2019-11-08T12:00:25-06:00 2018-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2018-01-01 813021580 FOUNDATION HEALTH LLC FOUN 9074585550 1650 COWLES STREET FAIRBANKS AK 99701 GARY RODERICK CFO 9074585550 2019-11-06 1 SARA ELIZABETH J HYRE P00235495 4254544919 2019-11-06 65.158.230.194 2019-11-06 08:31:05 PS P DE1D2BBAE0F1147E7A7EA18DABEA7E867F199504 A6788122FFC2A5A8460BF6C51534EA1DB831A18C 2018 2020-03-31 21:24:44Z GARY RODERICK 1650 COWLES STREET FAIRBANKS AK 99701 303311025 0 X WWW.FOUNDATIONHEALTH.ORG X LLC 2016 AK COMPASSIONATE HEALTH CARE FOR EVERY CHAPTER IN YOUR LIFE STORY. 13 10 2232 135 1574253 1130632 246726 238116 275244830 298741470 6491823 64613 3744016 4266826 285727395 303311025 0 200000 0 0 148779423 161760929 0 0 0 132877487 133943479 281656910 295904408 4070485 7406617 91369723 104873353 21726714 27185657 69643009 77687696 COMPASSIONATE HEALTH CARE FOR EVERY CHAPTER IN YOUR LIFE STORY. 0 0 244179174 200000 298778329 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 47,852 PATIENTS IN 2018 , INCLUDING 1,065 BABIES DELIVERED. THE HOME SERVED 187 INDIVIDUALS AND THE CLINIC PROVIDED ACCESS TO CARE FOR 47,746 PEOPLE. 244179174 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 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 1 1 0 0 0 1 111 0 1 2232 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AK X STEPHEN LESLIE 9074583310 1650 COWLES STREET FAIRBANKS AK 99701 JEFF COOK CHAIR 1.30 3.70 X X 0 0 0 GARY RODERICK TREASURER 0.50 1.20 X X 0 0 0 JOE FAULLBABER 1ST VICE PRESIDENT 1.50 3.60 X X 0 0 0 BILL VIVLAMORE SECRETARY 0.30 1.60 X X 0 0 0 ROGER FLOERCHINGER BOARD MEMBER 0.00 0.00 X 0 0 0 SCOTT BELL BOARD MEMBER 0.30 1.70 X 0 0 0 KAREN PERDUE BOARD MEMBER 1.20 1.90 X 0 0 0 LAURA BRUNNER MD BOARD MEMBER 40.00 0.80 X 408345 0 10931 STEVE FRANK BOARD MEMBER 0.30 0.90 X 0 0 0 RICHARD HATTAN BOARD MEMBER 0.60 0.00 X 0 0 0 MARK KOWAL MD BOARD MEMBER 0.70 0.00 X 0 0 0 ZACH WERLE BOARD MEMBER 40.00 0.20 X 385901 0 36526 TERI KISS RN BOARD MEMBER 40.00 0.60 X 174825 0 6566 JIM L LYNCH CEO 40.00 0.00 X 412601 0 34305 STEPHEN P LESLIE CFO 40.00 0.00 X 303948 0 8423 MICHAEL D POWERS TVC CEO 40.00 0.00 X 269484 0 23588 JENNIFER WELCH CHIEF HUMAN RESOURCE OFFICER 40.00 0.00 X 213485 0 34331 DANNY R ROBINETTE CMO 40.00 0.00 X 511881 0 39750 CLINT BROOKS ASSOC ADMIN 40.00 0.00 X 239561 0 28021 KARL H SANFORD ASSOC ADMIN 40.00 0.00 X 268777 0 11392 CAROL F BARNETT COMPLIANCE OFFICER 40.00 0.00 X 153858 0 8929 VANESSA A VENEZIA PHYSICIAN MANAGER 40.00 0.00 X 453517 0 43036 KAREN M JUSTIN-TANNER CNO 40.00 0.00 X 194075 0 9930 ROMEL C WRENN PHYSICIAN 40.00 0.00 X 1098387 0 43522 CARY S KELLER PHYSICIAN 40.00 0.00 X 905596 0 45563 GREGORY WOOD PHYSICIAN 40.00 0.00 X 865749 0 12213 MILAN BAJMOCZI PHYSICIAN 40.00 0.00 X 783349 0 27929 WENDELL EAMES PHYSICIAN 40.00 0.00 X 685062 0 45570 GREGORY JOHNSON FORMER CEO 0.00 0.00 X 474135 0 16311 8802536 0 486836 173 1 1 0 CROSS COUNTRY STAFFING INC LA LOCKBOX FILE 50941 LOS ANGELES CA 90074 MEDICAL STAFFING 7575970 MAYO COLLABORATIVE SVCS INC DBA MAYO MEDICAL LABORATORIES PO 91 MINNEAPOLIS MN 55480 REFERENCE LAB SERVICES & CONSULTING SERV 1600114 ALASKA SURGICAL SERVICES LLC PO BOX 96024 LAS VEGAS NV 89193 MEDICAL SERVICES 539250 PATHOLOGY CONSULTANTS 6453 3RD AVE SUITE 235 FAIRBANKS AK 99707 LAB SERVICES 514604 LOCUMTENENS COM PO BOX 405547 ATLANTA GA 30384 PHYSICIAN FEES 460675 23 231996 6120 238116 OUTPATIENT REVENUE 622110 130058094 128519825 1538269 INPATIENT REVENUE 621110 92395473 92395473 CLINIC 621111 46058400 46058400 NURSING HOME 623110 20571836 20571836 PHARMACY 446110 4467542 4441582 25960 5190125 5190125 298741470 57967 57967 226534 0 226534 226534 226534 6646 0 6646 6646 6646 CAFETERIA/MEALS 722514 2651756 2651756 DAY CARE CENTER 624410 1029972 1029972 MEDICAL RECORDS FEES 900099 30100 30100 328464 36859 10024 281581 4040292 303311025 297214100 1574253 4284556 200000 200000 4285986 3520954 765032 490446 403734 86712 127489034 105269880 22219154 2946673 2473436 473237 17749407 12903152 4846255 8799383 8050647 748736 393515 393515 240432 240432 83428 83428 28215957 23174106 5041851 732347 732347 3210794 2302992 907802 7052599 5871602 1180997 46706110 40318527 6387583 671735 389062 282673 108279 44413 63866 344768 284789 59979 1300736 973699 327037 MEDICAL SUPPLIES 19517340 19514839 2501 PHARMACEUTICAL SUPPLIES 9307278 9172917 134361 NON MEDICAL SUPPLIES 7326929 7172585 154344 UBI TAXES 299401 299401 8431831 2137840 6293991 295904408 244179174 51725234 0 16932451 23117606 0 14028002 64380274 53603417 5022539 7290999 3980567 4763538 541255 77739 312248 463516 741644 1606275 91369723 104873353 21126714 26411489 600000 774168 21726714 27185657 X 69643009 77687696 69643009 77687696 91369723 104873353 X 7406617 638070 X 0 1 X 1 0 X 0 0 0 0 0 0 1 65883 0 1 17545 83428 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 2018. IN 2018 FH PAID $65,883 FOR THESE SERVICES. ALASKA STATE HOSPITAL AND NURSING HOME ASSOCIATION USE 7% OF ALL DUES PAID TO THEM FOR SPECIFIC LOBBYING EXPENSES. 541255 77739 463516 463516 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 774168 774168 303267924 0 303267924 43101 43101 303311025 295861307 -43101 -43101 295904408 0 295904408 PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 43,101. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTEREST INCOME -43,101. 1 1 X 1 X 1 X 1 1 0 0 1489281 1489281 0.00500 64580912 54638183 9942729 0.03360 66070193 54638183 11432010 0.03860 85370 85370 0.00030 185526 185526 0.00060 356331 356331 0.00120 627227 627227 0.00210 66697420 54638183 12059237 0.04070 17200 17200 0.00010 7669 7669 0.00000 24869 24869 0.00010 1 10949521 52570061 52646389 -76328 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 1 1 X X X X X X X X X 16 1 0 0 1 X SEE PART V, SECTION C X 1 17 1 SEE PART V, SECTION C 0 1 X 100.000000000000 350.000000000000 X X 1 1 X X X 1 X HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH/PATIENTS__VISITORS/FINANCIAL_SERVICES/ X HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH/PATIENTS__VISITORS/FINANCIAL_SERVICES/ X HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH/PATIENTS__VISITORS/FINANCIAL_SERVICES/ 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 2: THE HOSPITAL, FAIRBANKS MEMORIAL HOSPITAL (FMH), WAS PREVIOUSLY OPERATED BY BANNER HEALTH THROUGH AN OPERATING LEASE WITH THE GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION (GFCHF) UP UNTIL 12/31/16 WHEN THE LEASE WAS TERMINATED. EFFECTIVE 1/1/17, FMH IS OPERATED BY FOUNDATION HEALTH, A NEWLY FORMED ENTITY OWNED BY THE GFCHF. FOUNDATION HEALTH APPLIED FOR AND RECEIVED TAX EXEMPT STATUS AS OF 1/1/17. IN CONJUNCTION WITH THE REORGANIZATION, THE FACILITY RECEIVED A NEW STATE LICENSE NUMBER. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE CHNA WAS CONDUCTED IN 2016. THE BANNER HEALTH CHNA STEERING COMMITTEE WAS FORMED, COMMISSIONED TO GUIDE THE CHNA PROCESS, AND WAS COMPRISED OF PROFESSIONALS FROM VARIOUS DISCIPLINES ACROSS THE ORGANIZATION. THE LIST OF STEERING COMMITTEE MEMBERS IS IN THE APPENDIX OF THE REPORT (URL INCLUDED IN 7.A.) BEGINNING IN 2016 THE COMMITTEE CONDUCTED AN ASSESSMENT OF THE HEALTH NEEDS OF RESIDENTS OF THE FAIRBANKS NORTH STAR BOROUGH, ALASKA AS WELL AS THOSE IN ITS PRIMARY SERVICE AREA. THE CHNA PROCESS UNDERTAKEN WAS CONDUCTED IN COMPLIANCE WITH FEDERAL REQUIREMENTS. FMH LEADERSHIP TEAM CREATED A COMMUNITY ADVISORY COUNCIL (CAC) OF COMMUNITY LEADERS THAT REPRESENTED THE UNDERSERVED, UNINSURED, AND MINORITY POPULATIONS. PARTICIPANTS WERE IDENTIFIED BASED ON THEIR ROLE IN PUBLIC HEALTH REALM OF THE HOSPITAL'S SURROUNDING COMMUNITY. EMPHASIS WAS PLACED ON IDENTIFYING POPULATIONS WITHIN THE SERVICE AREA THAT ARE CONSIDERED MINORITY AND/OR UNDERSERVED. EACH PARTICIPANT IS VESTED IN THE OVERALL HEALTH OF THE COMMUNITY AND BROUGHT PERSPECTIVE WITH REGARDS TO POPULATION'S HEALTH NEEDS. THE CAC MET OVER A PERIOD OF SEVERAL WEEKS TO REVIEW THE CURRENT HEALTH OUTCOMES DATA AND HEALTH FACTORS FOR THE AREA AND TO STUDY WRITTEN AND FOCUS GROUPS AS WELL AS INPUT SINCE THE PREVIOUS CHNA. RECOMMENDATIONS FOR PRIORITIZATION OF NEEDS CAME FROM THIS CAC AS A RESULT OF ALIGNING ANY DEMONSTRATED WORSENING TRENDS IN PRIMARY AND SECONDARY DATA FOR HEALTH OUTCOMES FOR THE AREA, IDENTIFICATION OF APPARENT HEALTH DISPARITIES, AND OTHER FACTORS OF CONCERN TO THE MEMBERS OF FOCUS GROUPS. THE CAC MEMBERSHIP IS LISTED IN THE REPORT (URL IN 7.A.) AND THEY REPRESENTED ORGANIZATIONS INCLUDING: FAIRBANKS NATIVE ASSOCIATION, TANANA CHIEFS CONFERENCE, FAIRBANKS NORTH STAR BOROUGH SCHOOL DISTRICT, BOROUGH ASSEMBLY, RAVEN LANDING (RETIREMENT COMMUNITY), FAIRBANKS RESCUE MISSION, FAIRBANKS RESOURCE AGENCY (DISABLED), CITY COUNCIL, INTERIOR COMMUNITY HEALTH (LOW INCOME), FAIRBANKS SENIOR CENTER, ALASKA STATE TROOPERS, FIRE AND RESCUE, AND REGIONAL COMMUNITY HEALTH. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PRIORITY 1) BEHAVIORAL HEALTH AND SUBSTANCE ABUSE - ADDRESSED INTERNALLY WITH ADDITIONAL PSYCHIATRIC AND SOCIAL WORK STAFF RESOURCES TO THE EMERGENCY DEPARTMENT. WITHIN THE COMMUNITY, FMH PROVIDED SUPPORT TO HELP ESTABLISH A COMMUNITY SOBERING CENTER, CONTINUES TO SUPPORT THE COMMUNITY SERVICE PATROL, AND CONTRIBUTES TO LEADERSHIP WITHIN A COMMUNITY COALITION FOR IMPROVEMENT IN BEHAVIORAL HEALTH ACCESS TO CARE. CONTRIBUTES LEADERSHIP TO THE OPIOID COLLABORATIVE LOCALLY AND STATEWIDE AND HAS INITIATED CHANGES TO LOCAL PRESCRIBING PROTOCOLS AND DEVELOPMENT OF HARM REDUCTION SERVICES INCLUDING ACCESS TO CARE FOR MEDICATION ASSISTED PROGRAM SERVICES. COLLABORATED WITH COMMUNITY PARTNERS FOR STRATEGIC PLANNING FOR ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE CASE MANAGEMENT (ACT/ICM). COLLABORATED WITH HOMELESS COALITION TO SPONSOR OPIOID AND CHRONIC PAIN EDUCATION. PRIORITY 2) CHRONIC DISEASE - FOCUS ON HEALTHLY LIFESTYLE EDUCATION. INTERNALLY DEVELOPED COMMUNITY EDUCATION MODULES AND EVENTS FOR HEALTHY EATING OPTIONS, DIABETES EDUCATION AND SUPPORT, BALANCE SCREENING, STROKE AWARENESS, AND OBESITY EDUCATION. CONTRIBUTED TO PLANNING AND OPERATION OF A MEN'S HEALTH FAIR WITH WIDE RANGE OF SCREENING AND EDUCATION RESOURCES. PROVIDED SUPPORT TO YOUTH AND OTHER COMMUNITY ATHLETIC ACTIVITIES AND SPORT EVENTS. PRIORITY 3) ACCESS TO CARE - FOCUS ON IMPROVING PERCENTAGE OF POPULATION WITH PRIMARY CARE PROVIDER AND NAVIGATION. COLLABORATED WITH MEDICAL STAFF OF PRIMARY CARE CLINICS TO RECRUIT PROVIDERS, MANAGE PRIMARY CARE PRACTICES TO IMPROVE ACCESS, SCHEDULING, AND ON-LINE PORTAL ACCESS, AND TO PROMOTE ACCESS BY PATIENTS WITHIN ALL SOCIOECONOMIC DEMOGRAPHICS. NEEDS IDENTIFIED BUT NOT PRIORITIZED DURING 2018 WERE 1) SENIOR CARE/ALZHEIMERS - THIS HAS BEEN THE FOCUS OF SEVERAL LOCAL ORGANIZATIONS FOR ALZHEIMERS AND SENIOR SERVICES AND 2) SEXUALLY TRANSMITTED INFECTIONS - PUBLIC HEALTH CLINIC EVALUATES AND REPORTS DATA WHICH WAS BELIEVED TO BE SKEWED DUE TO REPORTING INCIDENT IMPROVEMENTS. 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. PART V, SECTION B, LINE 7A HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH/ABOUT_FMH/COMMUNITY_HEALTH_NEEDS_ASSESSMENT PART V, SECTION B, LINE 10A HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH/ABOUT_FMH/COMMUNITY_HEALTH_NEEDS_ASSESSMENT 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 II: COMMUNITY BUILDING ACTIVITIES COALITION LEADERSHIP AND PARTICIPATION IN ESTABLISHED COMMUNITY COALITIONS FOR WELLNESS/OPIOIDS, BEHAVIORAL HEALTH ACCESS TO CARE, AND HOMELESSNESS. PROVIDE SPACE AND SUPPORT SERVICES FOR SEARCH PROGRAM. THIS PROGRAM PROVIDES WORKFORCE DEVELOPMENT FOR COMMUNITY MEMBERS WITH DEVELOPMENTAL AND INTELLECTUAL DISABILITIES. 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 12 FOR DISCUSSION REGARDING THE ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: MEDICARE REIMBURSEMENT DID NOT COVER THE FULL COST OF TREATING MEDICARE PATIENTS IN 2018. THE SHORTFALL IS $76,328. FOUNDATION HEALTH PROVIDES MEDICALLY NECESSARY HEALTH CARE SERVICES TO ALL PATIENTS REGARDLESS OF PAYER. MANY OTHER PROVIDERS MAY LIMIT OR NOT ACCEPT MEDICARE PATIENTS DUE TO THE INADEQUATE REIMBURSEMENT. THEREFORE, FOUNDATION HEALTH MAY OFTEN BE THE ONLY OPTION FOR MEDICARE PATIENTS IN OUR COMMUNITY. BY ACCEPTING INADEQUATE MEDICARE REIMBURSEMENT, WE REDUCE THE AMOUNT OF FINANCIAL ASSISTANCE AND BURDEN ON OTHER GOVERNMENTAL PROGRAMS, SUCH AS MEDICAID. 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: COMMUNITY TOWN HALL MEETINGS OPEN TO THE PUBLIC DURING TRANSITION FROM BANNER HEALTH - LED BY ADMINISTRATIVE TEAM AND GOVERNING BOARD OF ORGANIZATION. THE LINK FOR COMMUNITY FEEDBACK IS ON THE ORGANIZATION WEBSITE AND INITIATES AN EMAIL DIRECTLY TO COMMUNICATIONS DIRECTOR. THE CANCER TREATMENT PROGRAM CONDUCTS A FORMAL ANNUAL COMMUNITY NEEDS ASSESSMENT ACCORDING TO ACCREDITATION STANDARDS. THE ORGANIZATION BEGAN COMMUNITY FOCUS SURVEYS IN 2018 IN ANTICIPATION OF THE COMPLETION OF THE 2019 CHNA. 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). - 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. - THE POPULATION WITHIN THE INTERIOR ECONOMIC REGION IS ESTIMATED AT 111,214; WITH 97,121 IN THE PRIMARY AREA AND 14,093 IN THE SECONDARY AREA. - OVERALL, THE HOSPITAL'S SERVICE POPULATION IS ESTIMATED TO BE A POPULATION OF 139,288. - 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. THE POPULATION OF THE FNSB IS 52% MALE 48% FEMALE, CAUCASIANS REPRESENT 69% OF THE POPULATION AND HISPANIC 8%, BLACK 6%, ASIAN/PACIFIC ISLANDER 4%, AMERICAN INDIAN/ALASKA NATIVE 8%, OTHER 5%. MEDIAN HOUSEHOLD INCOME IS $76,250, PER CAPITA INCOME $35,328, MEDIAN AGE 33.9 AND 10% ARE OVER 65. MEDIAN HOUSE VALUE $230,000 AND 59% OF HOUSING IS OWNER OCCUPIED. OF ALL FAMILIES, 6% PSA BELOW THE POVERTY LEVEL, WITH CHILDREN 8%, AND SINGLE FEMALES WITH CHILDREN 30%. PERSONS WITHOUT HEALTH INSURANCE, UNDER AGE 65 AT 13%. VETERANS COMPRISE 11% 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; MAKING FACILITIES AVAILABLE TO CREDENTIALED COMMUNITY PROVIDERS; 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. 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. 1 UNIVERSITY OF ALASKA 3211 PROVIDENCE DRIVE ANCHORAGE AK 995088030 926000147 GOVERNMENT 200000 SCHOOL OF NURSING EXPANSION 1 0 X X X 1 0 0 1 0 1 0 0 0 LAURA BRUNNER MD BOARD MEMBER 214857 0 179649 0 13839 0 10791 0 140 0 419276 0 0 0 ZACH WERLE BOARD MEMBER 373638 0 10000 0 2263 0 11419 0 25107 0 422427 0 0 0 TERI KISS RN BOARD MEMBER 165881 0 8195 0 749 0 5602 0 964 0 181391 0 0 0 JIM L LYNCH CEO 258481 0 127891 0 26229 0 11178 0 23127 0 446906 0 0 0 STEPHEN P LESLIE CFO 189049 0 112135 0 2764 0 7657 0 766 0 312371 0 0 0 MICHAEL D POWERS TVC CEO 224508 0 37880 0 7096 0 3241 0 20347 0 293072 0 0 0 JENNIFER WELCH CHIEF HUMAN RESOURCE OFFICER 140888 0 72015 0 582 0 5903 0 28428 0 247816 0 0 0 DANNY R ROBINETTE CMO 319890 0 134506 0 57485 0 12756 0 26994 0 551631 0 0 0 CLINT BROOKS ASSOC ADMIN 186030 0 52439 0 1092 0 6676 0 21345 0 267582 0 0 0 KARL H SANFORD ASSOC ADMIN 215245 0 52439 0 1093 0 6676 0 4716 0 280169 0 0 0 CAROL F BARNETT COMPLIANCE OFFICER 140382 0 12532 0 944 0 5743 0 3186 0 162787 0 0 0 VANESSA A VENEZIA PHYSICIAN MANAGER 403944 0 28563 0 21010 0 11495 0 31541 0 496553 0 0 0 KAREN M JUSTIN-TANNER CNO 181407 0 12089 0 579 0 0 0 9930 0 204005 0 0 0 ROMEL C WRENN PHYSICIAN 846480 0 246902 0 5005 0 15869 0 27653 0 1141909 0 0 0 CARY S KELLER PHYSICIAN 836246 0 65000 0 4350 0 16388 0 29175 0 951159 0 0 0 GREGORY WOOD PHYSICIAN 694112 0 169896 0 1741 0 0 0 12213 0 877962 0 0 0 MILAN BAJMOCZI PHYSICIAN 766984 0 14685 0 1680 0 0 0 27929 0 811278 0 0 0 WENDELL EAMES PHYSICIAN 438093 0 226549 0 20420 0 14602 0 30968 0 730632 0 0 0 GREGORY JOHNSON FORMER CEO 0 0 0 0 474135 0 3336 0 12975 0 490446 0 0 0 PART I, LINE 4A GREG JOHNSON RECEIVED SEVERANCE OF $474,135 DURING 2018. 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 MANAGEMENT INCENTIVE PROGRAM PROVIDES AN INCENTIVE PAYMENT BASED ON ACHIEVEMENT OF TARGET MEASURES IN THE CATEGORIES OF PATIENT SATISFACTION (25%), CULTURE (15%), QUALITY/SAFETY (30%), AND FINANCIAL PERFORMANCE (30%). THE FINANCIAL TARGET IS OPERATING INCOME. 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 10,172 HOURS IN 24 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 638,070. DENALI CENTERLLC 1510 19TH AVENUE FAIRBANKS AK 99701 300945293 COMPREHENSIVE SHORT AND LONG TERM CARE CENTER AK 20135032 3023790 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL HOSPITAL LLC 1650 COWLES STREET FAIRBANKS AK 99701 320499956 HOSPITAL/HEALTHCARE SERVICES AK 223278399 90301489 FOUNDATION HEALTH LLC TANANA VALLEY CLINIC LLC 1001 NOBLE STREET FAIRBANKS AK 99701 611797882 PRIMARY CARE SERVICES AK 38767359 6962241 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL CARDIOLOGY CENTER LLC 1650 COWLES ST FAIRBANKS AK 99701 364841105 CARDIOLOGY CLINIC AK 15030085 511367 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL HOME MEDICAL EQUIPMENT LLC 19 COLLEGE RD STE D FAIRBANKS AK 99701 371830937 HOME MEDICAL EQUIPMENT RENTALS AND SALES AK 2157729 1173958 FOUNDATION HEALTH LLC GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION PO BOX 71396 FAIRBANKS AK 71396 920035784 OWN/LEASE HOSPITAL RELATED MEDICAL FACILITIES AK 501(C)(3) 509(A)(1) N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION C 638070 CASH GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION K 37470513 CASH GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION O 888661 CASH