FOR POLICIES THAT ENABLE BUILT ENVIRONMENT, ANTI-SMOKING REGULATIONS, AND MORE FRESH FOOD. WORK BY SKY LAKES AND LOCAL BLUE ZONES PROJECT STAFF IS AIMED AT ENCOURAGING MORE PHYSICAL ACTIVITY, PROMOTING SELF-AWARENESS ABOUT HEALTHFUL LIFESTYLES, AND CHANGING POLICIES - AT WORKPLACES, IN BUSINESS, AND AT GOVERNMENT LEVELS -- TO ALIGN WITH THAT PHILOSOPHY. SKY LAKES WAS INSTRUMENTAL IN THE DEVELOPMENT OF EXTENSIVE AREA TRAILS FOR HIKING, A PROTECTED BIKE LANE FROM CITY-CENTER TO A MUNICIPAL PARK, THE DEVELOPMENT OF A FAMILY-FRIENDLY PLAY AREA AT A NEIGHBORHOOD PARK, AND THE CREATION OF A NEW DOWNTOWN PARK IN RESPONSE TO THE BLUE ZONE PROJECT'S GUIDANCE IN CONCERT WITH THE SKY LAKES WELLNESS CENTER AND OTHER SKY LAKES DEPARTMENTS.SKY LAKES SPONSORED A THREE-YEAR "LEARN TO SWIM" PROGRAM FOR AREA THIRD-GRADERS AS A WAY TO FURTHER ENCOURAGES A LIFELONG HABIT OF PHYSICAL ACTIVITY AND WELLNESS. THE SPONSORSHIP, APPROXIMATELY $25,000 A YEAR, INVOLVES NEARLY 800 STUDENTS IN AREA PUBLIC AND PRIVATE SCHOOLS WHO TRAVEL TO THE ELLA REDKEY MUNICIPAL POOL TO GAIN VALUABLE LIFE-SAVING SKILLS. TO ENCOURAGE ADULTS, ESPECIALLY SENIORS, TO REMAIN PHYSICALLY ACTIVE, SKY LAKES AND CASCADES EAST HOST THE WALK WITH A DOC PROGRAM EVERY SATURDAY (EXCEPT MAJOR HOLIDAYS) AT A LOCAL SPORT PARK. AREA PHYSICIANS PRESENT ON A HEALTH-RELATED TOPIC AND THEN LEAD AN HOUR-LONG WALK WITH DOZENS OF PEOPLE IN ATTENDANCE. SKY LAKES IS ALSO A MAJOR SPONSOR OF COMMUNITY WALK-RUN EVENTS, A CHILDREN-ONLY RUNNING SERIES, AND AMATEUR SPORTS ACTIVITIES INCLUDING PICKLEBALL (SKY LAKES WAS A MAJOR SPONSOR OF NEW COURTS FOR THE LOCAL LEAGUE) AND AN ADULT BASKETBALL LEAGUE, AND BASEBALL SCHOLARSHIPS TO HELP ECONOMICALLY CHALLENGED AREA YOUTH.RELATED TO OBESITY IS DIABETES. DIABETES PREVENTION AND LIFESTYLE-CHANGE STRATEGIES WERE THE FOCUS OF A MULTI-MEDIA ADVERTISING AND AWARENESS CAMPAIGN COORDINATED BY SKY LAKES DIABETES EDUCATORS. REGULAR "COOKING MATTERS" CLASSES HOSTED BY THE SKY LAKES WELLNESS CENTER AND SUPPORTED BY CONTRIBUTIONS FROM THE MEDICAL CENTER ALSO FOCUS ON HEALTHY NUTRITION CHOICES TO SUPPORT WEIGHT REDUCTION AND DIABETES PREVENTION. SKY LAKES GENEROUSLY CONTRIBUTES TO LOCAL CHILDHOOD INTERVENTION PROGRAMS SUCH AS CASA, FRIENDS OF THE CHILDREN-KLAMATH FALLS, AND CITIZENS FOR SAFE SCHOOLS TO HELP SUPPORT THEIR EDUCATIONAL AND MENTORING EFFORTS AIMED AT TEACHING HEALTHY LIFESTYLE STRATEGIES TO CHILDREN AND YOUNG ADULTS.TO FURTHER SUPPORT HEALTHY NUTRITION, SUPPORTS THE KLAMATH-LAKE FOOD BANK AND ITS PRODUCE CONNECT PROGRAM, WHICH ANNUALLY DISTRIBUTES A QUARTER TON OF FRESH PRODUCE TOMORE THAN 4,000 HOUSEHOLDS IN THE AREA. SKY LAKES ALSO OPENS SOME OF ITS FACILITIES AS DISTRIBUTION SITES, AND ENCOURAGES STAFF TO VOLUNTEER IN THE DISTRIBUTION ACTIVITIES.MENTAL HEALTH IS A GROWING CONCERN IDENTIFIED IN THE NEEDS ASSESSMENT. KLAMATH COUNTY IS A VIBRANT COMMUNITY FACED WITH SOME CONCERNING MENTAL HEALTH CHALLENGES. THERE IS A HIGH PREVALENCE OF MENTAL HEALTH PROBLEMS AND AN UNFORTUNATE LACK OF MENTAL HEALTH PROVIDERS IN KLAMATH COUNTY. MENTAL HEALTH ISSUES OFTEN LEAD TO OTHER SOCIAL AND PHYSICAL HEALTH ISSUES, CREATING BROADER, COMMUNITY-WIDE PROBLEMS. ACTIVE INTERVENTION IN MENTAL HEALTH CASES IS BEYOND THE SCOPE OF SKY LAKES, ALTHOUGH THE ORGANIZATION WORKS IN CLOSE COORDINATION WITH KLAMATH BASIN BEHAVIORAL HEALTH AND SUPPORTS THE KBBH ROLE IN THE COMMUNITY.SKY LAKES EMPLOYEES, HOWEVER, PLAY AN ACTIVE ROLE IN COMMUNITY MENTAL HEALTH AND SUBSTANCE DISORDER PREVENTION ACTIVITIES. SKY LAKES WAS PIVOTAL IN CREATING THE KLAMATH WORKS AGENCY, WHERE STAFF HELP CLIENTS LEARN HOW TO APPLY FOR AND RETAIN JOBS; THE AGENCY IS HOUSED IN A SKY LAKES BUILDING.SKY LAKES IS AMONG THE AGENCIES BUILDING A NEW FACILITY TO AID PEOPLE IN MENTAL HEALTH CRISES OR SEEKING ALCOHOL AND SUBSTANCE ABUSE REHABILITATION THERAPY SERVICES. SKY LAKES CONTRIBUTED $200,000 TOWARD THE FACILITY'S CONSTRUCTION, AND, WHEN THE FACILITY IS OPEN, SKY LAKES WILL CONTRIBUTE TO ITS OPERATION.ACCORDING TO THE CHNA, THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) HAS IDENTIFIED KLAMATH COUNTY AS A HEALTH PROFESSIONAL SHORTAGE AREA. TO HELP COUNTER THE SHORTAGE OF PROVIDERS, SKY LAKES OPERATES THE CASCADES EAST FAMILY MEDICINE RESIDENCY IN COOPERATION WITH OREGON HEALTH & SCIENCE UNIVERSITY AND STAFFS THE ASSOCIATED CLINIC. EIGHT PHYSICIANS A YEAR STUDY FOR THREE YEARS AT THE KLAMATH FALLS PROGRAM EN ROUTE TO THEIR FAMILY MEDICINE SPECIALTY. THIS AMOUNTS TO AN INVESTMENT OF MORE THAN $2.3 MILLION (NET) ANNUALLY BY SKY LAKES. [SEE LINE 11 OVERFLOW LATER IN PART V] SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 13H: SKY LAKES PROVIDES PRESUMPTIVE ELIGIBILITY BY RELYING ON OUTSIDE AGENCIES DETERMINATION OF INCOME STATUS. PART V, SECTION B, LINE 3J OVERFLOW: AGE PLAYS A SIGNIFICANT ROLE ON THE HEALTH OF A COMMUNITY, AS DIFFERENT LIFE STAGES TEND TO EXPERIENCE HEALTH OUTCOMES UNIQUE TO THEIR AGE. IN KLAMATH COUNTY, THE MEDIAN AGE IS 42.6 YEARS. THOSE 65 AND OLDER COMPRISE 21.2 PERCENT OF THE POPULATION WHILE THOSE UNDER 18 COMPRISE 21.7 PERCENT. THE PRIMARY GOAL OF THE CHNA IS TO BETTER UNDERSTAND THE HEALTH OF OUR COMMUNITY AND TO DEVELOP LOCAL STRATEGIES TO ADDRESS OUR COMMUNITY'S SPECIFIC NEEDS AND IDENTIFIED PRIORITY ISSUES. THE CHNA INFORMS THE GROUP AND HELPS SET COMMUNITY PRIORITIES, ESTABLISHES BENCHMARKS AND MONITORS TRENDS IN THE HEALTH STATUS OF KLAMATH COUNTY RESIDENTS. THERE IS AN ADDED BENEFIT IN THAT THE IMPROVEMENT EFFORTS EXTEND TO OTHER REGIONS IN THE CATCHMENT AREA OUTSIDE THE DEFINED COMMUNITY. WE ACKNOWLEDGE THAT THE CHNA IS A LIVING DOCUMENT, ALLOWING US TO SEEK CONTINUOUS IMPROVEMENT AND FURTHER ANALYZE THE DATA AND, ULTIMATELY, IMPROVE THE HEALTH OF PEOPLE IN OUR COMMUNITY. UNDERSTANDING THAT HEALTH IS A PRODUCT OF MANY CONDITIONS AND FACTORS, AN ADAPTED VERSION OF THE STRATEGIC PLANNING FRAMEWORK DEVELOPED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO) IN COOPERATION WITH THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) WAS MADE TO CREATE THIS CHNA.THE STRATEGIC PLANNING FRAMEWORK THAT WAS ADAPTED FOR KLAMATH COUNTY IS KNOWN AS MOBILIZING ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP). MAPP IS A COMMUNITY-DRIVEN PROCESS THAT RESULTS IN THE IDENTIFICATION OF HEALTH ISSUES AND HEALTH IMPROVEMENT STRATEGIES THROUGH COMMUNITY MEMBER AND STAKEHOLDER ENGAGEMENT. THE PROCESS IS DESCRIBED MORE FULLY IN THE CHNA. FACILITATED BY COMMUNITY HEALTH LEADERS, MAPP IS INTENDED TO IMPROVE THE EFFICIENCY, EFFECTIVENESS, AND PERFORMANCE OF LOCAL HEALTHCARE SYSTEMS; SKY LAKES IS A PRINCIPAL PART OF THAT LOCAL SYSTEM. MAPP ALLOWS FOR AN ENHANCED UNDERSTANDING OF THE INFLUENCES ON COMMUNITY HEALTH THROUGH THE ANALYSIS OF POPULATION-BASED QUANTITATIVE DATA, LOCALLY GATHERED QUALITATIVE DATA, AND THE EXPERTISE OF KEY STAKEHOLDERS. THESE VARIOUS DATA-COLLECTION METHODS ALLOW FOR A BETTER UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH. THE SOCIAL DETERMINANTS OF HEALTH ARE THE CIRCUMSTANCES IN WHICH PEOPLE ARE BORN, RAISED, LIVE, AND WORK, IN ADDITION TO AVAILABLE RESOURCES. THEY PROVIDE A LENS THROUGH WHICH TO VIEW DIFFERENT POPULATIONS AND COMMUNITIES AND IDENTIFY CONDITIONS THAT PROMOTE HEALTH, RATHER THAN LIMIT IT. WITH THIS INFORMATION WE CAN COLLECTIVELY BETTER UNDERSTAND THE DRIVERS OF HEALTH OUTCOMES IN KLAMATH COUNTY AND DEVELOP STRATEGIES FOR HEALTH IMPROVEMENT. SKY LAKES AND OUR COMMUNITY PARTNERS COLLABORATIVELY AGREED TO UTILIZE THE HEALTHY COMMUNITIES INSTITUTE (HCI), WHICH MANAGES AND CONTINUALLY UPDATES A CENTRALIZED PUBLICALLY AVAILABLE WEB-BASED SOURCE OF POPULATION DATA AND COMMUNITY HEALTH INFORMATION, AS A PLATFORM. WITH IT, WE HAVE CONTINUAL MONITORING AND TRACKING ON SOME 150 INDICATORS THAT ARE ROUTINELY UPDATED. THESE INDICATORS WERE ASSESSED ON FOUR FACTORS:1) COMPARISON TO OREGON AND NATIONAL BENCHMARKS;2) TRENDS OVER TIME;3) HEALTH DISPARITIES; AND4) SEVERITY OF HEALTH ISSUES.THE HEALTH INDICATORS SELECTED MET AT LEAST THREE OF THE FOUR CONDITIONS:- KLAMATH COUNTY RATE IS HIGHER THAN THE OREGON STATE AVERAGE AND/OR DOES NOT MEET THE NATIONAL HEALTHY PEOPLE 2020 BENCHMARK;- THE TREND IS WORSENING;- CERTAIN POPULATIONS ARE EXPERIENCING A DISPARITY; OR- LONG-TERM CONSEQUENCE, PREMATURE DEATH, AND/OR HIGH HEALTH-RELATED EXPENDITURES ARE ASSOCIATED.THE FORMULATION OF CHNA COORDINATED BY SKY LAKES MEDICAL CENTER WAS STRONGLY INFLUENCED BY INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS AS WELL AS INDIVIDUALS IN THE COMMUNITIES WE SERVE. COMMUNITY INVOLVEMENT IS ESSENTIAL TO SUCCESSFUL PUBLIC HEALTH ACTION, AND THE PRIORITY AREAS FOR HEALTH IMPROVEMENT SHOULD REFLECT THE PROBLEMS OF GREATEST CONCERN TO THE LOCAL COMMUNITIES. SKY LAKES AND ITS PARTNERS REGULARLY SEEK COMMUNITY INPUT VIA LISTENING SESSIONS, FOCUS GROUPS, THE HOSPITAL'S PARTNERS IN CARE PATIENT-FAMILY ADVISORY COUNCIL, AND SURVEYS.COMMUNITY PERCEPTIONS REGARDING HEALTH NEEDS ARE CAPTURED IN NON-SCIENTIFIC SURVEYS AND INTERVIEWS CONDUCTED AT THE CONCLUSION OF COMMUNITY EVENTS HOSTED BY THE MEDICAL CENTER. INFORMATION FROM THESE ACTIVITIES HELPS INFORM FOLLOW-ON STRATEGIES AND PROGRAMS. PART V, SECTION B, LINE 11 OVERFLOW: TO HELP DEVELOP A NEW GENERATION OF PHYSICAL THERAPISTS, SKY LAKES INVESTED $200,000 TO HELP OREGON INSTITUTE OF TECHNOLOGY LAUNCH A DOCTOR OF PHYSICAL THERAPY PROGRAM, TO BE OFFERED IN PARTNERSHIP WITH OREGON HEALTH & SCIENCE UNIVERSITY. THE PROGRAM IS OREGON TECH'S FIRST DOCTORAL DEGREE.SKY LAKES ALSO IS A MAJOR SPONSOR OF HIGH SCHOOL AND COMMUNITY COLLEGE PROGRAMS AIMED AT TRAINING NURSES AND NURSE AIDES, AND ENCOURAGING STUDENT PARTICIPATION IN SCIENCE, TECHNOLOGY, ENGINEERING, MATH AND MEDICAL (STEM&M) CURRICULA. SKY LAKES PHARMACY ALSO HAS AN ACTIVE RESIDENCY PROGRAM TO FURTHER DEVELOP HEALTH CARE RESOURCES. SKY LAKES FUNDS THE PHARMACY RESIDENCY AT A NET EXPENSE OF APPROXIMATELY $250,000 ANNUALLY. SKY LAKES ALSO OFFERS STUDENTS IN A LOCAL COMMUNITY COLLEGE CLASSROOM INSTRUCTION REGARDING VARIOUS ASPECTS OF BEDSIDE CARE.SKY LAKES IS AN ENTHUSIASTIC PARTNER WITH LOCAL SCHOOLS IN ACADEMIC AS WELL AS ATHLETIC PROGRAMS. SKY LAKES ALSO ENCOURAGES PARTICIPATION IN EXTRA-CURRICULAR ACTIVITIES AT ALL LEVELS BY PROVIDING FUNDING FOR ROBOTICS, HEALTH OCCUPATIONS COMPETITION, AND ACADEMIC COMPETITIONS. HEALTH EQUITY IS BECOMING A PRIORITY IN THE HEALTH FIELD, AS NOT EVERYONE HAS THE CHANCE TO ACHIEVE OPTIMAL HEALTH DUE TO SOCIAL POSITION OR CIRCUMSTANCE. HEALTH INEQUITIES ARE DEMONSTRATED BY MARKED DIFFERENCES IN QUALITY OF LIFE, DISEASE RATES, AND ACCESS TO RESOURCES. RACIAL AND ETHNIC MINORITIES, SEXUAL MINORITIES, PEOPLE WITH DISABILITIES, AND OTHER VULNERABLE GROUPS MORE OFTEN FACE UNNECESSARY BARRIERS TO ACHIEVING OPTIMAL HEALTH, WHICH CAN BE ELIMINATED. THESE ARE AREAS IN WHICH SKY LAKES ACTIVELY SUPPORTS PUBLIC AND PRIVATE AGENCIES AND GOVERNMENT OFFICES AS THEY SEEK SOLUTIONS, BUT CANNOT BE EXPECTED TO ADDRESS THE NEEDS. TRANSPORTATION IS IDENTIFIED AS A NEED IN THE COMMUNITY, ESPECIALLY AMONG LOWER SOCIO-ECONOMIC POPULATIONS. SKY LAKES OUTPATIENT CARE MANAGEMENT PROVIDES HEALTH CARE-RELATED TRANSPORTATION TO MORE THAN 300 QUALIFYING INDIVIDUALS AT A NET COMMUNITY BENEFIT OF MORE THAN $22,000. EDUCATION IS ONE OF THE IDENTIFIED SOLUTIONS. IT CAN REDUCE POVERTY, INCREASE INCOME, AND PROVIDE MORE FUTURE OPPORTUNITIES. IT HELPS COMBAT INEQUALITY AND INJUSTICE, IS ASSOCIATED WITH BETTER OVERALL HEALTH, AND DRIVES SUSTAINABLE ECONOMIC GROWTH WITHIN A COMMUNITY. DIRECT INTERVENTION IS BEYOND THE SCOPE OF SKY LAKES, HOWEVER.HIGH RATES OF CHRONIC ABSENTEEISM AND MOBILITY WITHIN SCHOOL DISTRICTS HAVE BEEN IDENTIFIED AS MAIN FACTORS DRIVING DOWN RATES OF EDUCATIONAL SUCCESS. THIS IS WIDELY RECOGNIZED AMONG LEADERSHIP GROUPS ACROSS THE COUNTY, AND AS A RESULT, A STRONG PARTNERSHIP BETWEEN THE LOCAL HIGHER EDUCATION INSTITUTIONS, YOUTH MENTORING PROGRAMS, AND PUBLIC SCHOOLS HAS FORMED. KLAMATH PROMISE IS A POWERFUL INITIATIVE FOCUSED ON REDUCING ABSENTEEISM AND PROVIDING MENTORING TO HELP KLAMATH COUNTY ACHIEVE A 100 PERCENT GRADUATION RATE. SKY LAKES GENEROUSLY CONTRIBUTES FINANCIALLY TO KLAMATH PROMISE AND RELATED SCHOOL-BASED PROGRAMS AS WELL AS TO READING PROGRAMS SUCH AS SMART (START MAKING A READER TODAY) AIMED AT STUDENTS IN GRADES 1-3, AND ROTARY INTERNATIONAL-SPONSORED READING PROGRAMS FOR FIRST-GRADERS. OTHER SOCIAL DETERMINANTS OF HEALTH INCLUDE UNEMPLOYMENT, HOMELESSNESS, CRIME AND SAFETY. WHILE SKY LAKES WAS INSTRUMENTAL IN THE FORMATION OF THE INNOVATIVE KLAMATH WORKS AGENCY, WHICH HELPS ADDRESS MANY OF THOSE ISSUES, SKY LAKES IS UNABLE TO ADDRESS THE FUNDAMENTAL ISSUES. SUBSTANCE ABUSE, A MODIFIABLE HEALTH RISK, WILL BE ADDRESSED BY A SOBERING CENTER ON THE CAMPUS. SKY LAKES COMMITTED $200,000 TO ITS CONSTRUCTION AND PLEDGED TO COVER A SUBSTANTIAL PART OF ITS ANNUAL OPERATION TO ENSURE PROPER PATIENT CARE AND REHABILITATION TREATMENT."BUILT ENVIRONMENT" IS DEFINED AS OUR HUMAN-MADE SURROUNDINGS THAT INFLUENCE ACTIVITIES AND THEREFORE HEALTH BEHAVIORS AND SOCIAL NORMS. IMPROVED POPULATION HEALTH REQUIRES A FOCUS ON IMPROVING THE BUILT ENVIRONMENT BECAUSE OF THE IMPORTANT ROLE IT PLAYS IN PROMOTING HEALTH AND PREVENTING CHRONIC DISEASE. FOR EXAMPLE, WHEN THERE ARE SAFE AREAS - GREEN SPACES, PARKS, SAFE ROUTES, AND THRIVING BUSINESSES - EASILY ACCESSIBLE, PEOPLE FIND IT EASIER TO BE PHYSICALLY ACTIVE AND WALK TO THESE PLACES, FEEL SAFE, AND MEET WITH SOCIAL GROUPS. ALL OF THESE ACTIVITIES IMPROVE HEALTH. SKY LAKES HAS CONTRIBUTED FINANCIAL AND HUMAN RESOURCES TO HELP CREATE GREENSPACES IN DOWNTOWN KLAMATH FALLS, TO HELP REHABILITATE A MAJOR NEIGHBORHOOD PARK NEAR THE MEDICAL CENTER, AND ADD A CHILDREN'S PLAY AREA, AND TO HELP CREATE HIKING AND BIKING TRAILS IN AND AROUND THE CITY. SKY LAKES HAD A LEADERSHIP ROLE IN CREATING SAFE BIKE LANES CONNECTING DOWNTOWN AND THE LARGEST MUNICIPAL PARK IN THE CITY. THESE ARE STRATEGIES INTENDED TO ENCOURAGE PEOPLE TO BE MORE PHYSICALLY ACTIVE WHILE REDUCING VEHICULAR TRAFFIC. 18 1 - FAMILY MEDICINE RESIDENCY 2801 DAGGETT AVENUE KLAMATH FALLS OR 97601 MEDICAL CLINIC & MEDICAL RESIDENCY PGM 2 - OUTPATIENT IMAGING 2900 DAGGETT AVENUE KLAMATH FALLS OR 97601 OUTPATIENT DIAGNOSTIC IMAGING CENTER 3 - MOB II 3000 BRYANT WILLIAMS DRIVE KLAMATH FALLS OR 97601 MEDICAL CLINIC 4 - FAMILY PRACTICE CLINIC 1905 MAIN KLAMATH FALLS OR 97601 MEDICAL CLINIC 5 - MOB I 2200 BRYANT WILLIAMS DRIVE KLAMATH FALLS OR 97601 MEDICAL CLINIC 6 - CANCER TREATMENT CENTER 2610 URHMAN KLAMATH FALLS OR 97601 MEDICAL CLINIC 7 - CENTER FOR OCCUPATIONAL HEALTH 2621 CROSBY AVENUE KLAMATH FALLS OR 97603 HOME HEALTH SERVICES, EMPLOYEE ASSISTANCE PROGRAM 8 - ADULT MEDICINE & FAMILY PRACTICE 3001 DAGGETT AVENUE KLAMATH FALLS OR 97601 MEDICAL CLINICS 9 - UROLOGY CLINIC 2630 CAMPUS DRIVE KLAMATH FALLS OR 97601 MEDICAL CLINIC 10 - MOB III 2680 UHRMANN ROAD KLAMATH FALLS OR 97601 MEDICAL CLINIC 11 - FAMILY PRACTICE CLINIC 2617 ALMOND STREET KLAMATH FALLS OR 97601 MEDICAL CLINIC 12 - FAMILY PRACTICE CLINIC 2600 CLOVER KLAMATH FALLS OR 97601 MEDICAL CLINIC 13 - WELLNESS CENTER 128 SOUTH 11TH STREET KLAMATH FALLS OR 97601 MEDICAL CLINIC 14 - PULMONARY MEDICINE 2301 CLAIRMONT KLAMATH FALLS OR 97601 MEDICAL CLINIC 15 - COMMUNITY HEALTHEDUCATION 2200 NORTH ELDORADO AVENUE KLAMATH FALLS OR 97601 COMMUNITY EDUCATION FACILITY 16 - HUGH CURRIN HOUSE 2601 DAGGETT AVENUE KLAMATH FALLS OR 97601 RESIDENTIAL FACILITY FOR FAMILIES UNDERGOING CARE 17 - RECOVERY ZONE 2846 EBERLEIN AVE KLAMATH FALLS OR 97603 REHABILITATION SERVICES 18 - PEDIATRIC REHAB 2686 CAMPUS DRIVE KLAMATH FALLS OR 97601 REHABILITATION SERVICES PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED FOR THE FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS TABLE. THE RATIO WAS DERIVED USING WORKSHEET 2, 'RATIO OF PATIENT CARE COST-TO-CHARGES.' PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 7,964,416. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT: ACTIVITIES INCLUDE KLAMATH-LAKE CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES). CARES IS DEDICATED TO PROVIDING SAFE, COMPREHENSIVE, OBJECTIVE MEDICAL ASSESSMENTS, AND TO RAISING AWARENESS ABOUT CHILD ABUSE THROUGH COORDINATED, COLLABORATIVE EDUCATIONAL PROGRAMS. FOUR TIMES PER YEAR, DISCOUNTED AND FREE PRESCRIPTION DRUGS, ALONG WITH EDUCATIONAL SUPPORT BY LICENSED PHARMACISTS, ARE PROVIDED TO LOW INCOME ELDERLY THROUGH LOCAL SENIOR CENTERS. THE NO ONE DIES ALONE PROGRAM IS A VOLUNTEER PROGRAM THAT PROVIDES THE REASSURING PRESENCE OF A VOLUNTEER COMPANION TO DYING PATIENTS WHO WOULD OTHERWISE BE ALONE. SKY LAKES ALSO PARTICIPATES IN RELAY FOR LIFE, UNITED WAY AND OTHER LOCAL FUNDRAISING AND AWARENESS INITIATIVES, AS WELL AS ONGOING EFFORTS IN THE PERIOD OF PURPLE CRYING COMMUNITY EDUCATION CAMPAIGN. THERE ARE A NUMBER OF OTHER COMMUNITY SUPPORT ACTIVITIES THAT ARE PROVIDED, INCLUDING BUT NOT LIMITED TO SPONSORSHIP OF SUPPORT GROUPS FOR CANCER, ADOPTING FAMILIES AT CHRISTMAS, TRANSPORTATION ASSISTANCE TO INDIGENT PATIENTS, STAFF VOLUNTEER PARTICIPATION IN COMMUNITY EVENTS, AND FREE ACCESS TO MEETING ROOMS.COALITION BUILDING: THE LOCAL HEALTH DEPARTMENT, IN CONJUNCTION WITH THE OREGON HEALTH DEPARTMENT, PERIODICALLY PERFORMS HEALTH ASSESSMENTS OF THE PEOPLE IN THE COMMUNITIES SERVED BY SKY LAKES. THE MEDICAL CENTER WORKS WITH LOCAL HEALTH AUTHORITIES TO DETERMINE THE HEALTH INITIATIVES THAT CAN BE JOINTLY ADDRESSED BY COMMUNITY LEADERS, WITH SKY LAKES MEDICAL CENTER SERVING A SIGNIFICANT LEADERSHIP ROLE. SKY LAKES MEDICAL CENTER ACTIVELY PARTNERS WITH AGENCIES SUCH AS THE KLAMATH COUNTY HEALTH DEPARTMENT, OREGON HEALTH & SCIENCE UNIVERSITY, AND THE UNITED WAY OF THE KLAMATH BASIN IN HEALTH-IMPROVEMENT INITIATIVES. EMPLOYEES VOLUNTEER THEIR TIME FOR LEADERSHIP KLAMATH, KLAMATH HOSPICE AND MANY OTHER COMMUNITY SERVICE ORGANIZATIONS WHERE LEADERS COME TOGETHER.COMMUNITY HEALTH IMPROVEMENT ADVOCACY: SKY LAKES HEALTH IMPROVEMENT ADVOCACY TAKES PLACE VIA AN ANNUAL HEALTH FAIR AND ONGOING EDUCATIONAL OFFERINGS FOR HEART DISEASE, CHOLESTEROL SCREENING, WEIGHT MANAGEMENT, NUTRITION, DUII, EATING ON BUDGET, BREASTFEEDING, SMOKING CESSATION, CAR SEAT SAFETY, AIDS/HIV, AND DIABETES. IN ADDITION TO COMMUNITY MEMBERS, EDUCATIONAL OFFERINGS INCLUDE NURSING STUDENTS, ELEMENTARY, MIDDLE, HIGH SCHOOLS AND LOCAL COLLEGES. EMPLOYEE SUPPORT - TIME AND MONETARY DONATIONS - OF LOCAL FOOD BANKS IS ALSO ENCOURAGED. WORKFORCE DEVELOPMENT: SKY LAKES UNDERWRITES THE WAGES AND BENEFITS OF SELECTED NEW GRADUATES FROM THE LOCAL BACCALAUREATE NURSING PROGRAM. THESE NURSES SPEND 6 MONTHS ORIENTING TO VARIOUS INPATIENT UNITS BY SHADOWING EXPERIENCED REGISTERED NURSES IN ORDER TO DETERMINE THE BEST EMPLOYMENT "FIT" FOR THEM AND FOR SKY LAKES. PART III, LINE 4: BAD DEBTS ARE ACCRUED MONTHLY AT A FIXED PERCENTAGE OF GROSS CHARGES. BOOKED BAD DEBT EXPENSE IS ROUTINELY COMPARED TO ACTUAL BAD DEBT WRITEOFFS, WHICH INCLUDE PAYMENTS TO PREVIOUSLY RECORDED BAD DEBTS, AND THE ACCRUAL PERCENTAGE IS ADJUSTED ACCORDINGLY. THIS PROCESS HAS THE INTENDED EFFECT OF REALIZING BAD DEBT EACH MONTH AS A LESS VOLATILE EXPENSE.BAD DEBT EXPENSE INCLUDES PAYMENTS - PATIENT AND INSURANCE - TO PREVIOUSLY RECORDED BAD DEBTS.SKY LAKES MEDICAL CENTER OFFERS A CHARITY CARE APPLICATION TO ALL PATIENTS, EITHER IN PERSON OR MAKING IT AVAILABLE VIA US MAIL OR ON THE HOSPITAL'S WEBSITE. A SAMPLE OF PROCESSED CHARITY CARE APPLICATIONS WAS TAKEN. WE FOUND THAT 15% OF CHARITY CARE APPLICATIONS WERE TURNED TO BAD DEBT DUE TO LACK OF INFORMATION SUPPLIED BY THE HOUSEHOLD. WE ASSUME THAT ALL REMAINING BAD DEBT ACCOUNTS WERE CORRECTLY CLASSIFIED DURING OUR COLLECTION PROCESS. THIS 15% REPRESENTS $1,194,662.THE FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE IS CONTAINED ON PAGE 14 OF THE ATTACHED FINANCIAL STATEMENTS, ENTITLED 'PATIENT ACCOUNTS RECEIVABLE.' PART III, LINE 8: MEDICARE REIMBURSEMENTS DO NOT COVER THE COSTS OF DELIVERING CARE TO THE COMMUNITY. IN ADDITION, SKY LAKES IS A TEACHING HOSPITAL THAT PROVIDES ACCESS TO PRIMARY CARE IN A RURAL COMMUNITY THAT HAS A PHYSICIAN SHORTAGE.SKY LAKES DOES NOT UTILIZE A COST ACCOUNTING SYSTEM. VENDORS AND SURVEYING AGENCIES (GOVERNMENTAL AND NON-GOVERNMENTAL) ARE PROVIDED WITH THE MEDICARE COST REPORT COST-TO-CHARGE RATIO WHEN THEY REQUEST IT.COSTS OF ROUTINE AND ICU NURSING SERVICES ARE CALCULATED ON A PER DIEM. ANCILLARY SERVICE COSTS ARE CALCULATED BASED ON TOTAL COSTS INCLUDING OVERHEAD TO TOTAL CHARGES BY ANCILLARY SERVICE TO DEVELOP A RATIO OF COSTS-TO-CHARGES (RCC), WITH MEDICARE'S APPORTIONMENT CALCULATED BY TAKING MEDICARE CHARGES MULTIPLIED BY THE RCC DEVELOPED ON THE COST REPORT. PART III, LINE 9B: SKY LAKES PLACES ALL ACCOUNTS IDENTIFIED AS ELIGIBLE FOR FINANCIAL ASSISTANCE ON HOLD AND THEN MAKES ANY NECESSARY ADJUSTMENTS BEFORE STATEMENTS ARE SENT. MANY OF THESE ACCOUNTS ARE ADJUSTED OFF COMPLETELY AND NO STATEMENTS ARE SENT. SKY LAKES ALSO CALLS PAST DUE ACCOUNTS (THIRD STATEMENT) AND REVIEWS TO SEE IF FINANCIAL ASSISTANCE IS AVAILABLE. LARGER ACCOUNTS ARE REVIEWED BY FINANCIAL COUNSELORS AND CHANGE HEALTHCARE FOR FINANCIAL ASSISTANCE ELIGIBILITY OR MEDICAID ELIGIBILITY. BOTH GROUPS MAKE PROACTIVE CALLS AND FOLLOW UP WITH PATIENTS TO GET THE NECESSARY INFORMATION TURNED IN. PART VI, LINE 2: SKY LAKES MEDICAL CENTER ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES BY MONITORING THE HEALTHY COMMUNITIES INSTITUTE (HCI) INDICATORS TRACKED AND DISPLAYED AT HEALTHYKLAMATH.ORG. THAT WEBSITE IS THE COMMUNICATIONS TOOL OF THE LOCAL COMMUNITY COLLABORATIVE AIMED AT IMPROVING THE LIVABILITY OF THE REGION. THERE ARE MORE THAN 100 INDICATORS THAT MONITOR ACCESS QUESTIONS, RATES OF DISEASES INCLUDING CANCER AND DIABETES IN THE POPULATION, AS WELL AS MATERNAL AND INFANT HEALTH, MENTAL HEALTH, AND INDIRECT INFLUENCES OF HEALTH SUCH AS SUBSTANCE ABUSE AND STRESS. THE ORGANIZATION ALSO ACTIVELY ENGAGES THE ROBERT WOOD JOHNSON FOUNDATION - UNIVERSITY OF WISCONSIN'S ANNUAL COUNTY HEALTH RANKINGS TO MONITOR INDICATORS FOR HEALTH OUTCOMES, HEALTH BEHAVIORS, AND CLINICAL CARE IN ORDER TO FURTHER REFINE STRATEGIES AND PRIORITIZE ACTIVITIES.SKY LAKES REGULARLY ASKS ADULTS TO SELF-REPORT THEIR HEALTH STATUS VIA ANONYMOUS AND RANDOMIZED SURVEYS MAILED TO PATIENTS RECENTLY DISCHARGED FROM THE MEDICAL CENTER (INPATIENTS AND EMERGENCY DEPARTMENT), AND PEOPLE WHO HAVE USED SKY LAKES FACILITIES FOR OUTPATIENT TESTING AND TREATMENTS.THE GALLUP-HEALTHWAYS WELL-BEING INDEX ASKS QUESTIONS RELATED TO FIVE ELEMENTS OF WELLBEING: PURPOSE, SOCIAL, FINANCIAL, COMMUNITY, AND PHYSICAL. THE INDEX WAS LAUNCHED LOCALLY FIRST IN 2015 AND REPEATED ANNUALLY. MOST RECENTLY, THE 2018 ASSESSMENT TEAM COLLECTED 765 MAIL SURVEYS FROM INDIVIDUALS INSIDE THE KLAMATH FALLS URBAN GROWTH BOUNDARY.SKY LAKES USES FORMAL CONVERSATIONS WITH COMMUNITY PARTNERS AND MEDICAL COLLABORATORS, AND ACTIVELY PARTNERS WITH AGENCIES IN HEALTH-IMPROVEMENT INITIATIVES. KLAMATH COUNTY PUBLIC HEALTH, IN CONJUNCTION WITH THE OREGON HEALTH AUTHORITY, PERIODICALLY PERFORMS HEALTH ASSESSMENTS OF THE PEOPLE IN THE COMMUNITIES SERVED BY SKY LAKES. THE MEDICAL CENTER WORKS WITH LOCAL HEALTH AUTHORITIES TO DETERMINE THE HEALTH INITIATIVES THAT CAN BE JOINTLY ADDRESSED BY COMMUNITY LEADERS, WITH SKY LAKES SERVING A SIGNIFICANT LEADERSHIP ROLE. COMMUNITY MEMBERS' PERCEPTIONS REGARDING HEALTH NEEDS ARE CAPTURED IN NON-SCIENTIFIC SURVEYS CONDUCTED AT THE CONCLUSION OF COMMUNITY EVENTS HOSTED BY THE MEDICAL CENTER. PART VI, LINE 3: SKY LAKES MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY AND APPLICATION FOR ASSISTANCE IS LOCATED ON THE HOSPITAL'S WEBSITE IN ENGLISH AND SPANISH, IS REFERENCED IN THE ONLINE BILL-MANAGEMENT SECTION OF THE SITE, WITH HANDOUT MATERIAL LOCATED IN THE HOSPITAL AND OUTPATIENT CLINICS IN ENGLISH AND SPANISH, AND IS FEATURED IN MEDICAL CENTER PUBLICATIONS DISTRIBUTED TO HOMES IN THE SERVICE AREA. THE FINANCIAL ASSISTANCE POLICY AND ASSISTANCE APPLICATION ALSO ARE PROVIDED WHEN PATIENTS REGISTER FOR SERVICES, AT PATIENT FINANCIAL SERVICE WHEN THEY PAY THEIR BILLS IN PERSON, AND WHEN PATIENTS INQUIRE ABOUT THEIR BILLS OR ASSISTANCE. FURTHER, A REMINDER WITH THE WEBSITE URL IS ON THE BACK OF PATIENT BILLS. IN ADDITION, UNINSURED PATIENTS ARE PROVIDED PATIENT ADVOCACY-BASED ELIGIBILITY AND ENROLLMENT SERVICES FOR MEDICAID AND OTHER BENEFIT PROGRAMS. THE MEDICAL CENTER ENSURES INFORMATION ABOUT FINANCIAL ASSISTANCE AND APPLICATIONS FOR ASSISTANCE IS AT ALL PATIENT REGISTRATION AREAS AND OUR SPECIALLY TRAINED FINANCIAL COUNSELORS HELP APPLICANTS COMPLETE THE FORM. FINANCIAL COUNSELORS TELEPHONE UNINSURED PATIENTS WITH LARGE BALANCES TO PROACTIVELY OFFER ASSISTANCE. OUR ABILITY TO OFFER FINANCIAL ASSISTANCE IS CLEARLY LISTED ON EVERY STATEMENT AND ON MOST FORM LETTERS MAILED TO PATIENTS AND FAMILIES. IT ALSO IS COVERED DURING COURTESY PHONE CALLS IF THERE IS MENTION OF DIFFICULTY IN PAYING. SKY LAKES ALSO PROVIDES INFORMATION ABOUT FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS. WE HAVE ENGAGED THE SERVICES OF CHAMBERLIN EDMONDS, A COMPANY THAT SPEAKS WITH ALL UNINSURED INPATIENTS WHO MEET CLEARLY DEFINED CRITERIA. CHAMBERLIN EDMONDS STAFF ALSO REVIEW ALL QUALIFYING OUTPATIENT ACCOUNTS AND CONTACT PATIENTS TO DISCUSS THEIR ELIGIBILITY. THOSE STAFF FURTHER ASSIST PATIENTS IN COMPLETING FINANCIAL ASSISTANCE APPLICATIONS IF THEY ARE UNSUCCESSFUL GETTING ON A GOVERNMENT PROGRAM. THE SKY LAKES CANCER TREATMENT CENTER, A DEPARTMENT OF THE MEDICAL CENTER, ALSO HAS FINANCIAL COUNSELORS WHO ASSIST WITH PHARMACEUTICAL CO-PAY RELIEF THROUGH THE DRUG MANUFACTURERS, RELIEVING PATIENTS OF SOME OF THAT FINANCIAL OBLIGATION. THE MEDICAL CENTER, THROUGH A THIRD-PARTY RELATIONSHIP, ROUTINELY PROVIDES NO-CHARGE MEDICATIONS TO QUALIFYING PATIENTS THROUGH MAJOR PHARMACEUTICAL COMPANIES. PART VI, LINE 4: COMMUNITIES IN A 10,000-SQUARE-MILE, FOUR-COUNTY AREA ENCOMPASSING SOUTH-CENTRAL OREGON AND NORTH-CENTRAL CALIFORNIA COMPRISE THE SKY LAKES MEDICAL CENTER SERVICE AREA. WHILE KLAMATH COUNTY IS THE LARGEST POLITICAL UNIT IN THE SERVICE AREA, A TOTAL OF ROUGHLY 80,000 PEOPLE IN TWO OREGON COUNTIES, KLAMATH AND LAKE, AND TWO CALIFORNIA COUNTIES, MODOC AND SISKIYOU, RELY ON SKY LAKES FOR THEIR ACUTE HEALTHCARE NEEDS. BECAUSE THE POLITICAL BOUNDARIES OF THE SERVICE AREA MAKE ACCURATE MEASUREMENTS IMPOSSIBLE, DATA FOR KLAMATH COUNTY ARE USED FOR THIS NARRATIVE. THE POPULATION PRIMARILY TARGETED FOR HEALTH IMPROVEMENT ACTIVITIES IS INSIDE THE KLAMATH FALLS URBAN GROWTH BOUNDARY (UGB).KLAMATH COUNTY'S POPULATION IS APPROXIMATELY 67,650 (2018) WITH KLAMATH FALLS, AT 21,540 PEOPLE, BEING THE LARGEST CITY WITH AN EQUALLY LARGE SUBURBAN POPULATION. THE POPULATION OF THE UGB WAS ESTIMATED AT 43,500 PEOPLE, AND IT'S WIDELY HELD THAT ANOTHER 12,000 PEOPLE ARE SCATTERED IN ENCLAVES AROUND THE UGB.. THE POPULATION'S GENDER SPLIT IS EVEN WITH 50.0 PERCENT EACH FEMALE AND MALE, NEARLY 40 PERCENT OF THE TOTAL IS CONSIDERED "RURAL," ALSO, WHITE, NON-HISPANIC ACCOUNT FOR 89.1 PERCENT OF THE TOTAL, 4.9 PERCENT AS AMERICAN INDIAN. 13.4 PERCENT HISPANIC OR LATINO, AND ROUGHLY 1 PERCENT AFRICAN AMERICAN.THE MEDIAN HOUSEHOLD INCOME IN THE COUNTY (2014-2018) IS REPORTED AT $43,522, WITH 20.3 PERCENT OF THE POPULATION IN POVERTY. THAT COMPARES TO 18.7 PERCENT NATIONALLY AND 14.1 IN OREGON.THE COUNTY HEALTH RANKINGS FOR 2019 SHOWS KLAMATH COUNTY IS RANKED 35 OUT OF 36 RANKED OREGON COUNTIES. THE REPORT RANKS SUCH FACTORS AS:- POOR OR FAIR HEALTH (17 PERCENT VS THE NATIONAL BENCHMARK OF 12 PERCENT AND THE OREGON BENCHMARK OF 16 PERCENT),- ADULT SMOKING (18 PERCENT (DOWN FROM 23 PERCENT TWO YEARS EARLIER) VS 14 PERCENT NATIONALLY AND 16 PERCENT IN OREGON),- UNINSURED ADULTS (9 PERCENT VS 6 PERCENT NATIONALLY AND 7 PERCENT IN OREGON),- PRIMARY CARE PROVIDERS (1,110:1 VS 1,050:1 NATIONALLY AND 1,080:1 IN OREGON),- CHILDREN IN POVERTY (26 PERCENT VS 11 PERCENT NATIONALLY AND 17 PERCENT IN OREGON), AND- VIOLENT CRIME RATE (218 VS 63 NATIONALLY AND 249 IN OREGON). PART VI, LINE 5: BESIDES PROVIDING HIGH-QUALITY HEALTHCARE, SKY LAKES MEDICAL CENTER FURTHERS ITS TAX-EXEMPT PURPOSE AND FULFILLS ITS MEDICAL MISSION TO THE COMMUNITY BY PROVIDING OR SUBSIDIZING NUMEROUS CLASSES, SUPPORT GROUPS, SCREENINGS AND SELF-HELP PROGRAMS; FREE CHILDBIRTH PREPARATION CLASSES FOR MOMS-TO-BE, AND LACTATION EDUCATION FOR NEW MOMS; A FREE COMMUNITY HEALTH FAIR ATTENDED BY MORE THAN 2,500 PEOPLE A YEAR; A VARIETY OF PROGRAMS AIMED AT ENCOURAGING BETTER FITNESS AND IMPROVED NUTRITION, INCLUDING FOOD PREPARATION INSTRUCTION; AND SEPARATE SUPPORT GROUPS FOR PEOPLE AFFECTED BY CANCER AND THOSE WHO HAVE DIABETES. THESE ARE AUTHORIZED BY A 10-MEMBER BOARD OF DIRECTORS. SKY LAKES LABORATORY SERVICES, USING EXPERIENCE FROM THE ANNUAL HEALTH FAIR, PROVIDED NO-CHARGE SCREENINGS FOR DIABETES AND HEART DISEASE AT AN EVENT IN A NEARBY COMMUNITY HOSTED BY A NURSING STUDENT ORGANIZATION. ABOUT 60 PEOPLE WERE SERVED.ALSO, SKY LAKES HOSTS FREE "WALK WITH A DOC" PROGRAMS IN COOPERATION WITH AREA PHYSICIANS AND CLINICS. THE ABOVE ACTIVITIES ARE PROVIDED AT NO CHARGE AS PUBLIC SERVICES OF SKY LAKES AND ACTIVELY PROMOTED ONLINE, IN SOCIAL MEDIA, AND TRADITIONAL MEDIA. SKY LAKES ROUTINELY WORKS WITH COMMUNITY PARTNERS TO PROMOTE HEALTHIER NUTRITION CHOICES, HANDS-ON COOKING CLASSES, SMOKING CESSATION CLASSES, AND INCREASED PHYSICAL ACTIVITY. TO ENCOURAGE PEOPLE TO BE MORE ACTIVE, SKY LAKES OFFERS FREE PEDOMETERS TO PEOPLE INTERESTED IN KEEPING TRACK OF THEIR STEPS EN ROUTE TO A GOAL OF 10,000 STEPS A DAY. PEDOMETERS ARE OFFERED VIA THE MEDICAL CENTER'S QUARTERLY LIVE SMART MAGAZINE, VIA SOCIAL MEDIA, AND AT SKY LAKES-HOSTED EVENTS.SKY LAKES HELPED PROMOTE AND SUPPORT TWO BICYCLE EVENTS THAT SERVED APPROXIMATELY 4,200 PEOPLE IN ALL. THE MEDICAL CENTER ALSO DONATED NEARLY $2,700 IN SNACKS FOR PARTICIPANTS. SKY LAKES EMERGENCY DEPARTMENT STAFF MEMBERS CONDUCT HAND-HYGIENE EDUCATION AND FREE BLOOD PRESSURE CHECKS AT THE EVERY-OTHER-YEAR AREA SAFETY FAIR HOSTED BY AREA EMERGENCY SERVICES AGENCIES, AND AT SIMILAR COMMUNITY EVENTS. THE MEDICAL CENTER FURTHER PROMOTES HAND HYGIENE BY OFFERING FREE HAND SANITIZER BOTTLES AT COMMUNITY ACTIVITIES AND DURING SCHOOL EVENTS, AND SKIN PROTECTION USING A UV DEMONSTRATION FOLLOWED UP WITH FREE SUN SCREEN SAMPLES. THESE ACTIVITIES ARE IN COORDINATION WITH A MULTI-MEDIA PUBLIC SERVICE CAMPAIGN PROMOTING EARLY DETECTION SCREENINGS AND TESTS FOR CANCER, AND PROMOTING HEALTHIER BEHAVIORS. THE EMERGENCY DEPARTMENT ALSO PURCHASED AND DISTRIBUTED 200 "STOP THE BLEED" KITS AND PROVIDED TRAINING FOR MORE THAN 300 PEOPLE IN 27 CLASSES. THE NATIONALLY RECOGNIZED PROGRAM TEACHES HOW TO RECOGNIZE AND TREAT LIFE-THREATENING BLEEDING.SKY LAKES WAS ONE OF THE PRINCIPAL AGENCIES CONTRIBUTING TO KLAMATH COUNTY BEING AWARDED THE RWJF CULTURE OF HEALTH PRIZE IN 2018; ONE OF ONLY FOUR IN THE NATION. THE PRIZE RECOGNIZES THE COMMUNITY'S EFFECTS TO IMPROVE HEALTH OUTCOMES, WHICH WERE DRIVEN BY THE HEALTHY KLAMATH COALITION AND MANY FUNDED AND SUPPORTED BY SKY LAKES.SKY LAKES IS THE PRINCIPAL UNDERWRITER FOR CASCADES EAST FAMILY MEDICINE, A CLINIC AND A FAMILY PRACTICE RESIDENCY PROGRAM OPERATED IN PARTNERSHIP WITH OREGON HEALTH & SCIENCE UNIVERSITY. FINANCIAL SUPPORT FROM SKY LAKES AMOUNTS TO MORE THAN $4 MILLION WITH A NET COMMUNITY BENEFIT OF SOME $2.3 MILLION.KLAMATH-LAKE CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES) IS A SKY LAKES DEPARTMENT WITH A BUDGET OF $540,000 AND A NET COMMUNITY BENEFIT OF $68,000. AT CARES, CHILDREN WHO MAY BE VICTIMS OF ABUSE RECEIVE A WELL-CHILD MEDICAL EXAMINATION. IF A DISCLOSURE OF ABUSE IS MADE, THEY ARE SAFE TO SHARE THEIR EXPERIENCES. MORE THAN 350 CHILDREN ANNUALLY ARE ASSESSED FOR POSSIBLE ABUSE, MOST OF THEM SEXUAL ABUSE CASES ALONG WITH CHILD PHYSICAL ABUSE, DRUG-ENDANGERED CHILDREN, EXPOSURE TO DOMESTIC VIOLENCE, AND NEGLECT. EVEN IF SUSPECTED ABUSE IS NOT VERIFIED DURING AN EXAM, FAMILIES LEAVE CARES WITH PROFESSIONAL RECOMMENDATIONS RANGING FROM A FOLLOW-UP WITH A PRIMARY CARE PHYSICIAN TO A REFERRAL FOR COUNSELING. CARES FOLLOWS THE FAMILY FOR AT LEAST THREE MONTHS AFTER THE ASSESSMENT. IF CARES WAS NOT ASSOCIATED WITH SKY LAKES, THE SERVICE LIKELY WOULD NOT EXIST LOCALLY.A PROGRAM COORDINATED BY SKY LAKES FAMILY BIRTH CENTER IS CLOSELY ASSOCIATED WITH THE WORK AT CARES. SKY LAKES CONTRIBUTES $10,000 A YEAR AND PROVIDES STAFF TO HELP COORDINATE AND PROVIDE COLLATERAL SUPPORT IN THE WAY OF ADDITIONAL MULTI-MEDIA ADVERTISING TO FURTHER THE MESSAGE OF THE LOCAL "STOP THE HURT" ANTI-CHILD ABUSE CAMPAIGN AND "PERIODS OF PURPLE CRYING" ANTI-SHAKEN BABY CAMPAIGN. THE PROGRAMS ARE AIMED AT STOPPING INCIDENTS OF INFANT AND CHILD ABUSE AT THE HANDS OF ADULTS.IN ADDITION, KLAMATH COUNTY IS A PHYSICIAN-SHORTAGE AREA AND PHYSICIAN RECRUITMENT EFFORTS ARE UNDERWRITTEN BY THE MEDICAL CENTER. THE MEDICAL CENTER INVESTED MORE THAN $300,000 IN RECRUITING ACTIVITIES IN THE TAX YEAR AND SOME $5.3 MILLION (NET) IN CLINIC START-UP AND SUPPORT. THIS IS IN ADDITION TO THE UNDERWRITING SUPPORT FOR SKY LAKES FOR THE CASCADES EAST FAMILY MEDICINE RESIDENCY PROGRAM. A NUMBER OF SKY LAKES EMPLOYEES PROVIDE VOLUNTEER EDUCATIONAL SUPPORT IN THE FORM OF TEACHING, MENTORING, PROGRAM DEVELOPMENT, AND TOURS AND DEMONSTRATIONS FOR LOCAL SCHOOLS AND COLLEGES. SKY LAKES STAFF MEMBERS ALSO VOLUNTEER DURING WORK TIME TO DISTRIBUTE FRESH FRUITS AND VEGETABLES AT PRODUCE CONNECTION SITES TO FURTHER THE MEDICAL CENTER'S AIM OF IMPROVING NUTRITION AMONG THE POPULATION AND HELPING PEOPLE MAKE BETTER NUTRITION CHOICES.TO PROMOTE MORE PHYSICAL ACTIVITY AMONG YOUNG PEOPLE, SKY LAKES PROVIDED ALL AREA PUBLIC AND PRIVATE SCHOOL THIRD-GRADERS SWIMMING LESSONS AT THE CITY OF KLAMATH FALLS-OWNED MUNICIPAL SWIMMING POOL OVER A THREE-YEAR SPAN. SKY LAKES ALSO FUNDED SCHOLARSHIPS SO 12 QUALIFIED YOUTH COULD PLAY AT VARIOUS ABILITY LEVELS.SKY LAKES ENCOURAGES STAFF TO SEEK OPPORTUNITIES TO IMPROVE THE HEALTH OF THE COMMUNITY BEYOND THEIR NORMAL DUTIES. AMONG THEM:- A SKY LAKES OUTPATIENT CARE MANAGEMENT EMPLOYEE HELPS PUT ON CLASSES AT THE LOCAL SENIOR CENTER PROMOTING MENTAL FITNESS AND AGILITY; - SKY LAKES DIETITIANS SHARE THEIR KNOWLEDGE AT PRIVATE WORKSITES IN THE AREA; AND- SKY LAKES DIABETES EDUCATORS REGULARLY PRESENT TO COMMUNITY GROUPS HOW TO PREVENT DIABETES AND HOW TO RECOGNIZE PREDIABETES.SKY LAKES EMERGENCY DEPARTMENT PHYSICIANS, NURSES AND STAFF DONATED NEARLY 500 HOURS TO ASSIST THE MORE THAN 15 COMMUNITY-PARTNER AGENCIES PUT ON OPERATION PROM NIGHT FOR HIGH SCHOOL SENIORS, AND SUPPORT ITS MISSION OF PREVENTION. THE PROGRAM'S AIM IS TO HELP YOUNG ADULTS REALIZE THE DANGERS OF DISTRACTED DRIVING. THE PERFORMANCE THE AGENCIES ORCHESTRATE AROUND THE SPRING PROM SEASON FOR AREA HIGH SCHOOL STUDENTS ILLUSTRATES A GRIM REALITY: DISTRACTED DRIVING - DRIVING UNDER THE INFLUENCE OF ALCOHOL OR DRUGS, TEXTING, OR SIMPLY NOT PAYING ATTENTION - ACCOUNTS FOR THE DEATHS OF HUNDREDS YOUNG DRIVERS ANNUALLY.SKY LAKES TAKES AN ACTIVE ROLE IN THE DEVELOPMENT OF PROGRAMS TO HELP PROVIDE MENTAL HEALTH AND SUBSTANCE-DISORDER SERVICES FOR THE COMMUNITY. THE LOCAL ALCOHOL AND DRUG PLANNING COMMITTEE EVALUATES THE AVAILABILITY OF TREATMENT PROGRAMS AND ENHANCES COMMUNICATION AMONG PROVIDERS TO IMPROVE ACCESS TO TREATMENT AND SUPPORT FOR RECOVERY AND PREVENTION SERVICES. SEVERAL SKY LAKES STAFF MEMBERS ARE PART OF THE COMMITTEE AND ATTEND MEETINGS DURING REGULAR WORK TIMES.SKY LAKES WILLINGLY CONTRIBUTES TO CIVIC PROJECTS AND ENTHUSIASTICALLY SPONSORS AN ASSORTMENT OF EVENTS AND PROGRAMS TO ENCOURAGE INCREASED PHYSICAL ACTIVITY. SKY LAKES SPONSORS THE FALL AND SPRING HEALTHY KIDS RUNNING SERIES, A FIVE-WEEK RUNNING PROGRAM AT A LOCAL ELEMENTARY SCHOOL FOR KIDS FROM PRE-K TO EIGHTH GRADE. RECOGNIZING KLAMATH BASIN WINTERS CAN INTERFERE WITH PHYSICAL ACTIVITY, SKY LAKES DONATED $5,000 TO MAKE AN INDOOR SOCCER PRACTICE FACILITY AVAILABLE SO ADULTS WOULD BE ABLE TO SAFELY WALK. SIMILARLY, SKY LAKES SPENT MORE THAN $900,000 TO DEVELOP A BLIGHTED CITY BLOCK NEAR DOWNTOWN AND TURN IT INTO A MULTI-USE PARK WITH OPEN GREEN SPACE, A SPLASH PAD, AND A NATURAL AMPHITHEATER.SKY LAKES COMMITTED TO A THREE-YEAR, $600,000 GIFT ($200,000 PER YEAR ENDING IN 2018), LEVERAGING AN ADDITIONAL $1.2 MILLION GIFT FROM THE CAMBIA HEALTH FOUNDATION AND ENABLED THE LAUNCH OF THE BLUE ZONES PROJECT THAT WILL HELP KLAMATH FALLS BE A HEALTHIER COMMUNITY. THE LOCAL BLUE ZONES PROJECT CONTINUES BEYOND THE INITIAL THREE YEARS, AND SKY LAKES IS THE PRINCIPAL SPONSOR OF THE PROJECT; THE PROJECT STAFF ARE SKY LAKES EMPLOYEES.KLAMATH FALLS BECAME THE FIRST BLUE ZONE COMMUNITY IN THE PACIFIC NORTHWEST, AND SKY LAKES WAS THE FIRST DESIGNATED BLUE ZONES WORKSITE IN KLAMATH FALLS. [SEE LINE 5 OVERFLOW LATER IN PART VI] PART VI, LINE 7, REPORTS FILED WITH STATES OR PART VI, LINE 5 OVERFLOW: BEING A MAJOR SUPPORTER OF THE OREGON HEALTHIEST STATE TO HELP KLAMATH FALLS BECOME THE FIRST BLUE ZONES DEMONSTRATION COMMUNITY IN THE NORTHWEST, AND INVESTING IN THE BLUE ZONES PROJECT LOCALLY, SKY LAKES DEMONSTRATED ITS COMMITMENT TO IMPROVING OUR COMMUNITY'S HEALTH. FURTHER, ACHIEVING THE DESIGNATION AS THE FIRST BLUE ZONES WORKSITE IN THE NORTHWEST DEMONSTRATES OUR COMMITMENT TO CREATING A HEALTHIER WORK ENVIRONMENT BY SUPPORTING THE WELL-BEING OF OUR EMPLOYEES.TO HELP SUPPORT OTHER COMMUNITY NON-PROFIT ORGANIZATIONS HELP THE COMMUNITY FLOURISH, SKY LAKES PLEDGED $60,000 OVER FIVE YEARS ($15,000 A YEAR) TO THE KLAMATH COMMUNITY FOUNDATION.OTHER PARTNERSHIPS THAT HELP ENSURE THE SUCCESS OF PROGRAMS INCLUDE SKY LAKES SUPPORT OF: - KLAMATH-LAKE COMMUNITY ACTION SERVICES PROGRAM BY DONATING MATERIAL FOR ITS PROGRAM TO PROVIDE QUALIFYING INDIVIDUALS AND FAMILIES ACCESS TO MEDICAL AND DENTAL CARE, AND HYGIENE RESOURCES; - THE RED CROSS BY GIVING AT NO-CHARGE SPACE IN SKY LAKES FACILITIES FOR COMMUNITY BLOOD DRIVES;- KLAMATH HOSPICE'S CAMP EVERGREEN BY PROVIDING EMERGENCY MEDICATIONS FOR CAMP NURSES TO HELP KEEP CAMPERS SAFE, AND INDIVIDUAL WATER BOTTLES FOR PARTICIPANTS TO PROMOTE PROPER HYDRATION. SKY LAKES IS A REGULAR MAJOR SPONSOR OF THE AGENCY'S FUNDRAISING WALK-RUN TO BENEFIT THE CAMP;- MEDICAL MISSIONS TO CENTRAL AMERICA AND TO FIJI BY DONATING MEDICATIONS AND RELATED SUPPLIES AMOUNTING TO A RETAIL VALUE OF MORE THAN $5,000;- FRIENDS OF THE CHILDREN-KLAMATH FALLS AND THE LOCAL COURT APPOINTED SPECIAL ADVOCATES TO SUPPORT THEIR MISSIONS OF ADVOCACY FOR AT-RISK CHILDREN AND YOUTH;- SKY LAKES ALSO FUNDED THE FRIENDS OF THE CHILDREN GARDEN AND PANTRY TO HELP ADULTS TEACH MENTEES THE SKILLS NECESSARY TO HAVE SUCCESSFUL VEGETABLE GARDEN. THE CHILDREN LATER HARVESTED THEIR PRODUCE AND, THANKS TO ANOTHER GRANT FROM SKY LAKES FOR THE "PANTRY PROJECT," LEARNED HOW TO USE FRESH VEGETABLES IN MEALS;- BEYOND PROGRAMS FOR YOUTH, SKY LAKES ALSO PROVIDED $5,000 TO THE KLAMATH BASIN SENIOR CENTER TO HELP IMPROVE ACCESS TO HOT MEALS FOR SENIOR CITIZENS, $5,000 TO HELP FUND AWARMING CENTER FOR AREA HOMELESS, AND $6,000 TO THE OREGON TECH VETERANS ASSOCIATION TO HELP MILITARY VETERANS;- THE AMERICAN LUNG ASSOCIATION'S FREEDOM FROM SMOKING CLASSES BY PROVIDING TRAINING FOR EDUCATORS, FREE MEETING SPACE FOR THE CLASSES, AND MARKETING MATERIALS AND ADVERTISING TO PROMOTE THE CLASSES AND THEIR INTENT.SKY LAKES COMMUNITY PARTNERSHIPS INCLUDE:- AMERICAN CANCER SOCIETY- AMERICAN LUNG ASSOCIATION - KLAMATH FALLS GOSPEL MISSION- HEALTHY ACTIVE KLAMATH- KLAMATH FALLS CITY SCHOOLS AND STUDENTS- KLAMATH COUNTY SCHOOL DISTRICT AND STUDENTS- KLAMATH COMMUNITY COLLEGE AND STUDENTS- KLAMATH COUNTY CASA- KLAMATH COUNTY CHAMBER OF COMMERCE- KLAMATH HOSPICE- KLAMATH-LAKE FOOD BANK- OREGON INSTITUTE OF TECHNOLOGY AND STUDENTS - OREGON TECH VETERANS ASSOCIATION- KLAMATH BASIN RESEARCH AND EXTENSION CENTER- PREGNANCY HOPE CENTER- UNITED WAY OF THE KLAMATH BASIN- CITIZENS FOR SAFE SCHOOLS- KLAMATH PROMISE- ELLA REDKEY MUNICIPAL SWIMMING POOL- KLAMATH FALLS LITTLE LEAGUE - BABE RUTH BASEBALL- KLAMATH BASIN UNITED SOCCER- KLAMATH ICE SPORTS- KLAMATH-LAKE FOOD BANK 1 KLAMATH COUNTY SCHOOL DISTRICT 10501 WASHBURN WAY KLAMATH FALLS OR 97603 936000543 501(C)(1) 21500 HOSA PROGRAM ASSISTANCE KLAMATH COMMUNITY FOUNDATION PO BOX 1903 KLAMATH FALLS OR 97601 205502851 501(C)(3) 19000 SOFTWARE KLAMATH PUBLIC SAFETY PAC 316 MAIN ST KLAMATH FALLS OR 97602 463281965 501(C)(3) 17000 COMMUNITY BENEFIT CITY OF KLAMATH FALLS 222 S SIXTH ST KLAMATH FALLS OR 97601 936002195 501(C)(1) 12390 CHILDREN'S SWIM PROGRAM KLAMATH LAKE COUNTIES FOOD BANK 3231 MAYWOOD DR KLAMATH FALLS OR 97603 930873280 501(C)(3) 10805 FEED THE HUNGRY KLAMATH ICE SPORTS INC 5075 FOX SPARROW DR KLAMATH FALLS OR 97601 931279736 501(C)(3) 10070 BUILDING CAMPAIGN FRIENDS OF THE CHILDREN 3837 ALTAMONT DRIVE KLAMATH FALLS OR 97603 931290284 501(C)(3) 8800 CHILDREN ADVOCACY CASA OF CHILDREN OF KLAMATH COUNTY 731 MAIN STREET 202 KLAMATH FALLS OR 97601 931261640 501(C)(3) 7500 CHILDREN ADVOCACY KCDC 2960 MAYWOOD DRIVE 10 KLAMATH FALLS OR 97603 931175532 501(C)(3) 6000 MILITARY COMPETITION KLAMATH BASIN SENIOR 2045 ARTHUR STREET KLAMATH FALLS OR 97601 460716639 501(C)(3) 6000 SENIOR ADVOCACY KLAMATH ASSEMBLY OF GOD 235 S LAGUNA ST KLAMATH FALLS OR 97601 930513049 501(C)(3) 5000 FEED THE HUNGRY KLAMATH FALLS YOUTH BASEBALL 2261 S SIXTH ST KLAMATH FALLS OR 97601 680494059 501(C)(3) 5000 CHILDREN'S PROGRAMS BASIN UNITED SOCCER CLUB 4500 FOOTHILLS BLVD KLAMATH FALLS OR 97603 352190336 501(C)(3) 5000 WALKING PROGRAM STEEN'S SPORT PARK 4500 FOOTHILLS BLVD KLAMATH FALLS OR 97603 931226388 501(C)(3) 5000 CHILDREN'S BASEBALL PROGRAM 14 0 EDUCATION REIMBURSEMENT 21 50779 PATIENT ASSISTANCE 1115 43333 STUDENT LOAN/TUITION ASSISTANCE TO EMPLOYEES 9 16244 PART I, LINE 2: THE BOARD OF DIRECTORS MAKES DECISIONS ON LARGE GRANT AWARDS. SCHOLARSHIP AWARDS ARE BASED ON A WRITTEN POLICY. OTHER STIPENDS AND EDUCATIONAL SUPPORT REQUIRE, RESPECTIVELY, WORKED HOURS OR MINIMUM GRADING CRITERIA. PATIENT ASSISTANCE GRANTS ARE BASED ON ASSESSMENT OF NEED BY ASSIGNED PERSONNEL. X X X 0 0 0 0 0 0 0 0 0 PAUL STEWART PRESIDENT/CEO/SECRETARY/TREAS 529103 0 300000 0 0 0 32250 0 13884 0 875237 0 0 0 RICHARD E RICO VP/CFO 385706 0 73556 0 0 0 32250 0 19008 0 510520 0 0 0 STANTON T SMITH MD MEDICAL PROVIDER 564983 0 33751 0 0 0 13750 0 19008 0 631492 0 0 0 MARC ORLANDO MD MEDICAL PROVIDER 558402 0 32991 0 0 0 13750 0 19008 0 624151 0 0 0 JARED OGAO MD MEDICAL PROVIDER 563740 0 20000 0 0 0 13750 0 19008 0 616498 0 0 0 BRADLEY A KRAMER MD MEDICAL PROVIDER 582849 0 0 0 0 0 13750 0 19008 0 615607 0 0 0 DAVID CHADBOURNE MD MEDICAL PROVIDER 537847 0 0 0 0 0 13750 0 19008 0 570605 0 0 0 A KLAMATH FALLS INTERCOMMUNITY HOSPITAL AUTHORITY 931061020 498413EF6 2012-11-29 18288334 REFUNDING OF 2002 BONDS; ENERGY EFFICIENCY COSTS; RESERVE FUND 0 0 0 B KLAMATH FALLS INTERCOMMUNITY HOSPITAL AUTHORITY 931061020 498413FR9 2016-06-23 59146386 REFUNDING OF 2006 BONDS; NEW MEDICAL OFFICE BUILDINGS; PARKING FACILITIES 0 0 0 A 2839000 11772436 18288334 59879 257477 6198542 2013 0 1 1 1 B 983000 59146386 846856 25000000 33299530 2016 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 PAUL STEWART PRES/CEO LIFE INSURANCE POLICY PURCHASE X 1050000 1160671 0 1 1 1160671 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CONTROLLER, CFO AND OTHER STAFF BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE DUTY OF THE BOARD OF DIRECTORS OF SKY LAKES MEDICAL CENTER TO SAFEGUARD THE TAX EXEMPT STATUS OF SKY LAKES MEDICAL CENTER, AND AS SUCH THE BOARD WILL TAKE SERIOUSLY ANY CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER OR POTENTIAL BOARD MEMBER. ALL BOARD MEMBERS AND POTENTIAL MEMBERS MUST DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST. AN UPDATED STATEMENT OF SUCH POTENTIAL CONFLICTS SHALL BE SUBMITTED YEARLY BY ALL BOARD MEMBERS FOR REVIEW AT THE BOARD'S ANNUAL MEETING. AFTER DISCLOSURE OF THE POTENTIAL CONFLICT OF INTEREST AND AFTER ANY DISCUSSION WITH THE INTERESTED PARTY, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE MINUTES OF THE BOARD AND ALL COMMITTEES OF THE BOARD SHALL CONTAIN 1) THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST; 2) THE NATURE OF THE FINANCIAL INTEREST; 3) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR THE DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT; 4) THE CONTENT OF THE DISCUSSION INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 5) ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT; AND, 6) THE BOARD OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS COMPARATIVE DATA FOR THE CEO. FOR THE CEO POSITION ONLY, THE EVALUATION COMMITTEE COMPLETES A PERSONNEL ACTION FORM, WHICH IS SIGNED BY THE BOARD CHAIR. FOR ALL VP POSITIONS, ALL EVALUATIONS ARE MADE BY THE CEO, BASED ON A REVIEW OF MARKET DATA. THE COMPENSATION REVIEW PROCESS WAS LAST UNDERTAKEN IN JANUARY 2019. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ALL MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BOOK/TAX DIFFERENCE FROM PARTNERSHIPS 563,654. SOUTHERN OREGON EMERGENCY CARE LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 611595709 PHYSICIAN SERVICES OR 0 0 SKY LAKES MEDICAL CENTER SKY LAKES MEDICAL CENTER FOUNDATION 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946020 FUNDRAISING AND STEWARDSHIP; SUPPORT MEDICAL CENTER OR 501(C)(3) LINE 12A, I SKY LAKES MEDICAL CENTER 1 KLAMATH CARE SERVICES INC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946018 SUPPORT MEDICAL CENTER (INACTIVE) OR 501(C)(3) LINE 12C, III-FI SKY LAKES MEDICAL CENTER 0 KLAMATH MEDICAL BUSINESS CENTER LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 020731372 REAL AND PERSONAL PROPERTY RENTAL OR SKY LAKES MEDICAL CENTER INVESTMENT 24843 509592 0 7315 1 0.50000 WEST PHYSICIAN SERVICES LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 870696029 PHYSICIAN SERVICES OR SKY LAKES MEDICAL CENTER C -5043348 3893579 1.00000 1 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 WEST PHYSICIAN SERVICES LLC D 152586 INCREASE IN LIABILITY KLAMATH MEDICAL BUSINESS CENTER LLC K 120571 CASH TRANSFERRED