2016-11-14T19:09:17-06:00 2015-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2015-01-01 930386936 MID-COLUMBIA MEDICAL CENTER MID- 5412961111 PO BOX 1580 THE DALLES OR 97058 DON ARBON CFO 5412961111 2016-11-11 1 MARK E EKLUND CPA P00156145 5036974118 2016-11-11 2015 2017-02-10 21:41:12Z X DIANNE STORBY PO BOX 1580 THE DALLES OR 97058 135309564 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. 8 6 1135 175 0 0 134997 6667108 106979510 109629027 758068 792259 4563614 7954520 112436189 125042914 19653 126356 0 0 69859429 73724425 0 0 540548 39965841 42983982 109844923 116834763 2591266 8208151 60416427 72692438 26484710 31561646 33931717 41130792 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 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. 0 0 103636114 126356 117538410 ACUTE HOSPITAL CARE: INPATIENT DAYS 7,222, INPATIENT REHAB DAYS 1,392, OUTPATIENT OBSERVATION DAYS 1,158, LABORATORY TESTS 251,953, IMAGING TESTS 32,619, HOME HEALTH EPISODES 1,889, EMERGENCY VISITS 16,638, ENDOSCOPY VISITS 1,331, MEDICAL ONCOLOGY 9,051, OUTPATIENT SURGERIES 1,494, RADIATION ONCOLOGY OUTPATIENT PROCEDURES 7,602, TOTAL HOSPITAL OUTPATIENT VISITS 121,019 AND TOTAL OUTPATIENT CLINIC VISITS 110,366.SEE SCHEDULE H FOR NARRATIVE OF PROGRAM SERVICE ACCOMPLISHMENTS. 103636114 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 143 0 1135 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 OR X X MID-COLUMBIA MEDICAL CENTER 5412961111 1700 E 19TH STREET THE DALLES OR 97058 WALLACE WOLF JR DVM DIRECTOR 1.00 X 0 0 0 DAN BOLDT DIRECTOR 1.00 X X 0 0 0 PAUL CARDOSI MD SECRETARY 50.00 X X 269670 0 28494 ROB CARNAHAN CHAIR 1.00 X X 0 0 0 CARINA SCHMIDT VICE-CHAIR 1.00 X 0 0 0 PHIL BRADY DIRECTOR 1.00 X 0 0 0 MARK ENGER DIRECTOR 10.00 X 0 0 0 DUANE FRANCIS PRESIDENT & CEO 50.00 X X 0 672827 151052 DONALD ARBON CFO & VP FINANCE 50.00 X 0 225588 29395 REGINA ROSE VP CHIEF NURSING OFFICER 50.00 X 183741 0 32053 WILLIAM HAMILTON MD VP MEDICAL AFFAIRS 50.00 X 388355 0 35867 DIANNE STORBY EXEC VP OF OPERATIONS 1.00 50.00 X 0 289641 32197 ERICK LARSON VP CHIEF INFORMATION OFFIC 1.00 50.00 X 0 175863 26142 XINYU STEVE FU PHYSICIAN 50.00 X 701636 0 29794 JOHN SCHWARTZ PHYSICIAN 50.00 X 551521 0 24188 KEITH STELZER PHYSICIAN 50.00 X 592827 0 27294 GARY GINGRICH PHYSICIAN 50.00 X 456387 0 26688 MARK CULLEN PHYSICIAN 50.00 X 683383 0 22178 3827520 1363919 465342 107 0 1 0 OREGON HEALTH & SCIENCE UNIVERSITY 318 SW SAM JACKSON PARK RD PORTLAND OR 97239 PRO FEES FOR SPECIALTY CLINIC PROVIDERS 2719150 CORESOURCE INC PO BOX 83301 LANCASTER PA 17608 HEALTH INSURANCE CLAIMS PROCESSOR 657991 CELILO SURGICAL LLC 1810 E 19TH ST 225 THE DALLES OR 97058 PRO FEES, ER CALL 587250 QUEST DIAGNOSTICS 3 GIRALDA FARMS MADISON NJ 07940 LAB SERVICES 404101 PATRICK GRIMSLEY DO PC 1700 E 19TH ST THE DALLES OR 97058 ER PHYSICIAN & MEDICAL DIRECTOR 392489 21 25759 6641349 6667108 NET PATIENT SERVICE REVENUE 622110 109629027 109629027 109629027 258734 258734 110150 0 110150 110150 110150 10800175 10241117 25533 559058 -25533 533525 -25533 559058 FITNESS & SPA CENTER 713940 1153683 1153683 CAFETERIA 722100 784316 784316 DAYCARE 624410 435178 435178 5471193 5471193 7844370 125042914 117558014 0 817792 126356 126356 3827521 3255424 572097 55002847 50661810 4049157 291880 2502429 2283481 205639 13309 8382040 6942963 1438713 364 4009588 3670952 317801 20835 1500000 1500000 220900 220900 120477 117277 3200 10411 10411 6579785 5623241 811688 144856 350807 329602 10415 10790 489303 436537 52766 8968 8968 4095988 3435174 638083 22731 349117 307629 38747 2741 157937 157937 3366303 3052348 313696 259 1184068 1115571 68167 330 SUPPLIES 21855394 21590286 256958 8150 PURCHASED SERVICES 1390590 1390590 OTHER 1303934 646803 655407 1724 116834763 103636114 12658101 540548 2717667 3784610 1779877 1342125 13625322 16680945 16764 82486 250319 246790 1740821 1711258 4379614 3431933 71121127 44634449 16916294 26486678 12831870 13085735 500186 500687 368871 944606 1609784 1610560 3679038 2784025 60416427 72692438 9270701 11072961 7792 107982 11730640 16222719 5475577 4157984 26484710 31561646 X 32769280 34955919 1162437 6174873 33931717 41130792 60416427 72692438 X 8208151 -845485 -50014 -113577 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1389999 11182 51092 23019 1429254 1345021 8511 48321 11854 1389999 1310867 12621 27470 5937 1345021 1287095 6237 23245 5710 1310867 1266891 9137 17965 6898 1287095 0.71690 0.26460 0.01850 0 1 1 562933 562933 13973185 9581068 4392117 4230429 1875538 2354891 51873630 33177843 18695787 480950 480950 26486678 IBNR RESERVE 930552 SETTLEMENT RESERVES 1890731 DEFERRED COMPENSATION 1336701 4157984 X 120483616 707569 707569 119776047 5266867 5266867 125042914 116951801 707569 707569 116244232 590531 590531 116834763 PART V, LINE 4: THE FOUNDATION'S ENDOWMENT FUND IS A QUASI-ENDOWMENT THAT FUNDS THE MID-COLUMBIA HEALTH FOUNDATION OPERATING EXPENSES - ENDING BALANCE $1,024,711. THE REMAINING ENDOWMENT FUNDS SUPPORT SEVERAL SCHOLARSHIPS AND OTHER FUNDS EXPLAINED BELOW: TEMPORARY AND PERMANENTLY RESTRICTED FUNDS: - EVELYN KASER SCHOLARSHIP FUND: TO INSURE THAT INDIVIDUALS WHO DESIRE TO BECOME REGISTERED NURSES HAVE THIS EDUCATIONAL OPPORTUNITY DESPITE FINANCIAL CONCERNS. - LORNA & JOSEPH HALLIDAY FAMILY NURSING SCHOLARSHIP FUND: TO ASSIST INDIVIDUALS ASPIRING TO BECOME REGISTERED NURSES WHO GREW UP IN THE MID-COLUMBIA REGION. - MCMC BOARD OF TRUSTEES MEDICAL PROFESSIONALS SCHOLARSHIP: TO HELP DEFRAY SOME COLLEGE EXPENSES FOR GRADUATING SENIORS FROM THE DALLES HIGH SCHOOL. - PERMANENT SCHOLARSHIP FUND: EARNS INTEREST THAT IS ANNUALLY TRANSFERRED TO THE MID-COLUMBIA MEDICAL CENTER SCHOLARSHIP FUND. PART X, LINE 2: INCOME TAX POSITIONS THAT MEET A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN THE MEDICAL CENTER'S BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN THE MEDICAL CENTER'S STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2015 AND 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: IN-KIND SUPPORT FROM OREGON HEALTH & SCIENCE UNIVERSITY 707,569. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS FROM MID-COLUMBIA HEALTH FOUNDATION 50,014. CONTRIBUTIONS FROM OREGON HEALTH & SCIENCE UNIVERSITY 5,087,002. INCOME FROM PASSTHROUGH ENTITIES 129,851. PART XII, LINE 2D - OTHER ADJUSTMENTS: IN-KIND SUPPORT FROM OREGON HEALTH & SCIENCE UNIVERSITY 707,569. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES FOR MID-COLUMBIA HEALTH FOUNDATION 540,531. GRANT TO MID-COLUMBIA HEALTH FOUNDATION 50,000. 1 1 X 1 X 1 X 1 1 1 0 1 1 3236 2820844 2820844 0.02410 19810245 12963156 6847089 0.05860 3236 22631089 12963156 9667933 0.08270 29000 422997 422997 0.00360 462398 462398 0.00400 4994 4994 0.00000 20191 4540 15651 0.00010 1012666 1012666 0.00870 29000 1923246 4540 1918706 0.01640 32236 24554335 12967696 11586639 0.09910 28287 28287 0.00020 44867 44867 0.00040 186477 186477 0.00160 498 498 0.00000 260129 260129 0.00220 1 821877 82188 31504737 29334251 2170486 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 0 0 1 X X X X X X X X 13 1 1 1 1 X HTTP://WWW.MCMC.NET X 1 14 1 HTTP://WWW.MCMC.NET 0 0 1 X 200.000000000000 400.000000000000 1 1 X X 1 X HTTP://WWW.MCMC.NET X HTTP://WWW.MCMC.NET X HTTP://WWW.MCMC.NET X X X X X X 1 X 1 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 5: IN PREPARING THE CHNA IN 2014, THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY WE SERVE, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF/EXPERTISE IN PUBLIC HEALTH BY CREATING A COLLABORATIVE, CROSS-ORGANIZATIONAL, CROSS-COUNTY FORUM, THE MEMBERS OF WHICH AGREE ON THE NEEDS WITHIN OUR REGION AND COMMUNITIES AND AGREE TO SUPPORT OUR ABILITY TO ADDRESS THOSE NEEDS TOGETHER. WE ELECTED TO ALSO INCLUDE THE SOCIAL SERVICE AGENCIES AND NON-PROFITS THAT SERVE OUR AREAS' MOST VULNERABLE POPULATIONS.THE PERSONS CONSULTED INCLUDE: BARB SEATTER M.S., CATHERINE WHALEN, DIRECTOR OF COMMUNITY INITIATIVES MID-COLUMBIA MEDICAL CENTER (MCMC), COCO YACKLEY, ELLEN LARSEN RN, ERIN QUINN MSN, FNP, JULIE REYNOLDS PHD, MAIJA YASUI, MARK THOMAS CHAPLAIN, MEGAN MCANINCH MSC, TERI THALHOFER RN, BSN, DIRECTOR NORTH CENTRAL PUBLIC HEALTH DISTRICT. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 6A: THE HOSPITAL'S (MCMC) CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES: KLICKITAT VALLEY HEALTH, PROVIDENCE HOOD RIVER HOSPITAL AND SKYLINE HOSPITAL. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 6B: THE HOSPITAL'S (MCMC) CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITIES: COLUMBIA GORGE HEALTH COUNCIL, HOOD RIVER COUNTY HEALTH DEPARTMENT, KLICKITAT VALLEY HEALTH DEPARTMENT, MID-COLUMBIA CENTER FOR LIVING, NORTH CENTRAL PUBLIC HEALTH DISTRICT, ONE COMMUNITY HEALTH, PACIFIC SOURCE COMMUNITY SOLUTIONS. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 11: MCMC IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA IN THE FIRST YEAR OF THE IMPLEMENTATION PLAN BY COORDINATING EFFORTS ACROSS HEALTHCARE AND SOCIAL SERVICES, PROVIDING SERVICES TO ASSIST WITH HEALTH INSURANCE ENROLLMENT AND RE-ENROLLMENT (HIRING ASSISTERS), COORDINATING SERVICES ACROSS THE SPECTRUM OF HEALTHCARE PROVIDERS AND SUPPORTING DEVELOPMENT AND HEALTHY GROWTH IN THE EARLY STAGES OF CHILDHOOD. WE ADDRESS THE IDENTIFIED NEEDS THROUGH A THREE-STEP REPETITIVE PROCESS: 1) IDENTIFY, 2) INTEGRATE RESPONSE AND 3) COMPILE ACTION ITEMS. FIVE CONDITIONS MUST BE MET FOR COLLECTIVE IMPACT SUCCESS: A COMMON AGENDA, SHARED MEASUREMENTS, MUTUALLY REINFORCING ACTIVITIES, CONTINUOUS COMMUNICATION AND BACKBONE ORGANIZATION (A DEDICATED TEAM WITH SPECIFIC SKILLS TO PROVIDE THE SUPPORT NECESSARY FOR A COHESIVE INITIATIVE.) IN THE FIRST YEAR OF IMPLEMENTATION, THERE ARE NO IDENTIFIED AREAS IN WHICH NEEDS ARE NOT BEING ADDRESSED. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 16I: MCMC CHARGES AND A LINK TO OUR FAP ARE AVAILABLE ON THE OREGON PRICEPOINT WEBSITE: HTTP://WWW.ORPRICEPOINT.ORG HOSTED BY THE OREGON ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS; POLICY IS DISCUSSED WITH PATIENTS WHEN THEY BRING UP FINANCIAL NEED. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 18D: REPORT ONLY TO THIRD PARTY COLLECTION AGENCY: ASSET RECOVERY MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 19D: IF THE THIRD PARTY COLLECTION AGENCY (ASSET RECOVERY) IDENTIFIES THAT AN INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE INDIVIDUAL IS REFERRED BACK TO THE HOSPITAL FOR FURTHER REVIEW. MID-COLUMBIA MEDICAL CENTER PART V, SECTION B, LINE 22D: THE HOSPITAL ANNUALLY TAKES ACCOUNTS PAID BY COMMERCIAL INSURANCE, MEDICARE AND MEDICAID ADVANTAGE PLANS FOR THE PRIOR 12-MONTH PERIOD TO DETERMINE THE WRITE-OFF PERCENTAGE TO APPLY TO CHARGES FOR ANY INDIVIDUAL THAT IS SELF-PAY AT THE TIME OF BILLING. 11 1 - COLUMBIA HILLS FAMILY MEDICINE 1620 E 12TH STREET THE DALLES OR 97058 HOSPITAL BASED CLINIC 2 - RIVERVIEW INTERNAL MEDICINE 1825 E 19TH STREET THE DALLES OR 97058 HOSPITAL BASED CLINIC 3 - WATER'S EDGE INTERNAL MEDICINE 551 LONE PINE BLVD STE 201 THE DALLES OR 97058 HOSPITAL BASED CLINIC 4 - COLUMBIA CREST FAMILY MEDICINE 1935 E 19TH STREET THE DALLES OR 97058 HOSPITAL BASED CLINIC 5 - COLUMBIA RIVER WOMEN'S CENTER 1810 E 19TH STREET STE 209 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 6 - MCMC SPORTSORTHOPAEDIC MEDICINE 551 LONE PINE BLVD STE 302 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 7 - WATER'S EDGE CARDIOLOGY 551 LONE PINE BLVD STE 303 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 8 - MCMC OCCUPATIONAL HEALTH 1815 EAST 19TH STREET SUITE 2 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 9 - COLUMBIA CREST DERMATOLOGY 1935 E 19TH STREET STE 110 THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 10 - GORGE UROLOGY 1805 E 19TH STREET THE DALLES OR 97058 NON-HOSPITAL BASED CLINIC 11 - GORGE UROLOGY 810 12TH STREET HOOD RIVER OR 97031 NON-HOSPITAL BASED CLINIC PART I, LINE 3C: TRACK DIRECT LABOR AND OTHER COSTS IN EACH CATEGORY FOR ALL PATIENT SEGMENTS. IF ONLY REVENUE INFORMATION WAS AVAILABLE, A COST/CHARGE RATIO WAS APPLIED TO THE ESTIMATED COSTS PART I, LINE 7: COST-TO-CHARGE RATIO WAS UTILIZED; CCR WAS DERIVED FROM CALCULATION USED IN 2015 AUDITED FINANCIALS PART II, COMMUNITY BUILDING ACTIVITIES: MCMC PROMOTES THE HEALTH OF THE COMMUNITIES 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. BAD DEBT COST IS CALCULATED BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO PART III, LINE 3: WE COMPARED AMOUNTS ALLOWED FOR CHARITY CARE TO TOTAL CHARGES TO CALCULATE AN ESTIMATED RATE. PART III, LINE 4: DESCRIPTION OF BAD DEBT POLICY CAN BE FOUND ON PAGE 8 OF THE 2015 FINAL AUDITED FINANCIAL STATEMENTS 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 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 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 CONSUMERS 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.HEALTH OUTCOMES AND FACTORS 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, 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 AND PATIENT ACCOUNTS 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. PART VI, LINE 4: MID-COLUMBIA MEDICAL CENTER (MCMC) IS LOCATED IN THE DALLES, WASCO COUNTY, OREGON, WITH THE POPULATION OF WASCO COUNTY AT 25,775. 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 POPULATION TOTAL OF 50,340. MEDIAN INCOMES AND ETHNIC DEMOGRAPHICS VARY BY GEOGRAPHIC LOCATION. 2015 CENSUS DATA SHOWS MEDIAN INCOMES RANGE FROM $39,960 TO $46,490.WASCO COUNTY HAS THE LARGEST ETHNIC DIVERSITY WITH A DISTRIBUTION THAT IS 78% WHITE, 17% HISPANIC/LATINO, 4% AMERICAN INDIAN/ALASKA NATIVE AND 1% OTHER, STATISTICS WHICH REMAIN RELATIVELY UNCHANGED FROM 2014. SEVENTEEN PERCENT OF THE POPULATION LIVES BELOW THE POVERTY LEVEL AND 15% OF THE POPULATION UNDER THE AGE OF 65 IS UNINSURED. ADDITIONAL PUBLISHED DATA FROM THE OREGON HEALTH AUTHORITY CITES DECEMBER 31, 2014 MEDICAID PROGRAM ENROLLMENT IN WASCO COUNTY AT 7,563, AND 8,015 AT JULY 15, 2016, AN INCREASE OF 6%.IN ADDITION TO THE YEAR ROUND POPULATION, THE DALLES EXPERIENCES AN INFLUX OF 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 HEALTHCAREBOARD AND SENIOR EXECUTIVE LEADERSHIP ARE ACTIVELY INVOLVED IN PRIORITIZATION OF COMMUNITY INITIATIVES. A FULL-TIME DIRECTOR 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. 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 DISEASEPLANETREE HEALTH RESOURCE CENTER" IN ADDITION TO ISSUING THOUSANDS OF FREE ADMISSION PACKETS TO INPATIENTS, PHRC PROVIDED 60 BLOOD PRESSURE SCREENINGS IN 2015" 7,064 COMMUNITY MEMBERS TOOK ADVANTAGE OF FREE SERVICES AT PHRC" 181 PEOPLE ATTENDED THE FREE PHRC LECTURE SERIES WHICH INTRODUCED THE FOLLOWING TOPICS: LIVING WITH CHRONIC PAIN: TOOLS FOR MANAGEMENT MENTAL ILLNESS AND THE FAMILY: HOW TO COPE THIS AGING BODY COULD YOU REPEAT THAT? HEARING LOSS AND PREVENTIONDIABETES / OBESITY" MCMC HAS A ROBUST DIABETES EDUCATION OUTREACH FOCUS PROVIDING EDUCATIONAL SESSIONS THROUGHOUT OUR COMMUNITY AND SERVICE AREA. IN 2015 MCMC PROVIDED FOUR SCHOLARSHIPS TO LOW INCOME FAMILIES ATTENDING THE HEALTHY WEIGHT SOLUTIONS PROGRAM, WHICH PROVIDED NUTRITIONAL COUNSELING, HEALTHY COOKING DEMONSTRATIONS, INDIVIDUAL COUNSELING AND OVER 90 HOURS OF GROUP EDUCATIONGO RED FOR WOMEN'S HEART HEALTH" MCMC SPONSORS THIS EVENT EACH YEAR; IN 2015 255 REGISTRANTS PARTICIPATED IN A HEART EXPO/HEART WALK; OVER 150 REGISTRANTS PARTICIPATED IN THE HEART TRUTH WALK/RUN PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES OR LINE 5 CONTINUATION PATIENT REHABILITATION SERVICES" PATIENT REHABILITATION SERVICES PROVIDED COMMUNITY EDUCATION AND ASSISTANCE IN THE DECISION-MAKING PROCESS FOR COMMUNITY MEMBERS CONSIDERING TOTAL JOINT REPLACEMENT" 70 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. OVER 130 COMMUNITY MEMBERS ATTENDED THE SERIES " STEPS TO WELLNESS, TWO 90-MINUTE AND THREE 60-MINUTE TALKS GIVEN TO COMMUNITY MEMBERS AND PROVIDERS TO HELP THEM BETTER UNDERSTAND PAIN MANAGEMENT AND THE IMPORTANCE OF EDUCATION AND EXERCISE TO REACH THE GOAL OF LESSENING RELIANCE ON OPIATES. THE SERIES TARGETED MEDICAID AND MEDICARE RECIPIENTS AS WELL AS THE HISPANIC COMMUNITYFEMALE & FABULOUS FAIR" NOW IN ITS SECOND YEAR, THIS FREE HEALTH FAIR FOR WOMEN WAS ATTENDED BY 278 PARTICIPANTS; THE FAIR PROVIDED YOGA THERAPY CLASSES, HEALTHY COOKING CLASSES, CIRCUIT TRAINING, SKIN CHECKS WITH AN ON-STAFF DERMATOLOGIST, BREAST CARE, HORMONE REPLACEMENT THERAPY, WEIGHT LOSS AND NUTRITION, GENETICS, COMMUNICATION, SKIN CARE AND SKIN CANCER PREVENTION AND MINDFULNESS/SELF-CARE CLASSES LINE 5 CONTINUATION POVERTY AND UNINSUREDOUR PATIENT AND VISITOR SERVICES AND PATIENT ACCOUNTS 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.OTHER MEANINGFUL CONTRIBUTIONS IN THE YEAR 2015" ANNUAL COMMUNITY DRUG-TAKE BACK: MID-COLUMBIA MEDICAL CENTER, IN PARTNERSHIP WITH LOCAL LAW ENFORCEMENT, YOUTH THINK AND TRI-COUNTY HAZARDOUS WASTE & RECYCLING, OFFERS FREE DROP-OFF OF HOUSEHOLD PRESCRIPTION, OVER THE COUNTER, VITAMIN/SUPPLEMENTS AND PET MEDICINES" MCMC PRODUCES A QUARTERLY HEALTH MAGAZINE (WELL AWARE) DISTRIBUTED TO OVER 17,000 HOUSEHOLDS THROUGHOUT THE SURROUNDING COMMUNITY, AT A COST OF APPROXIMATELY $95,000" MCMC FACILITATES A VARIETY OF SUPPORT GROUPS ON A REGULAR BASIS, INCLUDINGO MONTHLY STROKE CLUB O MONTHLY FAMILY SUPPORT CLASSES O HEALTHY WEIGHT SOLUTIONS O MONTHLY PROSTATE CANCER SUPPORT GROUPO REACH FOR RECOVERY - BREAST CANCER SUPPORT GROUPO PARKINSON'S SUPPORT GROUP " CAR SEAT EVALUATIONS, BIKE HELMET PROGRAMS AND TRAUMA NURSES TALK TOUGH ARE OFFERED ANNUALLY AT MAJOR MCMC AND OTHER COMMUNITY EVENTS" WITH A WIDELY DIVERSE ETHNIC POPULATION IN THE SERVICE AREA, INTERPRETATION SERVICES ARE IN HIGH DEMAND. MCMC IMPLEMENTED AUDIO / VIDEO REMOTE INTERPRETING TECHNOLOGY TO MEET LANGUAGE NEEDS IN THE HOSPITAL 24/7 TO ASSIST PATIENTS SEEKING CARE THROUGHOUT OUR ORGANIZATION AND TO ANY OTHER LOCAL HEALTH SERVICE PROVIDER, REGARDLESS OF AFFILIATION WITH MCMC. SPANISH SPEAKING STAFF REMAIN AVAILABLE FOR NON-MEDICAL INTERPRETATION SERVICES AT BOTH THE HOSPITAL AND OUTPATIENT CLINICS. MCMC IS WORKING TO CERTIFY QUALIFIED STAFF AS MEDICAL INTERPRETERS IN ORDER TO MEET SPECIFIC STATE REGULATIONS AND GUIDELINES" MCMC PROVIDES MENTORING AND INTERNSHIP PROGRAMS DESIGNED TO HELP TRAIN EXISTING AND FUTURE CARE PROVIDERS SUCH AS PHARMACY TECHNICIANS, MEDICAL ASSISTANTS, HEALTH INFORMATION MANAGEMENT STUDENTS, CHILD CARE PROVIDERS, RADIOLOGICAL TECHNICIANS, NURSES AND RURAL HEALTH EMS 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 SOCIAL DETERMINANTS OF HEALTHMCMC IS INVOLVED IN A VARIETY OF COMMUNITY AND COALITION BUILDING AND HEALTH ADVOCACY ACTIVITIES REGARDING SUCH SOCIAL DETERMINANTS AS: HEALTH AS FOOD SECURITY, HOUSING AND TRANSPORTATION. THE REGIONAL COMMUNITY ACTION COUNCIL BEGAN PRIORITIZING AN IMPLEMENTATION STRATEGY AROUND THESE TOPICS BEGINNING IN 2014; MCMC IS A PRIMARY PARTNER IN THOSE EFFORTS. 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 STREET THE DALLES OR 97058 930854433 501(C)(3) 50000 TO PROVIDE FUNDS FOR THE RENOVATION OF THE DALLES HIGH SCHOOL GYM GORGE GROWN FOOD NETWORK PO BOX 752 HOOD RIVER OR 97031 262910949 501(C)(3) 10000 TO SUPPORT LOCAL FOOD NETWORK AND LOCAL FARMERS CHERRY CITY CRUSH PO BOX 1912 THE DALLES OR 97058 320330783 501(C)(3) 5000 SUPPORT OF ATHLETIC LEAGE PART I, LINE 2: AN INTERNAL GRANT MANAGER TRACKS ALL EXPENSES RELATED TO THE GRANT AND REPORTS THEM PERIODICALLY IN A WRITTEN REPORT TO THE GRANTOR. SOME GRANTS CONTAIN LINE-ITEM BUDGETS WHICH ALSO MUST BE MET AND ARE SUBJECT TO AUDIT BY THE GRANTOR. X X X X X 0 1 0 0 0 1 0 0 0 PAUL CARDOSI MD SECRETARY 251204 0 18466 0 0 0 13250 0 15244 0 298164 0 0 0 DUANE FRANCIS PRESIDENT & CEO 0 631127 0 41700 0 0 0 120316 0 30736 0 823879 0 0 DONALD ARBON CFO & VP FINANCE 0 225088 0 500 0 0 0 11427 0 17968 0 254983 0 0 REGINA ROSE VP CHIEF NURSING OFFICER 183716 0 25 0 0 0 9470 0 22583 0 215794 0 0 0 WILLIAM HAMILTON MD VP MEDICAL AFFAIRS 380974 0 7381 0 0 0 13250 0 22617 0 424222 0 0 0 DIANNE STORBY EXEC VP OF OPERATIONS 0 289141 0 500 0 0 0 13250 0 18947 0 321838 0 0 ERICK LARSON VP CHIEF INFORMATION OFFIC 0 175838 0 25 0 0 0 9125 0 17017 0 202005 0 0 XINYU STEVE FU PHYSICIAN 701611 0 25 0 0 0 13250 0 16544 0 731430 0 0 0 JOHN SCHWARTZ PHYSICIAN 551496 0 25 0 0 0 13250 0 10938 0 575709 0 0 0 KEITH STELZER PHYSICIAN 592802 0 25 0 0 0 13250 0 14044 0 620121 0 0 0 GARY GINGRICH PHYSICIAN 456362 0 25 0 0 0 13250 0 13438 0 483075 0 0 0 MARK CULLEN PHYSICIAN 679394 0 3989 0 0 0 13250 0 8928 0 705561 0 0 0 PART I, LINE 4B DUANE FRANCIS - $107,066 PART I, LINE 6 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. HEALTH CARE FOR THE MID-COLUMBIA REGION DIRECTLY CONTROLLING ENTITY OPERATING LOAN X 82486 0 0 0 MID-COLUMBIA HEALTH FOUNDATION RELATED TO MID-COLUMBIA HEALTH FOUNDATION BY COMMON PARENT ORGANIZATION OPERATING EXPENSES X 40760 0 0 0 DRY HOLLOW PROFESSIONAL CENTER INC WHOLLY OWNED SUBSIDIARY OF HEALTH CARE, THE CONTROLLING ENTITY OPERATING LOAN X 67222 0 0 0 190468 FORM 990, PART VI, SECTION A, LINE 6 HEALTH CARE FOR THE MID-COLUMBIA REGION IS THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 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 THE BOARD ENGAGES A PROFESSIONAL FIRM TO DO A REGIONAL AND NATIONAL SURVEY, ALONG WITH A COMPARISON OF ORGANIZATION COMPLEXITY AND STRUCTURE, AND THEN RECOMMENDS A SALARY AND BENEFITS RANGE TO THE BOARD. THIS IS ALL DONE CONFIDENTIALLY WITHOUT CEO PARTICIPATION. 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 XI, LINE 9: INCREASE IN RESTRICTED NET ASSETS 16,274. INCOME FROM PASSTHROUGH ENTITIES -129,851. FORM 990, PART XI, LINE 2C THE RESPONSIBILITY AND PROCESS FOR OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR. MID-COLUMBIA HEALTH FOUNDATION 1700 E 19TH STREET THE DALLES OR 97058 930854433 SUPPORT MID-COLUMBIA MEDICAL CENTER OR 501(C)(3) LINE 7 HEALTH CARE FOR THE MID-COLUMBIA REGION 1 HEALTH CARE FOR THE MID-COLUMBIA REGION 1700 E 19TH STREET THE DALLES OR 97058 930847905 HEALTH CARE SERVICES OR 501(C)(3) LINE 11C, III-FI 0 LONE PINE HEALTH & WELLNESS CENTER LLC 10210 194TH ST E101 GRAHAM WA 98338 263919508 MANAGE MEDICAL BUILDING/PROPERTY OR EXCLUDED 512-514 483138 3507772 0 0 0.30000 LPH&WC HOLDINGS LLC 1524 SHERMAN AVENUE HOOD RIVER OR 97031 811236711 RENTAL ACTIVITY OR UNRELATED 0 1 DRY HOLLOW PROFESSIONAL CENTER INC 1700 EAST 19TH STREET THE DALLES OR 97058 930631350 RENTAL BUILDING OR N/A C 0 0 1 1 1 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 MID-COLUMBIA HEALTH FOUNDATION B 50000 GRANTS PAID MID-COLUMBIA HEALTH FOUNDATION C 50014 GRANTS RECEIVED HEALTH CARE FOR THE MID-COLUMBIA REGION D 82486 LOANS TO RELATED PARTY LONE PINE HEALTH & WELLNESS CENTER D 750000 LOAN GUARANTEE MID-COLUMBIA HEALTH FOUNDATION E 40760 LOAN FROM RELATED PARTY DRY HOLLOW PROFESSIONAL CENTER E 67222 LOAN FROM RELATED PARTY HEALTH CARE FOR THE MID-COLUMBIA REGION K 203763 RENTAL AGREEMENT LONE PINE HEALTH & WELLNESS CENTER K 1592000 RENTAL AGREEMENT DRY HOLLOW PROFESSIONAL CENTER K 134346 RENTAL AGREEMENT HEALTH CARE FOR THE MID-COLUMBIA REGION M 1500000 MANAGEMENT CONTRACT MID-COLUMBIA HEALTH FOUNDATION P 540530 ACTUAL COSTS