2013-08-15T17:33:21-05:00 2012-09-30 910189318 MOSS ADAMS LLP 805 SW BROADWAY 1200 PORTLAND OR 97205 990 2011-10-01 930508781 SKY LAKES MEDICAL CENTER SKYL 5412746311 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 RICHARD RICO 5412746311 2013-08-13 1 WENDY CAMPOS P00448102 5032421447 2011 2016-02-24 21:20:13Z PAUL STEWART 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 393671612 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 8 1271 346 7351 3948 583985 519427 354932861 390702910 634469 1585916 352404 94687 356503719 392902940 334466 224181 0 0 72952593 78196204 0 0 0 268370292 296902508 341657351 375322893 14846368 17580047 175539803 194957124 67929677 69739902 107610126 125217222 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 311126146 22413 386011364 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. 27741086 UNCOMPENSATED CARE - DURING FISCAL YEAR 2012, SKY LAKES MEDICAL CENTER CONTINUED TO SEE AN INCREASE IN CHARITY CARE APPLICATIONS AND WRITE OFFS FOR BAD DEBT. BY WAY OF COMPARISON, THE ECONOMY IN KLAMATH COUNTY IS POORER THAN THE STATE OF OREGON, INCLUDING HIGHER UNEMPLOYMENT RATES AND MEDICAL INDIGENCY. CHARGES WRITTEN OFF UNDER OUR BROAD REACHING CHARITY CARE POLICY TOTALED $13,845,247. CHARGES WRITTEN OFF AS BAD DEBT TOTALED $13,895,839. AS A PERCENTAGE OF CHARGES, THESE REPRESENT 3.3% AND 3.6% RESPECITVELY. THE AVERAGE CHARITY CARE WRITE OFFS BACK TO 2004 RAN 2.8%. WE ARE DOING A MUCH BETTER JOB OF IDENTIFYING PATIENTS REQUIRING CHARITY CARE AT THE TIME SERVICE IS PROVIDED AND AVOIDING, AS MUCH AS POSSIBLE, HAVING SERVICES LATER CHARGED OFF AS BAD DEBT. THIS IS PUSHING UP OUR CHARITY CARE WRITE OFFS AND BRINGING DOWN OUR BAD DEBT WRITE OFFS. 6534494 170574 1600834 EDUCATIONAL SUPPORT - SKY LAKES MEDICAL CENTER COMMITS SIGNIFICANT DOLLARS AND MAN-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. 4492181 31194 3082106 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. 4492181 31194 3082106 349893907 1 1 0 0 0 0 0 0 0 0 1 0 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 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 218 0 1 1271 1 1 1 0 0 0 0 0 0 0 0 0 X 10 8 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 X JOHN BELL 3.00 X X 0 0 0 ROD WENDT 1.00 X X 0 0 0 KERMIT HOUSER 1.00 X 0 0 0 CLARK PEDERSON 1.00 X 0 0 0 BERNARD SIMONSON 1.00 X 0 0 0 WENDY WARREN MD 1.00 X 0 0 0 DOUGLAS MCINNIS DVM 1.00 X 0 0 0 GREGORY SINDMACK MD 10.00 X 13500 0 0 GRANT NISKANEN MD 40.00 X 274250 0 12250 PAUL R STEWART 50.00 X X 513302 0 26482 RICHARD RICO 50.00 X 303985 0 31630 PATRICK MAVEETY MD 40.00 X 452904 0 20878 TZANN T FANG MD 40.00 X 401082 0 31630 RICHARD DEVORE MD 40.00 X 325934 0 25257 NASSER G ABU-ERREISH MD 40.00 X 261145 0 14232 W CLAY MCCORD MD 40.00 X 219642 0 25973 2765744 0 188332 77 0 1 0 EBMS 2075 OVERLAND AVENUE BILLINGS MT 59102 BENEFIT PLAN ADMIN 607385 MODOC CONTRACTING COMPANY INC 409 PINE STREET KLAMATH FALLS OR 97601 CONSTRUCTION CONTRACTING COMPANY 534659 SOUTHERN OREGON LINEN SERVICES INC 635 AVENUE C WHITE CITY OR 97503 LINEN SERVICES 437777 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY SUITE 8 FORT LAUDERDALE FL 33308 STAFFING SERVICES 388999 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA STREET SUITE 300 OMAHA NE 68154 STAFFING SERVICES 311293 26 519427 11995 519427 PATIENT REVENUE 621990 386011364 386011364 OTHER PROGRAM REVENUE 621990 4691546 4691546 390702910 1613467 1613467 738566 648726 89840 89840 89840 7083 34634 -27551 -27551 -27551 114135 85312 28823 28823 PASSTHROUGH INCOME 621990 -1245 -8596 7351 OTHER INCOME 900099 -22731 -22731 -23976 392902940 390694314 7351 1681848 31194 31194 192987 192987 1238699 142221 1096478 58327255 53579052 4748203 2461791 2173419 288372 10820970 9850071 970899 5347489 3913188 1434301 299988 11328 288660 145057 322 144735 8005661 7164433 841228 824324 117773 706551 2238627 1435120 803507 2392460 56293 2336167 2763000 2671729 91271 134147 100809 33338 472969 391136 81833 3034255 -75309 3109564 8253926 2631586 5622340 1726099 790551 935548 CONTRACTUAL ALLOWANCE 205500950 205500950 SUPPLIES 25615789 25445848 169941 BAD DEBT EXPENSE 13895839 13895839 TAXES PAID ON UBI 2050 2050 21597367 19873367 1724000 375322893 349893907 25428986 0 388095 92098 37710047 29636460 20664948 23811862 2487606 2234783 2890033 2793011 174083457 88748831 85591650 85334626 4745469 28172899 2959246 3196520 18102709 19684865 175539803 194957124 4669107 7093782 2608182 2574744 51137164 50102082 1171848 1093445 8343376 8875849 67929677 69739902 X 107610126 125217222 107610126 125217222 175539803 194957124 X 17580047 27049 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1517300 1517300 109003745 48694514 60309231 4253919 2320508 1933411 43272954 30498922 12774032 16035539 7234887 8800652 85334626 ASSETS LIMITED AS TO USE 4910094 OTHER ASSETS 1582694 RISK POOL WITHHOLD RECEIVABLE 2274363 DEFERRED FINANCING COSTS 1594637 CONSTRUCTION IN PROCESS 3352193 OTHER RECEIVABLES 5970884 19684865 CAPITAL LEASE OBLIGATIONS 5555130 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3320719 8875849 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FIN 48 (ASC 740) FOOTNOTE - THE MEDICAL CENTER HAD NO UNRECOGNIZED TAX BENEFITS AT SEPTEMBER 30, 2012 OR AT SEPTEMBER 30, 2011. THE MEDICAL CENTER RECOGNIZES INTEREST ACCRUED AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AS AN ADMINISTRATIVE EXPENSE. DURING THE YEARS ENDED SEPTEMBER 30, 2012 AND 2011, THE MEDICAL CENTER RECOGNIZED NO INTEREST AND PENALTIES. THE MEDICAL CENTER FILES AN EXEMPT ORGANIZATION INFORMATION AND UNRELATED BUSINESS INCOME TAX RETURN IN THE U.S. FEDERAL JURISDICTION AND AN UNRELATED BUSINESS INCOME TAX RETURN WITH THE OREGON DEPARTMENT OF REVENUE. 1 1 X 1 X 1 X 1 1 0 1 1 8306 11681018 11681018 0.03230 27773447 29135257 -1361810 0.00000 8306 39454465 29135257 10319208 0.03230 11 12425 86204 86204 0.00020 1 5831381 1800694 4030687 0.01120 5 200618 12867720 8571302 4296418 0.01190 79084 79084 0.00020 17 213043 18864389 10371996 8492393 0.02350 17 221349 58318854 39507253 18811601 0.05580 10 228535 869778 552110 317668 0.00090 1 1600 9626 0 9626 0.00000 1 3500 7376 0 7376 0.00000 17 81816 290017 0 290017 0.00080 3 10025 459490 1000 458490 0.00130 32 325476 1636287 553110 1083177 0.00300 0 13895839 2640209 46613867 47964208 -1350341 X 1 1 1 1 SKY LAKES MEDICAL CENTER

2865 DAGGETT AVENUE KLAMATH FALLS OR 97601

X X X X SKY LAKES MEDICAL CENTER 1 1 X X X X X X X X X 11 1 0 1 X X X X 0 1 1 200.000000000000 1 400.000000000000 1 X X 1 1 X X X X X X 1 0 1 X 0 1 11 CANCER TREATMENT CENTER

2610 URHMANN ROAD KLAMATH FALLS OR 97601

MEDICAL CLINIC OUTPATIENT IMAGING

2900 DAGGETT AVENUE KLAMATH FALLS OR 97601

OUTPATIENT DIAGNOSTIC IMAGING CENTER FAMILY MEDICINE RESIDENCY

2801 DAGGETT AVENUE KLAMATH FALLS OR 97601

MEDICAL CLINIC & MEDICAL RESIDENCY PROGRAM MEDICAL OFFICE BUILDING I

2200 BRYANT WILLIAMS DRIVE KLAMATH FALLS OR 97601

MEDICAL CLINIC CENTER FOR OCCUPATIONAL HEALTH

2621 CROSBY AVENUE KLAMATH FALLS OR 97603

REHABILITATION SERVICES, HOME HEALTH SERVICES, EMPLOYEE ASSISTANCE PROGRAM MEDICAL OFFICE BUILDING II

3000 BRYANT WILLIAMS DRIVE KLAMATH FALLS OR 97601

MEDICAL CLINIC FAMILY PRACTICE CLINIC

1905 MAIN STREET KLAMATH FALLS OR 97601

MEDICAL CLINIC ENT CLINIC

2617 ALMOND STREET KLAMATH FALLS OR 97601

MEDICAL CLINIC COMMUNITY HEALTHEDUCATION

2200 NORTH ELDORADO AVENUE KLAMATH FALLS OR 97601

COMMUNITY EDUCATION FACILITY UROLOGY CLINIC

2630 CAMPUS DRIVE KLAMATH FALLS OR 97601

MEDICAL CLINIC HUGH CURRIN HOUSE

2601 DAGGETT AVENUE KLAMATH FALLS OR 97601

RESIDENTIAL FACILITY FOR FAMILIES UNDERGOING CARE 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 $ 13895839. 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. IN ADDITION TO PARTICIPATION IN RELAY FOR LIFE, UNITED WAY AND OTHER LOCAL FUNDRAISING AND AWARENESS INITIATIVES, SKY LAKES BEGAN PARTICIPATION IN THE PERIOD OF PURPLE CRYING COMMUNITY EDUCATION CAMPAIGN THIS YEAR. 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 ACCESS TO FREE MEETING ROOMS.LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: SKY LAKES AND SKY LAKES EMPLOYEES WORK IN CONJUNCTION WITH THE KLAMATH COUNTY HIGH SCHOOLS AND OREGON INSTITUTE OF TECHNOLOGY TO DEVELOP AN AWARENESS OF HEALTH CARE, HEALTH CARE CAREERS, AND SUPPORT FOR HEALTH PROFESSIONS EDUCATION SUPPORT AND TRAINING. SENIORS IN THE OREGON HEALTH & SCIENCE UNIVERSITY NURSING PROGRAM IN KLAMATH FALLS CONDUCT QUALITATIVE SURVEILLANCE OF THE PERCEIVED HEALTH STATUS OF PEOPLE IN NEARBY COMMUNITIES AND REPORT ON BARRIERS TO ACCESS TO HEALTHCARE IDENTIFIED BY THOSE COMMUNITIES. THE STUDENTS USE TOOLS INCLUDING ONE-ON-ONE INTERVIEWS, FOCUS GROUPS, PUBLIC MEETINGS, AND PHONE SURVEYS. THEIR DATA ARE SHARED WITH COMMUNITY LEADERS AND COMPARED WITH OTHER DATA TO DEVELOP COMPREHENSIVE IMPROVEMENT STRATEGIES.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 ALSO SUPPORTS COMMUNITY HEALTH IMPROVEMENT ADVOCACY VIA THE SOUTHERN OREGON METH PROJECT. SOMP IS MADE UP OF COMMUNITY BUSINESSES THAT HOPE TO HAVE AN IMPACT ON THE 75% OF CHILDREN IN FOSTER CARE THAT ARE THERE BECAUSE OF METH AND ON THE 8 OUT OF 10 ARRESTS BEING RELATED TO METH. OVERWHELMED COURTS AND JAILS IN OUR COMMUNITY HELP DRIVE THE SOMP PARTNERS TO COME TOGETHER TO STOP THE NEXT GENERATION FROM WORSENING THE PROBLEM. OTHER 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 A 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: IN THE NORMAL COURSE OF BUSINESS, THE MEDICAL CENTER PROVIDES CREDIT TERMS TO ITS PATIENTS, INCLUDING BILLING TO THIRD-PARTY INSURANCE CARRIERS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. PATIENT ACCOUNTS RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF RECEIVABLES, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THERE WAS NO CHANGE IN THE METHODOLOGY USED BY THE MEDICAL CENTER TO ESTIMATE THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND BAD DEBT PROVISION IN THE CURRENT YEAR.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 19% 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 19% REPRESENTS $2.2 MILLION. 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.SERVICES PROVIDED AND PAID ON THE MEDICARE FEE SCHEDULE (E.G. OUTPATIENT LAB TESTS, OUTPATIENT THERAPY SERVICES, OR PROVIDER BASED PHYSICIAN SERVICES) ARE NOT INCLUDED IN THE MEDICARE AMOUNTS INCLUDED IN PART III, SECTION B.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 CHAMBERLIN EDMONDS FOR FINANCIAL ASSISTANCE ELIGIBILITY OR MEDICAID ELIGIBILITY. BOTH GROUPS MAKE PROACTIVE CALLS AND FOLLOW UP WITH PATIENTS TO GET THE NECESSARY INFORMATION TURNED IN. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 1J: WHAT BEGAN AS A CONVERSATION BETWEEN THE COMMUNITY HEALTH OUTREACH MANAGER AT SKY LAKES MEDICAL CENTER, KLAMATH FALLS, ORE., AND THE HEALTH PROMOTION/DISEASE PREVENTION COORDINATOR AT KLAMATH COUNTY (ORE.) PUBLIC HEALTH BECAME THE SEED THAT TOOK ROOT AND THEN FLOURISHED INTO A MAJOR COLLABORATION AMONG LOCAL PUBLIC AND PRIVATE PARTNERS. AT THE SAME TIME, MEDICAL CENTER LEADERS RIGHTLY UNDERSTOOD THERE ARE POTENTIAL SOLUTIONS TO THE PROBLEMS OF POOR HEALTH THAT ARE BEYOND THEIR PURVIEW. THE MEDICAL CENTER TOOK THE LEAD TO HELP FIND WAYS EACH OF THE PARTNERS COULD USE THEIR UNIQUE EXPERTISE TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR SUCCESS IS MONITORED AND MEASURED BY THE HCI INDICATORS.WITHIN TWO MONTHS OF THE INITIAL MEETING, UNDER THE LEADERSHIP OF THE MEDICAL CENTER AND WITH THE FULL COOPERATION OF THE PARTNERS, THE "CORE FOUR" HAD AGREED TO A PLAN TO DEPLOY THE HCI WEB-BASED INDICATORS TOOL (HEALTHKLAMATH.ORG) AND A FRAMEWORK TO ACCOMMODATE THE VARIOUS OTHER COMMUNITY PARTNERS IN THE PROCESS. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COORDINATED BY SKY LAKES MEDICAL CENTER DONE IN KLAMATH COUNTY REPRESENTS THE COLLABORATIVE WORK BETWEEN SKY LAKES MEDICAL CENTER AND ITS LOCAL PARTNERS. THIS CHNA IS THE FIRST OF ITS KIND TO FORMALLY ASSESS AND DOCUMENT THE HEALTH OF OUR COMMUNITY UTILIZING A COORDINATED AND COLLABORATIVE PROCESS. IT IS THE FIRST STEP TO THE ONGOING PROCESS OF COMMUNITY HEALTH IMPROVEMENT. 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 WILL SET COMMUNITY PRIORITIES, AND ESTABLISH BENCHMARKS AND MONITOR TRENDS IN THE HEALTH STATUS OF KLAMATH COUNTY RESIDENTS WITH SPILLOVER TO OTHER REGIONS IN THE CATCHMENT AREA AND DEVELOP A PLATFORM FOR COLLABORATION TO IMPROVE HEALTH STATUS.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 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 PARTNERSHIPS (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. FACILITATED BY PUBLIC HEALTH LEADERS, MAPP IS INTENDED TO IMPROVE THE EFFICIENCY, EFFECTIVENESS, AND PERFORMANCE OF LOCAL HEALTHCARE SYSTEMS. 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. THE SOCIAL DETERMINANTS OF HEALTH 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. WHILE THE STANDARD MAPP INCLUDES FOUR ASSESSMENTS (COMMUNITY HEALTH STATUS ASSESSMENT, COMMUNITY THEMES AND STRENGTHS ASSESSMENT, LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT, AND THE FORCES OF CHANGE ASSESSMENT), THE LOCAL PARTNERS, GOING BY THE NAME HEALTHY KLAMATH, TAILORED MAPP TO BETTER FIT OUR COMMUNITY. THE PARTNERS DECIDED TO COMBINE THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT AND FORCES OF CHANGE ASSESSMENT INTO A SINGLE ASSESSMENT. THIS SPECIFIC COMBINATION WOULD THEN INCREASE EFFICIENCY AND UTILIZE RESOURCES MOST EFFECTIVELY. THE INFORMATION FOR THIS COMBINED ASSESSMENT WAS COLLECTED FROM STAKEHOLDERS WITH THE ABILITY TO SPEAK TO THE CURRENT SYSTEM AS WELL AS THE FUTURE OPPORTUNITIES AND UNCERTAINTIES THAT MAY AFFECT THE CURRENT SYSTEM. COLLECTING AND ANALYZING THE VOLUME OF DATA NECESSARY TO FULLY UNDERSTAND COMMUNITY HEALTH IS TIME- AND RESOURCE-INTENSIVE; HEALTHY KLAMATH PARTNERS COLLABORATIVELY SOUGHT A SOLUTION TO UTILIZE RESOURCES IN THE MOST EFFECTIVE MANNER. THE PARTNERS 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.HCI PROVIDES A PLATFORM FOR CONTINUAL MONITORING AND TRACKING ON 100+ INDICATORS SELECTED BY THE COMMUNITY PARTNERS. THESE INDICATORS WERE ASSESSED ON FOUR FACTORS: 1) COMPARISON TO OREGON AND NATIONAL BENCHMARK,2) TRENDS OVER TIME, 3) HEALTH DISPARITIES, AND4) SEVERITY OF HEALTH ISSUE. 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 THE CHNA COORDINATED BY SKY LAKES MEDICAL CENTER WAS STRONGLY INFLUENCED BY INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS AS WELL AS INDIVIDUALS IN KLAMATH COUNTY COMMUNITIES. 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. HEALTHY KLAMATH PARTNERS SOUGHT COMMUNITY INPUT VIA LISTENING SESSIONS, FOCUS GROUPS AND SURVEYS.THE COLLABORATION - COMMUNITY PARTNERS SEEKING BETTER HEALTH - HAS AT ITS CORE THE MEDICAL CENTER, THE LOCAL HEALTH DEPARTMENT, A MANAGED-CARE ORGANIZATION FOR THE MEDICAID POPULATION AND A FEDERALLY QUALIFIED HEALTHCARE PRACTICE WITH TWO FAMILY PRACTICE CLINICS IN THE COUNTY.THE PARTNERSHIP ALSO INCLUDES A LOCAL RURAL RESIDENCY PROGRAM, OREGON STATE UNIVERSITY'S EXTENSION IN KLAMATH COUNTY, OREGON HEALTH & SCIENCE UNIVERSITY'S NURSING PROGRAM AT OREGON INSTITUTE OF TECHNOLOGY, THE LOCAL NEWSPAPER AND THE REGION'S LARGEST RADIO STATION. THE ASSESSMENT LAUNCHED AS A RESULT OF SKY LAKES LEADERSHIP RECOGNIZING THERE ARE MYRIAD CAUSES FOR POOR HEALTH AND THE PROBLEM IS TOO LARGE FOR ANY ONE ORGANIZATION TO TAKE ON ALONE AND SO WORKED AS A "COMMUNITY CONVENER" TO GET OTHERS TO THE TABLE. THE INTENT WAS TO HEAR FROM MANY VOICES AND TO STRIVE FOR HARMONY AS WE WORKED TOGETHER TO MAKE IMPROVEMENTS THAT WOULD LAST. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 3: THE KLAMATH COUNTY CHNA COORDINATED BY SKY LAKES MEDICAL CENTER TAKES INTO ACCOUNT AN UNDERSTANDING OF THE ENVIRONMENT WE OPERATE WITHIN. UNDERSTANDING THE STRENGTHS AND WEAKNESSES OF THE CURRENT LOCAL HEALTHCARE SYSTEM, IN ADDITION TO ANY UPCOMING SOCIAL, POLITICAL, OR ECONOMIC CHANGES THAT COULD AFFECT THE SYSTEM IS INTEGRAL TO DEVELOPING PRIORITY AREAS OF FOCUS. HEALTHCARE REFORM AND THE CURRENT ECONOMIC CLIMATE ARE LARGELY IMPACTING THE LOCAL HEALTHCARE SYSTEM AND THESE STRUCTURAL CHANGES MUST BE ACCOUNTED FOR. THE HEALTHY KLAMATH PARTNERS IDENTIFIED A LIST OF KEY STAKEHOLDERS ORGANIZED BY SECTOR TO INTERVIEW FOR THIS ASSESSMENT. THE STAKEHOLDERS WERE SELECTED FOR THEIR ORGANIZATIONS' INFLUENCE ON COMMUNITY HEALTH AND THEIR ROLE IN THE PUBLIC HEALTH SYSTEM. THE STAKEHOLDERS, IN ADDITION TO SKY LAKES MEDICAL CENTER, INCLUDE KLAMATH COUNTY PUBLIC HEALTH, CASCADE COMPREHENSIVE CARE, CASCADE HEALTH ALLIANCE, KLAMATH OPEN DOOR CLINICS, KLAMATH FALLS PUBLIC SCHOOLS AND KLAMATH COUNTY SCHOOL DISTRICT, KLAMATH COMMUNITY COLLEGE, OREGON INSTITUTE OF TECHNOLOGY, AND APPROXIMATELY 16 OTHER AGENCIES AND ORGANIZATIONS. AS PART OF THE ASSESSMENT, THE PARTNERS CONDUCTED 20 INTERVIEWS WITH MORE THAN 25 LOCAL STAKEHOLDERS. EACH INTERVIEW BEGAN WITH AN EXPLANATION OF THE CHNA USING THE CHNA FRAMEWORK AND WITH A WRITTEN AND VISUAL DEFINITION OF HEALTH. THIS IS THE WRITTEN DEFINITION OF HEALTH USED IN THE INTERVIEWS: HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY (WORLD HEALTH ORGANIZATION). FURTHER, HEALTH IS NOT SIMPLY A STATE FREE FROM DISEASE BUT IS THE CAPACITY OF PEOPLE TO BE RESILIENT AND MANAGE LIFE'S CHALLENGES AND CHANGES (PUBLIC HEALTH ACCREDITATION BOARD).AFTER ANY QUESTIONS REGARDING THE CHNA WERE ANSWERED, THREE INTERVIEW QUESTIONS FOLLOWED: 1. HOW DOES YOUR ORGANIZATION CONTRIBUTE TO THE HEALTH OF THE COMMUNITY?2. WHAT DO YOU SEE AS YOUR ORGANIZATION'S ROLE IN THE LOCAL PUBLIC HEALTH SYSTEM?3. WHAT CHALLENGES DO YOU SEE THAT MAY AFFECT YOUR WORK (UPCOMING CHANGES IN LEGISLATION, FUNDING, TECHNOLOGY, NEW COLLABORATIONS, AND THE LIKE)?COMPLETE ANALYSIS OF THOSE INTERVIEWS AND THEIR RECOMMENDATIONS IS IN PROCESS.ALSO, OREGON HEALTH & SCIENCE UNIVERSITY SCHOOL OF NURSING STUDENTS CONDUCTED LISTENING SESSIONS AND FOCUS GROUPS IN SIX OUTLYING COMMUNITIES (MERRIL, MALIN, BONANZA, CHILOQUIN, MIDLAND, AND KENO) IN RURAL KLAMATH COUNTY. INFORMATION FROM THOSE SESSIONS AND INTERVIEWS ARE IN APPENDIX A OF THE CHNA.FURTHER QUALITATIVE ANALYSIS IN THE FORM OF A WEB-BASED SURVEY WAS CONDUCTED BY THE PARTNERS AND SPONSORED BY SKY LAKES MEDICAL CENTER. NEARLY 900 SELF-SELECTED RESPONDENTS TO THAT SURVEY PROVIDED ADDITIONAL COMMUNITY PERSPECTIVE FOR THE CHNA AND WILL BE USEFUL TO DEFINE STRATEGIES AND TACTICS GOING FORWARD. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 5C: BESIDES THE SKY LAKES MEDICAL CENTER WEBSITE (SKYLAKES.ORG), THE CHNA CONDUCTED BY THE HEALTHY KLAMATH PARTNERS AND COORDINATED BY THE MEDICAL CENTER ALSO WILL RESIDE ON THE HEALTHY KLAMATH WEBSITE (HEALTHYKLAMATH.ORG), ON THE KLAMATH COUNTY HEALTH DEPARTMENT WEBSITE, AND WILL BE AVAILABLE IN PRINT FORM AT SKY LAKES MEDICAL CENTER, AT THE HEALTH DEPARTMENT, AT THE LOCAL NEWSPAPER OFFICE (HERALD AND NEWS, 2701 FOOTHILLS ROAD, KLAMATH FALLS, OR), AND AT THE KLAMATH COUNTY LIBRARY. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 7: INFORMATION GATHERED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS FACILITATED BY THE COMMUNITY PARTNERS SEEKING BETTER HEALTH AND USING THE HEALTHY KLAMATH INITIATIVE INDICATES A STRATIFICATION OF PRIORITIES.DATA COLLECTED BY VARIOUS SURVEYS AGGREGATED BY THE HEALTHY COMMUNITIES INSTITUTE AND ORGANIZED AT HEALTHYKLAMATH.ORG INDICATE A RANGE OF NEEDS. AMONG THE TOP ARE: - ADULTS 65+ WITH INFLUENZA VACCINATION - ADULTS 65+ WITH PNEUMONIA VACCINATION - BABIES WITH LOW BIRTH WEIGHT - MOTHERS WHO RECEIVED EARLY PRENATAL CARE - DEATH RATE DUE TO COLORECTAL CANCER (AGE ADJUSTED).FURTHER, THE NUMBER OF LOCAL RESIDENTS WHO SELF-REPORTED THEIR HEALTH AS "GOOD" OR BETTER IS SIGNIFICANTLY LOWER THAN THE COMPARISON GROUP.WITH THAT AS A BACKDROP, THE COMMUNITY PARTNERS BROKE THE KEY DRIVERS OF HEALTH ACCORDING TO THE DATA INTO BROADER CATEGORIES, AND ASKED AREA RESIDENTS TO ASSIGN PRIORITY RANKS TO THEM.NEARLY 1,000 PEOPLE PARTICIPATED IN THE ONLINE, SELF-SELECT SURVEY. DATA COLLECTION REMAINED OPEN NINE DAYS (ONE WORK WEEK AND TWO WEEKENDS). AS THE FOLLOWING TABLES SHOW, RESIDENTS IDENTIFIED OBESITY, ACCESS TO MENTAL HEALTH AND LIMITING THE EFFECTS OF SUBSTANCE AND ALCOHOL ABUSE AND TOBACCO USE TOP SHORT-TERM (12-18 MONTHS) PRIORITIES. SIMILARLY, THE PRIORITIES FOR AN INTERMEDIATE TERM (18-36 MONTHS) LEFT IN PLACE THREE OF THE SHORT-TERM PRIORITIES AND MOVED TO THE TOP PRIORITIES LIST HEALTH INSURANCE COVERAGE AND YOUTH MENTORING. THE LONG-TERM (3+ YEARS) PRIORITIES CLOSELY ALIGN WITH THE OTHER CATEGORIES WITH THE TOP PRIORITY TO DECREASE POVERTY WHILE INCREASING THE HIGH SCHOOL GRADUATION RATE, ENCOURAGING HEALTHIER LIFESTYLES WITH BETTER NUTRITION AND MORE EXERCISE OPPORTUNITIES, AND BROADER HEALTH INSURANCE COVERAGE COMPRISING THE TOP SPOTS. IT IS CLEAR TO MOST THAT THOSE WHO PARTICIPATED IN THE SURVEY RECOGNIZE THAT OBESITY AND ITS ASSOCIATED COMPONENTS, PRIMARILY HEALTHIER EATING HABITS AND INCREASED ACTIVITY, ARE CLOSELY LINKED TO A VARIETY OF OTHER UNHEALTHFUL CONDITIONS. FURTHER, THERE IS A RECOGNITION THAT IN ORDER FOR THE CHANGES TO BE MORE OR LESS PERMANENT REQUIRES BROAD-BASED SYSTEMIC CHANGES RATHER THAN SO-CALLED INSTANT FIXES.THE COMMUNITY COALITION, LED IN NO SMALL MEASURE BY SKY LAKES MEDICAL CENTER AND RESPONSIBLE FOR ENSURING THERE IS PROGRESS TOWARD MAKING IMPROVEMENTS IN THE PRIORITIES, BROKE THE SHORT-, INTERMEDIATE- AND LONG-TERM PRIORITIES INTO AN EIGHT-POINT PROJECT LIST. SUCCESS ON ANY OF THE POINTS SUPPORTS PROGRESS ON OTHER POINTS.COMMUNITY PARTNERS SEEKING BETTER HEALTH TEAMS ARE FORMED AROUND:1. OBESITY, HEALTHY EATING, EXERCISE,2. ACCESS TO MENTAL HEALTH,3. SUBSTANCE AND ALCOHOL ABUSE,4. TRANSPORTATION,5. YOUTH MENTORING,6. INFRASTRUCTURE,7. DECREASING POVERTY, AND8. HEALTH POLICY CHANGES.NONE OF THE ISSUES CAN BE RESOLVED WITHOUT CONSIDERABLE ENERGY AND RESOURCES, YET PROGRESS IS BEING MADE. FOR INSTANCE, SKY LAKES MEDICAL CENTER HIRED A PHYSICIAN AND NURSE WITH PUBLIC HEALTH CREDENTIALS TO OPEN AND OPERATE A FIRST-EVER "WELLNESS CENTER" AIMED SPECIFICALLY AT IMPROVING OBESITY-RELATED HEALTH.AT THE SAME TIME, SKY LAKES MEDICAL CENTER HAS MADE SIGNIFICANT CONTRIBUTIONS TO SUPPORT NUTRITION, PARTICULARLY AMONG SENIOR CITIZENS, AND HOSTS REGULAR "FARMERS MARKETS" WITH EXTENSIVE EFFORTS TO ATTRACT THE LOWER-INCOME POPULATION TO THE EVENTS. ALSO, SKY LAKES MEDICAL CENTER HAS COMMITTED TO BE A MAJOR SOURCE OF ALTERNATE REVENUE TO ENSURE THE MUNICIPAL POOL CONTINUES TO HAVE SWIMMING OPPORTUNITIES, RECOGNIZING IT AS AN IMPORTANT TYPE OF ACTIVITY FOR MANY PEOPLE, PARTICULARLY MOBILITY IMPAIRED INDIVIDUALS. SKY LAKES MEDICAL CENTER AND COMMUNITY PARTNERS ARE ACTIVELY IMPROVING ACCESS TO MENTAL HEALTH THROUGH A VARIETY OF MECHANISMS. THE MEDICAL CENTER IS RIGOROUSLY RECRUITING FOR A PERMANENT PSYCHIATRIST TO PRACTICE LOCALLY AND LEVERAGE ADDITIONAL MENTAL HEALTH SERVICES FOR THE REGION.EFFORTS ARE UNDER WAY TO INCREASE: - THE AWARENESS AND THE FREQUENCY OF CANCER SCREENING OPPORTUNITIES TO ENCOURAGE AND SUPPORT THE EARLY DETECTION OF TUMORS; - DIRECT INTERVENTIONS FOR PEOPLE AT RISK OF DIABETES OR WHO HAVE BEEN DIAGNOSED WITH DIABETES TO IMPROVE THEIR CONDITIONS WITHOUT HOSPITALIZATION; AND - AWARENESS OF THE BENEFITS OF REGULAR LOW-IMPACT EXERCISES TO IMPROVE HEALTH AS WELL AS TO CONTROL AN ASSORTMENT OF CHRONIC DISEASES.WORKING WITH PHYSICIANS AND OTHER MEDICAL PROFESSIONALS, SKY LAKES MEDICAL CENTER ACTIVELY PROMOTES PRE-NATAL EDUCATION AMONG THE TARGET DEMOGRAPHIC BY OFFERING NO-CHARGE CHILDBIRTH PREPARATION CLASSES. THE MEDICAL CENTER ALSO HAS UNDERWAY A MORE EXPANSIVE PROGRAM USING NON-TRADITIONAL METHODS TO GET APPROPRIATE NUTRITION, EXERCISE AND CHILDBIRTH PREPARATION INFORMATION TO FIRST-TIME MOTHERS. MEASUREMENT DATA COLLECTED ON THE PROGRAMS ARE INCOMPLETE SO FIRM CONCLUSIONS REGARDING THEIR SUCCESS WOULD NOT BE APPROPRIATE. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 11H: HOUSEHOLD SIZE AND A MAXIMUM OUT-OF-POCKET EXPENDITURE. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 17E: SKY LAKES EMPLOYS A FIRM, CHAMBERLIN EDMONDS, THAT QUALIFIES PATIENTS FOR BENEFIT PROGRAMS. THEY SCREEN ALL OF SKY LAKES' UNINSURED PATIENTS FOR POSSIBLE MEDICAID, MEDICARE AND/OR DISABILITY BENEFITS. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 19D: SKY LAKES IS AWAITING CLARIFICATION ON 501(R) REGULATIONS, WHICH ARE PROPOSED. SKY LAKES MEDICAL CENTER PART V, SECTION B, LINE 21: SOME PATIENTS ARE ONLY ELIGIBLE FOR AN ANNUAL MAXIMUM OUT-OF-POCKET REDUCTION. PART VI, LINE 2: BESIDES FORMAL CONVERSATIONS WITH COMMUNITY PARTNERS AND MEDICAL COLLABORATORS, SKY LAKES MEDICAL CENTER ACTIVELY PARTNERS WITH AGENCIES SUCH AS THE KLAMATH COUNTY HEALTH DEPARTMENT AND THE UNITED WAY OF THE KLAMATH BASIN IN HEALTH-IMPROVEMENT INITIATIVES. THE 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. FURTHER, MEDICAL CENTER LEADERS USE INFORMATION AND DATA TRENDING FROM THE ROBERT WOOD JOHNSON FOUNDATION-SPONSORED UNIVERSITY OF WISCONSIN "COUNTY HEALTH RANKINGS" STUDY TO IDENTIFY SPECIFIC OPPORTUNITIES FOR IMPROVEMENT. COMMUNITY MEMBERS' PERCEPTIONS REGARDING HEALTH NEEDS ARE CAPTURED IN NON-SCIENTIFIC SURVEYS CONDUCTED AT THE CONCLUSION OF FREE HEALTH- AND WELLNESS-RELATED SEMINARS AND SIMILAR 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, IS REFERENCED IN THE ONLINE BILL-MANAGEMENT SECTION OF THE SITE, AND IS FEATURED IN THE MEDICAL CENTER'S ANNUAL REPORT AND PUBLISHED IN THE ANNUAL LIVE HEALTHY MAGAZINE. THE ANNUAL REPORT IS MAILED TO SOME 2,300 HOUSEHOLDS IN THE AREA AND THE MAGAZINE IS DISTRIBUTED TO ROUGHLY 17,000 HOUSEHOLDS IN THE MEDICAL CENTER'S CATCHMENT AREA USING THE LOCAL NEWSPAPER'S DISTRIBUTION NETWORK; BOTH ARE AVAILABLE ONLINE AND THE MAGAZINE IS PROMOTED VIA THE NEWSPAPER. THE FINANCIAL ASSISTANCE POLICY ALSO IS AVAILABLE WHEN SERVICES ARE PERFORMED. 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. ADDITIONALLY, 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 MOST FORM LETTERS WE MAIL. IT ALSO IS COVERED DURING COURTESY PHONE CALLS IF THERE IS MENTION OF DIFFICULTY IN PAYING MADE. THE ASSISTANCE ALSO IS DISCUSSED IF DIFFICULTY IN PAYING IS MENTIONED DURING INCOMING PHONE CALLS.IN ADDITION, SKY LAKES 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.BESIDES THE MAIN MEDICAL CENTER, THE SKY LAKES CANCER TREATMENT 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 INDIGENT PATIENTS THROUGH MAJOR PHARMACEUTICAL COMPANIES. PART VI, LINE 4: COMMUNITIES IN A 10,000-SQUARE MILE 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 TO 100,000 PEOPLE IN TWO OREGON COUNTIES AND TWO CALIFORNIA COUNTIES RELY ON SKY LAKES FOR THEIR ACUTE HEALTHCARE NEEDS.CENSUS DATA FROM 2010 SHOW KLAMATH COUNTY'S POPULATION AT 66,380, A 4.1 PERCENT INCREASE SINCE 2000, WITH 17.1 PERCENT 65 OR OLDER AND 23.1 PERCENT YOUNGER THAN 18. THE POPULATION'S GENDER SPLIT IS ALMOST EVEN WITH 50.1 PERCENT FEMALE. THE MEDIAN HOUSEHOLD INCOME IN THE COUNTY IS REPORTED AT $39,057, ALMOST $10,000 LESS THAN THE STATEWIDE MEDIAN, AND 20.2 PERCENT OF THE COUNTY'S POPULATION IS BELOW THE POVERTY LEVEL. THAT COMPARES WITH 14.3 PERCENT STATEWIDE.THE POPULATION SERVED BY THE MEDICAL CENTER IS FURTHER DESCRIBED BY THE RELATIVE RANKINGS FROM THE UNIVERSITY OF WISCONSIN STUDY. THE 2011 REPORT NOTES KLAMATH COUNTY IS RANKED 31ST OUT OF 33 RANKED OREGON COUNTIES (UP FROM 32ND A YEAR EARLIER) ON SUCH FACTORS AS: - POOR OR FAIR HEALTH (18 PERCENT VS THE NATIONAL BENCHMARK OF 10 PERCENT AND THE OREGON BENCHMARK OF 14 PERCENT),- ADULT SMOKING (24 PERCENT VS 14 PERCENT NATIONALLY AND 18 PERCENT IN OREGON),- UNINSURED ADULTS (23 PERCENT VS 11 PERCENT NATIONALLY AND 19 PERCENT IN OREGON), - PRIMARY CARE PROVIDERS (489:1 VS 631:1 NATIONALLY AND 739:1 IN OREGON),- UNEMPLOYMENT (13.4 PERCENT VS 5.4 PERCENT NATIONALLY AND 10.8 IN OREGON), - CHILDREN IN POVERTY (26 PERCENT VS 13 PERCENT NATIONALLY AND 16 PERCENT IN OREGON), AND- VIOLENT CRIME RATE (265 VS 73 NATIONALLY AND 271 IN OREGON).DURING 2011, APPROXIMATELY 28 PERCENT OF THE NEARLY 20,000 VISITS TO SKY LAKES MEDICAL CENTER'S EMERGENCY DEPARTMENT RESULTED IN AN INPATIENT STAY. ABOUT TWO-THIRDS OF THE INPATIENTS AT SKY LAKES CAME IN VIA THE ER, VERSUS THE STATE AVERAGE OF ABOUT HALF. 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; A FREE GENERAL COMMUNITY HEALTH FAIR ATTENDED BY MORE THAN 1,500 PEOPLE A YEAR, AND A SEPARATE FREE FAIR FOCUSED ON INFORMATION FOR PEOPLE WITH DIABETES; A VARIETY OF LECTURES AIMED AT ENCOURAGING GREATER FITNESS AND CULMINATING IN A SERIES OF COMPETITIONS, AND OTHER AGE-SPECIFIC PROGRAMS FOCUSING ON STRETCHING, TAI CHI AND LOW-IMPACT DANCE. MOST OF THESE EVENTS ARE EITHER FREE OR LOW COST, AND SCHOLARSHIPS ARE FREQUENTLY AVAILABLE. SKY LAKES MEDICAL CENTER ROUTINELY PARTNERS WITH OSU EXTENSION TO PROMOTE HEALTHIER NUTRITION CHOICES COUPLED WITH HANDS-ON COOKING CLASSES.THE MEDICAL CENTER, OSU, THE KLAMATH COUNTY HEALTH DEPARTMENT, KLAMATH TRIBAL HEALTH AND FAMILY SERVICES, AND CASCADES EAST FAMILY MEDICINE WORKED TOGETHER ON THE BETTER HEALTH PARTNERSHIP TO PROMOTE INCREASED PHYSICAL ACTIVITY AND IMPROVED NUTRITION WITH PARTICIPANTS RECEIVING ONE-ON-ONE MENTORING. TO ENCOURAGE PEOPLE TO BE MORE ACTIVE, SKY LAKES GAVE AWAY PEDOMETERS TO SOME 3,000 PEOPLE INTERESTED IN KEEPING TRACK OF THEIR STEPS EN ROUTE TO A DAILY GOAL OF 10,000 STEPS.MANY OF THOSE PEOPLE ALSO PARTICIPATED IN THE FREE 'COUCH TO 5K' SERIES, WHICH DEMONSTRATED WAYS TO BE MORE ACTIVE. THE CLIMAX OF THE SIX-SESSION SERIES IS THE ANNUAL 15-KILOMETER RUN, A 5K RUN/WALK FOR ADULTS, AND TWO SHORTER EVENTS - ONE-HALF AND ONE MILE - EVENTS FOR CHILDREN. THE EVENTS DRAW NEARLY 500 ENTRANTS FROM AROUND THE WEST WHO CROWD THE FIELD FOR THE RACES SPONSORED AND ORGANIZED BY THE MEDICAL CENTER STAFF AND VOLUNTEERS.SKY LAKES FAMILY BIRTH CENTER NURSES SPECIALLY TRAINED TO CHECK THAT INFANT CAR SEATS ARE APPROPRIATE AND PROPERLY INSTALLED INSPECT DOZENS OF SEATS A YEAR AT ONCE-A-MONTH FREE CHECKS. THE NURSES, IN COLLABORATION WITH KLAMATH COUNTY FIRE DISTRICT NO. 1, KLAMATH TRIBAL HEALTH AND FAMILY SERVICES, AND THE LOCAL HEAD START PROGRAM LAUNCHED THE CHECKS TWO YEARS AGO. THEY ALSO PROVIDE SEATS AT NO CHARGE TO QUALIFYING PARENTS.THE FAMILY BIRTH CENTER ALSO HOSTS FREE CLASSES TO HELP SOON-TO-BE SIBLINGS AND NO-CHARGE SESSIONS TO ENSURE THE EMOTIONAL HEALTH OF MOMS DURING AND AFTER PREGNANCY.SKY LAKES MEDICAL CENTER 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. SKY LAKES FINANCIAL SUPPORT FOR 2010 WAS $3.18 MILLION. ALSO, THE MEDICAL CENTER CARRIES THE VAST MAJORITY OF COSTS INCURRED IN THE RUNNING OF THE CHILD ABUSE RESOURCE AND EDUCATIONAL SERVICES AGENCY THAT SERVES KLAMATH AND LAKE COUNTIES. CASCADES EAST ALSO OPERATES A MOBILE CLINIC THAT PROVIDES NO-CHARGE HEALTHCARE SERVICES TO UN- AND UNDERINSURED POPULATIONS IN THE REGION. THE 15 CASCADES EAST MEDICAL STAFF LOG MORE THAN 1,000 MILES IN THE RV EACH YEAR AND PERFORM MORE THAN 200 PATIENT EXAMS. BESIDES REGULAR CLINICS AT KLAMATH FALLS LOCATIONS, THE RV VISITS THE RURAL COMMUNITIES OF GILCHRIST AND SPRAGUE RIVER. THE FUEL, MAINTENANCE, AND SUPPLIES ARE ALL PAID FOR BY SKY LAKES MEDICAL CENTER; THE SUM EXCEEDS $6,000 A YEAR.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' AND 'PERIODS OF PURPLE CRYING' CAMPAIGNS. THE PROGRAMS ARE AIMED AT STOPPING INCIDENTS OF INFANT AND CHILD ABUSE AT THE HANDS OF ADULTS.SIMILARLY, SKY LAKES IS AMONG THE COMMUNITY PARTNERS INVESTING IN THE 'SOUTHERN OREGON METH PROJECT,' WHICH TARGETS DRUG USE BY TEENS. THE MEDICAL CENTER ANNUALLY CONTRIBUTES $9,000 TO THE PUBLIC AWARENESS CAMPAIGN.IN ADDITION, KLAMATH COUNTY IS A PHYSICIAN-SHORTAGE AREA SO PHYSICIAN RECRUITMENT EFFORTS ARE ALSO UNDERWRITTEN BY THE MEDICAL CENTER RATHER THAN LOCAL MEDICAL PRACTICES INCURRING THAT EXPENSE. THE MEDICAL CENTER INVESTS UPWARDS OF $1 MILLION A YEAR IN RECRUITING ACTIVITIES. SKY LAKES PROVIDES FREE EDUCATION IN OR FOR THE SCHOOLS THROUGH ITS PARTNERSHIP WITH OREGON STATE UNIVERSITY EXTENSION'S NUTRITION EDUCATION PROGRAM. THE MEDICAL CENTER ALSO PARTNERS WITH OSU EXTENSION FOR THE EDUCATION SERIES FOR PEOPLE WITH DIABETES, AND THE THREE-CLASS 'MASTERY OF AGING WELL' SERIES. AND A NUMBER OF SKY LAKES MEDICAL CENTER EMPLOYEES PROVIDE VOLUNTEER EDUCATIONAL SUPPORT IN THE FORM OF TEACHING, MENTORING, PROGRAM DEVELOPMENT, AND TOURS AND DEMONSTRATIONS FOR LOCAL SCHOOLS AND COLLEGES.OTHER PARTNERSHIPS HELP ENSURE THE SUCCESS OF PROGRAMS SUCH AS: - THE KLAMATH CRISIS CENTER BY PROVIDING A NO-RENT VENUE FOR TWICE-A-MONTH EDUCATION AND TRAINING PROGRAMS; - THE LOCAL KLAMATH AND LAKE COMMUNITY ACTION SERVICES PROGRAM BY DONATING MATERIAL FOR ITS PROGRAM TO PROVIDE QUALIFYING INDIVIDUALS AND FAMILIES ACCESS TO MEDICAL AND DENTAL CARE, HYGIENE RESOURCES AND THE LIKE; - THE KLAMATH COUNTY RELAY FOR LIFE BY CONTRIBUTING $1,000 TOWARD CANCER RESEARCH AND PROVIDING SOME 700 SERVINGS OF HOME-MADE SOUP TO THOSE AT THE EVENT; - THE RED CROSS BY GIVING AT NO-CHARGE SPACE IN SKY LAKES FACILITIES FOR COMMUNITY BLOOD DRIVES; - THE LOCAL CHAPTERS OF THE MARCH OF DIMES, MUSCULAR SCLEROSIS ORGANIZATIONS, AND LOCAL EARLY CANCER DETECTION CAMPAIGNS BY CONTRIBUTING HUNDREDS OF DOLLARS EACH TO THEIR MISSIONS; AND - THE 'BASIN HEALTHY CHOICES' INITIATIVE COORDINATED BY THE KLAMATH COUNTY HEALTH DEPARTMENT AND THE HEALTHY ACTIVE KLAMATH COALITION, WHICH INCLUDES SKY LAKES MEDICAL CENTER. SKY LAKES CONTRIBUTES COUNTLESS HOURS OF STAFF TIME AND TALENT, AS WELL AS FACILITY AND OTHER RESOURCES, IN THE CAMPAIGN AIMED AT IMPROVING THE HEALTH OF PEOPLE IN THE REGION BY PROMOTING WORKPLACE WELLNESS, BETTER NUTRITION THROUGH FOOD CHOICES, AND INCREASED PHYSICAL ACTIVITY. HERE IS A LIST OF SOME OTHER SKY LAKES COMMUNITY PARTNERSHIPS: - AMERICAN ASSOCIATION OF UNIVERSITY WOMEN - AMERICAN CANCER SOCIETY - GOSPEL MISSION - HEALTHY ACTIVE KLAMATH - AREA PUBLIC SCHOOLS AND STUDENTS - INVEST IN YOUTH CONFERENCE - KLAMATH COMMUNITY COLLEGE AND STUDENTS - KLAMATH COUNTY CASA - KLAMATH COUNTY CHAMBER OF COMMERCE - KLAMATH CRISIS CENTER - KLAMATH FIRE PREVENTION COOPERATIVE - KLAMATH HOSPICE - KLAMATH-LAKE FOOD BANK - KLAMATH TRIBAL HEALTH AND FAMILY SERVICES - MULTIPLE SCLEROSIS SOCIETY - 'OPERATION PROM NIGHT' TO PREVENT DISTRACTED DRIVING - OREGON AIR NATIONAL GUARD AT KINGSLEY FIELD - OREGON INSTITUTE OF TECHNOLOGY AND STUDENTS (CLINICAL PRECEPTING, ETC.) - PREGNANCY HOPE CENTER - SANFORD HEALTH FOUNDATION - UNITED WAY OF THE KLAMATH BASIN - AREA 4-H PROGRAMS REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 KLAMATH COUNTY SCHOOL DISTRICT 10501 WASHBURN WAY KLAMATH FALLS OR 97603 936000543 GOVERNMENT ENTITY 22000 HOSA PROGRAM ASSISTANCE SKY LAKES MEDICAL CENTER FOUNDATION 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946020 501(C)(3) 9194 INFECTIOUS DISEASE CONFERENCE, CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES) AWARENESS & PREVENTION EDUCATION PROGRAM 2 0 EMPLOYEE STUDENT LOAN FORGIVENESS 18 100917 EXTERNSHIP STIPENDS 5 13200 STUDENT LOAN ASSISTANCE TO EMPLOYEES 14 56457 PATIENT ASSISTANCE 133 22413 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 GRANT NISKANEN MD 263750 0 0 0 10500 0 12250 0 0 0 286500 0 0 0 PAUL R STEWART 323302 0 190000 0 0 0 12250 0 14232 0 539784 0 0 0 RICHARD RICO 251110 0 52875 0 0 0 12250 0 19380 0 335615 0 0 0 PATRICK MAVEETY MD 452904 0 0 0 0 0 12250 0 8628 0 473782 0 0 0 TZANN T FANG MD 401082 0 0 0 0 0 12250 0 19380 0 432712 0 0 0 RICHARD DEVORE MD 325934 0 0 0 0 0 8625 0 16632 0 351191 0 0 0 NASSER G ABU-ERREISH MD 261145 0 0 0 0 0 0 0 14232 0 275377 0 0 0 W CLAY MCCORD MD 219642 0 0 0 0 0 11741 0 14232 0 245615 0 0 0 KLAMATH FALLS INTERCOMMUNITY HOSPITAL AUTHORITY 931061020 498413DQ3 2006-08-31 39329258 REVENUE AND REFUNDING; MERLE WEST MEDICAL CENTER PROJECT 0 0 0 39329258 558445 1170952 15000000 22599861 2007 0 1 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE CONTROLLER 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 CEO AND ALL VP POSITIONS. FOR THE CEO POSITION, THE COMPENSATION COMMITTEE COMPLETES A PERSONNEL ACTION FORM, WHICH IS SIGNED BY THE BOARD CHAIR. FOR ALL VP POSITIONS, THE COMMITTEE ACTS ON THE RECOMMENDATIONS MADE BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE ALL MADE AVIALABLE TO THE PUBLIC UPON REQUEST. AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATION: FORM 990, PART VII, SEC A, LINE 1A, COLUMN (B): SKY LAKES MEDICAL CENTER FOUNDATION: CLARK PEDERSON - BOARD CHAIR, 3 HOURS JOHN BELL - BOARD MEMBER, 1 HOUR KERMIT HOUSER - BOARD MEMBER, 1 HOUR DOUGLAS MCINNIS DVM - BOARD MEMBER, 1 HOUR GRANT NISKANEN MD - BOARD MEMBER, 1 HOUR BERNARD SIMONSEN - BOARD MEMBER, 1 HOUR GREGORY SINDMACK MD - BOARD MEMBER, 1 HOUR PAUL STEWART - BOARD MEMBER, 1 HOUR WENDY WARREN MD - BOARD MEMBER, 1 HOUR ROD WENDT - BOARD MEMBER, 1 HOUR CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -56,901. BOOK/TAX DIFFERENCE ON PASSTHROUGH INCOME 83,950. TOTAL TO FORM 990, PART XI, LINE 5: 27,049. SOUTHERN OREGON EMERGENCY CARE LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 611595709 PHYSICIAN SERVICES OR 0 657255 SKY LAKES MEDICAL CENTER SKY LAKES MEDICAL CENTER FOUNDATION 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946020 FUNDRAISING AND STEWARDSHIP; SUPPORT MED CENTER OR 501(C)(3) 11C SKY LAKES MEDICAL CENTER 0 KLAMATH CARE SERVICES INC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946018 SUPPORT MED CENTER (INACTIVE) OR 501(C)(3) 11C SKY LAKES MEDICAL CENTER 0 KLAMATH MEDICAL BUSINESS CENTER LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 020731372 REAL AND PERSONAL PROPERTY RENTAL OR N/A INVESTMENT 53132 548846 0 7351 1 0.50000 WEST PHYSICIAN SERVICES LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 870696029 PHYSICIAN SERVICES OR SKY LAKES MEDICAL CENTER C -9513632 2438173 1.00000 PREFERRED HEALTH PLAN INC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 931304315 HEALTH INSURANCE OR SKY LAKES MEDICAL CENTER C -161330 312009 0.87000 0 1 1 1 0 0 0 0 0 1 0 0 1 1 0 1 0 0 KLAMATH MEDICAL BUSINESS CENTER LLC J 116160 CASH TRANSFERRED