2018-11-15T17:59:33-06:00 2017-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1400 BELLEVUE WA 98004 990 2017-01-01 813021580 FOUNDATION HEALTH LLC FOUN 9074585550 PO BOX 71396 FAIRBANKS AK 99707 STEPHEN P LESLIE CFO 9074585550 2018-11-15 1 SARA ELIZABETH J HYRE P00235495 4254544919 2018-11-15 65.158.230.194 2018-11-15 14:14:13 PS P 2DE068ACBFA10A31F139242116409E8904B6E6F4 00A7300E43E73FAEAEBEB9E0895558C2993B7DE4 2017 2019-02-21 02:37:17Z X STEPHEN P LESLIE PO BOX 71396 FAIRBANKS AK 99707 285727395 0 X WWW.FOUNDATIONHEALTH.ORG X LLC 2016 AK COMPASSIONATE HEALTH CARE FOR EVERY CHAPTER IN YOUR LIFE STORY. 14 10 2085 126 1709895 597754 246726 275244830 6491823 3744016 285727395 0 0 148779423 0 0 132877487 281656910 4070485 91369723 21726714 69643009 COMPASSIONATE HEALTH CARE FOR EVERY CHAPTER IN YOUR LIFE STORY. 0 0 231538784 273551005 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 47,338 PATIENTS IN 2017 , INCLUDING 1,111 BABIES DELIVERED. THE HOME SERVED 203 INDIVIDUALS AND THE CLINIC PROVIDED ACCESS TO CARE FOR 40,838 PEOPLE. 231538784 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 144 0 1 2085 1 1 1 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 AK X STEPHEN LESLIE 9074583310 1650 COWLES STREET FAIRBANKS AK 99701 JEFF COOK CHAIR 1.00 1.50 X X 0 0 0 GARY RODERICK VICE CHAIR 1.00 1.20 X X 0 0 0 ROGER FLOERCHINGER TREASURER 0.30 1.20 X X 0 0 0 JOE FAULHABER SECRETARY 1.30 1.20 X X 0 0 0 SCOTT BELL BOARD MEMBER 0.60 1.00 X 0 0 0 KAREN PERDUE BOARD MEMBER 1.20 0.70 X 0 0 0 BILL VIVLAMORE BOARD MEMBER 0.40 1.00 X 0 0 0 RICHARD HATTAN BOARD MEMBER 0.60 0.40 X 0 0 0 STEVE FRANK BOARD MEMBER 0.20 0.40 X 0 0 0 MARK KOWAL MD BOARD MEMBER 0.30 0.00 X 0 0 0 LAURA BRUNNER MD BOARD MEMBER 40.00 0.00 X 298484 0 6956 TERI KISS RN BOARD MEMBER 40.00 0.00 X 149895 0 6248 CLAY TRIPLEHORN MD BOARD MEMBER 40.00 0.20 X 347762 0 40533 GREGORY L JOHNSON CEO THRU 12/17 40.00 0.00 X X 428862 0 21714 JIM L LYNCH COO/CEO BEG. 12/17 40.00 0.00 X 288288 0 14552 STEPHEN P LESLIE CFO 40.00 0.00 X 203105 0 9621 JOHN E COTTER ANCILLARY SERVICES DIRECTOR 40.00 0.00 X 186693 0 10577 DANNY R ROBINETTE CMO 40.00 0.00 X 367040 0 9018 KARL H SANFORD ASSOC. ADMIN. 40.00 0.00 X 208747 0 11788 CLINT BROOKS ASSOC. ADMIN. 40.00 0.00 X 189747 0 6523 KAREN M JUSTIN-TANNER CNO 40.00 0.00 X 173529 0 2936 JOSHUA L BURRILL COMPLIANCE OFFICER 40.00 0.00 X 182040 0 543 SHELLEY D EBENAL EXECUTIVE DIRECTOR GFCHF 0.00 40.00 X 233202 0 44310 ROMEL C WRENN PHYSICIAN MANAGER 40.00 0.00 X 1034656 0 15864 CARSON S WEBB PHYSICIAN 40.00 0.00 X 1252081 0 17276 MICHAEL D SWENSON PHYSICIAN MANAGER 40.00 0.00 X 443833 0 17664 VANESSA A VENEZIA PHYSICIAN MANAGER 40.00 0.00 X 425650 0 21596 6413614 0 257719 125 0 1 0 CROSS COUNTRY STAFFING INC LA LOCKBOX FILE 50941 LOS ANGELES CA 90074 MEDICAL STAFFING 10326284 INFOR US INC NW 7418 PO BOX 1450 MINNEAPOLIS MN 55485 PROGRAM SERVICES AND FEES 1138577 MAYO COLLABORATIVE SVCS INC PO BOX 9146 MINNEAPOLIS MN 55480 PHYICIANS REFERENCE SERVICES 1104204 MED DATA INC PO BOX 639190 CINCINNATI OH 45263 MEDICAL BILLING AGENCY 1015588 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PHYSICIAN FEES 862629 45 127930 118796 246726 OUTPATIENT REVENUE 622110 124418332 122750624 1667708 INPATIENT REVENUE 621110 82037812 82037812 CLINIC 621111 39960866 39960866 NURSING HOME 623110 20086355 20086355 PHARMACY 446110 4169368 4131068 38300 4572097 4572097 275244830 6482765 6482765 368249 0 368249 368249 368249 9058 0 9058 9058 9058 CAFETERIA/MEALS 722514 2421736 2421736 DAY CARE CENTER 624410 776983 776983 MDA MGMT FEES 900099 84000 84000 93048 12183 3887 76978 3375767 285727395 273551005 1709895 10219769 X 2658436 963104 1695332 117796517 95671572 22124945 2799870 2261362 538508 17089337 16625562 463775 8435263 6676574 1758689 244355 22093 222262 29162 29162 67149 67149 30908501 25641942 5266559 772346 772346 3164025 1656957 1507068 6156078 4352945 1803133 43797301 34392915 9404386 417108 246522 170586 114616 44261 70355 254216 189858 64358 1178132 902522 275610 MEDICAL SUPPLIES 20039927 20035870 4057 PHARMACEUTICAL SUPPLIES 9232581 9115428 117153 REPAIR AND MAINTENANCE 3527238 3517038 10200 SUBSIDY EXPENSE 185265 185265 0 12789487 9036994 3752493 281656910 231538784 50118126 0 16932451 64380274 5022539 3980567 488948 176700 0 312248 0 741644 0 91369723 21126714 0 600000 0 21726714 X 69643009 0 69643009 0 91369723 X 4070485 65572524 X 0 1 X 1 0 X 0 0 0 0 0 1 67149 0 0 0 67149 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 2017. 488948 176700 312248 312248 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 600000 600000 285643395 0 285643395 84000 84000 285727395 281572910 -84000 -84000 281656910 0 281656910 PART XI, LINE 4B - OTHER ADJUSTMENTS: MDA MGMT FEES NETTED WITH EXPENSE FOR FS PURPOSES 84,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: MDA MGMT FEE REVENUE REPORTED ON PART VIII -84,000. 1 1 X 1 X 350.000000000000 0 1 1 0 0 1312424 1312424 0.00470 63615892 49687904 13927988 0.04950 64928316 49687904 15240412 0.05420 102331 102331 0.00040 161242 161242 0.00060 217656 217656 0.00080 481229 481229 0.00180 65409545 49687904 15721641 0.05600 7700 7700 0.00000 5879 5879 0.00000 13579 13579 0.00000 1 17247562 51226071 57071661 -5845590 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 HTTPS://WWW.FOUNDATIONHEALTH.ORG/FMH/ABOUT_FMH/COMMUNITY_HEALTH_DOCS/FAIRBA X 1 17 0 1 0 1 X 350.000000000000 X 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 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 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 CONUNCTION WITH THE REORGANIZATION, THE FACILITY RECEIVED A NEW STATE LICENSE NUMBER. 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. PRIORITY 2) CHRONIC DISEASE - FOCUS ON HEALTHLY LIFESTYLE EDUCATION. INTERNALLY DEVELOPED COMMUNITY EDUCATION MODULES AND EVENTS FOR HEALTHY EATING OPTIONS, DIABETES EDUCATION AND SUPPORT, OBESITY EDUCATION, AND INDOOR AIR QUALITY. CONTRIBUTED TO PLANNING AND OPERATION OF A MEN'S HEALTH FAIR WITH WIDE RANGE OF SCREENING AND EDUCATION RESOURCES. PROVIDES SUPPORT TO YOUTH AND OTHER COMMUNITY ATHLETIC ACTIVITIES AND SPORT EVENTS. IN COLLABORATION WITH COMMUNITY ORGANIZATIONS ADVOCATE FOR STATEWIDE CAMPAIGN FOR "GET OUT AND PLAY EVERY DAY". 3) ACCESS TO CARE - FOCUS ON IMPROVING PERCENTAGE OF POPULATION WITH PRIMARY CARE PROVIDER. COLLABORATE WITH MEDICAL STAFF OF PRIMARY CARE CLINICS TO RECRUIT PROVIDERS, MANAGE PRIMARY CARE PRACTICES TO IMPROVE ACCESS, SCHEDULING, CALL ABANDONMENT RATE, AND ON-LINE PORTAL ACCESS, AND TO PROMOTE ACCESS BY PATIENTS WITHIN ALL SOCIOECONOMIC DEMOGRAPHICS. NEEDS IDENTIFIED BUT NOT PRIORITIZED DURING 2017 WERE 1) SENIOR CARE/ALZHEIMERS - WHICH WAS DEFERRED TO LOCAL ORGANIZATIONS FOR ALZHEIMERS AND 2) SEXUALLY TRANSMITTED INFECTIONS - WHICH WAS DEFERRED TO PUBLIC HEALTH AND WATCHFUL EVALUATION OF REPORTING DATA WHICH WAS BELIEVED TO BE SKEWED DUE TO REPORTING INCIDENT IMPROVEMENTS. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: DISCOUNTED CARE IS PROVIDED TO PATIENTS WITH ANNUAL HOUSEHOLD INCOME LESS THAN $125,000. FAIRBANKS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: COVERAGE THROUGH OTHER PROGRAMS OR INSURANCE MUST BE EXHAUSTED OR DENIED. 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 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 7 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 2017. THE SHORTFALL IS APPROXIMATELY $5.8M . 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. 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 PRIMARY SERVICE AREA IS ESTIMATED AT 106,470 AND 32,818 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 54% MALE 46% FEMALE, CAUCASIANS REPRESENT 69% OF THE POPULATION AND HISPANIC 9%, BLACK 6%, ASIAN/PACIFIC ISLANDER 3%, AMERICAN INDIAN/ALASKA NATIVE 7%, OTHER 6%. MEDIAN HOUSEHOLD INCOME IS $70,304, COST OF LIVING 132.4, MEDIAN AGE 31.8, MEDIAN HOUSE VALUE $234,000. OF ALL FAMILIES, 6% PSA BELOW THE POVERTY LEVEL, WITH CHILDREN 9%, AND SINGLE FEMALES WITH CHILDREN 30%. THE POPULATION IS REPRESENTED BY COMMERCIAL INSURANCE AT 68%, MEDICAID 17%, MEDICARE 8%, AND UNINSURED 7%. 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. LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: ALASKA DOES NOT REQUIRE FILING OF A COMMUNITY BENEFIT REPORT. X 1 1 X X X 1 0 0 0 0 0 0 1 0 LAURA BRUNNER MD BOARD MEMBER 186926 0 110456 0 1102 0 6177 0 779 0 305440 0 0 0 TERI KISS RN BOARD MEMBER 149182 0 0 0 713 0 4835 0 1413 0 156143 0 0 0 CLAY TRIPLEHORN MD BOARD MEMBER 220438 0 124358 0 2966 0 10789 0 29744 0 388295 0 0 0 GREGORY L JOHNSON CEO THRU 12/17 345881 0 81001 0 1980 0 10800 0 10914 0 450576 0 0 0 JIM L LYNCH COO/CEO BEG. 12/17 222101 0 65529 0 658 0 8884 0 5668 0 302840 0 0 0 STEPHEN P LESLIE CFO 175517 0 27268 0 320 0 7021 0 2600 0 212726 0 0 0 JOHN E COTTER ANCILLARY SERVICES DIRECTOR 167531 0 17952 0 1210 0 6701 0 3876 0 197270 0 0 0 DANNY R ROBINETTE CMO 365060 0 0 0 1980 0 0 0 9018 0 376058 0 0 0 KARL H SANFORD ASSOC. ADMIN. 177999 0 29750 0 998 0 7120 0 4668 0 220535 0 0 0 CLINT BROOKS ASSOC. ADMIN. 163069 0 26141 0 537 0 6523 0 0 0 196270 0 0 0 KAREN M JUSTIN-TANNER CNO 173338 0 0 0 191 0 0 0 2936 0 176465 0 0 0 JOSHUA L BURRILL COMPLIANCE OFFICER 50913 0 40000 0 91127 0 0 0 543 0 182583 0 0 0 SHELLEY D EBENAL EXECUTIVE DIRECTOR GFCHF 182926 0 50000 0 276 0 7746 0 36564 0 277512 0 0 0 ROMEL C WRENN PHYSICIAN MANAGER 801092 0 231486 0 2078 0 10800 0 5064 0 1050520 0 0 0 CARSON S WEBB PHYSICIAN 701148 0 550501 0 432 0 10800 0 6476 0 1269357 0 0 0 MICHAEL D SWENSON PHYSICIAN MANAGER 155891 0 287189 0 753 0 10800 0 6864 0 461497 0 0 0 VANESSA A VENEZIA PHYSICIAN MANAGER 392118 0 33245 0 287 0 10800 0 10796 0 447246 0 0 0 PART I, LINE 1A FOUNDATION HEALTH LLC PROVIDED ONE MONTH OF HOUSING TO JOSHUA BURRILL. THIS WAS TREATED AS TAXABLE COMPENSATION AND INCLUDED IN FORM W-2 WAGES. PART I, LINE 4A JOSHUA BURRILL RECEIVED SEVERANCE OF $83,007 DURING 2017. PART I, LINE 7 BONUS PAYMENT TO SHELLEY EBENAL IS DISCRETIONARY. THE BONUS WAS APPROVED BY GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION, FOUNDATION HEALTH'S SOLE MEMBER. 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 9244 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 CAF, 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 COPY OF THE FORM 990 WILL BE EMAILED TO THE FINANCE COMMITTEE MEMBERS 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 IX, LINE 11G CASUAL LABOR : PROGRAM SERVICE EXPENSES 10,957,575. MANAGEMENT AND GENERAL EXPENSES 711,661. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,669,236. PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 4,642,050. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,642,050. SERVICE CONTRACTS MAINT : PROGRAM SERVICE EXPENSES 2,539,571. MANAGEMENT AND GENERAL EXPENSES 1,018,973. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,558,544. OTHER: PROGRAM SERVICE EXPENSES 7,502,746. MANAGEMENT AND GENERAL EXPENSES 3,535,925. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,038,671. FORM 990, PART XI, LINE 9: ASSET TRANSFER FROM RELATED PARTY 65,572,524. DENALI CENTERLLC 1510 19TH AVENUE FAIRBANKS AK 99701 300945293 COMPREHENSIVE SHORT AND LONG TERM CARE CENTER AK 21132800 2994760 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL HOSPITAL LLC 1650 COWLES STREET FAIRBANKS AK 99701 320499956 HOSPITAL/HEALTHCARE SERVICES AK 214517314 90064123 FOUNDATION HEALTH LLC TANANA VALLEY CLINIC LLC 1001 NOBLE STREET FAIRBANKS AK 99701 611797882 PRIMARY CARE SERVICES AK 33821228 6277643 FOUNDATION HEALTH LLC FAIRBANKS MEMORIAL CARDIOLOGY CENTER LLC 1650 COWLES ST FAIRBANKS AK 99701 364841105 CARDIOLOGY CLINIC AK 14373609 756253 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 1798444 671373 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 65572524 CASH GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION K 36176972 CASH GREATER FAIRBANKS COMMUNITY HOSPITAL FOUNDATION O 702167 CASH