2011-08-12T15:48:36-05:00 2010-09-30 Moss Adams LLP 805 SW Broadway 1200 Portland OR 97205 990 2009-10-01 930508781 Sky Lakes Medical Center SKYL 5412746311 2865 Daggett Avenue Klamath Falls OR 97601 Richard Rico 5412746311 2011-08-11 1 Wendy Campos 5032421447 2009 2016-02-24 21:20:13Z RICHARD RICO 2865 Daggett Avenue Klamath Falls OR 97601 323530004 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. 9 8 1209 322 6018 4187 739439 640948 294833936 321053289 3898207 609910 -501304 461533 298970278 322765680 818659 327147 0 63678823 65459152 0 0 227701018 239866341 292198500 305652640 6771778 17113040 143654620 158047175 67656092 64829606 75998528 93217569 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 252214794 48428 317571920 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. 14817997 Uncompensated Care - During Fiscal Year 2010, Sky Lakes Medical Center continued to see an increase in 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 as Bad Debt totaled $14,817,997. As a percentage of charges, these represent 5.6%. For fiscal years 2009 and 2008, the percentage was 5.9% and 4.4%, respectively. 8538269 192594 1412423 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: Financial contributions to the Oregon Institute of Technology's (OIT) Allied Health Program and to the OIT Nursing Scholarship Fund; 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; committment 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. 6237313 86125 1813630 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. 6237313 86125 1813630 281808373 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 203 0 1 1209 1 1 1 0 0 0 0 0 0 0 0 9 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 CFO 5412746150 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 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 Linda Weider 1.00 X 0 0 0 Gregory Sindmack MD 1.00 X 0 0 0 Paul Stewart 40.00 X X 423169 0 25933 RICHARD RICO 40.00 X 194941 0 22262 GRANT W NISKANEN MD 40.00 X 201567 0 12250 FREDERICK L ZWARTVERWER MD 35.00 X 179313 0 20255 DON L YORK 40.00 X 156652 0 20196 WILLIAM MILIMUKA 40.00 X 145118 0 18230 Mychal B Amos 40.00 X 139489 0 24461 1440249 0 143587 37 0 1 0 HEALTH FUTURE 777 MURPHY ROAD MEDFORD OR 97504 THIRD PARTY ADMIN SERVICES 1780518 ASD HEALTHCARE PO BOX 848104 DALLAS TX 75284 CONTRACT LABOR 787469 SOUTHERN OREGON LINEN SERVICES INC 635 AVENUE C WHITE CITY OR 97503 LAUNDRY 533741 REVENUE CYCLE PARTNERS LLC 1643 LEWIS AVENUE 203 BILLINGS MT 59102 SELF PAY COLLECTION SERVICE 489711 THE MANDALA AGENCY 2855 NW CROSSING DRIVE SUITE 201 BEND OR 97701 MARKETING SERVICES 407262 19 640948 15218 640948 Patient Revenue 621990 317571920 317571920 Other Program Revenue 621990 3481369 3481369 321053289 612135 612135 922529 701589 220940 220940 220940 2225 -2225 -2225 -2225 131838 60510 71328 71328 OTHER INCOME 900099 418563 418563 INCOME FROM SUBSIDIARI 621990 -249298 -255316 6018 169265 322765680 320797973 6018 1320741 86125 86125 241022 241022 782046 782046 50090050 45410671 4679379 2212969 2023703 189266 7692919 7107261 585658 4681168 3470151 1211017 469487 16896 452591 136437 136437 5882578 5489457 393121 767701 20474 747227 1973684 1305475 668209 1482900 41759 1441141 1734950 1491642 243308 118309 101338 16971 392858 287700 105158 3298355 2055 3296300 7650188 2984758 4665430 3073289 542297 2530992 Contractual Allowance 149212998 149212998 Supplies 24382131 24406441 -24310 Bad debt expense 14817997 14817997 Charity Care 12743463 12743463 TAXES PAID ON UBI 1550 1550 11727466 10004690 1722776 305652640 281808373 23844267 0 186442 467564 9475730 25715056 20161503 21702325 2417207 2699898 3492605 2191378 160201833 72875680 91734160 87326153 1134829 2031344 2368682 14155629 14441290 143654620 158047175 5587317 4705771 2582065 2622197 52832329 52122247 1321903 1247993 5332478 4131398 67656092 64829606 X 75998528 93217569 75998528 93217569 143654620 158047175 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1325402 1325402 106470427 41277110 65193317 4198224 1870682 2327542 34688392 23943775 10744617 13519388 5784113 7735275 87326153 Assets LIMITED AS TO USE 4955968 Other Assets 1927630 Estimated third-party payor settlements 651972 Deferred Financing Costs 1641347 Construction in Process 590419 Other Receivables 4673954 14441290 Capital Lease obligations 4131398 4131398 Part X: Description of Uncertain Tax Positions Under FIN 48: The Medical Center had no unrecognized tax benefits at September 30, 2010 or at September 30, 2009. The Medical Center recognizes interest accrued and penalties related to unrecognized tax benefits as an administrative expense. During the years ended September 30, 2010 and 2009, the Medical Center recognized no interest and penalties. 1 1 1 X 1 X 1 1 1 0 1 1 5028691 5028691 0.01730 22210991 22244162 -33171 0.00000 27239682 22244162 4995520 0.01730 34 321864 371738 371738 0.00130 1 5902 4928097 1524947 3403150 0.01170 4 202358 6431881 1663726 4768155 0.01640 4 382 4961 4961 0.00000 43 530506 11736677 3188673 8548004 0.02940 43 530506 38976359 25432835 13543524 0.04670 4 101432 10528 10528 0.00000 5 100143 9569 9569 0.00000 7 2350 209886 209886 0.00070 16 203925 229983 229983 0.00070 0 5698508 1082717 41316360 42087961 -771601 X 1 1 SKY LAKES MEDICAL CENTER

2865 DAGGETT AVENUE KLAMATH FALLS OR 97601

X X X X 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. THE MEDICAL CENTER PERFORMS ONGOING CREDIT EVALUATIONS OF ITS PATIENTS, BUT TYPICALLY DOES NOT REQUIRE COLLATERAL. THE MEDICAL CENTER PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS THROUGH A CHARGE TO CURRENT EARNINGS FOR SPECIFIC RECEIVABLES JUDGED UNLIKELY TO BE COLLECTED BASED ON THE AGE OF THE RECEIVABLE, THE MEDICAL CENTER'S EXPERIENCE WITH THE DEBTOR, POTENTIAL OFFSETS TO THE AMOUNT OWED, AND ECONOMIC CONDITIONS. THE MEDICAL CENTER'S ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND BAD DEBT TOTALED $41,023,358 AND $38,018,414 AT SEPTEMBER 30, 2010 AND 2009, RESPECTIVELY.BAD DEBTS ARE ACCRUED MONTHLY AT A FIXED PERCENTAGE OF GROSS CHARGES. BOOKED BAD DEBT EXPENSE IS ROUTINELY COMPARED TO ACTUAL BAD DEBT WRITE OFFS, 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.BAD DEBT EXPENSE AT COST IS ESTIMATED BY APPLYING THE COST-TO-CHARGE RATIO TO TOTAL BAD DEBT EXPENSE. SKY LAKES MEDICAL CENTER OFFERS A CHARITY CARE APPLICATION TO ALL PATIENTS, EITHER IN PERSON, VIA US MAIL OR ON THE HOSPITAL'S WEBSITE. A SAMPLE OF PROCESSED CHARITY CARE APPLICATIONS WAS TAKEN, AND IT WAS FOUND THAT 19% OF CHARITY CARE APPLICATIONS WERE TURNED TO BAD DEBT DUE TO LACK OF INFORMATION SUPPLIED BY THE HOUSEHOLD. THE COST OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY IS THEREFORE ESTIMATED AT 19% OF THE TOTAL ESTIMATED COST OF BAD DEBT. 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. OP LAB TESTS, OP 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 AN 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. 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 ARE LOCATED ON THE HOSPITAL'S WEBSITE AND ARE REFERENCED IN THE ONLINE BILL-MANAGEMENT SECTION OF THE SITE. THEY ALSO ARE AVAILABLE WHEN SERVICES ARE PERFORMED. IN ADDITION, UNINSURED PATIENTS ARE PROVIDED PATIENT ADVOCACY BASED ON ELIGIBILITY AND ENROLLMENT SERVICES FOR MEDICAID AND OTHER BENEFIT PROGRAMS. THE MEDICAL CENTER ENSURES INFORMATION ABOUT FINANCIAL ASSISTANCE AND APPLICATIONS FOR ASSISTANCE ARE AT ALL PATIENT REGISTRATION AREAS AND SPECIALLY TRAINED FINANCIAL COUNSELORS HELP APPLICANTS COMPLETE THE FORMS. 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 MAILED. IT IS ALSO COVERED DURING COURTESY PHONE CALLS IF THERE IS MENTION OF DIFFICULTY IN PAYING 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 GOVERNMENT PROGRAMS. 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 16.4 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, COMPARED 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 32ND OUT OF 33 RANKED OREGON COUNTIES ON SUCH FACTORS AS: POOR OR FAIR HEALTH (19 PERCENT VS. THE NATIONAL BENCHMARK OF 10 PERCENT), ADULT SMOKING (24 PERCENT VS. 15 PERCENT NATIONALLY), UNINSURED ADULTS (23 PERCENT VS. 13 PERCENT), PRIMARY CARE PROVIDERS (489:1 VS. 631:1), UNEMPLOYMENT (13.8 PERCENT VS. 5.3 PERCENT), CHILDREN IN POVERTY (24 PERCENT VS. 11 PERCENT), HIGH SCHOOL GRADUATION (60 PERCENT VS. 92 PERCENT), TEEN BIRTH RATE (19 PERCENT VS. 22 PERCENT), SEXUALLY TRANSMITTED DISEASE (172 VS. 83), MOTOR VEHICLE CRASH DEATH RATE (24 VS. 12), VIOLENT CRIME RATE (272 VS. 100), AND SINGLE-PARENT HOUSEHOLDS (32 PERCENT VS. 20 PERCENT). DURING 2009, APPROXIMATELY 17 PERCENT OF THE 23,000 VISITS TO SKY LAKES MEDICAL CENTER'S EMERGENCY DEPARTMENT RESULTED IN AN INPATIENT STAY - THAT'S ABOUT 3 PERCENT HIGHER THAN THE STATE AVERAGE. ABOUT TWO-THIRDS OF THE INPATIENTS AT SKY LAKES CAME IN VIA THE ER, VERSUS THE STATE AVERAGE OF ABOUT 53 PERCENT. Part VI, Line 5: COMMUNITY SUPPORT: ACTIVITIES INCLUDE KLAMATH-LAKE CHILD ABUSE RESPONSE AND EVALUATION SERVICES (CARES). CARES IS DEDICATED TO PROVIDING SAFE, COMPREHENSIVE, OBJECTIVE MEDICAL ASSESSMENT, 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. THE LARGEST COMMUNITY SUPPORT ACTIVITY SUPPORTED BY SKY LAKES IS TRAUMA CALL COVERAGE. CALL PAY IS MADE TO SPECIALISTS THAT ARE NEEDED IN THE EVENT OF TRAUMA. THE SPECIALISTS ON THE TRAUMA CALL PANEL INCLUDE ORTHOPEDIC AND GENERAL SURGEONS AS WELL AS A NEUROSURGEON. WITHOUT THIS TRAUMA CALL PANEL, SEVERELY INJURED PATIENTS WOULD NEED TO BE STABILIZED IN THE SKY LAKES EMERGENCY DEPARTMENT AND THEN HAVE TO UNDERGO LIFE THREATENING TRANSPORT TO ANOTHER HOSPITAL WITH AVAILABLE SPECIALISTS. THE NEAREST HOSPITAL IS LOCATED 70 MILES ACROSS THE CASCADE MOUNTAIN RANGE. 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 SUPPORTS EMPLOYEES INTERESTED IN PARTICIPATING IN LEADERSHIP KLAMATH. THIS PROGRAM WAAS DEVELOPED BY THE KLAMATH COUNTY CHAMBER OF COMMERCE IN RESPONSE TO THE ONGOING NEED FOR LEADERSHIP IN ALL AREAS OF PUBLIC SERVICE. FOR PARTICIPANTS, THE PROGRAM CREATES A COMPREHENSIVE AND OBJECTIVE AWARENESS OF THE KLAMATH COMMUNITY IN ACTION. THE PROGRAM FOSTERS COMMITMENT TO OUR REGION AND DEVELOPS LEADERS TO MEET THE DEMANDS OF THE FUTURE. LEADERSHIP KLAMATH EXPOSES PARTICIPANTS TO THE REALITIES, OPPORTUNITIES AND CHALLENGES FACING OUR AREA. THE PROGRAM CHALLENGES CLASS PARTICIPANTS TO BECOME MORE INVOLVED IN THE DECISION-MAKING PROCESS OF KLAMATH COUNTY IN POLITICAL, SOCIAL AND BUSINESS ARENAS. SKY LAKES MEDICAL CENTER ALSO PROVIDES LABOR AND FINANCIAL SUPPORT TO THE LOCAL HIGH SCHOOL AND THE OREGON INSTITUTE OF TECHNOLOGY'S OREGON CENTER FOR HEALTH PROFESSIONS.COALITION BUILDING: AS THE LARGEST EMPLOYER IN KLAMATH COUNTY, EMPLOYEES ARE ENCOURAGED AND SUPPORTED TO PARTICIPATE IN COALITION BUILDING ACTIVITIES. AMONG THE ACTIVITIES SUPPORTED ARE HOSPICE CARE; THE TEACHING OF EMT, CPR AND FIRST AID TRAINING COURSES; SPEAKING ENGAGEMENTS AT LOCAL PARISHES AND CONGREGATIONS; AND INVOLVEMENT IN LOCAL AND STATE CHAPTERS OF SOROPTOMIST AND ROTARY. SOROPTOMIST'S MISSION IS TO IMPROVE THE LIVES OF WOMEN AND GIRLS IN LOCAL COMMUNITIES. THE CLUBS IN THE NORTHWESTERN REGION OF SOROPTOMIST HAVE AN IDENTIFYING PROJECT ENTITLED "PROJECT WOMEN'S HEALTH." THE PROJECT INCLUDES ACTIVITIES THAT ENHANCE AWARENESS, ADVOCACY, AND ACTION FOR WOMEN'S HEALTH ISSUES SUCH AS CARDIOVASCULAR DISEASE, CANCERS, MENOPAUSE AND HORMONE REPLACEMENT THERAPY, OSTEOPOROSIS, DIABETES, EATING DISORDERS, PRENATAL CARE, AND MENTAL AND EMOTIONAL HEALTH.COMMUNITY HEALTH IMPROVEMENT ADVOCACY: SKY LAKES MEDICAL CENTER SUPPORTS A COMMUNITY-BASED, UNIVERSITY-ADMINISTERED THREE-YEAR TRAINING PROGRAM FOR FAMILY PRACTITIONERS. WHILE SKY LAKES SUSTAINS SIGNIFICANT LOSSES IN THE SUPPORT OF THIS PROGRAM, IT DOES PROVIDE OUR COMMUNITY WITH ACCESS TO PHYSICIANS AND COORDINATED MEDICAL CARE THAT WOULD OTHERWISE NOT BE AVAILABLE IN THE KLAMATH "BASIN." THE RESIDENCY MEDICAL PRACTICE INCORPORATES HOME VISITS AND A MOBILE HEALTH CLINIC. THESE EXTENSIONS OF THE CLINIC SETTING PROVIDE OUTREACH MEDICAL CARE TO COMMUNITY MEMBERS THAT ARE NOT OTHERWISE ABLE TO ACCESS MEDICAL CARE IN THE TRADITIONAL CLINIC SETTING. SPORTS PHYSICALS FOR HIGH SCHOOL ATHLETES ARE PROVIDED FREE OF CHARGE AT THE RESIDENCY CLINIC. IN ADDITION TO LOSSES RELATED TO THE RESIDENCY PROGRAM, OTHER UNPROFITABLE HOSPITAL-AFFILIATED MEDICAL PRACTICES ARE SUPPORTED BY THE MEDICAL CENTER. PHYSICIAN ACCESS AND CONTINUITY OF CARE ARE DEEMED ESSENTIAL TO THE COMMUNITY. SKY LAKES ALSO SUPPORTS COMMUNITY HEALTH IMPROVEMENT ADVOCACY VIA THE SOUTHERN OREGON METH PROJECT (SOMP). 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 FACT THAT 8 OUT OF 10 ARRESTS BEING MADE ARE 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 THOSE MADE TO NURSING STUDENTS; ELEMENTARY, MIDDLE AND HIGH SCHOOLS; AND LOCAL COLLEGES. MEETING ROOMS AND EQUIPMENT ARE MADE AVAILABLE TO THE PUBLIC FOR RELATED ACTIVITIES. EMPLOYEE SUPPORT - TIME AND MONETARY DONATIONS - OF LOCAL FOOD BANKS IS ALSO ENCOURAGED.WORKFORCE DEVELOPMENT: SINCE SKY LAKES IS AN ISOLATED RURAL HOSPITAL LOCATED IN A PHYSICIAN SHORTAGE AREA, SPECIALTY PHYSICIANS ARE ROUTINELY BEING SOUGHT BY LOCAL MEDICAL PRACTICES AND BY THE HOSPITAL. MOST OF THESE SPECIALISTS DO LITTLE TO GENERATE REVENUE FOR THE MEDICAL CENTER BUT ARE NEEDED BY THE COMMUNITY. LOCAL PRACTICES ARE OFTEN NOT FINANCIALLY ABLE TO UNDERGO THE EXPENSIVE AND TIME CONSUMING RECRUITMENT PROCESS SO THEY WILL REQUEST FINANCIAL AND/OR EMPLOYMENT ASSISTANCE FROM THE MEDICAL CENTER. OTHER WORKFORCE DEVELOPMENT ACTIVITIES INCLUDE EDUCATION FOR NURSING STUDENTS, INCLUDING AN ORIENTATION PROGRAM FOR NEW GRADUATES THAT MAY OR MAY NOT BE ELIGIBLE FOR EMPLOYMENT AT SKY LAKES UPON COMPLETION OF THE PROGRAM; EDUCATIONAL LUNCHES FOR COMMUNITY HEALTH PROFESSIONALS; AND VARIOUS MENTORING PROGRAMS. Part VI, Line 6: Besides providing 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 upwards of 700 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 very low cost, and scholarships are frequently available. 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 series is the annual 15-kilometer run, a 5K run, and a 5K walk for adults, and two shorter events: one-half and one-mile events for children. In 2011, a record-setting 480 entrants crowded 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 to be sure 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 underwrites the losses incurred in running Cascades East Family Medicine, a clinic and a family practice residency program, and the 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 Sprage 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 collateral support in the way of additional 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. 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. OR 1 MERLE WEST CENTER FOR MEDICAL RESEARCH 104 N 11TH STREET Klamath FALLS OR 97601 931256310 501(C)(3) 15625 GENERAL OPERATIONS OREGON TECH FOUNDATION 3201 CAMPUS DRIVE Klamath FALLS OR 97601 237056213 501(C)(3) 50000 OREGON CENTER FOR HEALTH PROFESSIONS KLAMATH COUNTY SCHOOL DISTRICT 10501 WASHBURN WAY KLAmath FALLS OR 97603 936000543 20000 HEALTH OCCUPATIONS PROGRAM ASSISTANCE 2 1 EMPLOYEE STUDENT LOAN FORGIVENESS 22 107638 EXTERNSHIP STIPENDS 6 13200 EMPLOYEE TUITION REIMBURSEMENT - FORGIVEN 4 10007 STUDENT LOAN ASSISTANCE TO EMPLOYEES 19 61749 PATIENT ASSISTANCE 194 48428 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 Paul Stewart 303169 0 0 0 120000 0 12250 0 13683 0 449102 0 0 0 RICHARD RICO 194941 0 0 0 0 0 6609 0 15653 0 217203 0 0 0 GRANT W NISKANEN MD 201567 0 0 0 0 0 12250 0 0 0 213817 0 0 0 FREDERICK L ZWARTVERWER MD 179313 0 0 0 0 0 7703 0 12552 0 199568 0 0 0 DON L YORK 156652 0 0 0 0 0 8916 0 11280 0 176848 0 0 0 WILLIAM MILIMUKA 145118 0 0 0 0 0 7256 0 10974 0 163348 0 0 0 Mychal B Amos 139489 0 0 0 0 0 7385 0 17076 0 163950 0 0 0 KLAMATH FALLS INTERCOMMUNITY HOSPITAL AUTHORITY 931061020 498413dq3 2006-08-31 39329258 REVENUE AND REFUNDING; MERLE WEST MEDICAL CENTER PROJECT 0 0 39329258 1758464 20841397 1170952 558445 15000000 2007 0 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 SOUTH VALLEY BANK & TRUST (SVBT) PAUL STEWART IS THE CEO OF SLMC AND IS A VOTING BOARD MEMBER AT SVBT 63607 SLMC PAYS FEES AND INTEREST TO SVBT 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 Annually each member of the board signs the conflict of interest disclosure statement. Anyone who does not complete it is reminded until all statements are received. 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. SOUTHERN OREGON EMERGENCY CARE LLC 2865 DAGGET AVENUE KLAMATH FALLS OR 97601 611595709 PHYSICIAN SERVICES OR 631210 N/A SKY LAKES MEDICAL CENTER FOUNDATION 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 930946020 FUNDRAISING AND STEWARDSHIP; SUPPORT MED CENTER OR 501(C)(3) 11c N/A Klamath Care Services Inc 2865 DAGGETT AVENUE kLAMATH FALLS OR 97601 930946018 SUPPORT MED CENTER (INACTIVE) OR 509(c)(3) 11c N/A KLAMATH MEDICAL BUSINESS CENTER LLC 2865 DAGGETT AVENUE KLAMATH FALLS OR 97601 020731372 REAL AND PERSONAL PROPERTY RENTAL OR N/A INVESTMENT 88019 558994 0 6018 1 WEST PHYSICIAN SERVICES LLC 2868 daggett avenue klamath falls OR 97601 870696029 PHYSICIAN SERVICES OR N/A C -657311 2890188 1.00000 PREFERRED HEALTH PLAN INC 2868 daggett avenue klamath falls OR 97601 931304315 HEALTH INSURANCE OR N/A C 1609049 853900 0.87000 0 0 1 1 0 0 0 0 0 1 0 0 1 1 0 1 0 0 KLAMATH MEDICAL BUSINESS CENTER LLC J 104087 WEST PHYSICIAN SERVICES LLC D 356627 WEST PHYSICIAN SERVICES LLC P 225434