2012-11-20T14:52:10-08:00 2011-12-31 990 2011-01-01 930429015 Portland Adventist Medical Center PORT 5032516150 10123 SE Market Street Portland OR 97216 Mark Perry 2012-11-20 2011 2016-02-24 21:20:13Z RUSSELL THOMAS 10123 SE Market St Portland OR 97216 269623435 false false 1071 X www.adventisthealthnw.com X 1900 OR Our mission is to demonstrate the human expression of the healing ministry of Jesus Christ 13 8 2445 285 5563112 -17519 523213 621826 243719654 265403029 3714261 3190957 84950 56562 248042078 269272374 145739 185748 0 139176205 150440396 0 373914 108338566 112063492 247660510 262689636 381568 6582738 264432198 273490042 84225726 86610260 180206472 186879782 Our mission is to demonstrate the human expression of the healing ministry of Jesus Christ. false false 225915143 185749 254119602 Portland Adventist Medical Center (PAMC) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Portland Adventist Medical Center, the organization recognizes that not all individuals possess the ability to pay for essential medical services.Adventist Healths 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 or below cost providing health/wellness activities and community education programsNot only does Portland Adventist Medical Center provide low cost care to individuals covered by government programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. PAMC 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 2011 was $14,454,348.The following Inpatient services that were provided to all our patients. These services included:1,175 Babies delivered2,724 Surgeries performed20,087 Radiology procedures performed1,367 Cardiac Catheterizations and other procedures 269,626 Laboratory tests14,629 Patient days (Psychiatric Services)The following Outpatient services that were provided to all our patients in 2011. These services included:48,548 Emergency department visits4,138 Outpatient Surgeries performed86,865 Radiology procedures performed1,495 Cardiac Catheterizations and other procedures 319,364 Laboratory tests209,229 Medical clinic visits57,760 Rehab visitsHome Health Care services in 2011 that were provided to all our Home Health patients. These services included:36,185 Home Health visits42,764 Hospice patient days15,669 Home Medical Equipment deliveries7,460 Home Infusion Therapy daysPAMC 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 2011 was $3,673,346.Community Health Improvements ServicesCommunity Health Education: Healthful Living Lectures- Dr. Hans DiehlCancer Care Support GroupMedical personnel lactation educationSafety consultsAnswers to medication questions from the general publicKomen Care for The CureHealth Fair focusing on heart healthIntervention TrainingOregon Board of Medical ImagingComplete Health Improvement Project- Blood drawsAmerican Heart and Stroke WalkCommunity Based Clinical Services:Stroke Education and screeningMammography Voucher Program for uninsured womenHealth Care Support Services:Emergent transportation needs of discharging patientsCancer patient transportationEnrollment assistance in government funded health programsCoupons for homeless sheltersCancer Survivor EventCancer Support GroupGrief ClassesHealth Professionals EducationPhysiciansAdvanced Life Support for ObstetricsVarious health lecturesNurses/Nursing students:Student nurses- 46,622 hours 481 studentsNursing School subsidyOther Health Professionals Education:Surgical TechsDietetic educationHealth Resource KioskMedical Library open to publicHosted Caremark lecture SeriesVarious Grief/Care classes for Home health/Hospice professionals PT, OT, Speech therapy student trainingSubsidized Health Services:Hospital Outpatient Services:Cardiopulmonary RehabSubsidized Continuing CareHome HealthBehavioral Health ServicesPsych and Psych Physicians Services Financial and In-Kind DonationsCash Donations:Medical Teams InternationalIn-Kind Donations:Medical equipmentCompassionate FriendsBattle Ground Health CareFree space availability to non-profitsFood collection/ donationsAdministrative support to not-for-profit groupsNAMI Walk 2011Special need groups Board and committee membershipsCommunity Benefits OperationAssigned Staff:1026 total hoursCBISA software 225915143 true true false true false false false false false true true false false false true false false true false false false false false false true false true true false true true false false false false false false false false false false false false false false false false true true true false false true 299 0 true 2445 true true true false false false false false false true true false 0 false false false false false false false false false false false X 13 8 false false false false true false true true true false false false true true true true true true true true true false OR X Mark Perry 5032516150 10123 SE Market St Portland OR 97216 JONES HELMUTH 1.00 X 0 350 0 INNOCENT LARRY 1.00 X 0 350 0 REINER SCOTT 50.00 X X 0 907841 160287 DODDS LARRY 50.00 X X 0 685344 96060 CARMEN ROBERT 50.00 X X 0 1749297 39804 TORKELSEN MAX 1.00 X 0 2381 0 RIPPEY WESLEY 8.00 X 96255 2238 0 REIMCHE ALLAN 1.00 X 0 1637 0 JOBE MEREDITH 1.00 X 0 54617 0 HERBER STEVEN 1.00 X 0 219911 41678 GRAHAM RICARDO 1.00 X 0 2652 0 FRIESTAD CHRISTINE 1.00 X 0 2927 0 FIKE RUTHITA 1.00 X 0 635 0 CREITZ LYNN 1.00 X 0 3123 0 CAVINESS LARRY 1.00 X 0 2666 0 BRADSHAW ROBERT 1.00 X 0 4652 0 WING BILL 50.00 X 0 321581 89967 PERRY MARK 50.00 X 0 306079 71444 RUSSELL THOMAS 50.00 X 0 451956 103013 WEHTJE RODNEY 50.00 X 0 506336 95494 REBOK DOUGLAS 50.00 X 0 857414 147299 TRYON ELLEN 50.00 X 355250 0 0 RUSSELL DAVID 50.00 X 0 189432 48230 KINZER STEVEN 50.00 X 0 263404 63547 HEISER PAMELA 50.00 X 0 217168 55611 BENFIELD RONALD 50.00 X 0 247520 71887 Molloy Thomas 40.00 X 797879 0 19491 Patillo Dominic 40.00 X 481573 0 4470 Grise Murlan 40.00 X 400493 0 27333 Nerness Curtis 40.00 X 323704 0 31542 Balme Benjamin 40.00 X 298529 0 23810 JONES DERYL 0.00 X 0 1782626 8650 2753683 8784137 1199617 183 true true true Patrick L Hanley MD 10000 SE Main St Portland OR 97216 Medical Services 394365 Novia Strategies 13029 Danielson St Suite 200 Poway CA 920648811 Business Consultants 1182174 Oregon Anesthesiology Grp 120 NW 14th Ave Ste 300 Portland OR 97209 Medical Services 1265072 Northwest Cardiovas Inst 2222 NW Lovejoy Ste 606 Portland OR 97210 Medical Services 1626512 Portland Psyc Assoc Inc 9955 SE Washington 200 Portland OR 97216 Psyc Physician Serv 1706317 22 128410 493416 19200 621826 Other Revenue 900099 2330309 2330309 Partnr inc fr rel prg svc 900099 3596507 3596507 Reference Lab Services 621500 4528753 4528753 Rental Revenue - MOBs/Oth 531120 4647091 4647091 Patient Service Revenue 900099 248284803 248284803 2015566 36045 1034359 945162 265403029 3127852 3127852 0 0 0 63105 63105 63105 63105 60178 128410 93624 -33446 -33446 0 299900 257437 42463 42463 Medical Staff Funds 900099 47545 47545 47545 269272374 254247664 5563112 8839772 0 185748 185748 0 0 57600 57600 0 114016944 104613226 9190661 213057 4298297 4291780 6517 23238927 20213480 2981134 44313 8828628 8028727 784807 15094 0 653850 653850 438714 438714 0 0 0 11880907 7661126 4219781 1214296 167930 1046366 4184982 3241212 928269 15501 7544592 7493071 51521 0 9653418 9082592 547368 23458 828411 555415 264441 8555 0 334693 266009 68549 135 2880774 2880774 0 10858162 10782224 75938 1416139 1384376 31763 All other expense 941695 192314 748031 1350 Rent/Lease of Equipment 2259250 2259250 Purchased Services 25457338 11099618 14305269 52451 Pt Care Supplies 31516271 31516271 0 262689636 225915143 36400579 373914 2114866 6597445 81260243 80517629 225813 225000 35599349 40440982 0 0 0 2614503 3338877 1728541 2171212 275107078 149970454 128591967 125136624 594494 253646 1612585 1478694 40000 120000 90000 1552200 9959837 11657733 264432198 273490042 17324995 19127546 1028585 1174426 59131 19835 733334 65813015 65555119 84225726 86610260 X 176372456 182959396 1341516 1417878 2492500 2502508 180206472 186879782 264432198 273490042 X 6582738 90572 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false true false false false false true 3195 false true 21411 24606 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description A portion of the dues paid to the following organizations has been determined to be related to lobbying: Oregon Association of Hospitals and Health Systems--lobbying portion $21,200 Portland Business Alliance--lobbying portion $211 3433896 47906 33124 -23170 3491756 3253240 151645 38757 -9746 3433896 2980996 247619 32683 -8057 3253240 0.30000 0.70000 false false false 6643572 6643572 187619342 85018686 102600656 2088496 1396684 691812 78755668 63555084 15200584 125136624 Other Liabilities -50 Payable to related entities 61949527 Payables to third parties 1379007 Workers' comp liability 2226635 65555119 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Net Assets Rlsd from Restrictions $90572 Net Assets Rlsd from Restrictions $ -0 Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. X X X X false Golf Tournament 188588 128410 60178 2560 1781 23630 15926 49727 188588 128410 60178 2560 1781 23630 15926 49727 93624 -33446 true true X true X true X true true false false true true 11678 7623908 7623908 0.02900 43022 33725606 26395165 7330440 0.02790 54700 41349514 26395165 14954348 0.05690 5410 767997 223761 544236 0.00210 452709 123062 329647 0.00130 23677561 21091020 2586541 0.00980 212922 212922 0.00080 5410 25111189 21437843 3673346 0.01400 60110 66460703 47833008 18627694 0.07090 53733 53733 0.00020 5942 5942 59675 59675 0.00020 true 8356840 2841326 30085306 32128199 -2042893 X true true Caremark Behavioral health services 0.50000 Gastroenterology Associates Physican Specialist Svcs 0.74500 0.25500 PAR LLC Retirement residence mgmt 0.50000 ASSN-Unit Owners Plaza Cond Condo association mgmt 0.78000 Healthcare Resources Northw Managed care organization 1.00000 Gresham Family Medical Cent Physician Services 0.74500 0.12000 0.13500 1 0 Portland Adventist Medical Ctr

10123 SE Market Street Portland OR 97216

X X X X Portland Adventist Medical Ctr 1 true true 200.0000 true 399.0000 true X X X true false true false X true X false false 46 Adventist Health Physical Workforce

10101 SE Main Street LL Portland OR 97216

Workforce Therapy Clinic Advenstist Health Medical Clinic- Clackamas

11211 SE Sunnyside Road Clackamas OR 97015

Physician Clinic Adventist Health Medical Clinic- Diabetes & Endo Ctr

19255 SW 65th Ave Suite 110 Tualatin OR 97062

Physician Speciality Clinic Adventist Health Audiology

10201 SE Main Street Suite 1 Portland OR 97216

Audiology Services Adventist Health Medical Clinic- Rose City Family Medicine

7420 NE Sandy Blvd Portland OR 97213

Physician Clinic Adventist Health Medical Clinic- NW Orthopedic Specialists

10101 SE Main ST Suite 3012 Portland OR 97216

Physician Speciality Clinic Adventist Health Medical Clinic- Creekside Family Medicine

9200SE 91st Ave 220 Happy Valley OR 97086

Physician Clinic Adventist Health Medical Clinic- Radiation Oncology Center

10123 SE Market St Portland OR 97216

Physician Speciality Clinic Adventist Health Speech Therapy

10201 SE Main Street Suite 1 Portland OR 97216

Speech Theraphy Services Gresham Station Lab

831 NW Council Drivw Suite 120 Gresham OR 97030

Lab and Draw Station Adventist Health Medical Clinic-Mt Scott Internal Med

9200 SE 91st Ave Suite 300 Portland OR 97086

Physician Clinic Adventist Health Physical Therapy Vancouver

6069 SE 15th Street Vancouver WA 98683

Physical Therapy Clinic Adventist Health Home Infusion Therapy

5835 NE 122nd Ave 155 Portland OR 97320

Home Infusion Therapy Service Adventist Health Hospice-Tillamook

1015 Third St Tillamook OR 97141

Hospice Services- Tillamook Adventist Health Speciality Rehab

10101 SE Main Street LL Portland OR 97216

Speciality Rehab Therapy Clinic Adventist Health Medical Clinic-Gladstone Family Med

1105 Portland Ave Suite 2 Gladstone OR 97027

Physician Clinic Adventist Health Medical Clinic- NW Regional Heart Center

10000 SE Main St Suite 365 Portland OR 97216

Physician Speciality Clinic Adventist Health Medical Clinic-Occupational Medicine

10201 SE Main St Suite 29 Portland OR 97216

Physician Clinic and Corporate Services Adventist Health Medical Clinic-Camas

411 NE 6th Avenue Camas OR 98607

Physician Clinic Adventist Health Medical Clinic- Diabetes & Endo Ctr

10101 SE Main Street Suite 1001 Portland OR 97216

Physician Clinic Adventist Health Medical Clinic-Arthritis and Bone Care

10201 SE Main St Suite 25 Portland OR 97216

Physician Clinic Adventist Health Medical Clinic-Hoodland

24461 East Welches Road Welches OR 97067

Physician Clinic Adventist Health Physical Therapy Clackamas

13435 SE 97th LL101 Clackamas OR 97015

Physical Therapy Clinc Adventist Health Medical Clinic-Eastside Internal Med

10000 SE Main St Suite 128 Portland OR 97216

Physician Clinic Adventist Health Medical Clinic- Fishers Landing

417 SE 164th Ave Suite 300 Vancouver WA 98684

Physician Clinic Adventist Health Medical Clinic-Hazelwood

12615 NE Halsey Street Portland OR 97230

Physician Clinic Adventist Health Physical Therapy Sandy

37095 SE Hwy 26 Suite 102 Sandy OR 97055

Physical Therapy Clinic Tillamook Home Health

1015 Third Street Tillamook OR 97141

Home Health Services- Tillamook Adventist Health Oregon Hand Specialists

10000 SE Main St Suite 327 Portland OR 97216

Physician Speciality Clinic Adventist Health Medical Clinic-Portland Lung Clinic

10201 SE Main St Suite 11 Portland OR 97216

Physician Clinic Adventist Health Medical Clinic- Damascus

14450 SE Royer Road Damascus OR 97089

Physician Clinic Adventist Health Medical Clinic-Ventura Park

11510 SE Stark Street Portland OR 97216

Physician Clinic Adventist Health Medical Clinic- Cherry Park FP

10000 SE Main Street Suite 224 Portland OR 97216

Physician Clinic Adventist Health Medical Clinic-Sandy Family Practice & Urge

17055 Ruben Lane Sandy OR 97055

Physician Clinic and Urgent Care Adventist Health Medical Clinic-Internal Medicine Assoc

10201 SE Main St Suite 12 Portland OR 97216

Physician Clinic Adventist Health Medical Clinic- Gresham Station

831 NW Council Drive Suite 101 Gresham OR 97030

Physician Clinic Adventist Health Physical Therapy Gresham

831 NW Council Dr Suite 200 Gresham OR 97030

Physical Therapy Clinic Adventist Health Medical Clinic Gresham Station IM FP

831 NW Council Drive Suite 125 Gresham OR 97030

Physician Clinic Adventist Health Occupational Therapy

10101 SE Main Street LL Portland OR 97216

Occupational Therapy Services Adventist Health Medical Clinic- Rockwood Urgent Care

18750 SE Stark Street Portland OR 97233

Physician Clinic/ Urgent Care Adventist Health Physical Therapy Medical Center Outpt

10101 SE Main Street LL Portland OR 97216

Physical Therapy Services Adventist Health Home Medical Equipment

5835 NE 122nd Ave 155 Portland OR 97230

Home Medical Equipment Service Adventist Health Wound Healing and Hyperbaric Medicine

10201 SE Main St Suite 29 Portland OR 97216

Wound Care Service Adventist Health Hospice Portland

5835 NE 122nd Ave 155 Portland OR 97230

Hospice Services Adventist Health Home Health Agency

5835 NE 122nd Ave 155 Portland OR 97230

Home Health Services- Portland Adventist Health Gresham Station Imaging Center

831 NW Council Dr Suite 100 Gresham OR 97030

Imaging Center Part VI - Additional Information Supplemental for 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 for 7a-c: (Total expenses - (Provision for bad debts + Other revenue + Interest income)) divided by Gross patient charges7e,f,h,i are calculated based on specific expenses and revenues.7g uses specific cost to charge ratios for those departments Part V - Explanation of Number of Facility Type Hospice (2), Home Medical Equipment (1), Home Infusion Therapy (1),Home Health Services (2) Physician Clinics (27), Lab (1), Imaging (1), Pt/OT Clinics (10), Wound Care (1) Part VI - States Where Community Benefit Report Filed OR Part VI - Affilated Health Care System Roles and Promotion The hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communites served Part VI - Explanation Of How Organization Furthers Its Exempt Purpose We do not wait until a community member needs our services through our clinics or Emergency Department. We are active in the community we serve. By involving ourselves in various activities, groups, and outreaches, we communicate our willingness to serve our community and our commitment to our mission. Our community health needs assessment keeps us current with changes in the health of our community. By working with other groups and agencies we are better able to assess the needs of the community than if we relied only on our own resources. The hospital uses all available financial resources to improve the quality of the health care we provide and to better serve the needs of the community. Part VI - Community Building Activities Activities in this area focus on the root causes of health problems such as poverty and homelessness. By addressing the root causes of health problems, we help improve access to health care to individuals who might not be able to do so if these issues are ignored. While there are public health agencies that deal with these problems, they are limited to what they can do by budget limitations. Activities we were involved in 2011 include the following: 1)Mock job interviews with high school students.2)Shadow Nurses by students from the Center for Advanced Learning 6)Civic involvement and support of local Chambers of Commerce beyond normal business needs. Part VI - Community Information PAMCs primary service area is East Multnomah County. This area's lower income population as a percentage of the total population is growing as this population shifts from North Portland to East Portland. In addition the organization provides services to residents of Clackamas and Washington Counties in Oregon and Clark County in Washington. Portland, Vancouver (WA), and the suburbs surrounding these two cities lay within this four county area. Part VI - Patient Education of Eligibility for Assistance Financial assistance is a part of the community service provided by this hospital and is available to those individuals using our services.For those who are unable to pay, reasonable efforts will be made to assist the patient in obtaining help for payment of their medical bills from public agencies. If a patient indicates they cannot pay the bill, they are offered a charity care application. We contact an external firm to screen patients for eligibility for government assistance. The discussion of whether they can pay the bill may come up at any point (before admission, during the stay, after discharge or after the account is sent to a collection agency).Those who do not qualify for public funding will be considered for financial assistance under the hospital's financial assistance guidelines. Identifying a potential charity discount will begin as soon as information is provided that a patient may be receiving service. Part VI - Needs Assessment Every three years, PAMC partners with other local entities to conduct a community health needs assessment that helps to identify the health care gaps that exist within the hospitals service areas. That data and other key sources of information- such as the hospital's situation assessment, discharge data and pertinent healthcare trends- plays a prominent role in the hospital's annual strategic planning. Initiatives to achieve those goals are based on community demographics and the expressed and implied health care needs of the area's residents, communicated through the triennial community health needs assessment and other vehicles. Number of Hospital Faciltiy - 0 Part V, Line 19d - Other Billing Determination of Individuals Without Insurance The hospital's financial assistance policy has three income ranges for patients who received emergency, obsteric, and other medical care, which provides a discount based on Federal Poverty Guidelines. Number of Hospital Faciltiy - 0 Part V, Line 11h - Other Factors Used in Determing Amounts Charged Patients Income level and family size are considered. Individuals eligible for Medicaid also qualify for financial assistance Part III, Line 9b - Provisions On Collection Practices For Qualified Patients 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 III, Line 8 - Explanation Of Shortfall As Community Benefit The Medicare cost report apportions the hospitals 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 Revenue. *Medicare Cost Report Revenue 31,684,100 Prior Year Settlements 32,842 Cost Report Reimbursable Bad Debts 574,431 Estimates and Accrual Variances 25,372 Other (2,231,439) Subtotal - Amount reported in Pt III, line 5 30,085,306 Amounts include in Part 1, lines g and f 11,600,381 Total Medicare Revenue 41,685,687 *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 4 - Bad Debt Expense 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 as reported in the system-wide audited combined financial statements. The resulting figure has been reported as bad debts at cost on Part III, Line 2.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. 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, those accounts would have been reclassified from bad debt expense to charity care.The system-wide audited combined financial statements do not contain a footnote describing bad debt expense. Part I, Line 7g - Costs Associated With Physicans Clinics Specific ratios of cost to charges were use for each department.Departments: Hospice Home Health Cardiopulmonary Rehab Psych and Psych Physicians No Physician clinics are counted as subsidized X 0 0 X true true X X X X X false true false false false false false false false false TRYON ELLEN 355250 355250 RUSSELL DAVID 167131 22301 31397 16833 237662 15499 KINZER STEVEN 222163 41241 46681 16866 326951 30517 HEISER PAMELA 183188 33980 36500 19111 272779 22814 BENFIELD RONALD 242487 5033 52740 19147 319407 WING BILL 305801 15780 74419 15548 411548 PERRY MARK 240375 65704 52150 19294 377523 46464 RUSSELL THOMAS 364687 87269 83795 19218 554969 53610 WEHTJE RODNEY 340430 78784 87122 78557 16937 601830 52751 REINER SCOTT 577345 149092 181404 138780 21507 1068128 119583 REBOK DOUGLAS 533280 149092 175042 128096 19203 1004713 123894 DODDS LARRY 303557 171094 210693 79089 16971 781404 120139 CARMEN ROBERT 934340 267209 547748 18150 21654 1789101 424494 HERBER STEVEN 212461 7450 27400 14278 261589 Balme Benjamin 273439 25090 15014 8796 322339 Nerness Curtis 306928 16776 15014 16528 355246 Grise Murlan 335880 62458 2155 10802 16531 427826 Patillo Dominic 438179 2750 40644 4470 486043 Molloy Thomas 786677 11202 19491 817370 JONES DERYL 1782626 60 8590 1791276 1782626 Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Any items checked on this line are reported as taxable income to the employee, except first class or charter travel, which is only approved for business purposes on an exception basis. Wes Rippey MD Director Physician services false Form 990, Part VII, Line 1a-Board Comp Robert BradshawThe directors serve on the Board without compensation. Amounts reported generally are for taxable benefits. Further explanation for those directors who receive compensation for services rendered in their professional capacity is discussed for each individual as applicable.Steven HerberSteven Herber, MD concurrently served as a Director and the Chief Medical Officer (CMO) for St. Helena Hospital. During 2011, Dr. Herber accepted the full-time appointment as the Sr. Vice President of Medical Affairs for affiliated hospitals in the St. Helena Region. He stepped down from the Board at that time and became an employee of Adventist Health. The hospital paid Dr. Herber $52,000 for his CMO services, which were provided under contract approved by the Board Compliance Committee (BCC). In addition, the hospital purchased Dr. Herber's medical practice assets in the amount of $14,076 with the approval of BCC.Meredith JobeJobe & Stoterau, a law practice with which Meredith Jobe is affiliated, provided legal services regarding real estate matters to White Memorial Medical Center in the amount of $12,288. In addition, Mr. Jobe provided real estate, labor and general legal advice to Adventist Health System/West in the amount of $40,018. Wesley RippeyWesley Rippey, MD is the Chief Medical Officer for Portland Adventist Medical Center. The hospital paid Dr. Rippey $57,600 for his CMO services. Additionally, Dr. Rippey provides vascular study interpretations and on call coverage for patients of the hospital. The hospital paid $38,655 for these professional services. These services were provided under contract approved by the Board Compliance Committee. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available The hospital does not make its governing documents publicly available, beyond required filings of articles of incorporation with the secretary of state. The hospital does not make its conflict of interest policy publicly available. The hospital files monthly/quarterly summary financial reports with the state health planning agency. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees 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 24 percent spread from minimum to maximum (industry norm is approximately a 50 percent spread). A hospital CEO has a maximum potential incentive of 30 percent of base salary. (This incentive potential is less than the industry norm.) Other hospital executives have a maximum potential incentive of 20 percent of base salary. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts 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 internal audit staff review these questionnaires and disclosures each year during the audit process. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process The completed Form 990 is shared with members of the hospital's board of directors by electronic communication for their review prior to filing. A special board meeting is scheduled to answer questions and receive input from the board after their review but prior to filing. Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders Part VI, Line 7aThe hospital bylaws define its board of directors to be the same individuals who are members of the Adventist Health System/West board of directors. Adventist Health System/West, a California not-for-profit religious corporation, is the sole corporate member of the hospital.Part VI, Line 7bThe sole corporate member, Adventist Health System/West, must approve all changes to the articles of incorporation and bylaws. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder The hospital is organized as a not-for-profit religious corporation. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The hospital operates as an affiliate of Adventist Health System/West. White Memorial Medical Center 1720 Cesar E Chavez Ave Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Walla Walla General Hospital 1025 S Second Ave Walla Walla WA 99362 910617726 Hospital WA 501(c)(3) 1 Adventist Health SystemWest false Ukiah Adventist Hospital 275 Hospital Dr Ukiah CA 95482 941639901 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Northwest Medical Foundn of Tillamook 1000 Third St Tillamook OR 97141 930622075 Hospital OR 501(c)(3) 1 Adventist Health SystemWest false Sonora Community Hospital 1000 Greenley Rd Sonora CA 95370 941415069 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Simi Valley Hospital & Hlth Care Svcs 2975 N Sycamore Dr Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Selma Community Hospital Inc 1141 Rose Ave Selma CA 93662 770509133 Supporting Hanford Community Hospital CA 501(c)(3) 11, Typ 3 func integ Adventist Health SystemWest false San Joaquin Community Hospital 2615 Chester Ave Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false St Helena Hospital 10 Woodland Rd St Helena CA 94574 941279779 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Paradise Valley Hospital 2100 Douglas Blvd Roseville CA 95661 951816034 Wind Down After Sale of Hospital Facilities CA 501(c)(3) 1 Adventist Health SystemWest false Willits Hospital Inc 1 Madrone St Willits CA 95490 680108919 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Hanford Community Hospital 450 Mall Dr Hanford CA 93230 940535360 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Glendale Adventist Medical Center 1509 Wilson Ter Glendale CA 91206 951816017 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Feather River Hospital 5974 Pentz Road Paradise CA 95969 941101228 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Central Valley General Hospital 1025 N Douty Street Hanford CA 93230 770324630 Hospital CA 501(c)(3) 1 Adventist Health SystemWest false Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) 1 Adventist Health SystemWest false Adventist Health Clearlake Hospital Inc 15630 Ave 18th Ave Clearlake CA 95422 680395149 Hospital CA 501(c)(3) 3 Adventist Health SystemWest false Adventist Health SystemWest 2100 Douglas Blvd Roseville CA 95661 953484589 Support and Manage System-Wide Activities CA 501(c)(3) 1 NA false PAR LLC 10610 SE Clay Street Portland OR 97216 931262371 Sr Living OR N/A 4805222 10621787 true 39 false 0.50000 South Coast Medical Center 2100 Douglas Blvd Roseville CA 95661 952037291 Wind down after sale of hospital CA N/A C Corp Gastroenterlogy Associates PC 10000 SE Main St 112 Portland OR 97216 930583031 Physician Office OR N/A C Corp 1262900 336428 1.00000 Assn Unit Owners Portland Adv Condo 10101 SE Main St Portland OR 97216 930887521 Condo Assn-MOB OR N/A C corp 225342 53527 0.78000 Healthcare Resources Northwest 2625 SE 98th Ave Portland OR 97266 931166731 Medical Mgnt Services OR N/A C corp 14500345 3785730 1.00000 Gresham Family Medical Center 1700 SW 257th Ave Troutdale OR 97060 911768081 Physician Office OR N/A C Corp 2114024 324580 1.00000 true false false false true false false false true true true true true true true true true true Gastroenterlogy Associates PC p 485000 Gastroenterlogy Associates PC n 770200 Gastroenterlogy Associates PC a 30219 Assn Unit Owners Portland Adv Condo q 305209 Assn Unit Owners Portland Adv Condo p 134190 Assn Unit Owners Portland Adv Condo n 25704 Healthcare Resources Northwest r 1083256 Healthcare Resources Northwest q 379736 Healthcare Resources Northwest p 1954396 Healthcare Resources Northwest n 1100956 Healthcare Resources Northwest i 512 Healthcare Resources Northwest a 98423 Gresham Family Medical Center q 200000 Gresham Family Medical Center p 1973133 Gresham Family Medical Center n 716797 Gresham Family Medical Center m 30959 Gresham Family Medical Center a 132756 PAR LLC r 3030000