2021-11-01T14:39:39-05:00 2020-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2020-01-01 813021580 FOUNDATION HEALTH LLC FOUN 9074585550 1650 COWLES STREET FAIRBANKS AK 99701 GARY RODERICK CFO 9074585550 2021-10-28 1 GARY RODERICK 999009999 MEGAN R RYAN P00737884 4254544919 2021-10-28 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z GARY RODERICK 1650 COWLES STREET FAIRBANKS AK 99701 318130235 0 X WWW.FOUNDATIONHEALTH.ORG X LLC 2016 AK COMPASSIONATE HEALTH CARE FOR EVERY CHAPTER IN YOUR LIFE STORY. 18 15 2371 92 2101303 826984 252387 31356025 308333601 283651697 92937 58083 4237952 3064430 312916877 318130235 100000 0 0 0 174487378 184808272 0 0 0 142863508 133430554 317450886 318238826 -4534009 -108591 99415943 117689591 26262256 38644495 73153687 79045096 A LIFETIME OF EXCELLENT CARE PROVIDED BY YOUR COMMUNITY HEALTH CARE TEAM. 0 0 257246838 0 283666135 FOUNDATION HEALTH LLC OWNS AND OPERATES FAIRBANKS MEMORIAL HOSPITAL (HOSPITAL), DENALI CENTER (HOME), AND TANANA VALLEY CLINIC (CLINIC). THE HOSPITAL IS A GENERAL ACUTE, SOLE COMMUNITY, 152 BED FACILITY. THE HOSPITAL SERVES PATIENTS FROM FAIRBANKS AND THROUGHOUT THE INTERIOR OF ALASKA PROVIDING INPATIENT CARE, EMERGENCY CARE AND A BROAD ARRAY OF OUTPATIENT MEDICAL SERVICES. THE HOME IS A 90 BED SKILLED NURSING CARE HOME THAT PROVIDES POST ACUTE CARE FOR SHORT TERM PATIENTS, AS WELL AS LONG TERM CARE FOR OTHER PATIENTS. THE CLINIC IS A MULTI-SPECIALTY CLINIC THAT OFFERS 15 MEDICAL SPECIALITIES AND OPERATES A WALK-IN CLINIC WITH AFTER HOURS SERVICES. THE HOSPITAL SERVED 47,398 PATIENTS IN 2020, INCLUDING 975 BABIES DELIVERED. THE HOME SERVED 205 INDIVIDUALS AND THE CLINIC PROVIDED ACCESS TO CARE FOR 42,485 PEOPLE. 257246838 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 62 0 1 2371 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X GARY RODERICK CFO 9074583310 1650 COWLES STREET FAIRBANKS AK 99701 JEFF COOK BOARD PRESIDENT 2.10 0.20 X X 0 0 0 JOE FAULHABER VICE PRESIDENT 2.10 0.20 X X 0 0 0 SCOTT BELL TREASURER 1.70 0.20 X X 0 0 0 WILLIAM VIVLAMORE SECRETARY 1.30 0.10 X X 0 0 0 MARK SIMON BOARD MEMBER 0.90 0.20 X 6250 0 0 STEVE FRANK BOARD MEMBER 1.20 0.20 X 0 0 0 LAURA BRUNNER BOARD MEMBER 40.00 0.20 X 465089 0 14285 ZACH WERLE BOARD MEMBER 40.00 0.00 X 366883 0 44649 RYAN BINKLEY BOARD MEMBER 0.50 0.10 X 0 0 0 JON COOK BOARD MEMBER 0.30 0.00 X 0 0 0 RICHARD HATTAN BOARD MEMBER 1.30 0.20 X 0 0 0 GALEN JOHNSON BOARD MEMBER 1.40 0.20 X 0 0 0 CHERYL KILGORE BOARD MEMBER 0.70 0.20 X 0 0 0 KAREN PERDUE BOARD MEMBER 1.70 0.20 X 0 0 0 BEN ROTH BOARD MEMBER 0.60 0.00 X 0 0 0 ELIZABETH SCHOK BOARD MEMBER 0.60 0.00 X 0 0 0 MARGARET SODEN BOARD MEMBER 1.30 0.20 X 0 0 0 CHARLENE OSTBLOOM BOARD MEMBER 0.10 0.00 X 0 0 0 SHELLEY EBENAL EXECUTIVE DIECTOR FHP CEO 40.00 0.00 X 352914 0 40901 CLINT BROOKS CHIEF OPERT OFFICER SHARED SERV 40.00 0.00 X 317444 0 30614 GARY RODERICK CHIEF FINANCIAL OFFICER 40.00 0.00 X 280798 0 27085 DANNY ROBINETTE CHIEF MEDICAL OFFICER NON-MGMT 40.00 0.00 X 426000 0 22104 STEPHEN LESLIE PHYSICIAN SERV CHIEF OPERT OFFICER 40.00 0.00 X 291879 0 13163 TERI KISS CHIEF QUALITY OFFICER 40.00 0.00 X 229752 0 6752 JENNIFER N WELCH CHIEF HR OFFICER 40.00 0.00 X 201071 0 37019 ELIZABETH WOODYARD CHIEF CLINICAL SERVICES 40.00 0.00 X 292158 0 29284 ROMEL C WRENN PHYSICIAN 40.00 0.00 X 978003 0 32852 CARY S KELLER PHYSICIAN 40.00 0.00 X 913871 0 42584 MILAN BAJMOCZI PHYSICIAN 40.00 0.00 X 873310 0 30323 LEE M PIERSON PHYSICIAN 40.00 0.00 X 867466 0 22381 GREGORY J WOOD PHYSICIAN 40.00 0.00 X 758433 0 25519 CAROL F BARNETT COMPLIANCE OFFICER (THRU 01/2020) 40.00 0.00 X 109596 0 3068 7730917 0 422583 329 1 1 0 CROSS COUNTRY STAF LA LOCKBOX FILE 50941 LOS ANGELES CA 90074 MEDICAL STAFFING 7476862 MAYO COLLABORATIVE DBA MAYO MEDICAL LABORATORIES PO 91 MINNEAPOLIS MN 55480 REFERENCE LAB SERVICES & CONSULTING SERV 1960633 LOCUMTENENS COM PO BOX 405547 ATLANTA GA 30384 PHYSICIAN FEES 683060 PATHOLOGY CONSULTANTS PO BOX 70100 FAIRBANKS AK 99707 PATHOLOGICAL LAB SERVICES 505269 HURON CONSULTING SERVICES 550 WEST VAN BUREN STREET CHICAGO IL 60607 BUSINESS CONSULTING COMPANY 401389 28 31356025 31356025 OUTPATIENT REVENUE 622110 131378903 129312552 2066351 INPATIENT REVENUE 621110 77673927 77673927 CLINIC 621111 45239446 45239446 NURSING HOME 623110 20113921 20113921 PHARMACY 446110 3785552 3754656 30896 5459948 5459948 283651697 52895 52895 238141 0 238141 238141 238141 5188 0 5188 5188 5188 CAFETERIA/MEALS 722514 1689632 1689632 DAY CARE CENTER 624410 626726 626726 SERVICE INCOME 900099 285806 285806 224125 14438 4056 205631 2826289 318130235 281568888 2101303 3104019 3608758 2408575 1200183 152111162 122906037 29205125 3273239 2643698 629541 16876877 13541179 3335698 8938236 8089686 848550 215142 215142 116173 116173 65250 65250 18184890 13825723 4359167 172254 600 171654 1916799 64800 1851999 13285084 11092054 2193030 47888173 38950243 8937930 374138 267823 106315 54369 12457 41912 425967 240915 185052 1570684 1149141 421543 MEDICAL SUPPLIES 20811273 20756193 55080 PHARMACEUTICAL SUPPLIES 10535956 10309467 226489 NON MEDICAL SUPPLIES 8163136 6687461 1475675 UBI TAXES -120737 -120737 9772003 4300786 5471217 318238826 257246838 60991988 0 23884392 34307684 4121598 8680776 58602318 61797158 7949759 8654178 3339210 2945103 0 0 610449 0 908217 1304692 99415943 117689591 24250042 27462001 1137722 10159370 874492 1023124 26262256 38644495 X 73153687 79045096 73153687 79045096 99415943 117689591 X -108591 6000000 X 0 1 X 1 0 X 0 0 0 0 0 0 1 65250 0 1 18200 83450 0 PART II-B, LINE 1: FOUNDATION HEALTH (FH) ENGAGED AN INDEPENDENT CONTRACTOR TO PROVIDE GOVERNMENT RELATIONS AND LOBBYING CONSULTING SERVICES. THE CONTRACTOR WORKED WITH THE ALASKA STATE LEGISLATURE AND GOVERNMENT ON COMPLEX ISSUES RELATED TO FH'S CHARITABLE MISSION IN 2020. IN 2020 FH PAID $65,250 FOR THESE SERVICES. ALASKA STATE HOSPITAL AND NURSING HOME ASSOCIATION USE 7% OF ALL DUES PAID TO THEM FOR SPECIFIC LOBBYING EXPENSES. 0 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1023124 1023124 318105014 0 318105014 25221 25221 318130235 318213605 -25221 -25221 318238826 0 318238826 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 25,221. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTEREST INCOME -25,221. 1 1 X 1 X 1 X 1 1 0 0 847207 847207 0.00270 75377163 49953203 25423960 0.07990 76224370 49953203 26271167 0.08260 168865 168865 0.00050 170593 170593 0.00050 44124034 34263604 9860430 0.03100 280881 280881 0.00090 44744373 34263604 10480769 0.03290 120968743 84216807 36751936 0.11550 5115 5115 0.00000 86500 86500 0.00030 91615 91615 0.00030 1 18648420 54804487 48615772 6188715 X 1 1 1 1 FAIRBANKS MEMORIAL HOSPITAL 1650 COWLES STREET FAIRBANKS AK 99701 HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH GACH-004 X X X FAIRBANKS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE PART V, SECTION C X 1 20 1 SEE PART V, SECTION C 0 1 X 100.000000000000 350.000000000000 X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY BENEFIT STEERING COMMITTEE (CBSC) GUIDED ALL ASPECTS OF THE CHNA PROCESS INCLUDING OVERSIGHT OF THE ASSESSMENT DATA AND PROCESS, PRIORITIZING IDENTIFIED HEALTH NEEDS, AND DEVELOPMENT OF IMPLEMENTATION STRATEGIES AND REPORTING. THE CBSC SERVED AS OVERSIGHT TO A BROADER COMMUNITY ADVISORY COMMITTEE (CAC) COMPRISED OF KEY INFORMANTS AMONG COMMUNITY ENTITIES SUCH AS PUBLIC HEALTH, GOVERNMENT (SEVERAL STATE, LOCAL, TRIBAL, AND REGIONAL), EDUCATION, AND SOCIAL SERVICES INCLUDING REPRESENTATION OF THE UNDERSERVED, MARGINALIZED, UNINSURED, AND MINORITY POPULATIONS. THERE WERE NO PUBLIC COMMENTS RECEIVED (VIA THE ORGANIZATION WEBSITE LINK) FOR THE 2016 CHNA AND IMPLEMENTATION REPORTS.SUMMARY INPUT FROM THE COMMMUNITY: A PHASED PROCESS OVER A FOUR MONTH PERIOD IN FALL 2019 WITH OVERSIGHT FROM AN INTERNAL STEERING COMMITTEE AND INCLUDED THE COMMUNITY ADVISORY COUNCIL. THE PHASED PROCESS INCLUDED ANALYSIS OF DETERMINANTS OF HEALTH DATA AND COMMUNITY HEALTH ASSESSMENT SURVEYS, PRIORITIZATION, HEALTH IMPROVEMENT PLANNING, AND IMPLEMENTATION PLANNING. THE RESULTING CHNA AND CHIP REPORTS WERE REVIEWED AND APPROVED FOUNDATION HEALTH LLC 81-3021580 BY THE ORGANIZATIONS GOVERNING BOARD. THE COMMUNITY ADVISORY COUNCIL INCLUDED KEY INFORMANTS FROM THE FOLLOWING ORGANIZATIONS WITH (*) INDICATING ORGANIZATIONS WHOSE FOCUS IS LARGELY MEDICALLY UNDERSERVED, LOW INCOME, MINORITY POPULATIONS - *FAIRBANKS NATIVE ASSOCIATION, *FAIRBANKS COMMUNITY MENTAL HEALTH, *ALASKA DIVISION OF PUBLIC HEALTH, US ARMY MEDICAL DEPARTMENT, *LOVE INC OF THE TANANA VALLEY, *INTERIOR COMMUNITY HEALTH CENTER, *LITERACY COUNCIL OF ALASKA, *ALASKA HEALTH FAIR, *UNITED WAY OF THE TANANA VALLEY, CITY OF FAIRBANKS, FAIRBANKS NORTH STAR BOROUGH SCHOOL DISTRICT, *INTERIOR CENTER FOR NON-VIOLENT LIVING, *NORTH STAR COUNCIL ON AGING, *FAIRBANKS NORTH STAR BOROUGH. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: 1) MENTAL HEALTH -(RECOGNIZING THE COMORBIDITY OF SUBSTANCE USE) FOCUS ON REDUCTION OF WAIT TIME FOR OUTPATIENT ACCESS, PARTNER TO SUPPORT YOUTH AND ADOLESCENT LOCAL PLACEMENT, ADJUST TO MEDICAID 1115 WAIVER CHANGING GAPS, PARTNER FOR HOUSING AND WORKFORCE SHORTAGES, COORDINATE LOCAL PLANNING AND SERVICES.2) SENIOR CARE - IMPROVE PUBLIC AND LEADER UNDERSTANDING OF ISSUES, INCREASE ACCESSBILITY FOR MENTAL AND PHYSICAL FITNESS, AID NAVIGATION, ADDRESS MEDICAID ELIGIBILITY WAIT TIME, PARTNER FOR HOUSING SOLUTIONS, ASESS WORKFORCE DEVELOPMENT, COORDINATE PLANNING. 3) ACES/TRAUMA - IMPROVE COMMUNITY UNDERSTANDING AND IMPACTS, EXPAND PREVENTION AND RESILIENCY PROGRAMS, CREATE COLLABORATIVE GROUP.4) HEALTHY BEHAVIORS - IMPROVE UNDERSTANDING OF RECOMMENDATIONS FOR WELLNESS CHECKS, MOVEMENT, NUTRITION, IMMUNIZATION. INCREASE SCREENING FOR 2030 HEALTHY ALASKAN INDICATORS, IMPROVE VACCINATION RATES, DEVELOP RESOURCE GUIDE, JOINT PLANNING AMONG SERVICES. EACH OF THESE FOUR GROUPS HAS AN ONGOING COMMUNITY WORK GROUP TEAM ESTABLISHED AND THE ORGANIZATION WILL SUPPORT THE FACILITATION OF ONGOING COLLABORATIONS. NEEDS ASSESSED BUT NOT ADDRESSED (OR ADDRESSED AS SUBSETS OF THE MAJOR FOUR): POVERTY, AIR/WATER QUALITY, PRENATAL CARE RATES, PREVENTABLE INJURIES, DENTAL, TRANSPORTATION, MOBILITY, BURNOUT, SUBSPECIALTY ACCESS, REMOTE LOCATIONS, VISITING NURSES, AND INTELLECTUAL DEVELOPMENTAL DISABILITIES. THE IDENTIFIED NEEDS WHICH ARE NOT SPECIFICALLY ADDRESSED WERE NOT ENTIRELY EXCLUDED, MANY ARE WITHIN THE CONTEXT OF THE FOCUS AREAS; THEY DID NOT HOWEVER RISE TO THE PRIORITIZATION LEVELS DESCRIBED IN 3.E. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: THE ORGANIZATION USES A FIXED DOLLAR HOUSEHOLD INCOME AMOUNT TO IDENTIFY PATIENTS ELIGIBLE FOR DISCOUNTED CARE. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: COVERAGE THROUGH OTHER PROGRAMS OR INSURANCE MUST BE EXHAUSTED OR DENIED. FAMILY SIZE. PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE PRIORITIZED AS A RESULT OF IDENTIFYING COMMUNITY HEALTH NEEDS THROUGHT THE CHNA PROCESS. THE ANALYSE PROCESS INCLUDED AN EVALUATION OF EACH IDENTIFIED HEALTH NEED RELATIVE TO FACTORS INCLUDING SERIOUSNESS OF THE ISSUE, SIZE OF THE ISSUE, CLEAR DISPARTIES OR INEQUITIES, LOCAL NEED BEING WORSE THAN NATIONAL RATES, AND ABILITY TO IMPACT. THE RESULTING PRIORITIZED NEEDS INCLUDE MENTAL HEALTH, SENIOR CARE/AGING, ADVERSE CHILDHOOD EXPERIENCES (ACES) AND TRAUMA AND THEIR IMPACT ON HEALTH AT EVERY AGE, AND PHYSICAL HEALTH AND OVERALL HEALTHY BEHAVIORS IMPACTING CHRONIC CONDITIONS. PART V, SECTION B, LINE 7A: HTTPS://WWW.FOUNDATIONHEALTH.ORG/OUR_COMMUNITY/COMMUNITY_HEALTH/COMMUNITY_NEEDS/CHNA PART V, SECTION B, LINE 10A: HTTPS://WWW.FOUNDATIONHEALTH.ORG/OUR_COMMUNITY/COMMUNITY_HEALTH/COMMUNITY_NEEDS/CHIP PART V, SECTION B, LINE 16: WEBSITE APPLICABLE FOR LINES 16A, 16B, 16C:HTTPS://WWW.FOUNDATIONHEALTH.ORG/PATIENTS_AND_VISITORS/BILL_PAY/FINANCIAL_ASSISTANCE 2 1 - TANANA VALLEY CLINIC LLC 1001 NOBLE STREET FAIRBANKS AK 99701 MULTI SPECIALTY CLINIC 2 - DENALI CENTER 1510 19TH AVENUE FAIRBANKS AK 99701 SKILLED NURSING FACILITY PART I, LINE 3C: THE ORGANIZATION USES A FIXED DOLLAR HOUSEHOLD INCOME AMOUNT TO IDENTIFY PATIENTS ELIGIBLE FOR DISCOUNTED CARE. PART I, LINE 7: THE ORGANIZATION USED THE COST TO CHARGE RATIO FROM WORKSHEET 2 TO CALCULATE THE AMOUNTS REPORTED ON PART I, LINE 7. PART I, LINE 7G: FOUNDATION HEALTH OPERATES TANANA VALLEY CLINIC WHICH IS A MULTI-SPECIALTY CLINIC OFFERING FAMILY PRACTICE, PEDIATRIC, OB-GYN SERVICES AMONG OTHERS. THE CLINIC ACCEPTS ALL GOVERNMENT PAYERS INCLUDING MEDICARE AND MEDICAID WITH NO LIMITATIONS. THE CLINIC ALSO PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO QUALIFY. PART II: COMMUNITY BUILDING ACTIVITIES PROVIDE COALITION LEADERSHIP AND PARTICIPATION IN ESTABLISHED COMMUNITY COALITIONS FOR HOMELESSNESS, SUBSTANCE USE, BEHAVIORAL HEALTH CARE, AND PUBLIC HEALTH SERVICES SERVING THE INTERIOR OF ALASKA. PROMOTE COMMUNITY HEALTH VIA REPRESENTATION IN COMMUNITY COALITIONS FOR WELLNESS (SUICIDE PREVENTION), AGENET (SENIORS) AND ALASKA COMMISSION ON AGING (SENIORS). PROVIDE SPACE AND EMPLOYMENT COACHING SUPPORT SERVICES FOR WORKFORCE DEVELOPMENT AMONG PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (SEARCH PROGRAM) AND FOR STUDENTS IN PROGRAMS TO INTRODUCE HEALTH RELATED OCCUPATIONS. PART III, LINE 2: CONTRACTUAL (CT) AND BAD DEBT (BD) ALLOWANCES FOR HOSPITAL ACCOUNTS RECEIVABLE (A/R) BALANCES ARE CALCULATED EACH MONTH BY COMPARING TARGET ADJUSTMENTS TO OBSERVED ADJUSTMENTS; THE DIFFERENCE BETWEEN TARGET ADJUSTMENTS AND OBSERVED ADJUSTMENTS IS BOOKED AS AN ALLOWANCE. TARGET ADJUSTMENTS ARE FOUND BY APPLYING TARGET PERCENTAGES TO THE GROSS CHARGES THAT RESULTED IN CURRENT A/R BALANCES. TARGET PERCENTAGES ARE DERIVED FROM HISTORICAL ADJUSTMENT DATA, ON CLOSED ACCOUNTS, IN A LOOKBACK PERIOD CONTAINING 12 MONTHS. THE CT LOOKBACK PERIOD IS THE 12 MONTH PERIOD ENDING 3 MONTHS PRIOR TO THE CURRENT PERIOD. THE BD LOOKBACK PERIOD IS THE 12 MONTH PERIOD ENDING 15 MONTHS PRIOR TO THE CURRENT PERIOD. TARGET ADJUSTMENT PERCENTAGES ARE UPDATED EACH MONTH AND CALCULATED FOR ACCOUNT PORTFOLIOS BASED ON INPATIENT/OUTPATIENT DESIGNATION AND FINANCIAL CLASS. ACTUAL COLLECTIONS ON PRIOR PERIOD A/R BALANCES ARE REVIEWED TO ENSURE THE ALLOWANCE METHODOLOGY IS APPROPRIATE AND RELIABLY ESTIMATES A/R COLLECTABILITY. PART III, LINE 4: SEE AUDITED FINANCIAL STATEMENTS, PAGE 10 FOR DISCUSSION REGARDING THE ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 6 IS FROM THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS THAT WE BELIEVE MAY QUALIFY FOR FINANCIAL ASSISTANCE ARE TOLD ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND GIVEN AN APPLICATION (IF WANTED) DURING THE ADMISSIONS PROCESS. IF THE PATIENT APPLIES AND QUALIFIES, THE BALANCE IS WRITTEN OFF IN PART OR IN FULL. IF THE ACCOUNT IN NOT WRITTEN OFF ENTIRELY, THE REDUCED BALANCE IS TREATED IN THE SAME MANNER AS ACCOUNTS FOR PATIENTS WITHOUT INSURANCE, WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. THE COLLECTION POLICY INCLUDES 8 PATIENT STATEMENTS AND 2 REMINDER LETTERS SENT TO THE PATIENT. PAYMENT PLANS ARE MADE AVAILABLE; ATTEMPTS ARE MADE TO VERIFY PHYSICAL ADDRESSES OF PATIENTS; AND EFFORTS USED TO DETERMINE IF THE PATIENT MAY BE MEDICAID ELIGIBLE. OUR BILLING STAFF ATTEMPTS TO CONTACT AS MANY PATIENTS AS POSSIBLE. PART VI, LINE 2: A LINK FOR COMMUNITY FEEDBACK IS ON THE ORGANIZATION WEBSITE. THE LINK TRIGGERS AN EMAIL DIRECTLY TO THE COMMUNICATIONS DIRECTOR. THE COMMUNICATIONS DIRECTOR IS ACCOUNTABLE FOR ADDRESSING THE FEEDBACK AND REFERRING COMMUNITY NEED INPUT TO THE DIRECTOR, INTERNAL AND EXTERNAL AFFAIRS. THE TRAUMA TEAM OF THE EMERGENCY SERVICES AND THE CANCER TREATMENT PROGRAM CONDUCT FORMAL ANNUAL COMMUNITY NEEDS ASSESSMENTS ACCORDING TO ACCREDITATION STANDARDS. THE OUTCOME OF THEIR NEEDS ASSESSMENTS IS EVALUATED BY THE EXECUTIVE LEADERSHIP AND IS MERGED WITH ONGOING INPUT FOR THE NEXT CHNA. THE ADMINISTRATIVE TEAM OF THE HOSPITAL MAINTAINS FORMAL AND INFORMAL RELATIONSHIPS WITH GOVERNMENT, BUSINESS, PROVIDER, AND HEALTH SYSTEM CONSUMER GROUPS AND ROUTINELY ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AS REPRESENTED BY INPUT FROM THESE ENTITIES. PART VI, LINE 3: REGISTRATION STAFF OFFERS FINANCIAL ASSISTANCE INFORMATION AT THE TIME OF REGISTRATION FOR PATIENTS LACKING INSURANCE COVERAGE. MONTHLY BILLING STATEMENTS INCLUDE A PHONE NUMBER TO CALL FOR INFORMATION ON FINANCIAL ASSISTANCE AND POSSIBLE ELIGIBILITY FOR OTHER PROGRAMS. INPATIENTS WITH NO INSURANCE ARE CONTACT BY OUR INPATIENT FINANCIAL SERVICES REPRESENTATIVE FOR MEDICAID SCREENING. WE ALSO CONTRACT WITH A THIRD PARTY VENDOR TO CONDUCT OUTREACH TO DISCHARGED PATIENTS WITH SELF PAY BILLS TO ASSIST THEM TO APPLY TO OTHER PROGRAMS SUCH AS MEDICAID. MEDICARE FINANCIAL ASSISTANCE BROCHURES ARE AVAILABLE IN THE EMERGENCY DEPARTMENT AND OTHER REGISTRATION AREAS. INFORMATION REGARDING OUR FINANCIAL ASSISTANCE PROGRAM IS PUBLISHED ON OUR WEBSITE. PART VI, LINE 4: FAIRBANKS MEMORIAL HOSPITAL IS THE SOLE COMMUNITY PROVIDER AND ONLY STATE LICENSED HOSPITAL IN ITS PRIMARY AND SECONDARY SERVICE AREAS.- THE PRIMARY AREA INCLUDES THE 7,400 SQUARE MILE FAIRBANKS NORTH STAR BOROUGH (FNSB) POPULATION 100,031 - THE SECONDARY AREA IS APPROXIMATELY 127,000 SQUARE MILES OF WHAT IS REFERRED TO AS INTERIOR OR NORTHERN ALASKA - WITH VERY FEW OF THE COMMUNITIES IN THIS AREA ACCESSIBLE BY ROAD.- OVERALL, THE HOSPITAL'S SERVICE POPULATION IS ESTIMATED TO BE A POPULATION OF 139,288 WITH 89 PERCENT OF THE HOSPITAL BUSINESS SERVING THE PRIMARY AREA; FAIRBANKS NORTH STAR BOROUGH.- THE NEXT CLOSEST HOSPITAL IS 350 MILES SOUTH OF FAIRBANKS.THOSE WHO ARE NOT SERVED BY THIS HOSPITAL ARE POTENTIALLY RECEIVING SERVICES FROM TANANA CHIEFS CONFERENCE - CHIEF ANDREW ISAAC HEALTH CENTER (AN INDIAN HEALTH SERVICE), BASSETT ARMY COMMUNITY HOSPITAL (FOR MILITARY BENEFICIARIES), AND AN AMBULATORY SURGERY CENTER. PER U.S. CENSUS BUREAU, THE FAIRBANKS NORTH STAR BOROUGH POPULATION IS 71% WHITE, 6% ALASKA NATIVE/AMERICAN INDIAN, 4% BLACK, AND SMALLER PERCENTAGES ARE ASIAN, HISPANIC, AND TWO OR MORE RACIAL DESCENTS. THE MEDIAN AGE IS 31.7 YEARS WITH LARGEST AGE GROUP BEING 20-29 YEARS OLD (21%) AND ALL AGE GROUPS UNDER 40 EXCEED U.S. AVERAGE AND 13% ARE 60 AND OLDER.MEDIAN HOUSEHOLD INCOME IS $75,488, PER CAPITA INCOME $35,328. MEDIAN HOUSE VALUE $259,500 AND 59% OF HOUSING IS OWNER OCCUPIED. OF ALL PERSONS, 7.7% BELOW THE POVERTY LINE, CHILDREN 10%. PERSONS WITHOUT HEALTH INSURANCE, UNDER AGE 65 AT 13%. VETERANS COMPRISE 16% OF THE POPULATION. NO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS ARE PRESENT IN THE FNSB. PART VI, LINE 5: FAIRBANKS MEMORIAL HOSPITAL IS GOVERNED BY A COMMUNITY BOARD COMPRISED OF VOLUNTEER COMMUNITY REPRESENTATIVES. THE BOARD ESTABLISHES THE ORGANIZATIONS PRIORITIES, ENSURES OPERATIONS ARE CONSISTENT WITH THE NON-PROFIT PURPOSE AND MISSION, AND REINVESTS IN NEW EQUIPMENT AND TECHNOLOGY, NEW OR EXPANDED PATIENT SERVICES, AND MAINTAINS EXISTING ASSETS TO MEET COMMUNITY NEED AND LONG TERM HEALTH. FMH UTILIZES AN OPEN MEDICAL STAFF MODEL; THE HOSPITAL AND CLINIC ALSO EMPLOY AND CONTRACT WITH PROVIDERS TO ENSURE EFFICIENT, EVIDENCE-BASED, AND HIGH QUALITY CLINICAL CARE WITHIN AN INTEGRATED SYSTEM ALONG THE FULL CONTINUUM OF CARE. THE HOSPITAL FUNCTIONS IN A BOROUGH AND CITY GOVERNMENT STRUCTURE THAT DOES NOT INCLUDE A PUBLIC HEALTH INFRASTRUCTURE OUTSIDE THE STATE SYSTEM RESOURCES; THEREFOR, FOR ALL PUBLIC HEALTH INITIATIVES AND EMERGENCIES, THE HOSPITAL FUNCTIONS AS CRITICAL PUBLIC HEALTH FACILIATOR, PLANNER, AND PROVIDER. THE HOSPITAL ALSO FUNCTIONS IN COLLABORATION WITH ALASKA TRIBAL HEALTH PROVIDERS AND ARMY-AIRFORCE HEALTH PROVIDERS, ALL OF WHICH PARTNER FOR EMERGENCY PREPAREDNESS. PART VI, LINE 6: FOUNDATION HEALTH LLC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7: ALASKA DOES NOT REQUIRE FILING OF A COMMUNITY BENEFIT REPORT. X X X 1 0 0 1 0 1 0 0 0 ROMEL C WRENN PHYSICIAN 808041 0 164016 0 5946 0 11400 0 21452 0 1010855 0 0 0 CARY S KELLER PHYSICIAN 858248 0 0 0 55623 0 11400 0 31184 0 956455 0 0 0 MILAN BAJMOCZI PHYSICIAN 760519 0 107581 0 5210 0 0 0 30323 0 903633 0 0 0 LEE M PIERSON PHYSICIAN 698144 0 137598 0 31724 0 0 0 22381 0 889847 0 0 0 GREGORY J WOOD PHYSICIAN 670708 0 83605 0 4120 0 11400 0 14119 0 783952 0 0 0 LAURA BRUNNER BOARD MEMBER 339320 0 110822 0 14947 0 11400 0 2885 0 479374 0 0 0 DANNY ROBINETTE CHIEF MEDICAL OFFICER NON-MGMT 200897 0 0 0 225103 0 8712 0 13392 0 448104 0 0 0 ZACH WERLE BOARD MEMBER 274911 0 89065 0 2907 0 11400 0 33249 0 411532 0 0 0 SHELLEY EBENAL EXECUTIVE DIECTOR FHP CEO 301352 0 33540 0 18022 0 11400 0 29501 0 393815 0 0 0 CLINT BROOKS CHIEF OPERT OFFICER SHARED SERV 283476 0 29815 0 4153 0 11028 0 19586 0 348058 0 0 0 ELIZABETH WOODYARD CHIEF CLINICAL SERVICES 271865 0 19222 0 1071 0 7762 0 21522 0 321442 0 0 0 GARY RODERICK CHIEF FINANCIAL OFFICER 261855 0 13791 0 5152 0 423 0 26662 0 307883 0 0 0 STEPHEN LESLIE PHYSICIAN SERV CHIEF OPERT OFFICER 289107 0 0 0 2772 0 11400 0 1763 0 305042 0 0 0 JENNIFER N WELCH CHIEF HR OFFICER 181771 0 18720 0 580 0 7567 0 29452 0 238090 0 0 0 TERI KISS CHIEF QUALITY OFFICER 182108 0 20940 0 26704 0 5943 0 809 0 236504 0 0 0 CAROL F BARNETT COMPLIANCE OFFICER (THRU 01/2020) 10465 0 0 0 99131 0 450 0 2618 0 112664 0 0 0 PART I, LINE 4A DANNY ROBINETTE RECEIVED A SEVERANCE PAYMENT OF $212,389 DURING 2020. CAROL BARNETT RECEIVED A SEVERANCE PAYMENT OF $99,131 DURING 2020. PART I, LINE 5 PHYSICIANS RECEIVE PRODUCTION PAY IN ADDITION TO THEIR BASE COMPENSATION. A SET SPECIFIC RATE OF PAY IS PAID PER WORK RELATIVE VALUE UNIT PERFORMED OVER AN AGGREGATE THRESHOLD. PART I, LINE 6 THE EXECUTIVE PERFORMANCE INCENTIVE (EPI) IS AN INCENTIVE PAY PLAN DESIGNED TO REWARD AND RECOGNIZE EXECUTIVES FOR ORGANIZATION PERFORMANCE. THE AMOUNT OF THE ACTUAL AWARD IS DETERMINED AS A PERCENTAGE OF BASE PAY AND THE LEVEL OF PERFORMANCE ACHIEVED AGAINST FHP'S OPERATING PRIORITIES. EACH ELIGIBLE EXECUTIVE IS ELIGIBLE FOR A 15% TARGET / 20% MAXIMUM AWARD AS A PERCENTAGE OF BASE SALARY. IF ORGANIZATION PERFORMANCE FALLS ABOVE THE TARGET BUT BELOW THE MAXIMUM, THEN THE AWARD WOULD BE PRORATED TO BE PAID AS THE PERCENTAGE BETWEEN THE TARGET AND MAXIMUM RATE BASED ON THE GOAL RESULT. RESULTS ABOVE THE MAXIMUM WOULD BE PAID AT THE MAXIMUM PERCENTAGE. FORM 990, PART I, LINE 6: VOLUNTEER HOURS ARE CALCULATED BY INDIVIDUALS LOGGING THEIR HOURS ON OUR VOLGISTICS KIOSK AND THEIR TIME IS DIVIDED INTO CLERICAL AND PATIENT/RESIDENT CARE. THE TOTAL HOURS VOLUNTEERS SERVED WAS 3,711 HOURS IN 26 DEPARTMENTS. SOME EXAMPLES OF THEIR SERVICE INCLUDE OFFERING SPIRITUAL CARE BY DENOMINATION FOR THOSE WHO REQUEST IT AND PET THERAPY BY APPOINTMENT AS WELL AS BEDSIDE VISITS AND HELPING IN OUR CAFETERIA, GIFT SHOP AND VARIOUS OFFICES WHICH REQUEST THEIR ASSISTANCE. FORM 990, PART VI, SECTION A, LINE 6 FOUNDATION HEALTH'S SOLE MEMBER IS GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A FOUNDATION HEALTH'S SOLE MEMBER, GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION, APPOINTS 5 OF FOUNDATION HEALTH'S BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE APPROVAL BY THE ORGANIZATION'S SOLE MEMBER: 1) SALE OF ALL OR SUBSTANTIALLY ALL ASSETS OF THE COMPANY; 2) SUBSTANTIALLY CHANGING THE NATURE OR SCOPE OF THE BUSINESS OF THE COMPANY; 3) THE PARTICIPATION IN PARTNERSHIP AGREEMENTS, JOINT VENTURES, OR OTHER ASSOCIATIONS OF ANY KIND WITH ANY PERSON OR PERSONS; 4) EQUIPMENT PURCHASES EXCEEDING $5,000 AND EXCEEDING THE APPROVED OPERATING BUDGET; 5) ENTERING INTO GUARANTIES; INCURRING LIABILITIES; BORROWING MONEY, ISSUING NOTES, BONDS, AND OTHER OBLIGATIONS; OR SECURING ANY COMPANY OBLIGATION BY MORTGAGE OR PLEDGE OR ANY COMPANY PROPERTY OR INCOME; AND 6) LENDING MONEY, INVESTMENT OR REINVESTMENT OF THE COMPANY'S FUNDS, OR RECEIPT AND HOLDING OF PROPERTY AS SECURITY FOR REPAYMENT, INCLUDING, WITHOUT LIMITATION, LOANING MONEY TO, AND OTHERWISE HELPING THE MEMBER, ANY OFFICERS, EMPLOYEES, OR AGENTS. FORM 990, PART VI, SECTION B, LINE 11B A FULL COPY OF THE FORM 990 WILL BE EMAILED TO THE BOARD FOR THEIR REVIEW PRIOR TO SUBMISSION. ANY QUESTIONS WILL BE RESOLVED PRIOR TO OBTAINING THE SIGNATURE OF THE CFO. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS, OFFICERS AND THE QUALITY AND COMPLIANCE COMMITTEE MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST THAT MAY GIVE RISE TO A CONFLICT OF INTEREST PROMPTLY TO THE QUALITY AND COMPLIANCE COMMITTEE BOARD. THE COMMITTEE MUST THEN CONSIDER THE DISCLOSED INTEREST AND EITHER AUTHORIZE THE CONTINUATION OF THE POTENTIAL FINANCIAL INTEREST AND ANY RELATED TRANSACTION WITH APPROPRIATE PROTECTIONS, OR DISAPPROVE OF IT. OTHER FH EMPLOYEES MUST GO THROUGH A SIMILAR PROCESS OF DISCLOSURE TO THEIR RESPECTIVE SUPERVISOR AND TO THE QUALITY AND COMPLIANCE COMMITTEE. ALL BOARD MEMBERS, MEMBERS OF LOCAL BOARDS OF OWNED FACILITIES, OFFICERS OF FHP, ADMINISTRATORS, EMPLOYED PHYSICIANS, AND OTHER EMPLOYEES AND INDIVIDUALS DESIGNATED BY THEIR SUPERVISORS OR BY THE CHIEF COMPLIANCE OFFICER MUST COMPLETE AN ANNUAL SURVEY THAT IS DISTRIBUTED UNDER THE SUPERVISION OF THE CHIEF COMPLIANCE BOARD. THE SURVEY INCLUDES A QUESTIONNAIRE THAT IS DESIGNED TO IDENTIFY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, AS WELL AS OTHER TRANSACTION AND RELATIONSHIPS REQUIRED TO BE DISCLOSED IN THE FORM 990 AND SCHEDULE L. FORM 990, PART VI, SECTION B, LINE 15 FOUNDATION HEALTH PARTNERS USES A PAY RATE CALCULATOR IN ORDER TO DETERMINE COMPENSATION. THE FHP COMPENSATION BOARD APPROVES THE FHP PAY RATE CALCULATOR (PRC) GUIDELINES WHICH IS USED EVERY TIME AN OFFER OR PAY CHANGE IS MADE FOR AN EMPLOYEE. ANY OFFER OUTSIDE OF THE RECOMMENDED RANGE WILL REQUIRE AN APPROVAL. OFFER APPROVALS GO TO THE COMPENSATION AND BENEFITS TEAM, WHICH WILL THEN DECIDE WHAT TYPE OF APPROVAL IS ULTIMATELY REQUIRED. UNDER THE FHP PHILOSOPHY, AN EXCEPTION COMMITTEE WILL BE CREATED TO REVIEW REQUESTED EXCEPTIONS THAT ARE OTHERWISE CONTRARY TO FHP'S COMPENSATION PHILOSOPHY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ASSET TRANSFER FROM RELATED PARTY 6,000,000. 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