2019-11-13T10:39:24-06:00 2018-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2018-01-01 930622075 Northwest Medical Foundation Tillamook NORT 9164060000 1000 Third Street Tillamook OR 97141 Micah Smith Treasurer 9164060000 2019-11-02 1 Tracy S Paglia P00366884 2099556100 2019-11-02 172.9.161.112 2019-11-02 18:52:39 PD P F565611BDA9E00D03FA055086BAA92DB14EC1355 2CA4604677747A1B8287DC7DD1B2F222DAF5CAE3 2018 2020-04-17 16:48:07Z Tillamook Regional Medical Cente David Butler 1000 Third Street Tillamook OR 97141 88258938 0 1071 X www.adventisthealth.org/tillamook/ X 1973 OR Living God's love by inspiring health, wholeness and hope. 12 10 657 100 0 0 135807 180140 83609460 87209174 497302 869624 -74 0 84242495 88258938 15000 68833 0 0 41279912 43348351 0 0 52776 35359852 41678838 76654764 85096022 7587731 3162916 62712557 65583470 10774153 10482150 51938404 55101320 X Living God's love by inspiring health, wholeness and hope. 0 0 71302681 68833 87209174 See Schedule O 71302681 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 657 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X Jay Lipps VP System Controller 9167465932 PO Box 619135 Roseville CA 95661 Banks David Director 0.00 4.00 X 0 27620 0 Cherry Robert Director 0.00 4.00 X 0 25126 0 Davis Andrew Director 0.00 4.00 X 0 24002 0 Freedman John Director 0.00 4.00 X 0 718 0 Gabriel Melody Director thru 12/2018 0.00 4.00 X 0 20464 0 Graham Ricardo Director 0.00 4.00 X 0 1442 0 Heinrich Kerry Director 0.00 4.00 X 0 20485 0 Innocent Larry Director 0.00 4.00 X 0 31885 0 Pedersen James Director thru 07/2018 0.00 4.00 X 0 3625 0 Reiner Richard Director 0.00 4.00 X 0 27964 0 Reiner Scott Dir/Chair 0.00 50.00 X X 0 2458436 44472 Rippey Wesley Director thru 05/2018, Medical Officer, PNR 12.50 37.50 X 0 623943 47568 Salazar Velino Director 0.00 4.00 X 0 1542 0 Wing Bill Dir/Vice Chair/Asst Secr 0.00 50.00 X X 0 1875311 49315 Butler David President 50.00 0.00 X 0 502217 46704 Jobe Meredith Secretary 0.00 50.00 X 0 666615 38328 Smith Micah Treas/Asst Secr 50.00 0.00 X 0 222502 41418 Wagner Jack Asst Secretary thru 03/2018 0.00 50.00 X 0 1332908 34076 Leach Judy Strategy & Comm Exec, PNR 0.00 50.00 X 0 303187 31686 Newmyer Joyce President, PNR 12.50 37.50 X 0 1166598 42409 Reppert Joseph CFO 0.00 50.00 X 0 953615 46846 Saxon Kathleen PT Care Executive 0.00 50.00 X 0 229839 22324 Seufert Regina VP Physician/Clinic Svcs 0.00 50.00 X 0 221285 21543 Voshell Shane VP HR, PNR 0.00 50.00 X 0 261326 48260 Welch Donald Finance Officer, PNR 12.50 37.50 X 0 671125 44290 Kaba David Physician 50.00 0.00 X 503315 0 32875 LaFleur Brett Physician 50.00 0.00 X 533729 0 47229 Mitchell Brandon Physician 50.00 0.00 X 410599 0 49705 Naidoo Abendra Physician 50.00 0.00 X 456824 0 39704 Thompson Albert Physician 50.00 0.00 X 350953 0 28344 2255420 11673780 757096 67 0 1 0 Tillamook Emergency Services 1000 Third Street Tillamook OR 97141 Physician Services 2694634 Bivens Medical Corporation 20105 Geisendorfer Applegate CA 95703 Physician Services 1524666 Staff Care Inc PO BOX 281923 Atlanta GA 30384 Physician Services 949647 Gregory Opdahl MD PC 4950 Clam Way West Tillamook OR 97141 Ophthomology 668856 Rural Physicians Group 10624 S Eastern Avenue Ste A-263 Henderson NV 89052 Physician Services 638138 15 35000 12049 133091 180140 Patient service revenue 900099 86460728 86460728 Other revenue 900099 613720 613720 Dietary services 722210 86384 86384 Rental income 531120 48342 48342 87209174 869624 869624 88258938 87209174 0 869624 X 68833 68833 102182 102182 33482701 31802644 1680057 1064305 1037259 27046 6517877 6326926 190951 2181286 2052502 128784 4098487 358862 3739625 3555 3555 10692 10692 2646 2646 15850397 11690290 4114862 45245 193912 193912 945769 837671 106181 1917 3390341 706067 2684274 2390962 2092736 298226 326555 228466 92475 5614 228723 189232 39491 96344 96344 1732618 1728177 4441 294469 294469 Patient care supplies 9012498 8960372 52126 Quality assurance (hosp 2812411 2812411 Rental/leases costs, eq 57476 52100 5376 230983 -35326 266309 85096022 71302681 13740565 52776 25667188 33196667 16244774 11746970 1717030 1468058 90392 120451 47192192 35339930 11803902 11852262 703463 6485808 7199062 62712557 65583470 5595548 6216390 5178605 4265760 10774153 10482150 X 51875169 54977574 63235 123746 51938404 55101320 62712557 65583470 3162916 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 2646 2646 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. 63235 121979 17988 43480 123746 41331 96447 19446 55097 63235 697451 101947 758067 41331 1324795 159334 786678 697451 1830000 187892 693097 1324795 0.00000 0.00000 1.00000 0 0 1056181 1056181 27779852 20335917 7443935 3250201 1301127 1949074 15105958 13702886 1403072 11852262 Receivables from related organizations 3899630 Receivables from third party payors 1942841 Other receivables 988016 Other assets 368575 7199062 Payables to related organization 3444000 Workers' compensation liability 723818 Other liabilities 97942 4265760 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. 1 1 X 1 X 1 X 1 1 0 1 1 2909461 2909461 0.03420 2909461 2909461 0.03420 838098 288266 549832 0.00650 172378 172378 0.00200 255289 69 255220 0.00300 74062 74062 0.00090 1339827 288335 1051492 0.01240 4249288 288335 3960953 0.04660 4120 4120 0.00000 41000 41000 0.00050 256222 256222 0.00300 301342 301342 0.00350 1 1152742 325880 27945989 27026912 919077 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 16 1 1 1 1 X See Sch H Part VI - Needs Assesment X See Sch H Part VI - Needs Assesment X 1 18 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 2016 CHNA data collection process can be summarized as follows: Review of prior CHNA reporting effortsCollection of most recently available demographic, socioeconomic and health indicator data Data gathering was accomplished by using a widely-distributed community survey, engaging with community focus groups and conducting key stakeholder interviews. Community Survey: Northwest Medical Foundation Tillamook dba Tillamook Regional Medical Center (AHTM) conducted community organization surveys that asked about the health problems and health needs of the community. The community organization survey was emailed to organizations that collaborate with AHTM in the form of an online survey. The survey addressed what community the organization serves, what is healthy in their community, what is not and what their community needs to be healthy. Twenty-five people responded to the online survey. Community Focus Groups: Twenty-eight people participated in three different focus groups. The focus groups were conducted at AHTM and at Tillamook Seventh-day Adventist Church from March 21-22, 2016. Members of the focus groups included individuals or organizations that represented the medically underserved, low-income, and minority populations served by our hospital, as well as, community members at large. Focus group participants were snowball sampled through existing support groups and classes at AHTM and leveraging of hospital administration's professional networks.Key Informant Interviews: Sixty-three people were surveyed in the form of ten key informant interviews. The groups were comprised of key leaders from an array of agencies including, local coalitions, not-for-profits, healthcare providers, and human service agencies. These were conducted by phone from February to April 2016. Key informants were identified through existing partnerships with community based organizations. 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 Census, Centers for Disease Control and Prevention, Community Commons, Nielsen, 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: AHTM partnered with the following organizations in conducting the 2016 CHNA: Care, Inc., Complete Health Improvement Project, Manzanita Emergency Volunteer Corps, North Tillamook Emergency Preparedness, NW Regional Education Service District, The Rinehart Clinic, and the Tillamook Commission on Children & Families. 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. 2018 saw the increase in availability and access to health care through a 4.8% increase in urgent care visits and the expansion in urgent care hours. Ninety-six percent of our patients were able to be assigned a medical home in 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 - 1,241 (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 - 21.3. 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 - 30.5. No cost prescription drug program. Number of community members served - 154.6. Conducted monthly grief support groups in Manzanita and Tillamook. Number of community members served - 293.7. Conducted monthly Alzheimer's support group for caregivers. Number of community members served - 43.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. 2018 saw 357 patients enrolled in chronic disease management plans. There were 15,801 patients visits to specialty clinics in 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. 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 - 618.3. Complete Health Improvement Program (CHIP) lifestyle wellness classes offered to community members. Number of community members served - 33.4. Serving up Hope community dinner for those who are homeless and food insecure. Number of community members served - 1,433.5. 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.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 were screened 2018. A total of 2,298 patient visits in 2018 were seen with the addition of two full time behavioral health providers. Interventions:1. Provide Wellspring respite care for patients with cognitive impairment who reside in community care settings. Number of community members served - 137.2. Provide comprehensive medical and behavioral health care to inmates lodged in the Tillamook County Jail. Number of community members served - 342.3. Optimize Your Brain Classes: Seven Week class to cover principals of understanding brain function and how lifestyle behaviors will benefit you. Number of community members served - Seven.4. 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.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. Seventy-eight children were screened for school readiness in 2018 and a 14.8% increase in the number of pediatric patient served in the primary care setting. 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 two-six years that screens 12 areas of health and development. Number of community members served - 78.2. Pediatric Services. Number of community members served - 6,900. 3. Certified Athletic Trainer at Tillamook High School providing services to student athletes. Number of community members served - 11,375 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-E 103 SW Highway 224 Suite B Estacada OR 97023 Rural health clinic 8 - Adventist Health TillamookMedical Group-H 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 Ser 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 that 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 27,945,989Prior Year Settlements 207,713Cost Report Reimbursable Bad Debts 68,710Estimates and Accrual Variances 304,980 Other 2,161,588Total Medicare Revenue 30,688,980*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 2016 CHNA, the 2019 Community Health Plan (CHP) Update for fiscal year 20108, the 2018 Community Health Plan (CHP) Update for fiscal year 2017, and the 2016 Implementation Strategy (adopted in May 2017), which includes the 2016 CHP, are posted on the Hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/The CHNA, Implementation Strategy, and the CHPs are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/Hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact. Committee/Board Participation includes: NW Regional Education Service District; Head Start Child and Family Development Program; Community Action Resource Enterprises (CARE, Inc.); Oregon Food Bank-Tillamook County Services; Food, Education, Agriculture, Solutions Together (FEAST); Tillamook Seventh-day Adventist Church; North County Food Bank-Nehalem; Tillamook Family Counseling Center; Northwest Oregon Regional Housing Center; and others. 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/patient-resources/financial-assistance/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: AHTM's service area is all of Tillamook County, 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. In the primary service area, the current year population is approximately 25,000. The largest age group is comprised of persons aged 45-64 years, with a median age of 49.2 compared to the U.S. median age of 37.9. The population is primarily composed of individuals who identify as White (89.8%) and the smallest group is composed of individuals who identify as Pacific Islander (0.3%) followed by African Americans (0.5%). In terms of ethnicity, 12.2% of the population is of Hispanic origin. English is the dominant language spoken in the service area. The percent of the population older than five years old that speaks English less than "very well" is low in the primary service area at 6% for Nehalem, 0.5% for Cloverdale, and 2.8% for Tillamook. The median income for all households is $43,037 which is lower than both the State of Oregon ($50,521) and the U.S. ($53,046). 29.2% of household in the area have an annual income of less than $25,000 compared to 24.1% for Oregon State and 23.4% for the U.S. 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; and3) 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, and3) 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 System/West, a health care system that 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 tele pharmacy 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 1 CARE 2310 First Street Suite 2 Tillamook OR 97141 931062448 501(c)(3) 10000 "Home for Care" Capital Campaign Tillamook County Community Health CentersTillamook County Wellness PO Box 489 Tillamook OR 97141 936002312 Gov't 30000 Prevention of Chronic Disease-Diabetes Tillamook Seventh-day Adventist Church 2610 1st Street Tillamook OR 97141 264220036 501(c)(3) 0 7833 Invoice Education equipment Wellness Education-Prevention of Chronic Diseases Tillamook County Community Health Centers PO Box 489 Tillamook OR 97141 936002312 Gov't 0 5500 Invoice Retinavue equipment Prevention of Chronic Disease-Diabetes The Rinehart Clinic PO Box 176 Wheeler OR 97147 931191794 501(c)(3) 0 5500 Invoice Retinavue equipment Prevention of Chronic Disease-Diabetes 4 0 Part I, Line 2: Grants and other assistance are made in response to specific requests and identified need by community groups and nonprofits. A letter restricting use of the granted funds to the purpose mutually agreed is sent with each cash donation. X X X X 1 1 0 0 0 0 0 0 0 Reiner Scott Dir/Chair 0 1339257 0 747881 0 371298 0 16682 0 27790 0 2502908 0 289242 Rippey Wesley Director thru 05/2018, Medical Offic 0 565539 0 0 0 58404 0 20249 0 27319 0 671511 0 0 Wing Bill Dir/Vice Chair/Asst Secr 0 1015353 0 603273 0 256685 0 16682 0 32633 0 1924626 0 191758 Butler David President 0 301537 0 98200 0 102480 0 16682 0 30022 0 548921 0 34997 Jobe Meredith Secretary 0 419684 0 111013 0 135918 0 16682 0 21646 0 704943 0 59224 Smith Micah Treas/Asst Secr 0 157339 0 11496 0 53667 0 11914 0 29504 0 263920 0 0 Wagner Jack Asst Secretary thru 03/2018 0 180671 0 414342 0 737895 0 11182 0 22894 0 1366984 0 0 Leach Judy Strategy & Comm Exec, PNR 0 237547 0 48964 0 16676 0 16682 0 15004 0 334873 0 0 Newmyer Joyce President, PNR 0 657199 0 294310 0 215089 0 16682 0 25727 0 1209007 0 115201 Reppert Joseph CFO 0 686470 0 152446 0 114699 0 16682 0 30164 0 1000461 0 0 Saxon Kathleen PT Care Executive 0 178481 0 28022 0 23336 0 11862 0 10462 0 252163 0 0 Seufert Regina VP Physician/Clinic Svcs 0 170839 0 26352 0 24094 0 11538 0 10005 0 242828 0 0 Voshell Shane VP HR, PNR 0 189911 0 40615 0 30800 0 14265 0 33995 0 309586 0 0 Welch Donald Finance Officer, PNR 0 398127 0 97502 0 175496 0 16682 0 27608 0 715415 0 93616 Kaba David Physician 502324 0 0 0 991 0 16682 0 16193 0 536190 0 0 0 LaFleur Brett Physician 532738 0 0 0 991 0 11182 0 36047 0 580958 0 0 0 Mitchell Brandon Physician 385627 0 8270 0 16702 0 16682 0 33023 0 460304 0 0 0 Naidoo Abendra Physician 454544 0 0 0 2280 0 16682 0 23022 0 496528 0 0 0 Thompson Albert Physician 339932 0 3352 0 7669 0 16682 0 11662 0 379297 0 0 0 Part I, Lines 4a-b 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. Wagner, Jack - severance payment - $598,810 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for nonvested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. Butler, David - $34,997 Jobe, Meredith - $59,224 Newmyer, Joyce - $115,201 Reiner, Scott - $289,242 Welch, Donald - $93,616 Wing, Bill - $191,758 Charles Saxon Family member of Key EE, K. Saxon 102182 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 AHTM, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve, by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does AHTM provide low cost care to individuals covered by government-programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHTM recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2018 was $2,909,461. The following Inpatient services that were provided to all our patients. These services included: - 176 Babies delivered - 272 Surgeries performed - 4,494 Patient days The following Outpatient services that were provided to all our patients. These services included: - 10,950 Emergency department visits - 85,437 Outpatient surgeries performed - 85,437 Outpatient visits - 96,283 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 2018 was $1,051,493. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ Form 990, Part VI, Section A, line 6 The Hospital is organized as a public benefit corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit public benefit 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 Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital CEOs and CFOs, 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 CEOs and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital 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 and Bylaws with the Oregon Secretary of State and Oregon Department of Justice. The Hospital does not make its Conflict of Interest Policy publicly available. The Hospital files monthly/quarterly summary financial reports with the Oregon Health Authority. Form 990, Part IX, line 11g Physician professional fees: Program service expenses 7,321,810. Management and general expenses 1,800. Fundraising expenses 0. Total expenses 7,323,610. Other medical professional fees: Program service expenses 90,037. Management and general expenses 0. Fundraising expenses 0. Total expenses 90,037. Consulting and other management fees: Program service expenses 49,933. Management and general expenses 103,840. Fundraising expenses 0. Total expenses 153,773. Other professional fees non-medical: Program service expenses 183,656. Management and general expenses 78,487. Fundraising expenses 0. Total expenses 262,143. Contract labor: Program service expenses 1,445,329. Management and general expenses 65,586. Fundraising expenses 0. Total expenses 1,510,915. Purchased medical services: Program service expenses 332,139. Management and general expenses 1,755. Fundraising expenses 0. Total expenses 333,894. Repairs and maintenance: Program service expenses 677,858. Management and general expenses 1,091. Fundraising expenses 0. Total expenses 678,949. All other purchased services: Program service expenses 1,591,905. Management and general expenses 104,454. Fundraising expenses 45,245. Total expenses 1,741,604. Revenue cycle fees: Program service expenses -2,377. Management and general expenses 3,757,849. Fundraising expenses 0. Total expenses 3,755,472. Form 990, Part VII: 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 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 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 & 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