2020-10-26T08:57:11-05:00 2019-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-01-01 930386936 MID-COLUMBIA MEDICAL CENTER MID- 5412961111 PO BOX 1580 THE DALLES OR 97058 WENDY APLAND CFO 5412961111 2020-10-13 1 TERRI REXRODE CPA MST P00096513 9206620016 2020-10-13 184.100.239.163 2020-10-13 15:08:04 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7D2FE2EA17AC540A2D29D4112E82844D375299C1 2019 2021-01-29 14:40:06Z DENNIS KNOX PO BOX 1580 THE DALLES OR 97058 137021775 0 X WWW.MCMC.NET X 1984 OR TO LEAD AND ACT AS A CATALYST IN PROMOTING HEALTH FOR ALL PEOPLE; TO RECOGNIZE THE INDIVIDUAL AS A WHOLE HUMAN BEING WITH DIFFERENT NEEDS THAT MUST BE ENTHUSIASTICALLY MET; TO COMMUNICATE A VISION OF HEALTH, ART, EDUCATION, TECHNOLOGY AND A CENTER FOR HEALING WHICH WILL CONTINUALLY UPGRADE THE QUALITY OF LIFE IN THE COMMUNITY ENVIRONMENT IN WHICH WE ALL LIVE; TO EMPOWER PEOPLE TO BECOME PARTNERS IN THEIR HEALTH CARE.GUIDED BY THIS MISSION MCMC CONTINUES TO BE A SIGNIFICANT PARTNER CONTRIBUTING TO THE OVERALL HEALTH OF THE COMMUNITIES IT SERVES. 9 7 1073 232 0 0 37462 49748 130679352 133371578 823050 3349894 575986 250555 132115850 137021775 877607 614974 0 0 69334403 74255798 0 0 0 58600787 61113337 128812797 135984109 3303053 1037666 63130359 66067234 29450683 28919766 33679676 37147468 X TO LEAD AND ACT AS A CATALYST IN PROMOTING HEALTH FOR ALL PEOPLE; TO RECOGNIZE THE INDIVIDUAL AS A WHOLE HUMAN BEING WITH DIFFERENT NEEDS THAT MUST BE ENTHUSIASTICALLY MET; TO COMMUNICATE A VISION OF HEALTH, ART, EDUCATION, TECHNOLOGY AND A CENTER HEALING WHICH WILL CONTINUALLY UPGRADE THE QUALITY OF LIFE IN THE COMMUNITY ENVIRONMENT IN WHICH WE ALL LIVE; TO EMPOWER PEOPLE TO BECOME PARTNERS IN THEIR HEALTH CARE.GUIDED BY THIS MISSION MCMC CONTINUES TO BE A SIGNIFICANT PARTNER CONTRIBUTING TO THE OVERALL HEALTH OF THE COMMUNITIES IT SERVES. 0 0 128674967 614974 133100903 ACUTE HOSPITAL CARE:INPATIENT DAYS 6,499, INPATIENT REHAB DAYS 783, OUTPATIENT OBSERVATION DAYS 1,599, LABORATORY TESTS 214,424, IMAGING TESTS 30,706, HOME HEALTH EPISODES 2,026, EMERGENCY VISITS 15,060, ENDOSCOPY VISITS 1,875, MEDICAL ONCOLOGY 9,605, OUTPAIENT SURGERIES 1,518, RADIATION ONCOLOGY OUTPATIENT PROCEDURES 7,162, TOTAL HOSPITAL OUTPATIENT VISITS 102,878 AND TOTAL OUTPATIENT CLINIC VISITS 88,123.SEE SCHEDULE H FOR NARRATIVE OF PROGRAM SERVICE ACCOMPLISHMENTS. 128674967 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 124 0 1073 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X X WENDY APLAND 5412961111 PO BOX 1580 THE DALLES OR 97058 DENNIS KNOX PRESIDENT & CEO 40.00 X X 635212 0 29891 KEITH STELZER PHYSICIAN 40.00 X 542103 0 42496 GARY GINGRICH PHYSICIAN 40.00 X 466343 0 31290 LARRY KAHL - TERMED COO 40.00 X 424134 0 29767 NATHAN ULLRICH PHYSICIAN 40.00 X 394642 0 33215 MARC MCALLISTER PHYSICIAN 40.00 X 385618 0 41255 DONG XIANG PHYSICIAN 40.00 X 359848 0 34047 DAVID STURGEON - TERMED CFO 40.00 X 353614 0 24320 SERENE PERKINS CMO 40.00 X 324901 0 27206 PAUL CARDOSI MD DIRECTOR 40.00 X 309631 0 35955 DONALD WENZLER CNO 40.00 X 243472 0 27954 DALE LEPPER CIO 40.00 X 226907 0 12095 WENDY APLAND CFO 40.00 X 74961 0 4351 EDWIN BODE INTERIM CFO 40.00 X 73777 0 2223 WALLACE WOLF JR DVM CHAIR 1.00 X X 0 0 0 CARINA SCHMIDT VICE-CHAIR 1.00 X X 0 0 0 DANIEL BOLDT SECRETARY 1.00 X X 0 0 0 PHIL BRADY DIRECTOR 1.00 X 0 0 0 FRANK TODA DIRECTOR 1.00 X 0 0 0 MICHAEL HILL DIRECTOR 1.00 X 0 0 0 MICHELE SPATZ DIRECTOR 1.00 X 0 0 0 4815163 0 376065 109 0 1 0 ADAMS CONSTRUCTION 1215 E 18TH STREET THE DALLES OR 97058 CONSTRUCTION OF IMMEDIATE CARE FACILITY 439307 PATRICK GRIMSLEY DO PC 2880 BEAR RIDGE DR HOOD RIVER OR 97031 ER PHYSICIAN 316251 ROSONKE MEDICAL GROUP PC 4125 STONEGATE DR HOOD RIVER OR 97031 ER PHYSICIAN GROUP 309715 JOHN ELLIOTT MD 1027 LINCOLN ST HOOD RIVER OR 97031 ER PHYSICIAN 302579 WILLIAM BRAD FARRIS MD 905 STATE ST HOOD RIVER OR 97031 ER PHYSICIAN 258483 14 49748 49748 NET PATIENT SERVICE REVENUE 621500 106981692 106981692 PHARMACY REVENUE 446110 24478655 24478655 FITNESS & SPA CENTER 713940 1390001 1390001 CAFETERIA 900099 521230 521230 133371578 552051 552051 2797843 0 2797843 2797843 2797843 250555 250555 250555 137021775 133100903 0 3871124 X 614974 614974 623531 623531 60971499 58047928 2923571 2491483 2390545 100938 5991843 5975787 16056 4177442 4020464 156978 150253 150253 99724 99724 20957329 18261355 2695974 380950 380950 6076019 5592317 483702 2095417 2021958 73459 5586868 5522331 64537 371713 300730 70983 238892 188212 50680 521766 521766 4884033 4647004 237029 729955 708221 21734 MEDICAL SUPPLIES EXPENS 14572582 14570849 1733 REPAIRS & MAINTENANCE 2351579 2301868 49711 DUES & SUBSCRIPTIONS 219404 81472 137932 1876853 1802981 73872 135984109 128674967 7309142 0 13741 6008264 7913418 16983255 17746909 1962303 1877376 1406985 1491740 77805452 56050075 22771840 21755377 8266866 12566995 1410669 1410669 2401282 3209904 63130359 66067234 14281154 14642562 150706 180336 12646349 11018265 2372474 3078603 29450683 28919766 X 30756724 34969288 2922952 2178180 33679676 37147468 63130359 66067234 X 1037666 2430126 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 79841 79841 0 PART II-B, LINE 1: 2019 OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS DUES $58,643; 2019 AMERICAN HOSPITAL ASSOCIATION DUES $21,198 622933 622933 18523081 14013461 4509620 6902661 3485953 3416708 50289526 38463661 11825865 1467251 87000 1380251 21755377 MALPRACTICE LIABILITY - IBNR 670052 POST-RETIREMENT BENEFIT 1389656 DUE TO RELATED PARTIES 1018895 3078603 X 137159943 138168 138168 137021775 0 137021775 135369135 0 135369135 614974 614974 135984109 PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE MEDICAL CENTER DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 138,168. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS TO FOUNDATION 614,974. 1 1 X 1 X 1 X 1 1 1 0 1 1 1185313 1185313 0.00870 15955908 12211245 3744663 0.02750 17141221 12211245 4929976 0.03620 16 3707 277280 277280 0.00200 1 64 375297 375297 0.00280 3 269 7392 7392 0.00010 6596 250 6346 0.00000 7 0 1297580 1297580 0.00950 27 4040 1964145 250 1963895 0.01440 27 4040 19105366 12211495 6893871 0.05060 1 0 150118 150118 0.00110 1 180 174373 174373 0.00130 2 180 324491 324491 0.00240 1 2528856 36029202 39534417 -3505215 X 1 1 1 1 MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREET THE DALLES OR 97058 WWW.MCMC.NET 14-0500 X X X MID-COLUMBIA MEDICAL CENTER 1 0 0 1 X X X X X X X 19 1 1 1 1 X HTTP://WWW.MCMC.NET X 0 0 1 X 200.000000000000 400.000000000000 1 1 X X X 1 X HTTP://WWW.MCMC.NET X HTTP://WWW.MCMC.NET X HTTP://WWW.MCMC.NET X X X X X X X 1 X 0 X X X X 1 X 0 0 MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 5: MID-COLUMBIA MEDICAL CENTER PARTICIPATED AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) IN A COLLABORATIVE NEEDS ASSESSMENT IN 2019 WHICH INCLUDED INPUT FROM SIX COUNTY HEALTH DEPARTMENTS, FOUR HOSPITALS, THE LOCAL COORDINATED CARE ORGANIZATION, SOCIAL SERVICES AGENCIES IN THE REGION, HEALTH CARE PROVIDERS IN THE SERVICE REGION AND CONSUMER'S REPRESENTATIVE OF THE SAME. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 6A: MID-COLUMBIA MEDICAL CENTER, KLICKITAT VALLEY HEALTH, PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL, SKYLINE HOSPITAL MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 6B: COLUMBIA GORGE HEALTH COUNCIL, HOOD RIVER COUNTY HEALTH DEPARTMENT, KLICKITAT COUNTY HEALTH DEPARTMENT, MID-COLUMBIA CENTER FOR LIVING, NORTH CENTERAL PUBLIC HEALTH DISTRICT, ONE COMMUNITY HEALTH, PACIFIC SOURCE COMMUNITY SOLUTIONS, SKAMANIA COUNTY HEALTH DEPARTMENT, FOUR RIVERS EARLY LEARNING HUB, UNITED WAY, ADVANTAGE DENTAL, EASTERN OREGON CCO, SOUTHWEST ACCOUNTABLE COMMUNITIES OF HEALTH MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 11: THE NEXT COMMUNITY HEALTH IMPROVEMENT PLAN THROUGH COLUMBIA GORGE HEALTH COUNCIL IS SLATED FOR COMPLETION IN THE SUMMER OF 2020, THIS WILL HELP GUIDE MID-COLUMBIA MEDICAL CENTER'S INDIVIDUALIZED IMPLEMENTATION PLAN. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 16J: MCMC CHARGES AND A LINK TO OUR FINANCIAL ASSISTANCE POLICY ARE AVAILABLE ON THE OREGON PRICEPOINT WEBSITE: HTTP://WWW.ORPRICEPOINT.ORG HOSTED BY THE OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS. THE POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. 10 1 - WATER'S EDGE MEDICAL CLINIC 551 LONE PINE BLVD SUITE 201 THE DALLES OR 97058 HOSPITAL BASED CLINIC 2 - MCMC FAMILY MEDICINE 1620 E 12TH STREET THE DALLES OR 97058 HOSPITAL BASED CLINIC 3 - COLUMBIA CREST MEDICAL CLINIC 1935 E 19TH STREET THE DALLES OR 97058 HOSPITAL BASED CLINIC 4 - COLUMBIA RIVER WOMEN'S CENTER 1810 E 19TH STREET SUITE 209 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 5 - MCMC SURGICAL CLINIC 1810 E 19TH STREET SUITE 225 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 6 - GORGE UROLOGY 1805 E 19TH STREET THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 7 - MCMC SPECIALTY CLINICS AT NICHOLS LANDIN 33 NICHOLS PARKWAY HOOD RIVER OR 97031 NON-HOSPITAL BASED CLINIC 8 - MCMC OCCUPATIONAL HEALTH 1815 E 19TH STREET SUITE 2 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 9 - MCMC SPECIALTY CLINICS AT WOODS COURT 1619 WOODS COURT HOOD RIVER OR 97031 NON-HOSPITAL BASED CLINIC 10 - COLUMBIA GORGE ENT AND ALLERGY 1815 E 19TH STREET SUITE 1 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC PART I, LINE 7: COST-TO-CHARGE RATIO WAS UTILIZED; CCR WAS DERIVED FROM CALCULATION USED IN 2019 MEDICARE COST REPORT. PART I, LINE 7G: COSTS INCLUDE $4,551 FOR SOMOS MIGRANT OUTREACH CLINIC AND $2,841 WAS FOR WOMEN'S AND CHILDREN'S SERVICES FOR A TOTAL OF $7,392. PART II, COMMUNITY BUILDING ACTIVITIES: MCMC PROMOTES THE HEALTH OF THE COMMUNITES WE SERVE BY PARTICIPATING IN REGIONAL EMERGENCY PREPAREDNESS PROGRAMS (PANDEMIC, NATURAL DISASTERS, AREA AND STATE TRAUMA ADVISORY BOARDS) AND DRILLS; BY SERVING AS AN ADVOCATE FOR THE COMMUNITY WITH REGARD TO LOCAL, STATE-WIDE AND REGIONAL HEALTH INITIATIVES; ACTING IN ADVISORY CAPACITY WITH OTHER LOCAL, STATE, AND REGIONAL ORGANIZATIONS IN ORDER TO CREATE, ACCESS AND PROVIDE SERVICES OTHERWISE NOT AVAILABLE TO THE COMMUNITY; WORKING WITH THE LOCAL COMMUNITY COLLEGE AND EMS TO EDUCATE AND TRAIN FUTURE HEALTHCARE WORKERS BY PROVIDING JOB SHADOWING AND MENTORING PROGRAMS AS WELL AS DONATED SUPPORT TO THE COLLEGE FOR SPECIFIC NURSING PROGRAMS AND PROVIDING IN-KIND STAFF DONATED HOURS TO LOCAL SCHOOL ATHLETIC FUNCTIONS IN A MEDICAL CAPACITY (INJURED STUDENTS). PART III, LINE 2: DESCRIBES ALLOWANCE FOR BAD DEBT EXPENSE AT GROSS CHARGE. THE ESTIMATE IS BASED PRIMARILY ON THE MEDICAL CENTER'S HISTORICAL COLLECTION EXPERIENCE, MANAGEMENT'S ESTIMATE OF THE PATIENT'S ECONOMIC ABILITY TO PAY AND THE EFFECTIVENESS OF COLLECTIONS EFFORTS. PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, BAD DEBT EXPENSE WAS INSIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS AND WAS NOT DISCRETELY PRESENTED.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (INCLUDING BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: MEDICARE COST REPORT COST TO CHARGE RATIO METHODOLOGY IS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. MID-COLUMBIA MEDICAL CENTER CONTINUES TO PROVIDE CLINICAL SERVICES TO MEDICARE PATIENTS AT A DEFICIT AS PART OF OUR COMMITMENT TO THE RESIDENTS OF THE COMMUNITIES WE SERVE. THIS DEFICIT IS CONSISTENT WITH OUR TAX-EXEMPT STATUS AND INTERNAL MISSION TO PROVIDE COMMUNITY BASED HEALTHCARE REGARDLESS OF PATIENTS' ABILITY TO PAY. PART III, LINE 9B: IN CASES WHERE THE PATIENT HAS QUALIFIED FOR FULL OR PARTIAL CHARITY CARE, THE AMOUNT IS WRITTEN DOWN IN THE PATIENT ACCOUNT AND NO ATTEMPT IS MADE TO COLLECT THE AMOUNT WRITTEN DOWN. PART VI, LINE 2: COMMUNITY BENEFIT PRIORITIES AND ALLOCATIONS ARE GUIDED BY A COMMUNITY ASSESSMENT PROCESS WHICH UTILIZES QUANTITATIVE AND QUALITATIVE DATA OBTAINED FROM INTERNAL SOURCES AS WELL AS ASSESSMENT DATA FROM KEY COMMUNITY PARTNERS. MID-COLUMBIA MEDICAL CENTER PARTICIPATED AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) IN A COLLABORATIVE NEEDS ASSESSMENT IN 2019 WHICH INCLUDED INPUT FROM SIX COUNTY HEALTH DEPARTMENTS, FOUR HOSPITALS, THE LOCAL COORDINATED CARE ORGANIZATION, SOCIAL SERVICES AGENCIES IN THE REGION, HEALTH CARE PROVIDERS IN THE SERVICE REGION AND CONSUMER'S REPRESENTATIVE OF THE SAME. DETAILS ON THE METHODOLOGY, PARTICIPANTS AND REGIONAL RESULTS ARE ADDRESSED IN THE COLUMBIA GORGE REGIONAL COMMUNITY HEALTH ASSESSMENT AGENCY REPORT AND HEALTH CARE PROFESSIONAL SESSIONS WERE CONDUCTED IN ORDER TO CAPTURE AND RANK THE PRIMARY PERCEIVED NEEDS IN THE GORGE REGION. OVERALL NEEDS IDENTIFIED WERE ADEQUATE INCOME, STABLE HOUSING, FOOD, TRANSPORTATION AND HEALTH PREVENTION AND BOTH MEDICAL AND BEHAVIORAL HEALTH. ACCESS TO CARE WAS AN ADDITIONAL REGION WIDE IDENTIFIED ISSUE. THE NEXT COMMUNITY HEALTH IMPROVEMENT PLAN THROUGH CGHC IS SLATED FOR COMPLETION IN THE SUMMER OF 2020, THIS WILL HELP GUIDE MCMC'S INDIVIDUALIZED IMPLEMENTATION PLAN.MANY HEALTH OUTCOMES AND FACTORS REMAINED STEADY FROM THE 2016 ASSESSMENT TO 2019, OF PARTICULAR CONCERN IN WASCO COUNTY INCLUDE A HIGH RATE OF CHRONIC DISEASE, PREVALENCE OF ADULT AND CHILD OBESITY, TEEN PREGNANCY, LIMITED ACCESS TO HEALTHY FOODS, DENTAL CARE AND AFFORDABLE HOUSING, HIGH SCHOOL GRADUATION RATE AND A RELATIVELY HIGH PERCENTAGE OF THE POPULATION REPORTING INADEQUATE SOCIAL SUPPORT. PART VI, LINE 3: OUR PATIENT AND VISITOR SERVICES STAFF TAKE AN ACTIVE ROLE IN ASSISTING LOW-INCOME AND UNDER/UN-INSURED PATIENTS (THERE ARE SOME EXEMPTIONS IN PLACE TO THE INDIVIDUAL MANDATE REQUIRED BY THE AFFORDABLE CARE ACT) WITH COMPLETING APPLICATIONS FOR THE OREGON HEALTH PLAN. APPLICATIONS (IN ENGLISH AND SPANISH) ARE AVAILABLE AT REGISTRATION AND IN PATIENT ACCOUNTS IN BOTH THE HOSPITAL AND THE OUTPATIENT CLINICS. THIS APPLICATION PACKET OUTLINES THE PROCESS AND PROVIDES PHONE NUMBERS AND CONTACT INFORMATION FOR ASSISTANCE WITH ENROLLMENT; STAFF HOURS ARE ALSO ACTIVELY DEDICATED TO ASSISTING IN THE PRESUMPTIVE ELIGIBILITY PROGRAM. PART VI, LINE 4: MID-COLUMBIA MEDICAL CENTER (MCMC) IS LOCATED IN THE DALLES, WASCO COUNTY, OREGON, WITH THE POPULATION OF WASCO COUNTY AT 26,505. MCMC SERVES A WIDE GEOGRAPHIC AREA OF RURAL NORTH CENTRAL OREGON ALONG THE COLUMBIA RIVER. THIS SERVICE AREA INCLUDES WASCO, SHERMAN AND GILLIAM COUNTIES IN OREGON AND KLICKITAT COUNTY IN WASHINGTON STATE FOR A COMBINED POPLUATION TOTAL OF 52,214. MEDIAN INCOMES AND ETHNIC DEMOGRAPHICS VARY BY GEOGRAPHIC LOCATION. 2018 CENSUS DATA SHOW MEDIAN INCOME RANGE FROM $42,976 TO $50,973.WASCO COUNTY HAS THE LARGEST ETHNIC DIVERSITY WITH A DISTRIBUTION THAT IS 74% WHITE, 19% HISPANIC/LATINO, 4% AMERICAN INDIAN/ALASKA NATIVE AND 4% OTHER, STATISTICS WHICH REMAIN RELATIVELY UNCHANGED FROM 2014. FOURTEEN PERCENT OF THE POPULATION LIVES BELOW THE POVERTY LEVEL AND 11% OF THE POPULATION UNDER THE AGE OF 65 IS UNINSURED. 2019 DATA FROM THE OREGON HEALTH AUDITORY CITES MARCH 2019 MEDICAID PROGRAM ENROLLMENT IN WASCO COUNTY AT 7,778, AND 9,843 AT DECEMBER 2018, AN INCREASE OF 21%.IN ADDITION TO THE YEAR ROUND POPULATION, THE DALLES EXPERIENCES AN INFLUX OVER 15,000 SEASONAL WORKERS IN SUPPORT OF THE HARVEST OF OUR AGRICULTURAL ECONOMY. PART VI, LINE 5: MID-COLUMBIA MEDICAL CENTER IS A MISSION-DRIVEN ORGANIZATION WHOSE PURPOSE IS: TO LEAD AND ACT AS A CATALYST IN PROMOTING HEALTH FOR ALL PEOPLE TO RECOGNIZE THE INDIVIDUAL AS A WHOLE HUMAN BEING WITH DIFFERENT NEEDS THAT MUST BE MET ENTHUSIASTICALLY TO COMMUNICATE A VISION OF HEALTH, ART, EDUCATION, TECHNOLOGY AND A CENTER FOR HEALING WHICH WILL CONTINUALLY UPGRADE THE QUALITY OF LIFE IN THE COMMUNITY ENVIRONMENT IN WHICH WE LIVE TO EMPOWER PEOPLE TO BECOME PARTNERS IN THEIR HEALTHCARE BOARD AND SENIOR EXECUTIVE LEADERSHIP ARE ACTIVELY INVOLVED IN PRIORITIZATION OF COMMUNITY INITIATIVES. A FULL-TIME COORDINATOR OF MCMC'S COMMUNITY INITIATIVES DEPARTMENT OVERSEES IMPLEMENTATION OF PROGRAMS AND ACTS AS THE PRIMARY LIAISON IN COMMUNITY COLLABORATIONS. DISCUSSION AND RECOMMENDATION OF COMMUNITY BENEFIT FOCUS AREAS CENTERS AROUND FIVE KEY COMPONENTS: ALIGNMENT WITH THE ORGANIZATION'S STRATEGIC PLAN; LIKELIHOOD OR FEASIBILITY OF HAVING A MEASURABLE IMPACT ON THE ISSUE; ALIGNMENT WITH CORE ORGANIZATIONAL COMPETENCIES; EFFICIENT ALLOCATION OF RESOURCES AND ALIGNMENT WITH PARTNERS WHO HAVE RESOURCES ALLOCATED TOWARD THE ISSUE. THE MID-COLUMBIA MEDICAL CENTER COMMUNITY BENEFIT COMMITTEE (CBC), FORMED IN 2019, IS AN ADVISORY COMMITTEE FOCUSED ON LEADING COMMUNITY BENEFIT INITIATIVES BOTH INSIDE AND OUTSIDE THE WALLS OF THE HOSPITAL. THESE ACTIVITIES INCLUDE IMPROVING CARE AND ACCESS FOR VULNERABLE POPULATIONS, PROMOTING COMMUNITY HEALTH, AND ENGAGING IN RESEARCH AND EDUCATION AS DRIVEN BY THE COLUMBIA GORGE HEALTH COUNCIL'S COMMUNITY HEALTH ASSESSMENT. MCMC'S COMMUNITY BENEFIT COMMITTEE CONSISTS OF REPRESENTATION FROM OUR MEDICAL STAFF, NURSING LEADERSHIP, MARKETING AND OUTREACH, FINANCIAL STAFF, OUTPATIENT CLINICS AND OTHER KEY STAFF WHO CONTRIBUTE TO AND INFLUENCE THE OVERALL COMMUNITY BENEFIT OF OUR HOSPITAL. THE CBC IS RESPONSIBLE FOR ENSURING THAT MCMC STRATEGIC PLANS EFFECTIVELY ADDRESS THE SPECIFIC HEALTH NEEDS OF OUR COMMUNITY AS IDENTIFIED THROUGH THE CHA; EXTENDING AND STRENGTHENING MCMC'S PROGRAMS' COMMUNITY BENEFIT SERVICES; AND CHAMPIONING COMMUNITY COLLABORATIONS WITH GOVERNMENT, NONPROFIT, OR OTHER HEALTHCARE RELATED ORGANIZATIONS.NEEDS ASSESSMENTCOMMUNITY BENEFIT PRIORITIES AND ALLOCATIONS ARE GUIDED BY A COMMUNITY ASSESSMENT PROCESS WHICH UTILIZES QUANTITATIVE AND QUALITATIVE DATA OBTAINED FROM INTERNAL SOURCES AS WELL AS ASSESSMENT DATA FROM KEY COMMUNITY PARTNERS. MID-COLUMBIA MEDICAL CENTER PARTICIPATED AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) IN A COLLABORATIVE NEEDS ASSESSMENT IN 2019 WHICH INCLUDED INPUT FROM SIX COUNTY HEALTH DEPARTMENTS, FOUR HOSPITALS, THE LOCAL COORDINATED CARE ORGANIZATION, SOCIAL SERVICES AGENCIES IN THE REGION, HEALTH CARE PROVIDERS IN THE SERVICE REGION AND CONSUMER'S REPRESENTATIVE OF THE SAME. DETAILS ON THE METHODOLOGY, PARTICIPANTS AND REGIONAL RESULTS ARE ADDRESSED IN THE COLUMBIA GORGE REGIONAL COMMUNITY HEALTH ASSESSMENT AGENCY REPORT AND HEALTH CARE PROFESSIONAL SESSIONS WERE CONDUCTED IN ORDER TO CAPTURE AND RANK THE PRIMARY PERCEIVED NEEDS IN THE GORGE REGION. OVERALL NEEDS IDENTIFIED WERE ADEQUATE INCOME, STABLE HOUSING, FOOD, TRANSPORTATION AND HEALTH PREVENTION AND BOTH MEDICAL AND BEHAVIORAL HEALTH. ACCESS TO CARE WAS AN ADDITIONAL REGION WIDE IDENTIFIED ISSUE. THE NEXT COMMUNITY HEALTH IMPROVEMENT PLAN THROUGH CGHC IS SLATED FOR COMPLETION IN THE SUMMER OF 2020, THIS WILL HELP GUIDE MCMC'S INDIVIDUALIZED IMPLEMENTATION PLAN.MANY HEALTH OUTCOMES AND FACTORS REMAINED STEADY FROM THE 2016 ASSESSMENT TO 2019, OF PARTICULAR CONCERN IN WASCO COUNTY INCLUDE A HIGH RATE OF CHRONIC DISEASE, PREVALENCE OF ADULT AND CHILD OBESITY, TEEN PREGNANCY, LIMITED ACCESS TO HEALTHY FOODS, DENTAL CARE AND AFFORDABLE HOUSING, HIGH SCHOOL GRADUATION RATE AND A RELATIVELY HIGH PERCENTAGE OF THE POPULATION REPORTING INADEQUATE SOCIAL SUPPORT. PREVENTION AND EDUCATIONADULT AND CHILDHOOD OBESITY-MID-COLUMBIA MEDICAL CENTER PARTNERS WITH THOSE IN THE COMMUNITY SEEKING TO IMPROVE OR ENHANCE THEIR HEALTH THROUGH LIFESTYLE CHANGES AND CHOICES, PARTICULARLY IN THE AREAS OF OBESITY AND HEART DISEASE. -FREE COMMUNITY EDUCATION LECTURES FEATURING THE FOLLOWING TOPICS: -HPV & STI'S IN TEENS -NUTRITION & PAIN MANAGEMENT -TOTAL JOINT REPLACEMENTS -FALL PREVENTION -COPING WITH THE BLUESPATIENT REHABILITATION SERVICES, CENTER FOR MIND BODY MEDICINE -PATIENT REHABILITATION SERVICES PROVIDED COMMUNITY EDUCATION AND ASSISTANCE IN THE DECISION-MAKING PROCESS FOR COMMUNITY MEMBERS CONSIDERING TOTAL JOINT REPLACEMENT -39 PARTICIPANTS ATTENDED THE FREE MOMMY WELLNESS CLASSES; AN INTERDISCIPLINARY PROGRAM FOR PREGNANT AND NEW MOTHERS WITH CHILDREN UP TO TWO YEARS OF AGE, ITS PURPOSE IS TO PROVIDE EDUCATION AND EXERCISE DESIGNED TO PROMOTE HEALTHY LIFESTYLE HABITS FOR MOTHER AND CHILD. THE PROGRAM ALSO ADDRESSES BABY SIGN LANGUAGE AND DEVELOPMENT, PELVIC HEALTH FOR MOTHERS, BABY-MOTHER BONDING AND LACTATION SUPPORT. MOMMY WELLNESS TARGETS LOW INCOME, MINORITY AND UNDER-SERVED WOMEN AND THEIR YOUNG CHILDREN -PERSISTENT PAIN EDUCATION PROGRAM IS AN EIGHT-WEEK CLASS WHICH PROVIDES EDUCATION ON PAIN NEUROSCIENCE, ADAPTIVE COPING STRATEGIES, NUTRITION, MINDFULNESS, PROPER MEDICATION AND SLEEP HYGIENE TO PEOPLE WHO ARE DEALING WITH CHRONIC PAIN ISSUES. -PARKINSON'S SUPPORT GROUP HAD 20 ATTENDEES WITH THE CLASS FOCUSING ON RAISING AWARENESS FOR PATIENTS AND CAREGIVERS TO ADVOCATE FOR MAINTAINING INDEPENDENCE -ASSISTED LIVING BALANCE CLASS OFFERED TO ALL RESIDENTS OF FLAGSTONE ASSISTED LIVING AND THE DALLES SENIOR CENTER; BALANCE AND FALL RISK SCREENING AND CONSULTATIONS WERE OFFERED -CENTER FOR MIND BODY MEDICINE OFFERED MONTHLY MINDFULNESS MEDITATION AND BREATH CLASSES THROUGHOUT THE YEAR, WITH FOCUS ON LOWERING STRESS AND ANXIETY THROUGH MEDITATION AND BREATHING. FURTHER GOALS TO HELP RESHAPE THE RELATIONSHIP WITH MENTAL AND PHYSICAL PAIN AND REDUCE 'BRAIN CHATTER.' THESE CLASSES WERE FREE TO THE COMMUNITYPOVERTY AND UNINSUREDOUR PATIENT AND VISITOR SERVICES STAFF TAKE AN ACTIVE ROLE IN ASSISTING LOW-INCOME AND UNDER- / UN-INSURED PATIENTS (THERE ARE SOME EXEMPTIONS IN PLACE TO THE INDIVIDUAL MANDATE REQUIRED BY THE AFFORDABLE CARE ACT) WITH COMPLETING APPLICATIONS FOR THE OREGON HEALTH PLAN. APPLICATIONS (IN ENGLISH AND SPANISH) ARE AVAILABLE AT REGISTRATION AND IN-PATIENT ACCOUNTS IN BOTH THE HOSPITAL AND THE OUTPATIENT CLINICS. THIS APPLICATION PACKET OUTLINES THE PROCESS AND PROVIDES PHONE NUMBERS AND CONTACT INFORMATION FOR ASSISTANCE WITH ENROLLMENT; STAFF HOURS ARE ALSO ACTIVELY DEDICATED TO ASSISTING IN THE PRESUMPTIVE ELIGIBILITY PROGRAMOTHER MEANINGFUL CONTRIBUTIONS IN THE YEAR 2019 -MCMC FACILITATES A VARIETY OF SUPPORT GROUPS ON A REGULAR BASIS, INCLUDINGO MONTHLY STROKE CLUB O MONTHLY FAMILY SUPPORT CLASSES O PARKINSON'S SUPPORT GROUP O PRE- OR BORDERLINE DIABETES CLASSO SURVIVORSHIP (POST-CANCER) SUPPORT GROUP -CAR SEAT EVALUATIONS AND FREE BIKE HELMETS AND FITTINGS ARE AVAILABLE YEAR-ROUND THROUGH OUR EMERGENCY DEPARTMENT -MCMC PROVIDES MENTORING AND INTERNSHIP PROGRAMS DESIGNED TO HELP TRAIN EXISTING AND FUTURE CARE PROVIDERS SUCH AS PHARMACY TECHNICIANS, EMS TECHNICIANS, MEDICAL ASSISTANTS, HEALTH INFORMATION MANAGEMENT STUDENTS, CHILDCARE PROVIDERS, RADIOLOGICAL TECHNICIANS, NURSES AND RURAL HEALTH PROVIDERS -PHYSICIANS AND NURSES PROVIDE ACCESS TO FREE OR REDUCED COST PRIMARY CARE; MCMC ALSO PROVIDES SCHOOL NURSING SERVICES AT THE ELEMENTARY AGE LEVEL FOR LOCAL SCHOOLS -PROVIDES SUPPORT FOR THE AMERICAN RED CROSS BLOOD DRIVES -ENCOURAGES STAFF TO VOLUNTEER TO MAKE A DIFFERENCE THROUGH SERVICE TO MEMBERS OF THE COMMUNITY -PROVIDES FREE MEETING FACILITIES FOR VARIOUS CHARITABLE, CIVIC AND SUPPORT GROUPS -MCMC DEVELOPED A PROGRAM CALLED SOMOS: SERVING OREGON AND ITS MIGRANTS BY OFFERING SOLUTIONS. THIS PROGRAM WAS DESIGNED TO ASSIST MIGRANT WORKERS IN OUR COMMUNITY WITH RECEIVING FREE HEALTH SCREENINGS AND REFERRALS AS APPROPRIATE. THE PROGRAM SERVES THE UNDERSERVED MINORITY AND LOW-INCOME MIGRANT POPULATION.SOCIAL DETERMINANTS OF HEALTHMCMC IS INVOLVED IN A VARIETY OF COMMUNITY AND COALITION BUILDING AND HEALTH ADVOCACY ACTIVITIES REGARDING SUCH SOCIAL DETERMINANTS AS: FOOD AS HEALTH SECURITY, HIGH SCHOOL DROP-OUT RATES, TEEN PREGNANCY, HOUSING AND TRANSPORTATION. THE HOSPITAL ALSO PARTICIPATES AS A MEMBER OF THE COLUMBIA GORGE HEALTH COUNCIL (CGHC) IN PROVIDING OVERSIGHT AND GOVERNANCE OF THE COORDINATED CARE ORGANIZATION FORMED BY PACIFICSOURCE COMMUNITY SOLUTIONS (PACIFICSOURCE.) CGHC IS A NONPROFIT CORPORATION COMPRISED OF THE MEDICAL CENTER, WASCO AND HOOD RIVER COUNTIES, CENTRAL OREGON INDEPENDENT PRACTICE ASSOCIATION, INC., ONE COMMUNITY HEALTH, PACIFICSOURCE, PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL AND AT-LARGE MEMBERS OF THE COMMUNITY 1 MID-COLUMBIA HEALTH FOUNDATION 1700 E 19TH ST THE DALLES OR 97058 930854433 501(C)(3) 614974 OPPERATIONAL SUPPORT 1 0 PART I, LINE 2: OPERATIONAL SUPPORT IS BASED OF THE GENERAL LEDGER & SUPPORTING JOURNAL ENTRIES MAINTAINED MID-COLUMBIA MEDICAL CENTER ON BEHALF OF THE FOUNDATION. X X X X X 1 1 0 0 0 1 0 1 0 DENNIS KNOX PRESIDENT & CEO 481682 0 150562 0 2968 0 14000 0 15891 0 665103 0 0 0 KEITH STELZER PHYSICIAN 542103 0 0 0 0 0 13950 0 28546 0 584599 0 0 0 GARY GINGRICH PHYSICIAN 466343 0 0 0 0 0 14000 0 17290 0 497633 0 0 0 LARRY KAHL - TERMED COO 221529 0 18936 0 183669 0 13477 0 16290 0 453901 0 0 0 NATHAN ULLRICH PHYSICIAN 302892 0 0 0 91750 0 13950 0 19265 0 427857 0 0 0 MARC MCALLISTER PHYSICIAN 385618 0 0 0 0 0 14000 0 27255 0 426873 0 0 0 DONG XIANG PHYSICIAN 359848 0 0 0 0 0 14000 0 20047 0 393895 0 0 0 DAVID STURGEON - TERMED CFO 179816 0 15339 0 158459 0 10660 0 13660 0 377934 0 0 0 SERENE PERKINS CMO 305819 0 0 0 19082 0 14000 0 13206 0 352107 0 0 0 PAUL CARDOSI MD DIRECTOR 309631 0 0 0 0 0 14000 0 21955 0 345586 0 0 0 DONALD WENZLER CNO 222584 0 15296 0 5592 0 12163 0 15791 0 271426 0 0 0 DALE LEPPER CIO 210105 0 13824 0 2978 0 11222 0 873 0 239002 0 0 0 PART I, LINES 4A-B THE INCENTIVE COMPENSATION PLAN FOR THE QUALIFIED PERSON WAS BASED LARGELY ON NET PROFESSIONAL FEES GENERATED DIRECTLY BY THE QUALIFIED PERSON, COMMON PRACTICE FOR EMPLOYED PHYSICIANS. PART I, LINE 6 THERE IS AN INCENTIVE BASED COMPENSATION PLAN FOR THE EXECUTIVE TEAM BUT IT IS BASED ON MORE THAN JUST FINANCIAL RESULTS. PART I, LINE 7 EXECUTIVES IDENTIFIED RECEIVED INCENTIVE PAY IN JULY 2019 EARNED FOR 2018 GOAL ACHIEVEMENT. FORM 990, PART VI, SECTION A, LINE 6 HEALTH CARE FOR THE MID-COLUMBIA REGION IS THE SOLE MEMBER. ON APRIL 4, 2019, THE OPERATIONS AND RELATED ASSETS AND LIABILITIES OF HEALTH CARE FOR THE MID-COLUMBIA REGION WERE MERGED INTO MID-COLUMBIA MEDICAL CENTER. AS A RESULT, MID-COLUMBIA MEDICAL CENTER WILL EXIST AS THE PARENT OVER THE AFFILIATES OF THE FOUNDATION AND DRY HOLLOW. NO CHANCE TO THE OVERALL SCOPE OF OPERATIONS OCCURRED AS A RESULT OF THIS EVENT. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE RETURN IS SUBMITTED TO THE BOARD OF TRUSTEES FOR REVIEW. UPDATES ARE MADE AS NECESSARY BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C WE ANNUALLY REQUIRE ALL OFFICERS AND DIRECTORS TO SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. IF A CONFLICT WAS DISCOVERED FOR AN OFFICER OR DIRECTOR WITH A SIGNED DISCLOSURE STATEMENT, THEY WOULD BE SUBJECT TO CORRECTIVE ACTION UP TO AND INCLUDING TERMINATION FOR VIOLATION OF OUR POLICY. IF THEY SELF-DISCLOSED A POTENTIAL CONFLICT OF INTEREST ON THE FORM, WE WOULD GATHER INFORMATION ON THE ISSUE AND MAKE A DETERMINATION ON HOW SEVERE THE CONFLICT IS AND WHETHER OR NOT THE INDIVIDUAL COULD REMAIN AN OFFICER OR DIRECTOR. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION COMMITTEE WAS DESIGNED WHICH INCLUDED MEMBERS OF THE BOARD OF TRUSTEES, HR DIRECTOR AND COMPENSATION SPECIALIST. COMPENSATION COMMITTEE AGED AND/OR UPDATED PREVIOUSLY SUPPLIED COMPENSATION DATA FROM OUTSIDE FIRM BASED ON COMMERCIALLY AVAILABLE SALARY SURVEYS. THE CEO THEN NEGOTIATES WITH THE BOARD, WHICH COMPARES THE COMPENSATION DISCUSSED WITH THE ANALYSIS JUST DESCRIBED AND THEN VOTES ON AND APPROVES A NEW CONTRACT IN EXECUTIVE SESSION WITHOUT CEO PRESENCE OR PARTICIPATION IN THE VOTE. THE COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS DETERMINED USING A SURVEY OF MARKET RATES FOR SIMILAR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 AS REQUESTED. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,317,773. MANAGEMENT AND GENERAL EXPENSES 2,695,974. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,013,747. PROFESSIONAL FEES AND CONSULTING: PROGRAM SERVICE EXPENSES 11,943,582. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,943,582. FORM 990, PART XI, LINE 9: NET ASSETS TRANSFERRED FROM AFFILIATES 2,430,126. FORM 990, PART XI, LINE 2C THE RESPONSIBILITY AND PROCESS FOR OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR. 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